System simulation. On the modelling of large-scale health care systems.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to M D Levine.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Concern about weight gain after quitting smoking is common among women, however, little is known about the characteristics of women concerned about this weight gain. We characterized concerns about smoking and weight, smoking behaviors and eating attitudes among weight-concerned women smokers. Women (N= 219) were participants in a larger trial comparing different approaches to treating postcessation weight gain concerns, and endorsed considerable concern about postcessation weight gain. Women completed assessments of smoking behavior, nicotine dependence and eating attitudes prior to beginning treatment. Although weight-concerned women smokers expected to gain 16.5 lb after quitting, most were willing to tolerate a weight gain of only 5 lb. A substantial number expressed unwillingness to gain any weight at all. However, weight-concerned women did not have elevated nicotine dependency or aberrant eating attitudes. Thus, although weight-concerned women smokers expected to gain large amounts of weight after quitting, they expressed a willingness to tolerate only minimal weight gain. The discrepancy between expected and tolerable weight gain may undermine efforts to quit smoking in this group of women.
Specific concerns about weight gain following smoking cessation inhibit attempts to quit smoking, especially in women. However, adjunct interventions to prevent weight gain after cessation have generally been successful only in attenuating, rather than preventing, weight gain. More aggressive weight control adjuncts may be necessary to prevent cessation-induced weight gain. On the other hand, weight control programs have not been found to improve long-term smoking abstinence and, in fact, may actually impede abstinence, necessitating a search for alternative approaches to addressing weight concerns. Since the typical amount of weight gain is essentially trivial from a health standpoint, particularly when compared with the health benefits of quitting smoking, the most appropriate clinical strategy may be to combat the weight concerns themselves rather than the weight gain. A second alternative approach is to focus all treatment efforts on smoking cessation alone, to avoid placing excessive burdens on participants resulting from attempting simultaneous changes in multiple health behaviors (i.e., smoking and those related to weight). The rationales for these three clinical approaches to addressing concerns about weight gain-more effective weight control, direct reduction in weight concerns by cognitive-behavioral treatment, and smoking cessation only-are presented, followed by descriptions of the adjunct treatments based on these approaches currently being evaluated in a clinical outcome study with women trying to quit smoking.
Comparison of the health status of 53 delinquent and 51 nondelinquent boys revealed that 57 percent of the delinquents, as compared with 20 percent of the nondelinquents, had experienced two or more serious adverse health events (such as hospitalization, loss of consciousness, or an automobile accident). Physical examinations revealed many more conditions requiring intervention in the delinquent than in the nondelinquent boys. Major differences in the two groups' use of health care were apparent: 34 percent of the delinquents either had no medical care or had used only the emergency room, as contrasted with only 8 percent of the nondelinquents. An overall health index that was used to compare the two groups remained statistically significant for a subset of 16 pairs matched on socioeconomic indicators. These results do not imply an etiological link between health status and delinquency, but they do suggest a strong de facto link. The recurrent hospitalizations of the delinquent boys, their substantial use of medications, and their episodic use of health care underscore the importance of an awareness on the part of public health personnel of this group's medical status and of the urgent need for adequately planning the health care of all youngsters in the juvenile justice system.