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Biomedical subjects

M C Fiore

Publications and source records attributed to M C Fiore.

At least 37 records · Page 2Linked to original sources
PubMed1999

Development and validation of the Wisconsin Smoking Withdrawal Scale.

The accurate assessment of nicotine withdrawal is important theoretically and clinically. A 28-item scale, the Wisconsin Smoking Withdrawal Scale, was developed that contains 7 reliable subscales tapping the major symptom elements of the nicotine withdrawal syndrome. Coefficients alpha for the subscales range from .75 to .93. This scale is sensitive to smoking withdrawal, is predictive of smoking cessation outcomes, and yields data that conform to a 7-factor structure. The 7 scales predicted intratreatment smoking, chi2(7, N = 163) = 15.19, p = .034. Moreover, the questionnaire is sufficiently brief so that it can be used in both clinical and research contexts.

Adult↗
PubMed1998

Objective assessment of ocular and respiratory alterations in employees in a sick building.

BACKGROUND: Sick building syndrome (SBS) is a constellation of diffuse, "irritative" symptoms predominantly involving the eyes and the respiratory tract. To date, the effects of working in a "sick building" have not been adequately assessed using objective measures. We undertook the present study to determine whether objective alterations could be found in the eyes and respiratory' tracts of employees working in an office building in which a high rate of SBS had been reported in the preceding year. METHODS: We studied 163 office workers: 87 workers from a modern, air-conditioned building (the sick building), and 76 employees employed in three traditional-style office buildings (the comparison buildings). After being surveyed for SBS symptoms, all subjects underwent a series of objective tests, including spirometry, a methacholine test, prick tests for aeroallergens, and submitted tear samples. In addition, Schirmer's test and the break-up time test were used to explore for potential ocular effects of sick building exposure. RESULTS: Employees in the sick building complained more frequently of ocular symptoms, upper-airway disturbances, and general and respiratory' symptoms than did employees in the comparison buildings; prick tests were positive in 20% and 17.4%, respectively. Groups did not differ significantly on spirometry measures. Bronchial hyperreactivity to methacholine (PD15 = 16.348 mumol) was present in 20.5% of the sick building workers and in 16.2% of comparison buildings workers. Methacholine dose-response slope values were similar. Stability of tear film was significantly reduced (P < 0.01) in the employees in the sick building compared with employees in the comparison buildings. CONCLUSIONS: Our results indicate that (1) atopy does not seem to influence the prevalence of SBS symptoms, and (2) the lower respiratory tract seems unaffected by exposure to a "sick building," but (3) alterations in tear film stability do exist after such exposure.

Adult↗
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

Profiles in discouragement: two studies of variability in the time course of smoking withdrawal symptoms.

Research has suggested that the time course of the smoking withdrawal syndrome is fairly invariant across smokers and that smoking withdrawal symptoms are weakly related to relapse. Withdrawal data from 2 clinical trials of the nicotine patch were analyzed to evaluate these characterizations. In both studies, patients were clustered according to the shapes of their withdrawal profiles across 8 weeks of treatment. In each study, 3 clusters with distinct temporal patterns of withdrawal symptomatology emerged. Clusters included both abstinent and lapsing patients, and patch dose was unrelated to cluster membership. Patients with "atypical" patterns of smoking withdrawal (e.g., late symptomatic elevations) were more likely to relapse than patients who showed a gradual elimination of withdrawal. Withdrawal shape, duration, and severity all contributed significantly to the prediction of relapse. Measures of negative affect closely tracked withdrawal symptoms over time within clusters. Topics for future smoking withdrawal research are discussed.

Administration, Cutaneous↗
PubMed1998

Does over-the-counter nicotine replacement therapy improve smokers' life expectancy?

OBJECTIVE: To determine the public health benefits of making nicotine replacement therapy available without prescription, in terms of number of quitters and life expectancy. DESIGN: A decision-analytic model was developed to compare the policy of over-the-counter (OTC) availability of nicotine replacement therapy with that of prescription ([symbol: see text]) availability for the adult smoking population in the United States. MAIN OUTCOME MEASURES: Long-term (six-month) quit rates, life expectancy, and smoking attributable mortality (SAM) rates. RESULTS: OTC availability of nicotine replacement therapy would result in 91,151 additional successful quitters over a six-month period, and a cumulative total of approximately 1.7 million additional quitters over 25 years. All-cause SAM would decrease by 348 deaths per year and 2940 deaths per year at six months and five years, respectively. Relative to [symbol: see text] nicotine replacement therapy availability, OTC availability would result in an average gain in life expectancy across the entire adult smoking population of 0.196 years per smoker. In sensitivity analyses, the benefits of OTC availability were evident across a wide range of changes in baseline parameters. CONCLUSIONS: Compared with [symbol: see text] availability of nicotine replacement therapy, OTC availability would result in more successful quitters, fewer smoking-attributable deaths, and increased life expectancy for current smokers.

Adult↗
PubMed1997

Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research.

CONTEXT: The Agency for Health Care Policy and Research (AHCPR) published the Smoking Cessation: Clinical Practice Guideline in 1996. Based on the results of meta-analyses and expert opinion, the guideline identifies efficacious interventions for primary care clinicians and smoking cessation specialty providers. OBJECTIVE: To determine the cost-effectiveness of clinical recommendations in AHCPR's guideline. DESIGN: The guideline's 15 recommended smoking cessation interventions were analyzed to determine their relative cost-effectiveness. Then, using decision probabilities, the interventions were combined into a global model of the guideline's overall cost-effectiveness. PATIENTS: The analysis assumes that primary care clinicians screen all presenting adults for smoking status and advise and motivate all smokers to quit during the course of a routine office visit or hospitalization. Smoking cessation interventions are provided to 75% of US smokers 18 years and older who are assumed to be willing to make a quit attempt during a year's time. INTERVENTION: Three counseling interventions for primary care clinicians and 2 counseling interventions for smoking cessation specialists were modeled with and without transdermal nicotine and nicotine gum. MAIN OUTCOME MEASURE: Cost (1995 dollars) per life-year or quality-adjusted life-year (QALY) saved, at a discount of 3%. RESULTS: The guideline would cost $6.3 billion to implement in its first year. As a result, society could expect to gain 1.7 million new quitters at an average cost of $3779 per quitter, $2587 per life-year saved, and $1915 for every QALY saved. Costs per QALY saved ranged from $1108 to $4542, with more intensive interventions being more cost-effective. Group intensive cessation counseling exhibited the lowest cost per QALY saved, but only 5% of smokers appear willing to undertake this type of intervention. CONCLUSIONS: Compared with other preventive interventions, smoking cessation is extremely cost-effective. The more intensive the intervention, the lower the cost per QALY saved, which suggests that greater spending on interventions yields more net benefit. While all these clinically delivered interventions seem a reasonable societal investment, those involving more intensive counseling and the nicotine patch as adjuvant therapy are particularly meritorious.

Adult↗
PubMed1997

Smoking cessation: principles and practice based upon the AHCPR Guideline, 1996. Agency for Health Care Policy and Research.

Cigarette smoking remains the leading preventable cause of morbidity and premature mortality in the United States. Although the vast majority of smokers come in contact with the health care system on a regular basis, clinical smoking cessation interventions happen infrequently and in a non-systematic manner. In 1996, the Agency for Health Care Policy and Research (AHCPR) "Smoking Cessation Clinical Practice Guideline" provided detailed clinical practice recommendations based on a review of some 3,000 articles in the research literature and dozens of supporting meta-analyses. This article presents a simple four-step model for clinical smoking cessation interventions, including systematic identification of smoking status, brief cessation advice from clinicians, assessment of patient motivation, and detailed assistance for those willing to stop smoking. It also provides the empirical basis for the AHCPR Guideline recommendations.

Administration, Cutaneous↗
PubMed1997

The direct effects of nicotine use on human health.

Tobacco is one of the leading preventable causes of death in the United States. The role of some of the specific components of tobacco and tobacco pyrolysis in causing human disease has been well described. However, the health risks attributable to nicotine alone have not been fully determined, especially for long-term use. Nicotine is a potent chemical that has powerful effects on the human body, especially when administered rapidly or at high doses. Although many of these effects are deleterious, others may be beneficial. In certain special populations, such as the developing fetus, or persons with significant cardiovascular disease, nicotine has greater adverse effects. Because of the recent emphasis on using nicotine to treat tobacco dependence, as well as the interest in using nicotine as a possible agent for reducing overall tobacco use, clarifying the effects of long-term nicotine use on human health is important.

Chronic Disease↗
PubMed1997

Assessing the generalizability of smoking studies.

We used data from the 1986 Adult Use of Tobacco Survey, 10 studies of self-quitters and seven studies of treatment seekers, to illustrate how subpopulations of smokers might differ; e.g. treatment seekers vs. self-quitters and research volunteers vs. smokers in the general population. Smoking researchers may wish to use our results to determine whether their sample is similar to the population of interest.

Adult↗
PubMed1996

Characterization of tobacco withdrawal symptoms: transdermal nicotine reduces hunger and weight gain.

The accurate assessment of both tobacco withdrawal and the impact of the nicotine patch on withdrawal may be compromised by attrition of subjects, or by subjects smoking during withdrawal. To reduce these occurrences, 211 participants were provided with intensive cessation counseling while trying to quit smoking with either nicotine (21 mg) or placebo transdermal patches. Subject attrition was low, with 80.5% of participants continuing through the 5-week study period. Abstinence rates were also high over this period (75% and 61% in active and placebo groups, respectively). In this multisite, double-blind trial, withdrawal severity was assessed using a nine-item daily self-report questionnaire, and abstinence was confirmed via CO monitoring. Abrupt smoking cessation increased multiple tobacco withdrawal symptoms/signs including craving for cigarettes, irritability, anxiety, appetite, sleep disruption, difficulty concentrating, restlessness, depression, and impatience. Treatment with transdermal nicotine reduced craving for cigarettes, anxiety, irritability, and appetite, as well as weight gain (1.85 versus 2.88 kg mean gain over 4 weeks in active and placebo groups, respectively).

Administration, Cutaneous↗
PubMed1995

Varying nicotine patch dose and type of smoking cessation counseling.

OBJECTIVE: To compare the efficacy and safety of 22-mg and 44-mg doses of transdermal nicotine therapy when it is paired with minimal, individual, or group counseling to improve smoking cessation rates. DESIGN: An 8-week clinical trial (4 weeks double-blind followed by 4 weeks open label) using random assignment of participants to both dose (22 or 44 mg) and counseling (minimal, individual, or group) conditions. PARTICIPANTS: Daily cigarette smokers (> or = 15 cigarettes per day for at least 1 year) who volunteered to participate in a study of smoking cessation treatment. A total of 504 participants were enrolled at two sites. INTERVENTION: Four weeks of 22- or 44-mg transdermal nicotine therapy followed by 4 weeks of dosage reduction (2 weeks of 22 mg followed by 2 weeks of 11 mg). Counseling consisted of a self-help pamphlet (minimal); a self-help pamphlet, a brief physician motivational message, and three brief (< 15 minutes) follow-up visits with a nurse (individual); or the pamphlet, the motivational message, and eight weekly 1-hour group smoking cessation counseling visits (group). All participants returned weekly to turn in questionnaires and for assessment of their smoking status. MAIN OUTCOME MEASURES: Abstinence from smoking was based on self-report, confirmed by an expired carbon monoxide concentration lower than 10 ppm. Withdrawal severity was assessed by means of an eight-item self-report questionnaire completed daily. RESULTS: Smoking cessation rates for the two nicotine patch doses and three levels of counseling did not differ significantly at either 8 weeks or 26 weeks following the quit date. Among those receiving minimal contact, the 44-mg dose produced greater abstinence at 4 weeks than did the 22-mg dose (68% vs 45%; P < .01). Participants receiving minimal-contact adjuvant treatment were less likely to be abstinent at the end of 4 weeks than those receiving individual or group counseling (56% vs 67%; P < .05). The 44-mg dose decreased desire to smoke more than the 22-mg dose, but this effect was not related to success in quitting smoking. Transdermal nicotine therapy at doses of 44 mg produced a significantly greater frequency of nausea (28%), vomiting (10%), and erythema with edema at the patch site (30%) than did a 22-mg dose (10%, 2%, and 13%, respectively; P < .01 for each adverse effect). Three serious adverse events occurred during use of the 44-mg patch dose. CONCLUSIONS: There does not appear to be any general, sustained benefit of initiating transdermal nicotine therapy with a 44-mg patch dose or of providing intense adjuvant smoking cessation treatment. The two doses and all adjuvant treatments produced equivalent effects at the 26-week follow-up, and the higher patch dose produced more adverse effects. Higher-dose (44-mg) nicotine replacement does not appear to be indicated for general clinical populations, although it may provide short-term benefit to some smokers attempting to quit with minimal adjuvant treatment.

Administration, Cutaneous↗
PubMed1995

Tobacco withdrawal and nicotine replacement influence objective measures of sleep.

Research has not adequately characterized the impact of tobacco withdrawal on objectively assessed sleep parameters despite the recent inclusion of insomnia as a nicotine withdrawal sign in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Moreover, whether 24-hr nicotine replacement aids or interferes with sleep during withdrawal is unknown. In a double-masked, randomized clinical trial, 34 cigarette smokers who were motivated to quit received either active nicotine patches or placebo patches while quitting. Sleep was polysomnographically monitored for 2 precessation nights and 3 postcessation nights. The study demonstrates that among dependent smokers (a) tobacco withdrawal increases objectively assessed sleep disturbance (sleep fragmentation) and (b) nicotine replacement results in postcessation improvements in important polysomnographic measures of sleep quality (sleep fragmentation, Stage 3 and Stage 4 sleep).

Double-Blind Method↗