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...on nicotine
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www.ProjectCork.org
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Fall 2003
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A population study of low-rate smokers: Quitting history
and instability over time.
Zhu SH; Sun JC; Hawkins S; Pierce J; Cummins S. Health Psychology 22(3):
245-252, 2003. (31 refs.)
This study used 1 longitudinal and 2 cross-sectional population surveys to compare
stability of low-rate daily smokers (less than 5 cigarettes per day) with other
daily smokers and occasional smokers. Few low-rate smokers maintained consumption
level; 36% retained smoking status after 20 months, compared with 82% and 44%
for regular daily and occasional smokers, respectively. In a dynamic process,
established smokers quit smoking and/or modified (decreased or increased) consumption.
Low-rate and occasional smokers quit at higher rates than regu-lar daily smokers
(odds ratios 3: 1) but were replenished by new members, many converted from regular
daily smokers. The overall trend is an increasing proportion of low-consump-tion
smokers while smoking prevalence declines. The dynamic process his implications
for tobacco control efforts and for addiction theory.
Copyright 2003, American Psychological Association, Inc. and
Division of Health Psychology.
An examination of the process of relapse prevention therapy designed to aid
smoking cessation.
Stoffelmayr B; Wadland WC; Pan W. Addictive Behaviors 28(7): 1351-1358,
2003. (15 refs.)
The process of relapse prevention (RP) therapy is examined. Patients' res-ponses
were recorded primarily during telephonic, RP counseling designed to facilitate
smoking cessation. A compu-ter program that prompted counselor initiatives and
provided a framework for the recording of patient responses guided counselor
interaction with patients. A total of 437 patients took part in 1650 counseling
sessions and reported 2882 urge/lapse situations. The 2531 situations, for which
complete data were available, and 4879 coping responses were analyzed. The main
findings are (1) the descriptions of urge/lapse situations provided by patients
in treatment are similar to those derived by research that aimed to discover
the determinants of relapse without specific treatment, (2) number of coping
responses rather than number of situations is related to treatment outcome, and
(3) the more coping responses discussed during treatment, the better the treatment
outcome.
Copyright 2003, Elsevier Science Ltd.
Efficacy of nicotine patch in smokers with a history of alcoholism.
Hughes JR; Novy P; Hatsukami DK; Jensen J; Callas PW. Alcoholism: Clinical
and Experimental Research 27(6): 946-954, 2003. (49 refs.)
Background: Smokers with a history of alcohol dependence may have more difficulty
quitting, might relapse to alcohol use, and might especially benefit from nicotine
replacement therapy for smoking cessation. Methods: One hundred fifteen smokers
with a history of alcohol dependence (median of 5 years previously) were randomly
assigned to either a 21-mg nicotine patch or placebo in a trial designed to be
as, similar as possible to a prior study that examined smokers with no history
of alcoholism. Both studies were of heavy smokers with similar levels of nicotine
dependence; thus, any differences in trials would be due to a history of alcohol
problems per se. Results: In the current trial, adjusted prolonged smoking abstinence
in those with a history of alcohol dependence was higher in the active than the
placebo group at end-of-treatment (28% vs. 11%; odds ratio, 3.2; p = 0.04) and
at 6-month follow-up (24% vs. 6%; odds ratio, 4.9; p = 0.02). Among subjects
not lost to follow-up, none reported drinking problems or increases in craving
for alcohol. Smoking abstinence was not lower and the odds ratio for nicotine
patch therapy was not greater in smokers with a history of alcohol dependence
than in smokers with no such history. Conclusions: Heavy smokers with a history
of alcoholism benefit from nicotine patch treatment. A history of alcohol problems
after a period of stable sobriety does not appear to influence smoking outcomes
or response to nicotine replacement. Although no smokers relapsed to alcohol
use, a trial that follows up all subjects is needed to verify this.
Copyright 2003, Research Society on Alcoholism.
Environmental tobacco smoke and absenteeism related to respiratory illness
in schoolchildren.
Gilliland FD; Berhane K; Islam T; Wenten M; Rappaport E; Avol E et al. American
Journal of Epidemiology 157(10): 861-869, 2003. (27 refs.)
Household environmental tobacco smoke (ETS) exposure accounts for substantial
morbidity among young children, but the ETS-associated morbidity burden among
school-age children is less well defined. Illness-related school absenteeism
is a measure of a broad spectrum of adverse effects of ETS exposure in school-age
children. The authors investigated the relations between ETS exposure, asthma
status, and illness-related school absenteeism in a cohort of 1,932 fourth-grade
schoolchildren from 12 southern California communities during January-June 1996.
Incidence rates and adjusted relative risks of illness-related absences were
determined by using an active surveillance system. The effects of ETS exposure
on absenteeism were assessed by using stratified incidence rates and Poisson
regression to adjust for sociodemographic factors. ETS exposure was associated
with an increased risk of respiratory-illness-related school absences (relative
risk (RR) = 1.27, 95% confidence interval (CI): 1.04, 1.56). Children living
in a household with two or more smokers were at increased risk of such absences
(RR = 1.75, 95% CI: 1.33, 2.30). Children's asthma status affected their response
to ETS. Compared with unexposed children without asthma, children with asthma
were at increased risk of respiratory-illness-related school absences when exposed
to one (RR = 2.35, 95% CI: 1.49, 3.71) or two or more (RR = 4.45, 95% CI: 2.80,
7.07) household smokers. Children without asthma also had an increased risk if
exposed to two or more smokers (RR = 1.44, 95% CI: 1.04, 2.00). Therefore, ETS
exposure is associated with increased respiratory-related school absenteeism
among children, especially those with asthma.
Copyright 2003, Johns Hopkins University School of Hygiene and
Public Health.
Most smokeless tobacco use is not a causal gateway to cigarettes: Using order
of product use to evaluate causation in a national US sample.
Kozlowski LT; O'Connor RJ; Edwards BQ; Flaherty BP. Addiction 98(8): 1007-1085,
2003. (34 refs.)
Aims To evaluate non-causal and causal patterns of smokeless tobacco (SIT) and
cigarette use; to assess the prevalence of 'non-gateway' and possible 'gateway
patterns of SIT use. Design and setting Data from the Cancer Control Supplement
to the 19 8 7 National Health Interview Survey, a representative survey of non-institutionalized
adults in the United States. From reported age at first use, participants were
categorized by type and sequence of tobacco product use. SUDAAN 8.0.1 was used
for statistical analyses. Participants Males aged 18-34 (n=3454), weighted to
provide estimates of the US population. A subsample of males aged 23-34 (n=2614)
was analyzed to minimize the possibility of future product switching. Measurements
Smoking status, smokeless tobacco (snuff, chewing tobacco, both) use status,
age at regular use of cigarettes, age at first use of smokeless tobacco. Findings
Of those 23-34-year-olds who had ever used SLT with or without cigarettes. 77.2%
(95%, CI: 71.3, 83.3) were classifiable as non-gateway users in that 35.0% (95%
CI: 29.9, 40.1) had only used SIX and 42.2% (95%, CI: 36.8, 47.7) had used cigarettes
first. Cigarette use in younger cohorts was less common, despite increased SLT
use. Those who used cigarettes before moist snuff were 2.1 times more likely
to have quit smoking (95% CI 1.21,6.39) than cigarette-only users. Conclusions
The large majority of SLT users are non-gateway users. Causal gateway effects
should be of minor concern for policy. SLT may be more likely to prevent smoking
than cause it.
Copyright 2003, Society for the Study of Addiction to Alcohol
and Other Drugs.
Shade tobacco and Green Tobacco Sickness in Connecticut.
Trape-Cardoso M; Bracker A; Grey M; Kaliszewski M; Oncken C; Ohannessian C et
al. Journal of Occupational and Environmental Medicine 45(6): 656-661,
2003. (15 refs.)
The prevalence of Green Tobacco Sick-ness (GTS) among shade tobacco farm-workers
in Connecticut is unknown. We conducted a study to determine the prevalence of
GTS in farmworkers work-ing in shade tobacco fields who presented for clinical
care at medical student-run clinics. A retrospective chart review of the tobacco
workers seen at Farmworkers' Clinics during 2001 was instituted in this study.
Although GTS was not clinically diagnosed in any of the patients, we found 15
% diagnoses that could be attributed to possible GTS by ICD-9 code review. Using
a stricter GTS case definition, the frequency rate decreased to 4 %. Nonsmokers
were significantly more likely than smokers to report GTS-like symptoms (P < 0.01).
Isolated symptoms of headache and dizziness were significantly more frequent
among nonsmokers than smokers (P < 0.05). In conclusion, cases of possible GTS
were found in Connecticut shade tobacco workers. Nonsmokers were more at risk
to have possible GTS than smokers.
Copyright 2003, Williams & Wilkins.
US public universities' compliance with recommended tobacco-control policies.
Halperin AC; Rigotti NA. Journal of American College Health 51(5): 181-188,
2003. (26 refs.)
To address the rise in tobacco use among college students, several national health
organizations, including the American College Health Association, recommend that
colleges enact smoking bans in and around all campus buildings, including student
housing, and prohibit the sale, advertisement, and promotion of tobacco products
on campus. Key informants at 50 US public universities, one from each state,
Were interviewed during the 2001/2002 academic year to assess the prevalence
of these recommended policies. More than half (54%) of the colleges banned smoking
in all campus buildings and student residences, 68% had no tobacco sales on campus,
and 32% of the schools' newspapers did not accept tobacco advertising. Regional
differences in adoption of these campus tobacco-control policies were present.
Although this national sample of public universities had implemented some of
the recommended policies, they must take further actions to comply fully with
campus tobacco-control guidelines.
Copyright 2003, Helen Dwight Reid Educational Foundation.
Modifying exposure to smoking depicted in movies: A novel approach to preventing
adolescent smoking.
Sargent JD; Dalton MA; Heatherton T; Beach M. Archives of Pediatrics & Adolescent
Medicine 157(7): 643-648, 2003. (22 refs.)
Background: Most behavioral approaches to adolescent smoking address the behavior
directly. We explore an indirect approach: modifying exposure to portrayals of
smoking in movies. Objectives: To describe adolescents' exposure to smoking in
movies and to examine factors that could modify such exposure. Design: Occurrences
of smoking were counted in each of 601 popular movies. Four thousand nine hundred
ten northern New England junior high school students were asked to report which
movies they had seen from a randomly generated subsample of 50 films, and responses
were used to estimate exposure to the entire sample. Analysis: The outcome variable
was exposure to movie smoking, defined as the number of smoking occurrences seen.
Risk factors for exposure included access to movies (movie channels, videotape
use, and movie theater); parenting (R [restricted]-rated movie restrictions,
television restrictions, parenting style); and characteristics of the child (age,
sex, school performance, sensation-seeking propensity, rebelliousness, and self-esteem).
We used multiple regression to assess the association between risk factors and
exposure to movie smoking. Results: Subjects had seen an average of 30% of the
movie sample (interquartile range, 20%-44%), from which they were exposed to
1160 (interquartile range, 640-1970) occurrences of smoking. In a multivariate
model, exposure to movie smoking increased (all P values <.001) by about 10%
for each additional movie channel and for every 2 videos watched per week. Exposure
increased by 30% for those going to the movie theater more than once per month
compared with those who did not go at all. Parent restriction on viewing R-rated
movies resulted in a 50% reduction in exposure to movie smoking. There was no
association between parenting style and exposure to movie smoking. Much of the
protective effect of parent R-rated movie restriction on adolescent smoking was
mediated through lower exposure to movie smoking. Conclusions: Adolescents see
thousands of smoking depictions in movies, and this influences their attitudes
and behavior. Exposure to movie smoking is reduced when parents limit movie access.
Teaching parents to monitor and enforce movie access guidelines could reduce
adolescent smoking in an indirect, yet powerful, manner.
Copyright 2003, American Medical Association.
Individual differences in nicotine intake per cigarette.
Patterson F; Benowitz N; Shields P; Kaufmann V; Jepson C; Wileyto P et al. Cancer
Epidemiology, Biomarkers & Prevention12(5): 468-471, 2003. (26 refs.)
The increase in levels of blood nicotine that occurs from smoking a single cigarette,
sometimes referred to as a "nicotine boost," is an individualized measure of
how much nicotine has been extracted from smoking a cigarette. This study investigated
the demographic, smoking status, and psychological predictors of nicotine boost
in a sample of 190 treatment-seeking smokers. Boost was assessed by comparing
plasma nicotine levels before and after participants smoked one of their own
brand cigar-ettes ad libitum. Positive affect (mood) was a significant positive
pre-dictor of nicotine boost, controlling for baseline cotinine levels and cigarette
brand (Federal Trade Commission) nicotine delivery. However the proportion of
variability accounted for in the model was relatively small (5%). Future research
on individual differences in nicotine boost is warranted -- to clarify the role
of psychological, physiological, and cigarette-related determinants.
Copyright 2003, American Association for Cancer Research.
Efficacy of nicotine patch in smokers with a history of alcoholism.
Hughes JR; Novy P; Hatsukami DK; Jensen J; Callas PW. Alcoholism: Clinical
and Experimental Research 27(6): 946-954, 2003. (49 refs.)
Background: Smokers with a history of alcohol dependence may have more difficulty
quitting, might relapse to alcohol use, and might especially benefit from nicotine
replacement therapy for smoking cessation. Methods: One hundred fifteen smokers
with a history of alcohol dependence (median of 5 years previously) were randomly
assigned to either a 21-mg nicotine patch or placebo in a trial designed to be
as, similar as possible to a prior study that examined smokers with no history
of alcoholism. Both studies were of heavy smokers with similar levels of nicotine
dependence; thus, any differences in trials would be due to a history of alcohol
problems per se. Results: In the current trial, adjusted prolonged smoking abstinence
in those with a history of alcohol dependence was higher in the active than the
placebo group at end-of-treatment (28% vs. 11%; odds ratio, 3.2; p = 0.04) and
at 6-month follow-up (24% vs. 6%; odds ratio, 4.9; p = 0.02). Among subjects
not lost to follow-up, none reported drinking problems or increases in craving
for alcohol. Smoking abstinence was not lower and the odds ratio for nicotine
patch therapy was not greater in smokers with a history of alcohol dependence
than in smokers with no such history. Conclusions: Heavy smokers with a history
of alcoholism benefit from nicotine patch treatment. A history of alcohol problems
after a period of stable sobriety does not appear to influence smoking outcomes
or response to nicotine replacement. Although no smokers relapsed to alcohol
use, a trial that follows up all subjects is needed to verify this. Copyright
2003, Research Society on Alcoholism.
Assessment and diagnosis of nicotine dependence in mental health settings.
Peterson AL; Hryshko-Mullen AS; Cortez Y. American Journal on Addictions 12(3):
192-197, 2003. (28 refs.)
This study evaluated the frequency of documented assessment of smoking status
and the diagnosis of nicotine dependence in a random sample of 153 mental health
records and 152 medical records. The results indicated that tobacco use was routinely
documented in the mental health records (88%) and medical records (87%). However,
a diagnosis of nicotine dependence was given in only 2% of the mental health
records (1/49) and 7% of the medical records (2/30) for those patients with documented
regular tobacco use. These results suggest that clinicians do not routinely diagnose
Nicotine Dependence even when diagnostic criteria are met.
Copyright 2003, American Academy of Psychiatrists in Alcoholism
and Addictions.
Spit (smokeless) tobacco Intervention for high school athletes: Results after
1 year.
Walsh MM; Hilton JF; Ellison JA; Gee L; Chesney MA; Tomar SL et al. Addictive
Behaviors 28(6): 1095-1113, 2003. (43 refs.)
Objective: To determine the efficacy of a spit tobacco (ST) intervention designed
to promote ST cessation and discourage ST initiation among male high school baseball
athletes. Methods: This study was a cluster-randomized controlled trial. Forty-four
randomly selected high schools in rural California were randomized within strata
(prevalence of ST use and number and size of baseball teams) to either the intervention
or the control group. Ninety-three percent of eligible baseball athletes participated,
yielding 516 subjects in 22 intervention schools and 568 subjects in 22 control
schools. Prevalences of sustained ST cessation and ST use initiation over 1 year
were assessed by self-report. Multivariate logistic regression models for clustered
responses were used to test the null hypotheses of no association between group
and the two outcomes, adjusted for the stratified design and baseline imbalances
between groups in significant predictors of ST use. Results: Prevalence of cessation
was 27% in intervention high schools and 14% in control high schools (odds ratio
(OR)=2.29; 95% confidence interval (CI), 1.36?3.87). The intervention was especially
effective in promoting cessation among those who, at baseline, lacked confidence
that they could quit (OR=6.4; 95% CI, 1.0?4.3), among freshmen (OR=15; 95% CI,
0.9?260), and among nonsmokers (OR=3.2; 95% CI, 0.9?11). There was no significant
difference between groups in the prevalence of ST initiation. Conclusions: This
intervention was effective in promoting ST cessation, but was ineffective in
preventing initiation of ST use by nonusers.
Copyright 2003, Elsevier Science.
Effects of nicotine deprivation on urges to drink and smoke in alcoholic
smokers.
Cooney JL; Cooney NL; Pilkey DT; Kranzler HR; Oncken CA. Addiction 98(7):
913-921, 2003. (33 refs.)
Aim: This study examined the effect of nicotine deprivation on alcohol and smoking
urges in a sample of alcohol-dependent smokers in early recovery. Design: Using
a within-subjects design, participants underwent two cue-reactivity laboratory
sessions in which they rated their urges for alcohol and cigarettes during the
following three trials: baseline, neutral cue and mood induction combined with
alcohol beverage cue exposure. One session was completed after 34 hours of nicotine
deprivation and another in a non-deprived state. Participants: Forty alcohol-dependent
heavy smokers recruited from a substance abuse day treatment program. Measurements:
Self-reported urge to drink, urge to smoke and salivation. Findings: Results
showed that during the non-deprived session, alcohol cue presentations were associated
with significant increases in urges to drink and urges to smoke. Acute nicotine
deprivation led to increased smoking urges, but was not associated with increased
urges to drink alcohol. Conclusions: Findings suggest that the acute effects
of smoking cessation are unlikely to increase risk of relapse to alcohol in alcoholic
patients who are undergoing treatment.
Copyright 2003, Society for the Study of Addiction to Alcohol
and Other Drugs.
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