Copyright (c) 2009 All rights reserved. http://works.bepress.com/ockenej Recent documents in Judy K Ockene en-us Sun, 31 May 2009 09:58:34 PDT 3600 http://works.bepress.com/ockenej/166 http://works.bepress.com/ockenej/166 Thu, 26 Jun 2008 08:38:32 PDT OBJECTIVES: The purpose of this work was to identify characteristics that predict progression from the first inhalation of a cigarette to dependence. We studied a cohort of 1246 public school 6th-graders in 6 Massachusetts communities (mean age at baseline: 12.2 years). METHODS: We conducted a 4-year prospective study using 11 interviews. We assessed 45 risk factors and measured diminished autonomy over tobacco with the Hooked on Nicotine Checklist and evaluated tobacco dependence according to the International Classification of Diseases, 10th Revision. Cox proportional-hazards models were used. RESULTS: Among 217 youths who had inhaled from a cigarette, the loss of autonomy over tobacco was predicted by feeling relaxed the first time inhaling from a cigarette and depressed mood. Tobacco dependence was predicted by feeling relaxed, familiarity with Joe Camel, novelty seeking, and depressed mood. CONCLUSIONS: Once exposure to nicotine had occurred, remarkably few risk factors for smoking consistently contributed to individual differences in susceptibility to the development of dependence or loss of autonomy. An experience of relaxation in response to the first dose of nicotine was the strongest predictor of both dependence and lost autonomy. This association was not explained by trait anxiety or any of the other measured psychosocial factors. These results are discussed in relation to the theory that the process of dependence is initiated by the first dose of nicotine. Joseph R. DiFranza Adolescent Adolescent Behavior Advertising as Topic Child Depression Disease Susceptibility Exploratory Behavior Female Humans Interviews as Topic Longitudinal Studies Male Personal Autonomy Proportional Hazards Models Prospective Studies Relaxation Tobacco Use Disorder http://works.bepress.com/ockenej/165 http://works.bepress.com/ockenej/165 Thu, 26 Jun 2008 08:38:26 PDT OBJECTIVE: To extend the findings of the first Development and Assessment of Nicotine Dependence in Youth study by using diagnostic criteria for tobacco dependence and a biochemical measure of nicotine intake. The first study found that symptoms of dependence commonly appeared soon after the onset of intermittent smoking. DESIGN: A 4-year prospective study. SETTING: Public schools in 6 Massachusetts communities. PARTICIPANTS: A cohort of 1246 sixth-grade students. INTERVENTIONS: Eleven interviews. MAIN OUTCOME MEASURES: Loss of autonomy over tobacco as measured by the Hooked on Nicotine Checklist, and tobacco dependence as defined in International Classification of Diseases, 10th Revision (ICD-10). RESULTS: Among the 217 inhalers, 127 lost autonomy over their tobacco use, 10% having done so within 2 days and 25% having done so within 30 days of first inhaling from a cigarette; half had lost autonomy by the time they were smoking 7 cigarettes per month. Among the 83 inhalers who developed ICD-10-defined dependence, half had done so by the time they were smoking 46 cigarettes per month. At the interview following the onset of ICD-10-defined dependence, the median salivary cotinine concentration of current smokers was 5.35 ng/mL, a level that falls well below the cutoff used to distinguish active from passive smokers. CONCLUSIONS: The most susceptible youths lose autonomy over tobacco within a day or 2 of first inhaling from a cigarette. The appearance of tobacco withdrawal symptoms and failed attempts at cessation can precede daily smoking; ICD-10-defined dependence can precede daily smoking and typically appears before consumption reaches 2 cigarettes per day. Joseph R. DiFranza Adolescent Behavior, Addictive Child Cotinine Female Humans Incidence International Classification of Diseases Interviews as Topic Male Massachusetts Personal Autonomy Prospective Studies Psychological Tests Risk Assessment Risk Factors Saliva Schools Smoking Smoking Cessation Students Time Factors Tobacco Use Disorder http://works.bepress.com/ockenej/164 http://works.bepress.com/ockenej/164 Fri, 28 Mar 2008 16:59:13 PDT CONTEXT: Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain. OBJECTIVE: To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States. DESIGN: Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 8.5 years) in which 16608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998. INTERVENTIONS: Participants received conjugated equine estrogens, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, in 1 tablet (n = 8506) or placebo (n = 8102). MAIN OUTCOMES MEASURES: The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome. A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes. RESULTS: On May 31, 2002, after a mean of 5.2 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits. This report includes data on the major clinical outcomes through April 30, 2002. Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 1.29 (1.02-1.63) with 286 cases; breast cancer, 1.26 (1.00-1.59) with 290 cases; stroke, 1.41 (1.07-1.85) with 212 cases; PE, 2.13 (1.39-3.25) with 101 cases; colorectal cancer, 0.63 (0.43-0.92) with 112 cases; endometrial cancer, 0.83 (0.47-1.47) with 47 cases; hip fracture, 0.66 (0.45-0.98) with 106 cases; and death due to other causes, 0.92 (0.74-1.14) with 331 cases. Corresponding HRs (nominal 95% CIs) for composite outcomes were 1.22 (1.09-1.36) for total cardiovascular disease (arterial and venous disease), 1.03 (0.90-1.17) for total cancer, 0.76 (0.69-0.85) for combined fractures, 0.98 (0.82-1.18) for total mortality, and 1.15 (1.03-1.28) for the global index. Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures. The absolute excess risk of events included in the global index was 19 per 10 000 person-years. CONCLUSIONS: Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women. All-cause mortality was not affected during the trial. The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD. Jacques E. Rossouw Aged Breast Neoplasms Clinical Trials Data Monitoring Committees Colorectal Neoplasms Coronary Disease Endometrial Neoplasms *Estrogen Replacement Therapy Estrogens, Conjugated (USP) Female Fractures, Bone Humans Medroxyprogesterone 17-Acetate Middle Aged Myocardial Infarction Postmenopause Progesterone Congeners Proportional Hazards Models Pulmonary Embolism Risk Stroke Survival Analysis Thrombosis Treatment Outcome http://works.bepress.com/ockenej/163 http://works.bepress.com/ockenej/163 Fri, 28 Mar 2008 16:59:07 PDT Smoking cessation greatly reduces morbidity and mortality associated with coronary artery disease (CAD). This paper presents details of an individually delivered smoking intervention program for patients with CAD that had been shown to be effective in a previously reported randomized clinical trial. Treatment components include inpatient counseling, followed by a single outpatient visit and follow-up by telephone. This approach compared to traditional outpatient group intervention engenders much higher levels of patient participation and is suitable to the special needs of cardiac patients. Jean L. Kristeller Behavior Therapy Coronary Disease Counseling Female Humans Male Middle Aged Smoking Smoking Cessation http://works.bepress.com/ockenej/162 http://works.bepress.com/ockenej/162 Fri, 28 Mar 2008 16:59:01 PDT This study investigated whether the opportunity to obtain Continuing Medical Education (CME) credit together with a five-dollar bill increased response rates and questionnaire completion rates in a physician survey involving mailed questionnaires. One thousand, three hundred and fourteen cardiologists, family practitioners, general internists (non-surgeons) and 264 vascular surgeons randomly identified from the American Medical Association database participated. After two, of up to four, questionnaire mailings, the opportunity to obtain CME credit and a five-dollar bill were included with questionnaire mailings. Among non-surgeons, 26.5% responded to pre-incentive mailings and 30.2% of those initially unresponsive replied after the interventions. Among surgeons, 39% responded to pre-incentive mailings and 32.7% of those initially unresponsive replied after the interventions. In conclusion, the opportunity to receive CME credit combined with a small monetary incentive is an effective motivation for physicians participating in a study involving mailed questionnaires. Mary McGrae McDermott Adult *Education, Medical, Continuing Female Humans Male Middle Aged *Physicians *Questionnaires United States http://works.bepress.com/ockenej/161 http://works.bepress.com/ockenej/161 Fri, 28 Mar 2008 16:58:55 PDT A case-control study was undertaken to examine differences in the extent of cardiopulmonary resuscitation (CPR) training among family members of patients with and without coronary heart disease. There were no significant differences in the proportion of family members of patients with coronary disease (22.0%) who had ever taken a CPR course compared to family members of patients seen in a primary care clinic (25.6%) or in randomly selected neighborhood controls (28.7%). Family members of patients with coronary disease, however, had not only taken fewer CPR courses but had taken these courses considerably further in the past than had respective comparison groups. Moreover only 9% of these family members had taken CPR due to their family member's coronary disease. Robert J. Goldberg Adult Age Factors *Coronary Disease Data Collection Educational Status *Family Female Humans Male Massachusetts Middle Aged Resuscitation http://works.bepress.com/ockenej/160 http://works.bepress.com/ockenej/160 Fri, 28 Mar 2008 16:58:50 PDT To investigate those factors associated with patients' cigarette smoking status, 455 consecutive patients seen in two specialty clinics and one general medicine clinic at a university medical center were studied. Patient's age, sex, health status, and number of previous cessation attempts discriminated current from ex-smokers. A strong interaction was observed between sex and disease status with females showing a greater impact of smoking-related disease on smoking behavior than males. Judith K. Ockene Adult Ambulatory Care Female *Health *Health Status Humans Male Middle Aged Questionnaires Risk *Smoking http://works.bepress.com/ockenej/159 http://works.bepress.com/ockenej/159 Fri, 28 Mar 2008 16:58:44 PDT Joseph R. DiFranza Adult Chewing Gum Counseling Female Humans Nicotine Physician's Role *Physicians, Family Role Playing Smoking http://works.bepress.com/ockenej/158 http://works.bepress.com/ockenej/158 Fri, 28 Mar 2008 16:58:39 PDT Diane M. Becker Advertising as Topic Cardiovascular Diseases Humans *Plants, Toxic Risk Factors Smoking Smoking Cessation *Tobacco Tobacco Smoke Pollution United States http://works.bepress.com/ockenej/157 http://works.bepress.com/ockenej/157 Fri, 28 Mar 2008 16:58:33 PDT PURPOSE: The Multiple Risk Factor Intervention Trial (MRFIT), a randomized clinical trial for the primary prevention of coronary heart disease, enrolled 12,866 men (including 8194 cigarette smokers) aged 35-57 years at 22 clinical centers across the United States. Participants were randomized either to special intervention (SI), which included an intensive smoking cessation program, or to usual care (UC). After 16 years of follow-up, lung cancer mortality rates were higher in the SI than in the UC group. Since rates of smoking cessation in SI were higher than those for UC for the 6 years of the trial, and since risk of lung cancer mortality is known to decline with smoking cessation, these results were unexpected. The purpose of the present study was to investigate hypotheses that could explain the higher observed lung cancer mortality rates in the SI as compared with the UC group. METHODS: Analytic methods were employed to determine whether SI and UC participants differed either in baseline characteristics or in characteristics that changed during the trial and to determine whether these differences could explain the higher rates of lung cancer mortality among SI as compared to UC participants. Rates of mortality from coronary heart (CHD) were examined to explore the possibility that prevention of CHD death may have contributed to greater mortality due to lung cancer in the SI group. RESULTS: From randomization through December 1990, 135 SI and 117 UC participants died from lung cancer. The relative difference between the SI and U groups adjusted for age and number of cigarettes smoked per day, was 1.17 (95% CI:0.92-1.51). The greatest difference between the SI and UC groups in lung cancer mortality rates occurred among the heaviest smokers at baseline who did not achieve sustained smoking cessation by year 2. In this group the rates of death from CHD were approximately the same among the SI and UC subjects. No differences in baseline characteristics were found between SI and UC smokers who did not achieve sustained cessation by year 2, and there were no differences in follow-up characteristics between the two study groups that could explain the difference in lung cancer mortality. CONCLUSIONS: None of the hypotheses proposed to explain the unexpected higher rates of lung cancer mortality among SI as compared with UC subjects were sustained by the data. Thus we conclude that the difference observed is due to chance, and that a longer period of sustained smoking cessation plus follow-up is necessary to detect a reduction in lung cancer mortality as a result of smoking cessation intervention in a randomized clinical trial. B. Jessica Shaten Adult Cohort Studies Coronary Disease Humans Lung Neoplasms Male Middle Aged Nutrition Physiology Risk Factors Smoking Cessation Time Factors