Biomedical subjects

E Lichtenstein

Publications and source records attributed to E Lichtenstein.

13 recordsLinked to original sources

PubMed1992

The context of smoking initiation and maintenance: findings from interviews with youths.

The characteristics of initial cigarette-smoking situations and subsequent situations in which adolescents received an offer to smoke were examined by means of interviews with 287 youths in grades 7 through 10. Initiation of smoking generally took place in a social context (89%), with small groups (2.7 people) of same-gender, older (2.1 years), peers (and siblings) who were smokers (60%). In one-third of these onset situations, another novice smoked for the first time. Most subjects (81%) reported that they smoked their first cigarette because they accepted an offer. The characteristics of the onset situation did not significantly differ between regular and experimental smokers. The situations for later offers to smoke were similar: small groups of same-gender, slightly older, cigarette-smoking peers (and siblings). Descriptive and comparative data also are presented on procurement, perceived prevalence, parental influence, cravings, quit attempts, beliefs about ease of quitting, and intention to smoke. These data suggest that school-based interventions may not be sufficient to address the broad social context surrounding adolescent tobacco use. Community-wide interventions are advocated.

Adolescent↗

PubMed1992

Smoking cessation: what have we learned over the past decade?

This article discusses developments in understanding smoking and smoking cessation, methodological issues, and intervention approaches over the past 10 years. Although effective multisession clinic interventions have been developed, such programs reach relatively few smokers. This has led to self-help, work site, health care setting, and community interventions aimed at delivering less intensive programs to larger populations. Conceptual and empirical developments and trends within these above delivery contexts are reviewed, and avenues of research are identified. Nicotine replacement strategies have benefited from technological advances (e.g., transdermal patches) and present continuing challenges with respect to integration with behavioral strategies and incorporation into primary care medical settings. Research over the next decade should focus on the development of cost-effective interventions that can reach representative and high-risk smokers.

Administration, Cutaneous↗

PubMed1992

Smokeless tobacco habits and oral mucosal lesions in dental patients.

As part of a smokeless tobacco (ST) intervention study, we collected data on tobacco use habits and oral health for 245 male ST users aged 15 to 77. The study sample was identified during routine dental office visits and represents a relatively diverse population of patients. Oral health data collection included grading the clinical appearance of oral mucosal lesions using Greer and Poulson's classification system, as well as identifying and recording the primary anatomic location of ST placement. Results show that 78.6 percent of ST users had observable oral lesions, 23.6 percent of which were in the most clinically advanced category (degree III). Of the lesions noted, 85 percent were in the same location the patient identified as his primary area of smokeless tobacco placement. In a comparison sample of 223 non-ST-users with the same age distribution, only 6.3 percent had observable lesions. A multiple logistic regression model for ST users showed that lesion presence and severity were most significantly related to current frequency of ST use.

Adolescent↗

PubMed1992

Patient referral to a smoking cessation program: who follows through?

BACKGROUND: While health care providers are often urged to refer smokers to a smoking cessation program, little information is available about patient adherence to such advice. METHODS: A group of primary care patients who smoked (N = 1380) received brief advice to quit from their provider, and were then asked to stay and talk to a counselor for more information. Counselors randomly delivered one of two interventions. For the intervention group, referral to a specific group cessation program was emphasized, and for the control group, quitting advice was merely repeated. The referral intervention included a video in which role models testified to the acceptability and usefulness of the HMO's group program. The usual program fees were waived, and patients received a supportive, follow-up telephone call 1 week after their visit. RESULTS: In the referral intervention group, 53.2% of patients agreed to go to the cessation program and 11.3% actually attended, compared with only .006% of the patients who received advice only. Logistic regression analyses revealed that patients who were contemplating quitting were more than five times as likely to respond to the referral compared to precontemplators (smokers who were not seriously considering quitting). Older, heavier smokers were also more likely to attend a group session. CONCLUSIONS: An intensive, specific referral to a group smoking cessation program can increase participation by patients. Most patients, however, will not attend a group program; therefore, a brief office-based intervention for all smokers should precede referral.

Adolescent↗

PubMed1992

Effective smokeless tobacco intervention for dental hygiene patients.

This study was designed to test the effectiveness of a smokeless tobacco (ST) intervention delivered in the oral healthcare office setting. A total of 518 male ST users were identified by questionnaire in clinic waiting rooms and then randomly assigned to either a usual-care control group or a special intervention group. Dental hygienists took the primary role in delivering the intervention, which consisted of a soft-tissue examination with special attention to oral lesions, advice to quit ST, distribution of self-help materials, a short video on why and how to stop using smokeless tobacco, and encouragement to set a quit date. Follow-up assessments conducted three months after the office visit showed that a significantly greater proportion of intervention group patients had stopped using ST (32% of the intervention group participants versus 21% of control group patients, kappa 2 = 8.03, p less than .01). The intervention protocol is described in detail so that dental hygienists may adapt it for use in their practice.

Adolescent↗

PubMed1991

Community Intervention Trial for Smoking Cessation (COMMIT): opportunities for community psychologists in chronic disease prevention.

Opportunities for participation in chronic disease prevention programs are discussed in the context of a description and analysis of the National Cancer Institute's Community Intervention Trial for Smoking Cessation (COMMIT). COMMIT involves 11 matched pairs of communities with random assignment to the intervention condition within each pair. The 4-year intervention is guided by a partly standardized protocol and embodies a number of community psychology principles. The relative congruence of COMMIT with community psychology principles and methods is discussed with particular emphasis on Kelly's (1988) model of community research. Community psychology's participation in chronic disease prevention trials requires understanding of the programmatic framework of National Institutes of Health prevention research and recognition of the constraints imposed by the framework on community psychology practices.

Community Mental Health Services↗

PubMed1991

Nurse-assisted smoking counseling in medical settings: minimizing demands on physicians.

BACKGROUND: In an effort to find more practical smoking intervention models for primary-care settings, three physician-and-nurse team approaches to patient counseling were compared with brief physician advice alone. METHODS: Subjects were 3,161 adult smokers surveyed while waiting to see 1 of 40 primary-care physicians. Physicians delivered a brief stop-smoking prompt to 2,707 (86%) of these smokers and referred them to an on-site smoking counselor (e.g., nurse) who randomly provided a two-page pamphlet (advice-only control) or one of three brief nurse-assisted interventions: (a) self-quit training, (b) recruitment to a group program, or (c) a combination intervention. Smokers usually (87%) agreed to see the counselor. RESULTS: After 3 months, subjects in the three nurse-assisted conditions were more likely to report a serious quit attempt (50% vs 39%, P less than 0.001) than were physician-advice-only subjects. Quit rates at 3 months were also higher (P less than 0.001) in the nurse-assisted self-quit (12.9%), recruitment (14.1%), and combination (13.0%) conditions, compared with those for brief physician advice only (7.6%). CONCLUSION: If long-term efficacy is confirmed, these nurse-assisted counseling approaches will serve as practical smoking intervention models for most medical-care delivery settings.

Adult↗

PubMed1979