PubMed Health⌕ Search

Biomedical subjects

Timothy B Baker

Publications and source records attributed to Timothy B Baker.

28 records · Page 2Linked to original sources
PubMed2003

Targeting smokers at increased risk for relapse: treating women and those with a history of depression.

Some studies have shown that female smokers and smokers with a history of depression have an increased risk of relapse following smoking cessation treatment. This study examined the efficacy of bupropion sustained-release (SR) and the nicotine patch for smoking cessation in subgroups of smokers at possible risk for relapse. Data for this study were from a previously published randomized, double-blind, placebo-controlled clinical trial in which 893 smokers were randomized to four treatment conditions: placebo tablet + placebo patch, placebo tablet + 21 mg/24-hr nicotine patch, 300mg bupropion SR + placebo patch, and 300mg bupropion SR + 21 mg/24-hr nicotine patch. Study medication continued for 8 weeks after the quit day; brief individual cessation counseling was provided during weekly clinic visits. In comparison to the placebo tablet, bupropion SR approximately tripled 1-year non-smoking rates among women and previously depressed individuals. In contrast, the nicotine patch did not significantly improve cessation rates for any group. We conclude that bupropion SR is a first-line treatment for smoking that has the potential to benefit all smokers, especially women and the previously depressed.

Administration, Cutaneous↗
PubMed2003

Transdisciplinary science applied to the evaluation of treatments for tobacco use.

Transdisciplinary research involves the integration of measures and methods across diverse response systems and levels of analysis, with that integration occurring via a synthesis of theories and models of different scientific disciplines. This paper first discusses the need for transdisciplinary research. The paper then articulates a model to guide the comprehensive evaluation of treatments for tobacco use and discusses how transdisciplinary research might be integrated into this treatment evaluation model. The potential benefits and costs of a transdisciplinary approach are discussed, along with selected research projects from the Transdisciplinary Tobacco Use Research Centers.

Humans↗
PubMed2003

Use of the vital sign stamp as a systematic screening tool to promote smoking cessation.

OBJECTIVES: To examine the ability of a simple system-wide screening assessment tool, an expanded vital sign stamp, to increase rates of smoker identification, physician advice to quit smoking, and physician assistance in quitting and abstinence rates. PARTICIPANTS AND METHODS: This study is a pretest, posttest design in which 5 primary health care clinics were randomly assigned to either the intervention condition, which received the vital sign stamp, or the control condition. Participants (N = 9439) were surveyed by using exit interviews at the 5 clinics, both before and after the vital sign intervention was implemented. Participants who were identified as smokers were then contacted 1 year later for follow-up. The study began in February 1995, and all follow-up visits were completed by December 1998. RESULTS: Implementation of the vital sign stamp significantly increased the rates at which physicians asked participants about their smoking status (17.2% vs 7.5%). However, the rates of physicians advising smokers to quit, assisting them in quitting, and arranging follow-up either stayed constant or decreased. The number of quit attempts and abstinence rates also stayed constant. CONCLUSION: A simple system-wide screening assessment tool, while effective in identifying more tobacco users, did not increase the rates at which physicians advised or assisted smokers to quit. Further system-wide changes may be needed to ensure that effective tobacco-dependence treatments are given to smokers.

Adult↗
PubMed2003

Smoking withdrawal dynamics: I. Abstinence distress in lapsers and abstainers.

Smoking withdrawal reports from a clinical trial (n = 893) were submitted to hierarchical linear modeling as a cross-method replication of a heterogeneity approach to withdrawal measurement and to clarify the influence of postcessation smoking on symptom reports. Five individual difference parameters tapping distinct facets of withdrawal were derived: intercepts (mean severity), linear slope (direction and rate of change), quadratic trend (curvature), volatility (scatter) and, among lapsers, a cigarette coefficent (smoking-related deflections of symptoms). All parameters were highly variable across persons. Lapsers had more aversive symptom patterns than abstainers, and symptoms tended to be higherthan otherwise predicted on lapse days. These results reinforce the conclusion that withdrawal symptoms are highly variable and argue against discarding withdrawal data from participants who lapse.

Administration, Cutaneous↗
PubMed2003

Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relations.

In this article, the authors assessed whether continuously scaled symptom parameters derived from growth models (T. M. Piasecki et al., 2003) are linked to smoking at long-term follow-up by using data from a large-scale clinical trial (N = 893). Results revealed that higher withdrawal intercepts, positive linear slopes, and greater volatility were all positively associated with relapse, and cigarette coefficients (indicating smoking-induced withdrawal reduction) were negatively related to relapse. In models keyed around the first lapse to smoking, those destined to lapse reported more severe withdrawal during abstinence, and withdrawal patterns discriminated groups defined according to lapse duration. The findings complement earlier heterogeneity studies in implicating the pattern of changing withdrawal symptoms over time as a factor strongly associated with smoking relapse.

Adult↗
PubMed2002

Effectiveness of a clinic-based strategy for implementing the AHRQ Smoking Cessation Guideline in primary care.

BACKGROUND: The Agency for Healthcare Research and Quality Smoking Cessation Practice Guideline recommends systematic assessment of smoking status and counseling of smokers at every visit, but the actual effectiveness of the guideline in primary care practice is unknown. METHODS: We conducted a nonrandomized, controlled before-after trial of a guideline-derived intervention that includes routine identification and brief counseling of smokers by nurses and medical assistants, coupled with free nicotine replacement therapy (NRT) and telephone counseling of those smokers who are willing to make a quit attempt, and feedback on performance of guideline-recommended activities. The intervention was pilot tested at 1 family practice (FP) clinic over a 2-month period; patterns of usual care were observed concurrently at four control FP clinics. We obtained exit interviews of 651 consecutive adult smokers who presented for routine, nonemergency care. Abstinence (7-day point prevalence) was determined by telephone interview during 6-month follow-up. RESULTS: Concordance with guidelines was significantly greater for all recommended actions at the test site during the intervention versus baseline (P < or = 0.05). Significantly more intervention versus baseline patients at the test site reported abstinence at 2-month follow-up (21 vs. 4%, P = 0.0004), and more patients tended to be abstinent at 6-month follow-up (21 vs. 11%, P = 0.08). No significant differences in 2- or 6-month quit rates between intervention and baseline patients were observed at the control sites. CONCLUSIONS: Implementation of a guideline-driven smoking cessation intervention that focuses primarily on smokers who are interested in making a quit attempt is associated with increased abstinence in primary care practice.

Adult↗
PubMed2002

How will we know a lapse when we see one? Comment on Leri and Stewart (2002).

The article by F. Leri and J. Stewart (2002) addresses the validity of animal models of relapse in a more sophisticated manner than does much prior research. These researchers have shown that drug self-administration can be influenced by the presence of drug contingent cues as well as by active self-administration versus passive infusion of "lapse" doses. This research also leads to additional questions about the external validity of animal relapse models. Current relapse models may lack validity because of the parameters of drug exposure, because abstinence is imposed on the organism, and because there is no motivational influence that counters resumption of drug self-administration. F. Leri and J. Stewart's (2002) article encourages a more thorough assessment of the motivational context of relapse models.

Animals↗
PubMed2002

Have we lost our way? The need for dynamic formulations of smoking relapse proneness.

Current smoking cessation treatments seem to differ from one another in the proportion of ex-smokers who survive the first few days of the quit attempt. After this initial effect, parallel relapse processes appear to unfold in all treatment groups; no available treatments seem to alter the nature of this late relapse process. True relapse prevention will require that we obtain a better understanding of the forces contributing to relapse across the span of the cessation attempt. A working model of dynamic relapse processes may be necessary before treatments can be improved. In this paper, we suggest that the conceptual model of relapse proneness (RP) described originally by the National Working Conference on Smoking Relapse can serve as an ecumenical organizational framework that may be used to integrate and conceptualize relapse data in ways that could generate new strategies for relapse research and inform treatment design. As an illustration, we sketch a preliminary model of RP which postulates that physical withdrawal, stressors/temptations, and cessation fatigue each make independent, time-shifted contributions to relapse risk. A new round of descriptive research focused on relapse proneness processes may be a prerequisite for improving existing smoking cessation interventions.

Administration, Cutaneous↗
PubMed2002

Predicting relapse back to smoking: contrasting affective and physical models of dependence.

Traditional models of physical dependence suggest that nicotine dependence should be reflected by the extent of drug exposure (e.g., smoking rate) and by evidence of physiological adaptation (e.g., withdrawal severity). An affective model suggests that nicotine dependence should be related to an individual's tendency to experience negative affect and expectations that nicotine use would ameliorate such affect. This research investigated the ability of these 2 models to predict relapse back to smoking at 6 months postquit. Logistic regression models were developed and tested in 505 heavy smokers participating in nicotine patch clinical trials. Results supported both models, but the most potent predictor of outcome was postquit negative affect, which accounted for much of the predictive validity of traditional measures of nicotine dependence. Affective reactivity appears to be a core constituent of dependence.

Adult↗