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Biomedical subjects

S J Curry

Publications and source records attributed to S J Curry.

At least 37 records · Page 2Linked to original sources
PubMed1998

Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization.

BACKGROUND: Lack of information about the effect of insurance coverage on the demand for and use of smoking-cessation services has prevented widescale adoption of coverage for such services. METHODS: In a longitudinal, natural experiment, we compared the use and cost effectiveness of three forms of coverage with those of a standard form of coverage for smoking-cessation services that included a behavioral program and nicotine-replacement therapy. The study involved seven employers and a total of 90,005 adult enrollees. The standard plan offered 50 percent coverage of the behavioral program and full coverage of nicotine-replacement therapy. The other plans offered 50 percent coverage of both the behavioral program and nicotine-replacement therapy (reduced coverage), full coverage of the behavioral program and 50 percent coverage of nicotine-replacement therapy (flipped coverage), or full coverage of both the behavioral program and nicotine-replacement therapy. RESULTS: Estimated annual rates of use of smoking-cessation services ranged from 2.4 percent (among smokers with reduced coverage) to 10 percent (among those with full coverage). Smoking-cessation rates ranged from 28 percent (among users with full coverage) to 38 percent (among those with standard coverage). The estimated percentage of all smokers who would quit smoking per year as a result of using the services ranged from 0.7 percent (with reduced coverage) to 2.8 percent (with full coverage). The average cost to the health plan per user who quit smoking ranged from $797 (with standard coverage) to $1,171 (with full coverage). The annual cost per smoker ranged from $6 (with reduced coverage) to $33 (with full coverage). The annual cost per enrollee ranged from $0.89 (with reduced coverage) to $4.92 (with full coverage). CONCLUSIONS: Use of smoking-cessation services varies according to the extent of coverage, with the highest rates of use among smokers with full coverage. Although the rate of smoking cessation among the benefit users with full coverage was lower than the rates among users with plans requiring copayments, the effect on the overall prevalence of smoking was greater with full coverage than with the cost-sharing plans.

Adolescent↗
PubMed1998

Promoting smoking cessation among women who seek cervical cancer screening.

OBJECTIVE: To determine whether 1) women smokers are aware that smoking increases their risk for cervical cancer; 2) awareness of risk factors and its impact on motivation to quit smoking vary by age; and 3) providers are advising smokers to quit smoking during routine gynecologic visits. METHODS: Women aged 18 years and older who had a Papanicolaou test in the prior month were identified from a managed care cytology database. Four weeks after receiving their test result, women were called to complete a health behavior survey in which their smoking status, sexual history, knowledge of risk factors for cervical cancer, and motivation to quit smoking were assessed. RESULTS: Only 49% of the 613 smokers surveyed were aware that smoking increased their risk of cervical cancer. Women aged 34 years and younger were significantly more likely to agree that smoking increased their risk for cervical cancer than women aged 45 years or older (54% versus 40%). Concern that smoking might cause cervical cancer or other cancers was endorsed highly by women as a motivator for cessation, particularly for women smokers aged 18-26 (mean 8.1 and 7.6 on 10-point scales, respectively). About 50% of the women reported that their provider had asked about smoking and had encouraged cessation. Only about 30% of smokers were aware of well-established risk factors for cervical cancer such as the number of lifetime sexual partners and not using a condom. CONCLUSION: Routine gynecologic screening visits represent an important and underutilized clinical opportunity to intervene with young women smokers.

Adolescent↗
PubMed1998

Partner smoking status and pregnant smoker's perceptions of support for and likelihood of smoking cessation.

Perceptions of support for cessation of smoking during pregnancy, likelihood of quitting, and partner smoking status were explored in a sample of 688 pregnant smokers (372 baseline smokers and 316 baseline quitters). Women with nonsmoking partners were significantly more likely to be baseline quitters than women with partners who smoked. Baseline quitters reported significantly more positive support from their partners than did continuing smokers (p = .02). Neither partner smoking status nor partner support at baseline was associated with cessation or relapse later in pregnancy. Women reported greater support, both positive and negative, from nonsmoking partners than from partners who smoked (p = .001). Among partner smokers, those who were trying to quit were perceived to be particularly supportive. Cessation interventions for expectant fathers may increase pregnant women's success at quitting.

Adult↗
PubMed1998

Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies.

OBJECTIVES: This study examined whether pregnancy intention was associated with cigarette smoking, alcohol drinking, use of vitamins, and consumption of caffeinated drinks prior to pregnancy and in early pregnancy. METHODS: Data from a telephone survey of 7174 pregnant women were analyzed. RESULTS: In comparison with women whose pregnancies were intended, women with unintended pregnancies were more likely to report cigarette smoking and less likely to report daily vitamin use. Women with unintended pregnancies were also less likely to decrease consumption of caffeinated beverages or increase daily vitamin use. CONCLUSIONS: Pregnancy intention was associated with health behaviors, prior to pregnancy and in early pregnancy, that may influence pregnancy course and birth outcomes.

Adult↗
PubMed1998

Use of health services by children of smokers and nonsmokers in a health maintenance organization.

OBJECTIVES: Use of health services by children of smokers and nonsmokers was compared to assess whether exposure to environmental tobacco smoke resulted in greater use of health services among children of smokers. METHODS: Primary care and emergency room visits, asthma-related prescriptions, and inpatient stays over the 42-month study period were compared for children of smokers (n = 498) and nonsmokers (n = 1062) who were enrolled in a health maintenance organization. Parents of children aged 1 through 11 years were identified from participants in 2 randomized smoking cessation trials. RESULTS: After adjustment for parental age, education, and health status and for child's age, there were no differences between children of smokers and children of nonsmokers in use of primary care or emergency room visits, asthma-related prescriptions, or inpatient stays. However, among those with any preventive care visits, children of smokers had significantly fewer visits than children of nonsmokers. CONCLUSIONS: Further study is needed to elucidate whether parents who smoke underutilize health services for their children or use services differently from nonsmoking parents and whether these differences have cost implications.

Ambulatory Care↗
PubMed1997

Collaborative management of chronic illness.

In chronic illness, day-to-day care responsibilities fall most heavily on patients and their families. Effective collaborative relationships with health care providers can help patients and families better handle self-care tasks. Collaborative management is care that strengthens and supports self-care in chronic illness while assuring that effective medical, preventive, and health maintenance interventions take place. In this paper, the following essential elements of collaborative management developed in light of behavioral principles and empirical evidence about effective care in chronic illness are discussed: 1) collaborative definition of problems, in which patient-defined problems are identified along with medical problems diagnosed by physicians; 2) targeting, goal setting, and planning, in which patients and providers focus on a specific problem, set realistic objectives, and develop an action plan for attaining those objectives in the context of patient preferences and readiness; 3) creation of a continuum of self-management training and support services, in which patients have access to services that teach skills needed to carry out medical regimens, guide health behavior changes, and provide emotional support; and 4) active and sustained follow-up, in which patients are contacted at specified intervals to monitor health status, identify potential complications, and check and reinforce progress in implementing the care plan. These elements make up a common core of services for chronic illness care that need not be reinvented for each disease.

Chronic Disease↗
PubMed1997

A dietary intervention in primary care practice: the Eating Patterns Study.

OBJECTIVES: This study evaluated the effectiveness of a low-intensity dietary intervention in primary care practice in lowering dietary fat intake and raising dietary fiber intake. METHODS: A randomized controlled trial of 28 physician practices in six primary care clinics enrolled, by telephone, adult patients who had appointments for nonurgent nonacute visits. Of 3490 eligible patients contacted, 2111 completed baseline interview; 86.1% also completed a 12-month follow-up. Physicians gave intervention participants a self-help booklet and a brief motivational message. Changes in fat and fiber from baseline to 12-month follow-up were evaluated. RESULTS: Intervention and control groups both reported a decrease in fat intake and an increase in fiber intake. The differential change and 95% confidence interval (CI) for the percentage of energy obtained from fat was -1.2 (CI = -0.71, -1.7) (P = .0015), for grams fiber/1000 kcal 0.32 (CI = -0.066, 0.71) (P = .086), for fat score -0.044 (CI = -0.016, -0.072) (P = .010), and for fiber score 0.036 (CI = 0.011, 0.061) (P = .014), with greater reductions in fat and greater increase in fiber in the intervention group. CONCLUSIONS: This low-intensity intervention was effective in dietary behavior change.

Adult↗
PubMed1997

Application of a behavioral approach to measuring dietary change: the fat- and fiber-related diet behavior questionnaire.

This study reports the validity, reliability, and responsiveness of a 33-item fat- and fiber-related behavior questionnaire (FFB) and describes how this instrument provides insight into the process of adopting healthy diets. Data are from the Eating Patterns Study, a randomized clinical trial of a physician-delivered, self-help intervention to reduce fat and increase fiber intake. Intervention (n = 850) and control participants (n = 945) completed both a food frequency questionnaire and the FFB at baseline and at 3 and 12 months postintervention. Validity, as assessed by correlation of the FFB with the food frequency questionnaire at baseline, was 0.53 for fat (fat scale with percentage energy from fat) and 0.50 for fiber (fiber scale with fiber g/1000 kcal; both P < 0.001). Reliability, as assessed by the intraclass correlation in controls across all three time points, was 0.77 for the fat scale and 0.74 for the fiber scale (both P < 0.001). The largest changes in fat-related behavior were in avoiding fat as a flavoring and in using specially manufactured low-fat foods, and the largest changes in fiber-related behavior were in substituting high-fiber versions of common foods. Overall, the FFB was a reasonably valid and reliable measure of dietary intake, which provided insight into the behavioral effects of the dietary intervention.

Behavior Therapy↗
PubMed1996

Predicting participation in a dietary intervention to lower cholesterol among individuals with hyperlipidemia.

Adult men and women (N = 8,748) were given blood cholesterol tests and completed a measure of fat intake and a staging questionnaire that assessed readiness to adopt a cholesterol-lowering diet. Eligibility for the trial was based on plasma cholesterol levels and self-reported dietary intake. Of 772 eligible participants, 545 (70.6%) agreed to join. In multivariate analyses, joiners did not differ from nonjoiners by age, total cholesterol levels, or self-reported dietary fat intake. Women were more likely than men to join the study. Individuals in the preparation stage (defined on the basis of a staging algorithm derived from the transtheoretical model of change) were more likely to join the trial than were precontemplators. An understanding of the determinants of participation in a dietary intervention may be important in the enhancement of high-risk individuals' acceptance of recommendations to make dietary changes.

Adult↗
PubMed1995

The impact of smoking and quitting on health care use.

BACKGROUND: The magnitude and timing of the impact of effects of smoking cessation on inpatient and outpatient health care use are uncertain. METHODS: Comparison of the use of outpatient and hospital services over time of 2440 persistent smokers and 244 biochemically verified quitters, all of whom were participants in two independent randomized trials of smoking cessation interventions. RESULTS: Continued smokers in both trials experienced a 7% to 15% increase in outpatient visits and a 30% to 45% increase in hospital admissions over 5 to 6 years of follow-up. The positive slopes approached or reached statistical significance for all use variables in both trial populations. Among quitters, all health care use rates significantly increased during the year in which they quit; after that, the rates declined progressively. By the fourth year after quitting, all use rates among quitters were lower than those for smokers. The increase in hospitalizations during the year of quitting was more often a cause rather than a consequence of successful smoking cessation. CONCLUSION: Successful smoking cessation appears to halt the progressive increase in the use of health services associated with continued smoking within a 4-year period.

Health Services↗
PubMed1995

Primary and secondary prevention of alcohol problems: U.S. internist attitudes and practices.

OBJECTIVE: To describe internists' involvement in primary and secondary prevention of alcohol-related problems, and to evaluate relationships between preventive practices and training, attitudes, and work patterns. DESIGN: Cross-sectional survey. PARTICIPANTS: A random sample of 152 board-certified internists, < or = 65 years old, who practiced primary care in the continental United States, was selected from the American Medical Association's master list. Ten were ineligible; 99 (70%) of the remaining 142 internists completed questionnaires. MAIN OUTCOME MEASURES: The authors evaluated the internists' preventive practices, including the frequency with which they assessed patients' alcohol consumption and advised patients about safe levels of alcohol consumption. The authors also evaluated the internists' opinions about safe levels of alcohol consumption, training and attitudes regarding advising patients about safe levels of consumption, and work patterns. RESULTS: Ninety-four percent of the respondents believed they had a responsibility to advise all patients about safe levels of alcohol consumption (primary prevention), though only 30% often/always did so. Eighty percent often/always advised patients who drank three or more drinks daily about safe levels of alcohol consumption (secondary prevention), but many (45%) did not routinely ask patients how much they drank daily. Preventive practices correlated positively with the number of hours/week internists practiced primary care, and with their belief in the effectiveness of preventive advice about alcohol consumption. CONCLUSIONS: Internists believe they have a responsibility for primary prevention of alcohol-related problems, but only a minority actively practice it. In contrast, many internists practice secondary prevention, offering advice about safe alcohol consumption to patients who drink three or more drinks daily. The effectiveness of such secondary prevention is limited, however, by incomplete screening regarding level of alcohol consumption.

Adult↗
PubMed1995

Community patterns of transdermal nicotine use and provider counseling.

OBJECTIVES: To examine how transdermal nicotine is prescribed and used in the general population, and to identify variables associated with successful smoking cessation in patch users. DESIGN: Retrospective cohort survey. SETTING: A random sample of 70 pharmacies in King County, Washington, were asked to participate. Of those, 33 pharmacies ran computer searches of prescriptions for any nicotine patch dispensed between July 1 and December 31, 1992. A total of 1,087 individuals receiving patches were identified. PATIENTS: At least eight months after the nicotine patches were purchased, 972 subjects received questionnaires by mail from the participating pharmacies. The survey was completed by 433 (45.2%) subjects. MAIN RESULTS: Eighty percent of the respondents requested patches from a provider, 81% of whom were primary care physicians. Ninety-six percent used the patch, 45% smoked while using the patch, and 37% reported having quit smoking. Smoking cessation was associated with daily patch application (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2-2.2), abstinence during patch use (OR 7.7, 95% CI 4.8-12.5), and a longer duration of patch use (p = 0.001). A score reflecting counseling intensity by the provider was associated with abstinence while using patches and smoking cessation (chi 2 for tread = 0.01 and 0.04, respectively). CONCLUSIONS: Most nicotine patch users request treatment from a primary care physician, suggesting motivation to quit. Almost half continue to smoke while using the patch, a behavior that appears related to a lower level of counseling and an inability to quit. Increasing counseling may positively impact nicotine-patch-assisted smoking cessation in the general population.

Administration, Cutaneous↗
PubMed1995

A randomized trial of self-help materials, personalized feedback, and telephone counseling with nonvolunteer smokers.

The incremental effects of (a) a self-help booklet alone, (b) self-help booklet with computer-generated personalized feedback, and (c) self-help booklet, personalized feedback, and outreach telephone counseling were evaluated in a population-based, nonvolunteer sample of smokers. Smokers (N = 1,137) were identified through a telephone survey of a random sample of 5,903 enrollees in a health maintenance organization and randomized to a no-treatment control group or 1 of the 3 intervention conditions. Smoking status was ascertained 3, 12, and 21 months postrandomization. Cotinine validation of self-reported cessation was obtained at the 12-month follow-up. Overall, the telephone counseling significantly increased smoking cessation at the 3-month follow-up, but not at 12 or 21 months. Among smokers who were precontemplative at baseline, telephone counseling significantly increased prevalent abstinence at 3 and 12 months and continuous abstinence at 21 months (defined as self-reported abstinence at 3, 12, and 21 months).

Adult↗
PubMed1995

School-level application of a social bonding model to adolescent risk-taking behavior.

Adolescent bonding--attachment to, commitment to, and involvement in conventional social activities-decreases the likelihood of engaging in some risk-taking behaviors. The extent to which bonding opportunities in the school environment affect individual's bonding and risk-taking behaviors is less explored. This study tested a model that includes individual and environmental indicators of bonding to predict cigarette smoking, drinking, drug use, and sexual activity among ninth grade students. Survey data representing students in 20 schools in seven western states are reported. Twelfth grade students' bonding and other demographic variables aggregated by school served as environmental indicators of bonding opportunities to predict ninth grade students' bonding and risk-taking behavior. Path analyses indicate the school environment has a direct influence on ninth grade students' bonding and, in turn, on the likelihood they will engage in risky behavior. Implications of these findings for future research directions and intervention design are discussed.

Adolescent↗
PubMed1994

Implementation and acceptance of outreach telephone counseling for smoking cessation with nonvolunteer smokers.

Brief supportive telephone counseling is a promising adjunct to self-help smoking cessation programs. This article reports rates of participation, predictors of participation, and content of telephone counseling calls with nonvolunteer smokers who were identified through health surveys administered to a random sample of enrollees in a health maintenance organization. Eighty-six percent of smokers accepted at least one of three counselor calls; 66% accepted all three calls. Baseline characteristics associated with acceptance of calls included being female and greater average length of time to the first cigarette of the day. Acceptance did not differ significantly by stage of cessation. First calls with smokers who accepted all three calls were longer and were more likely to be with smokers who were willing to take a specific next action step. Overall, 12% of the sample reported having quit smoking by the third counseling call, with the highest quit rate (23%) among smokers who, at baseline, were planning to quit in the next month. Implications for large-scale interventions with smokers in health care and other organizations are discussed.

Adult↗
PubMed1993

A randomized trial of the impact of risk assessment and feedback on participation in mammography screening.

BACKGROUND: Although rates of mammography screening among women in the general population have been increasing they still fall short of national goals. This study evaluated the effects on rates of participation in mammography screening of obtaining risk factor information and providing general or personalized risk information through direct mailed correspondence. METHODS: Women enrollees in a health maintenance organization (N = 2,076), age 50 and above, were randomized to one of the following four groups: (a) no risk factor questionnaire + generic invitation, (b) no risk factor questionnaire + general risk invitation, (c) risk factor questionnaire + general risk invitation, and (d) risk factor questionnaire + personal risk invitation. Computerized visit records were monitored for 12 months following a mailed invitation to assess whether a mammogram had been obtained. RESULTS: Overall participation was 37.5% and the rate of participation did not differ significantly across groups (P = 0.26). Participation was related to age (P < 0.02), with rates highest for women ages 60-69 years (42.7%) compared with those for women ages 50-59 (35.5%) and those age 70+ (33.7%). Among women with a family history of breast cancer, the personalized risk invitation was associated with significantly higher participation compared with general risk invitation (66.7 versus 42.9%, respectively; P < 0.003). CONCLUSIONS: Women with a family history of breast cancer are more likely to obtain a mammogram if that fact is reinforced as a risk factor. Research on environmental barriers to mammography screening may suggest alternative strategies for increasing participation.

Adult↗