Smoking behavioral factors as predictors of risks.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
T M Vogt
Publications and source records attributed to T M Vogt.
Biochemical validation of smoking status: pros, cons, and data from four low-intensity intervention trials.
Biochemical validation of smoking status has long been considered essential, but recent reports have questioned its utility in certain kinds of field trials. We describe efforts to biochemically validate self-reports of smoking cessation from participants in four large-scale randomized trials in outpatient clinics, hospitals, worksites, and dental clinics. These studies included over 5,000 adults smokers who participated in the population-based low-intensity intervention evaluations. At a 1-year follow-up, 798 subjects reported no tobacco use. We attempted to verify these reports using saliva continine/carbon monoxide validation procedures. Overall, there was a moderately high nonparticipation rate (27%), a low disconfirmation rate (4%), and a high self-reported relapse rate (12%) in the interval between survey and biochemical validation. There were no differences between intervention and control conditions on any of the above variables. Longer durations of self-reported abstinence were strongly related to increased probability of biochemical confirmation. Differences in results across projects were related to how biochemical validation was conducted. These results, as well as statistical power considerations, raise questions about whether biochemical validation procedures are practical, informative, or cost-effective in such population-based, low-intensity intervention research.
Adult↗
Tobacco cessation interventions in health care settings: rationale, model, outcomes.
Health care settings provide opportunities to reach populations of tobacco users with personalized cessation assistance. We describe a model for doing so which emphasizes a team approach, minimizes the burden on clinicians, and uses brief counseling by allied professionals, videos, written materials, and telephone calls to augment clinician advice. The model has been implemented in several diverse settings including outpatient, inpatient, and dental clinic managed care; fee-for-service dentistry and pediatric practices; and planned parenthood clinics. Data from several randomized trials support the effectiveness of the approach. The brief, low-intensity interventions derived from the model appear to be sustainable on a routine basis in many settings.
Administration, Cutaneous↗
Microsatellite instability in malignant melanomas.
Microsatellite instability (MSI) is caused by deficient DNA mismatch repair, and results in a "mutator" phenotype. Recent studies have produced contradictory results about the frequency and significance of MSI in malignant melanomas. In this study, we therefore determined the time of onset and relative frequency of MSI during the progression of melanocytic tumours, including benign melanocytic naevi. We examined 7 different microsatellite loci in 9 melanocytic naevi, 25 primary malignant melanomas and 8 melanoma metastases. None of the melanocytic naevi showed MSI. In contrast, moderate frequency of MSI in 1/12 (8%) was detected in thin melanomas of <0.75 mm vertical thickness and in 1/8 (12%) of those with a thickness >0.75 mm and < 1.5 mm. The rate of MSI was increased in tumours thicker than 1.5 mm (2/5) and in melanoma metastases, with over 25% (2/8) of the lesions investigated. We conclude that MSI occurs in a considerable subset of malignant melanomas and that there is a pattern consistent with increasing frequency of MSI with progression of melanocytic tumours.
Adult↗
Changes in smoking associated with hospitalization: quit rates, predictive variables, and intervention implications.
BACKGROUND: Hospitalization can provide one of the most opportune times to prompt smoking cessation. This study determined the frequency of various smoking cessation related behaviors occurring during and following hospitalization and identified variables associated with these outcomes. METHODS: A sample of 526 HMO members who smoked prior to hospitalization and were hospitalized for nonpregnancy related, nonterminal conditions were surveyed to assess the natural history of smoking cessation associated with hospitalization. RESULTS: Three events were studied: not smoking while hospitalized (51% of subjects), attempting to quit following hospitalization (37%), and smoking status one year after hospitalization (16% abstinent). Similar factors were associated with not smoking in the hospital and quit attempts: older persons and patients with circulatory/respiratory diagnoses were only half as likely to smoke in the hospital as other patients and twice as likely to try to quit. Different variables predicted smoking status at follow-up: heavier smokers were significantly more likely to stop (26% cessation) than light or moderate smokers (10% and 11% cessation, respectively). DISCUSSION: The hospital may be an effective setting for smoking cessation programs, especially those aimed at heavy smokers. Research is needed to determine whether smokefree hospital policies alter smoking rates following hospitalization.
Adolescent↗
Smoking behavior and attitudes of employees of a large HMO before and after a work site ban on cigarette smoking.
Smoking-related data collected during 1976-87 by anonymous cross-sectional surveys of nonphysician employees of a large medical care organization were used to assess how a work site smoking ban affected employees' smoking behavior and attitudes. The smoking ban was implemented at 11 work sites at various times during 1985-86. All work sites had three or more pre-ban surveys and one or two post-ban surveys. The majority of employees reported support for the smoking ban. The ban's effects were assessed by comparing observed post-ban rates with expected rates projected from secular trends in the pre-ban data by the use of logistic regression models that included age, sex, education, and job class as covariates. The work site smoking ban had a substantial effect on the presence of smoke in the work environment, but no short-term effect on smoking prevalence or attempts to quit. The apparent effect of the ban on quantity of cigarettes smoked was assessed by a pre-ban and post-ban analysis of the 1986-87 survey data. A nonequivalent post-ban and post-ban comparison was used to estimate the secular trend. A significant reduction of 1.4 cigarettes per day (P = 0.022) was found in smokers' rate during working hours.
Adult↗
Relation of life events to blood pressure control in the SHEP pilot trial.
The Systolic Hypertension in the Elderly (SHEP) pilot trial was a five-center study in which 551 persons aged 60 years or older with isolated systolic hypertension were given antihypertensive drugs or placebos in order to determine the effects on blood pressure control and possible side effects of therapy. A life events inventory was administered to the cohort one year into the study. Results of this inventory were then compared to blood pressure and changes in blood pressure in the placebo and active therapy groups. One or more of the life events assessed were present in about 65% of the population. Although the sample was too small to detect very subtle effects, there was no evidence in this study that either individual or groups of life events play a major role in blood pressure regulation of persons with isolated systolic hypertension.
Aged↗
Does gender affect response to a brief clinic-based smoking intervention?
INTRODUCTION: Although recent reviews suggest few gender differences in smoking-cessation outcomes, it is important to establish whether gender differences exist in response to the brief interventions increasingly recommended as part of routine medical care. METHODS: We used data from an efficacious primary care-based smoking intervention to examine gender differences in smoking characteristics, use of intervention components, self-reported quitting activities, and cessation outcomes among all smokers randomized to receive clinician advice and nurse-assisted intervention (n = 1,978, 58% female). RESULTS: Although female and male smokers differed on a number of sociodemographic and smoking-related characteristics, they were equally likely to participate in each step of the recommended intervention. Female and male smokers were also equally likely to report quit attempts and cessation at 3, 12, and 3 and 12 months (combined long-term cessation endpoint). Similarly, no gender difference in relapse at 12 months was seen. Women attempting to quit used a greater number and variety of smoking-cessation strategies, suggesting that, although outcomes were similar, the processes of cessation may vary by gender. CONCLUSIONS: Since this brief intervention in primary care was equally efficacious and acceptable to female and male smokers, broader implementation in medical settings of this population-based approach to reducing tobacco use is warranted. Indeed, widespread implementation of smoking-cessation programs in medical settings may particularly benefit women, who are more likely than men to have contacts with the medical care system.
Adult↗