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Biomedical subjects

Nancy A Rigotti

Publications and source records attributed to Nancy A Rigotti.

44 records · Page 3Linked to original sources
PubMed2002

Measuring the loss of autonomy over nicotine use in adolescents: the DANDY (Development and Assessment of Nicotine Dependence in Youths) study.

CONTEXT: There is no validated, theory-based tool for assessing the onset of nicotine dependence. However, the use of all addictive substances can result in a loss of autonomy. We propose that nicotine dependence begins when autonomy is lost, ie, when the sequelae of tobacco use, either physical or psychological, present a barrier to quitting. OBJECTIVES: To test the autonomy theory of nicotine dependence, and to evaluate the Hooked on Nicotine Checklist (HONC) as a measure of the loss of autonomy over tobacco use. DESIGN: The psychometric performance and concept validity of the HONC were evaluated in a 30-month prospective longitudinal study of the natural history of tobacco use in a cohort of 679 seventh-grade students. RESULTS: As hypothesized, endorsement of a single item on the HONC was associated with a failed attempt at smoking cessation (odds ratio [OR], 29; 95% confidence interval [CI], 13-65), continued smoking until the end of follow-up (OR, 44; 95% CI, 17-114), and daily smoking (OR, 58; 95% CI, 24-142). Scores on the HONC correlated with the maximum amount smoked (r = 0.65; P<.001) and the maximum frequency of smoking (r = 0.79; P<.001). Internal reliability was 0.94. A 1-factor solution explained 66% of the total variance. CONCLUSIONS: The data support the autonomy theory that dependence begins with the loss of autonomy. The autonomy theory represents a potentially useful alternative to current concepts of nicotine dependence for adolescents, and the HONC appears to measure lost autonomy in adolescents. Construct validity was demonstrated by its utility in predicting failed cessation and the progression of tobacco use. In addition, the psychometric properties were excellent.

Adolescent↗
PubMed2002

Effects of gender on relapse prevention in smokers treated with bupropion SR.

BACKGROUND: Recent data suggest that women smokers respond differently than men to cessation pharmacotherapies, particularly nicotine replacement therapy (NRT). Lower abstinence and higher relapse rates are often reported for women treated with NRT. Gender effects for those treated with non-nicotinic, bupropion-hydrochloride sustained release for relapse prevention have not been studied. METHODS: Data from a multicenter relapse-prevention (RP) trial of bupropion (November 1995-June 1998) were analyzed for gender differences. Men and women smokers (N=784) were treated with open-label bupropion for 7 weeks. Those abstinent at Week 7 (n=432) were enrolled in the double-blind relapse-prevention phase and randomized to placebo or continued bupropion for 45 additional weeks. RESULTS: Differences in point-prevalence abstinence rates between men (61.8%) and women (55.6%) in open-label bupropion (Week 7) were not significant. In the RP-phase Week 52, continuous abstinence rates for men and women were 37.8% and 36.4% (bupropion) and 36.6% and 29.9% (placebo), respectively; point-prevalence abstinence rates for men and women were 54.1% and 55.9% (bupropion) and 42.9% and 41.3% (placebo), respectively. Abstinence rates and time to relapse were superior for both men and women who received longer treatment. Gender differences within treatment groups were not significant. Median time to relapse was equal for men and women within each treatment group: Week 32 for bupropion and Week 20 for placebo. CONCLUSIONS: Our data suggest that bupropion is a promising pharmacotherapy for preventing relapse, particularly for women.

Adult↗
PubMed2002

Use of a computerized risk-appraisal instrument for cancer prevention education of medical students.

BACKGROUND: Interactive computer-based tools are increasingly used for patient and medical student instruction. METHOD: To assess medical students' responses to a computer-based risk-appraisal instrument aimed at teaching concepts of risk and cancer prevention, and to evaluate perceived barriers to using such tools in clinical practice and knowledge about risk factors for colon cancer. DESIGN: An electronic survey of 133 second-year medical students elicited their responses to the instrument after using it for a case-based learning exercise. RESULTS: The students identified several potential barriers to use, including inadequate time during the office visit (75% of students) and problems with literacy (48%). They were generally knowledgeable about risk factors for colon cancer. 84% found the instrument "very helpful" or "somewhat helpful" in understanding a case patient's health and setting priorities for behavioral changes. CONCLUSIONS: Medical students may benefit from exposure to interactive, computer-based tools such as health-appraisal instruments when learning skills in risk counseling and cancer prevention. Second-year students were already concerned about having adequate time during office visits to use such instruments.

Clinical Competence↗
PubMed2002

Effect on smoking cessation of switching nicotine replacement therapy to over-the-counter status.

OBJECTIVES: This study examined whether the change in nicotine replacement therapy sales from prescription to over the counter (OTC) status affected smoking cessation. METHODS: We used the 1993-1999 Massachusetts Tobacco Surveys to compare data from adult current smokers and recent quitters before and after the OTC switch. RESULTS: No significant change over time occurred in the proportion of smokers who used nicotine replacement therapy at a quit attempt in the past year (20.1% pre-OTC vs 21.4% post-OTC), made a quit attempt in the past year (48.1% vs 45.2%), or quit smoking in the past year (8.1% vs 11.1%). Fewer non-Whites used nicotine replacement therapy after the switch (20.7% pre-OTC vs 3.2% post-OTC, P =.002), but the proportion of Whites using nicotine replacement therapy did not change significantly (20.6% vs 24.0%). CONCLUSIONS: We observed no increase in Massachusetts smokers' rates of using nicotine replacement therapy, making a quit attempt, or stopping smoking after nicotine replacement therapy became available for OTC sale. There appear to be other barriers to the use of nicotine replacement therapy besides visiting a physician, especially among minority smokers.

Adolescent↗
PubMedDate not supplied

Hospital- and clinic-based smoking cessation interventions for smokers with cardiovascular disease.

Cigarette smoking is the leading preventable cause of death in the United States and a major risk factor for cardiovascular disease (CVD). Large observational epidemiologic studies conducted in diverse populations have demonstrated a strong association between smoking and CVD morbidity and mortality. Observational epidemiologic studies have also demonstrated a substantial benefit of smoking cessation on cardiovascular morbidity and mortality. Smoking cessation after myocardial infarction reduces subsequent cardiovascular mortality by nearly 50%. Therefore, the use of effective strategies to reduce the prevalence of tobacco use is a high priority for both the primary and secondary prevention of CVD. Effective smoking cessation interventions have been identified in randomized controlled trials in the general population of smokers. These methods, which include behavioral counseling and pharmacotherapy, are incorporated into clinical practice guidelines for physicians in the United States and Great Britain. A smaller but still substantial body of evidence demonstrates the efficacy of these interventions in hospital- and clinic-based settings for smokers with CVD. This evidence is sufficient to support the routine implementation of these smoking cessation methods in inpatient and outpatient settings for smokers with CVD.

Ambulatory Care↗
PubMedDate not supplied

Statewide evaluation of youth access ordinances in practice: effects of the implementation of community-level regulations in Massachusetts.

The objectives of the study described in this article were to test whether community-level youth access ordinances reduce adolescents' perceived access to tobacco, purchase attempts, and tobacco use. A telephone survey was performed of a random sample of 3,831 Massachusetts adolescents linked to a database of all town-level youth access ordinances in the state. Respondents' perceived ease of access to tobacco, attempts to purchase tobacco, and tobacco use (ever smoking and current [past 30-day] smoking) were assessed. The association of these outcomes with the characteristics of youth access ordinances in the respondents' town of residence (n = 314) was tested in multilevel analyses that included town-level clustering, controlled for multiple individual and environmental characteristics, including a measure of community-level anti-smoking sentiment. Community-level youth access ordinances were not associated with adolescents' perceived access to tobacco, purchase attempts, or tobacco use, with two exceptions: (1) banning free-standing displays was associated with a 40% reduction in perceived access to tobacco (OR = 0.6; 95% CI, 0.4-0.9) and (2) a vending machine ban was associated a 30% higher report of perceived access to tobacco (OR = 1.3; 95% CI, 1.1-1.5). This study found no consistent associations between community-level youth access ordinances and adolescents' perceived access to tobacco, purchase attempts, or smoking prevalence.

Adolescent↗
PubMedDate not supplied

Tobacco-control policies in 11 leading managed care organizations: progress and challenges.

CONTEXT: Although evidence-based national guidelines for tobacco-dependence treatment have been available since 1996, translating these guidelines into clinical practice is challenging. PRACTICE PATTERN EXAMINED: Policies regarding tobacco-dependence treatment (e.g., written guidelines and coverage of pharmacotherapy) and implementation strategies of 11 U.S. managed care organizations known to have strong tobacco-control programs. DATA SOURCES: Detailed telephone interviews with multiple informants at each health plan and review of written treatment guidelines and policies for tobacco dependence. RESULTS: Although 10 of 11 plans had adopted tobacco-dependence treatment guidelines consistent with the national guideline, fewer had guidelines for special groups, such as adolescents (6 plans), parents (5 plans), pregnant women (5 plans), and hospitalized smokers (3 plans). Most plans offered clinician training and recommended office systems to support provider efforts; however, fewer actively facilitated their implementation. Most plans provided other support for tobacco treatment, including dedicated budgets, designated staff, and an oversight committee. All plans offered some coverage for tobacco-cessation pharmacotherapy and behavioral counseling, although not to the extent recommended by the national guideline. CONCLUSION: Implementation of national tobacco-treatment guidelines is feasible in closed-panel managed care organizations. However, even these leading health plans could do more to comply with national practice guidelines on tobacco-dependence treatment and make it easier for clinicians to help patients stop smoking (e.g., through increased training and expanded coverage of tobacco-dependence treatment).

Evidence-Based Medicine↗