Biomedical subjects

Sharon M Hall

Publications and source records attributed to Sharon M Hall.

At least 19 recordsLinked to original sources

PubMed2006

Cognitive interviews for measurement evaluation of the Fagerström Test for Nicotine Dependence (FTND) in smokers with schizophrenia spectrum disorders.

People diagnosed with schizophrenia have among the highest known rates of tobacco use. While the Fagerström Test for Nicotine Dependence (FTND) is the most widely used measure of nicotine dependence, recent research has questioned its applicability for individuals with schizophrenia. The current study employed cognitive interviews to evaluate the FTND with smokers diagnosed with schizophrenia spectrum disorders, recruited from an acute inpatient psychiatry setting, and a comparison group of smokers recruited from the community. The groups were comparable on tobacco use variables and FTND scores. Detailed qualitative cognitive interviews indicated all subjects understood the FTND items. For both groups, the FTND missed nocturnal smoking, reported as weekly by 80% of patients and 47% of controls. Finishing other people's cigarettes also was under-reported on the FTND. Restrictions to smoking were common across groups. The cognitive interview methodology proved useful for understanding how individuals interpreted and answered the FTND items. Overall, the qualitative findings identified limitations in the FTND for both groups, with the limitations generally more pronounced among patients with schizophrenia.

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

Psychometric evaluation of the Quality of Life Interview, Brief Version, in injection drug users.

The authors investigated the psychometric characteristics of the Quality of Life Interview, Brief Version (QOLI-BV; A. F. Lehman, 1995) in 126 injection drug users recruited for a clinical trial. The QOLI-BV assesses global and domain-specific quality of life. Participants completed the instrument at baseline and 3 and 6 months later. Most scales showed acceptable internal consistency. Convergent and discriminant validity were demonstrated through correlations with the SF-36, the Beck Depression Inventory, and demographic variables. Scale means rose over time, suggesting that the QOLI-BV is sensitive to change. Unexpectedly, lower baseline QOLI-BV scores predicted opiate abstinence at follow-up. The QOLI-BV appears to be an acceptable quality-of-life measure for use in clinical trials of opioid dependence treatments.

Adult↗

PubMed2006

Treatment for cigarette smoking among depressed mental health outpatients: a randomized clinical trial.

OBJECTIVES: Using a brief contact control, we tested the efficacy of a staged care intervention to reduce cigarette smoking among psychiatric patients in outpatient treatment for depression. METHODS: We conducted a randomized clinical trial that included assessments at baseline and at months 3, 6, 12, and 18. Three hundred twenty-two patients in mental health outpatient treatment who were diagnosed with depression and smoked > or =1 cigarette per day participated. The desire to quit smoking was not a prerequisite for participation. Staged care intervention participants received computerized motivational feedback at baseline and at 3, 6, and 12 months and were offered a 6-session psychological counseling and pharmacological cessation treatment program. Brief contact control participants received a self-help guide and referral list of local smoking-treatment providers. RESULTS: As we hypothesized, abstinence rates among staged care intervention participants exceeded those of brief contact control participants at months 12 and 18. Significant differences favoring staged care intervention also were found in occurrence of a quit attempt and stringency of abstinence goal. CONCLUSION: The data suggest that individuals in psychiatric treatment for depression can be aided in quitting smoking through use of staged care interventions and that smoking cessation interventions used in the general population can be implemented in psychiatric outpatient settings.

Adolescent↗

PubMed2005

The construct of internalization: conceptualization, measurement, and prediction of smoking treatment outcome.

BACKGROUND: Depression symptoms and diagnoses are associated with failure to quit smoking in most studies, but not all. METHOD: A new measure of internalization (i.e. symptoms of depression or anxiety, or poor mood) was created to investigate whether internalization would predict smoking cessation in 549 smokers from three randomized clinical trials with inconsistent findings. RESULTS: Predicted item locations based on a map of the construct of internalization agreed with empirical locations based on item response theory. Internalization was highly correlated with neuroticism. Logistic regressions showed that internalization improved upon the predictions of other affect-related measures. High baseline internalization decreased abstinence from smoking at end of treatment and 3 months thereafter. History of major depression (single-episode or recurrent) failed to predict abstinence. CONCLUSIONS: The broad, dimensional construct of internalization as conceptualized herein appears to be an important predictor of smoking cessation.

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

Preliminary evidence of the association between the history of childhood attention-deficit/hyperactivity disorder and smoking treatment failure.

Smoking rates are elevated among individuals with attention-deficit/hyperactivity disorder (ADHD). The association of ADHD diagnosis and smoking treatment outcome has not been examined. The present study examined abstinence rates among 428 adult smokers participating in two randomized controlled trials. Treatments included nicotine replacement, antidepressants, and psychological interventions. Childhood ADHD was assessed retrospectively by diagnostic interview. In a survival analysis, ADHD status predicted time to relapse after controlling for gender, history of depression, and baseline smoking variables. Only 1 of 47 participants with a history of childhood ADHD remained abstinent by week 52, compared with 18% of those who had no history of childhood ADHD (adjusted OR=0.36, 95% CI=0.28-0.45). The current findings provide preliminary evidence for an association between childhood ADHD and smoking cessation treatment failure. Further investigation is warranted.

Adult↗

PubMed2005

Identification and treatment of substance misuse on an inpatient psychiatry unit.

This chart review study examined identification and treatment of substance misuse on an inpatient psychiatry ward before and after the hospital's administration made changes to increase attention to patients' substance misuse. Before the ward changes, 113 of 250 inpatients (45 percent) were identified as misusing substances. Misusers were significantly more likely to be younger, male, single, and cigarette smokers. After the ward changes, substance misuse was more than twice as likely to be addressed in treatment planning and discharge diagnoses, and referrals to substance abuse treatment were nearly twice as likely to be made. Changes in assessment of and treatment planning for psychiatric inpatients may increase attention to substance misuse.

California↗

PubMed2005

Older adults' and case managers' perceptions of smoking and smoking cessation.

OBJECTIVE: This study explores older smokers' and case managers' perceptions of smoking and smoking cessation. METHODS: Data were collected from 48 case managers via focus group sessions and questionnaires and from 20 smoking clients via structured interviews. RESULTS: Case managers identified barriers to addressing clients' smoking at the client, staff, and organizational levels. Clients and case managers lacked information on the benefits of smoking cessation in older adults. The majority of clients interviewed had no plans to quit smoking. DISCUSSION: Results suggest that smoking cessation programs for this population need to be geared to clients who are not ready to quit. Education about the benefits of quitting smoking in older adults is needed for both case managers and smokers.

Aged↗

PubMed2005

The relationship between smoking history and current functioning in disabled community-living older adults.

PURPOSE: This study was conducted to determine characteristics associated with continued cigarette use in frail older adults and to examine how smoking history relates to current psychiatric, cognitive, and occupational functioning. METHODS: Archival records were gathered for 1,064 patients (69% women) who entered On Lok SeniorHealth Services between January 1996 and December 2000. Participants were interviewed on program entry and assessed for smoking history, depressive symptoms, affective disorders, cognitive functioning, alcohol use, and physical functioning (activities of daily living [ADLs] and instrumental ADLs). Cross-sectional analyses were conducted to examine functioning at enrollment relative to smoking history. RESULTS: Smoking history was related to age at program entry, with current smokers entering On Lok at an earlier age than former or never smokers. Current smokers were more likely to be male, to be of Caucasian or African American descent, to consume alcohol on a regular basis, and to be more independent on ADLs. Specifically, they were more independent on tasks related to their capacity to procure cigarettes or continue smoking, including shopping, using transportation, managing money, dressing themselves, and walking. Smoking history was related to depression, with symptoms lower for current and former smokers. CONCLUSIONS: Current smokers present for services at an earlier age and have higher levels of independence on ADLs instrumental to nicotine use. Data indicate characteristics associated with continued smoking and provide a foundation for targeting older individuals for cessation efforts.

Activities of Daily Living↗

PubMed2004

Predictors of health functioning in two high-risk groups of smokers.

The relative and combined health effects of cigarette smoking, heroin use, and depression were examined in 322 clinically depressed smokers and 117 opioid-dependent smokers participating in two studies of the San Francisco Treatment Research Center. Opioid-dependent smokers averaged 16 years (S.D.=9) of heroin use; 3% of depressed smokers used opiates in the past 6 months. Cigarettes per day (M=15, S.D.=10) and Beck Depression (BDI-II) scores (M=21, S.D.=11) were comparable between the two groups. Health functioning was assessed using the Medical Outcomes Study Short Form (SF-36). Adjusting for demographic differences, depressed smokers reported better physical but poorer emotional health relative to opioid-dependent smokers. Both groups scored significantly lower than published norms (p<.05). Within groups, severity of depressive symptoms, tobacco use, and opiate use were independent predictors of lower health functioning (p<.05). Examining risk-related subgroups based on depression scores (BDI-II> or =20), cigarettes per day (> or =1 pack), and opiate use, number of risk factors was monotonically related to health functioning in both samples. Individuals with two or more risk factors scored the lowest (p<.05). Severity of depressive symptoms, tobacco use, and opiate use contributed individually and collectively to lower health functioning. Blended treatments that target multiple risk factors are needed to improve health outcomes.

Adult↗

PubMed2004

Depressed smokers and stage of change: implications for treatment interventions.

Tobacco Dependence among smokers with psychiatric disorders has been under-addressed by the mental health, addictions, and tobacco control communities. This study examined depressed smokers' readiness to quit and the applicability of the Stages of Change framework to a psychiatric sample. Currently depressed smokers (N=322) were recruited from four outpatient psychiatric clinics. Participants averaged 16 cigarettes per day (S.D.=10) and 24 years (S.D.=13) of smoking. The majority (79%) reported intention to quit smoking with 24% ready to take action in the next 30 days. Individuals in the preparation stage reported more prior quit attempts, a greater commitment to abstinence, increased recognition of the cons of smoking, and greater use of the processes of change. Precontemplators were least likely to identify a goal related to their smoking behavior. Depressive symptom severity and history of recurrent depressive episodes were unrelated to readiness to quit. This study is one of the first to examine the smoking behaviors of currently depressed psychiatric outpatients. The level and longevity of their tobacco use underscore the need for cessation interventions. The consistency in hypothesized patterns among theoretical constructs of the Stages of Change model supports the transfer of stage-tailored interventions to this clinical population.

Adult↗

PubMed2004

Depression and smoking: from the Transtheoretical Model of change perspective.

This study investigated the associations among history of depression, current depressive symptoms, and constructs of the Transtheoretical Model (TTM) of change: stages of change, decisional balance, temptation, and processes of change for smoking cessation. Participants were 239 current smokers (70.7% male, 49.8% African-American, mean cigarettes per day=19.8, 42.3% were in precontemplation). Results showed that participants with a history of depression reported higher current depressive symptoms. No significant relationship was observed between stages and history or current level of depressive symptoms. Current depressive symptoms, rather than depression history, was related to other TTM constructs: pros of smoking, temptation to smoke under habitual and negative affect situations, and the self-reevaluation process of change.

Adolescent↗

PubMed2004

Influences of mood, depression history, and treatment modality on outcomes in smoking cessation.

The relationship between major depressive disorder (MDD), treatment modality, and mood was evaluated in smokers participating in cessation programs. Participants (N = 549, 53.7% women, 46.3% men, 28% endorsing past MDD episodes) were randomly assigned to a cognitive-behavioral treatment (CBT) or health education (HE) intervention. Participants with a history of recurrent MDD (MDD-R) had higher rates of abstinence in CBT compared with HE even when the contribution of mood and the interaction between mood and an MDD x Treatment variable were included in the model. Likewise, higher levels of mood disturbance were reported by MDD-R smokers compared with those reporting a single episode. The study replicated results reported by R. A. Brown et al. (2001) and expanded upon them by evaluating the differential contribution of poor mood on cessation outcomes relative to MDD history.

Adult↗

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

Cost and cost-effectiveness of standard methadone maintenance treatment compared to enriched 180-day methadone detoxification.

AIMS: To compare the cost and cost-effectiveness of methadone maintenance treatment and 180-day methadone detoxification enriched with psychosocial services. DESIGN: Randomized controlled study conducted from May 1995 to April 1999. SETTING: Research clinic in an established drug treatment program. PARTICIPANTS: One hundred and seventy-nine adults with diagnosed opioid dependence. Intervention Patients were randomized to methadone maintenance (n = 91), which required monthly 1 hour/week of psychosocial therapy during the first 6 months or 180-day detoxification (n = 88), which required 3 hours/week of psychosocial therapy and 14 education sessions during the first 6 months. MEASUREMENTS: Total health-care costs and self-reported injection drug use. A two-state Markov model was used to estimate quality-adjusted years of survival. Findings Methadone maintenance produced significantly greater reductions in illicit opioid use than 180-day detoxification during the last 6 months of treatment. Total health-care costs were greater for maintenance than detoxification treatment ($7564 versus $6687; P < 0.001). Although study costs were significantly higher for methadone maintenance than detoxification patients ($4739 versus $2855, P < 0.001), detoxification patients incurred significantly higher costs for substance abuse and mental health care received outside the study. Methadone maintenance may provide a modest survival advantage compared with detoxification. The cost per life-year gained is $16 967. Sensitivity analysis revealed a cost-effectiveness ratio of less than $20 000 per quality-adjusted life-year over a wide range of modeling assumptions. CONCLUSIONS: Compared with enriched detoxification services, methadone maintenance is more effective than enriched detoxification services with a cost-effectiveness ratio within the range of many accepted medical interventions and may provide a survival advantage. Results provide additional support for the use of sustained methadone therapy as opposed to detoxification for treating opioid addiction.

Adult↗

PubMed2004

Extended nortriptyline and psychological treatment for cigarette smoking.

OBJECTIVE: Accepted treatments for cigarette smoking rarely achieve abstinence rates of >35% at 1 year. Low rates may reflect failure to provide extended and multifocal treatment for this complex and chronic addiction. Using a chronic disease model of smoking, the authors undertook a study to determine the effects of long-term antidepressant and psychological treatment. METHOD: One hundred sixty smokers of > or =10 cigarettes/day were randomly assigned to one of four treatment conditions in a two-by-two (nortriptyline versus placebo by brief versus extended treatment) design. All subjects received 8 weeks of a transdermal nicotine patch, five group counseling sessions, and active or placebo treatment. Interventions for subjects in brief treatment ended at this point. Subjects in extended treatment continued taking drug or placebo to week 52 and received an additional 9 monthly counseling sessions, with checkup telephone calls midway through each session. Subjects were assessed at baseline and weeks 12, 24, 36, and 52. The principal outcome variables were repeated abstinence at each assessment after the first over a 1-year period and a point prevalence of 7 days of abstinence. RESULTS: At week 52, point-prevalence abstinence rates with missing subjects imputed as smokers were 30% for placebo brief treatment, 42% for placebo extended treatment, 18% for active brief treatment, and 50% for active extended treatment. With missing subjects omitted, these rates were 32%, 57%, 21%, and 56%, respectively. CONCLUSIONS: Comprehensive extended treatments that combine drug and psychological interventions can produce consistent abstinence rates that are substantially higher than those in the literature.

Administration, Cutaneous↗