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S Shiffman

Publications and source records attributed to S Shiffman.

At least 19 recordsLinked to original sources
PubMed2001

The efficacy of computer-tailored smoking cessation material as a supplement to nicotine patch therapy.

The study evaluated the efficacy of the Committed Quitters Program (CQP), a computer-tailored set of printed behavioral support materials offered free to purchasers of NicoDerm CQ patches, as a supplement to the nicotine patch and the standard brief User's Guide (UG) and audiotape. Callers to the CQP enrollment were randomized to either CQP (n=1854) or just the UG (n=1829). Abstinence and use of program materials were assessed by telephone interview at 6 and 12 weeks (the latter falling 2 weeks after patch use was to be discontinued). Considering all respondents, abstinence rates did not differ significantly between the UG and CQP groups. As expected, among those who reported they used their assigned materials (80.1% of the sample) smokers who received CQP demonstrated higher quit rates at both 6 weeks (38.8% v. 30.7%) and 12 weeks (18.2% v. 11.1%), compared to the UG group. Among those who used it, the Committed Quitters Program proved to be an effective behavioral treatment, improving quit rates over nicotine replacement therapy and a brief untailored written guide and audiotape.

Administration, Cutaneous↗
PubMed2001

Effect of oral nicotine dosing forms on cigarette withdrawal symptoms and craving: a systematic review.

RATIONALE: Oral nicotine dosing forms such as nicotine gum have been found to be effective in helping smokers to stop. Some, but not all studies have also found that they reduce the severity of withdrawal discomfort. With new oral nicotine products being developed and use of existing products widening, it is important to determine the strength of evidence that these forms of nicotine replacement reduce overall withdrawal discomfort and individual withdrawal symptoms including craving. OBJECTIVES: To assess the strength of evidence that oral nicotine reduces the severity of overall withdrawal discomfort and individual withdrawal symptoms, including craving. METHODS: All published studies reporting effects of nicotine gum, inhaler, lozenge and sublingual tablet on recognised withdrawal symptoms were scanned and those that met a set of quality criteria were included in the review. The key characteristics of these studies were summarised and their findings tabulated. RESULTS: Of 27 studies that reported effects of oral nicotine products on at least one withdrawal symptom, 12 met the quality criteria (eight for nicotine gum, three for inhaler, one for microtab, none for 1 mg lozenge). Because of limitations on the reporting of the studies it was not possible to carry out meta-analyses and good data were available only for the first week of abstinence. Six out of seven studies reporting it found an effect on total withdrawal discomfort, nine out of nine found an effect on irritability, three out of four found an effect on anxiety and the only study that looked at it found an effect on depressed mood. Seven of 11 studies that looked at it found an effect on craving, but only three out of seven of the studies of nicotine gum. For other withdrawal symptoms the findings were more mixed. CONCLUSIONS: We conclude that the strength of evidence that oral nicotine forms reduce total withdrawal discomfort, irritability and anxiety is high. There is some evidence for an effect on depressed mood and craving although in the latter case the evidence is less good for gum than other forms. Future studies of nicotine effects on withdrawal should meet minimum quality standards for design and reporting to enable results to be combined and compared across studies.

Administration, Oral↗
PubMed2001

A multi-dimensional analysis of cue-elicited craving in heavy smokers and tobacco chippers.

AIMS: This research examined the performance of a broad range of measures posited to relate to smoking craving. DESIGN: Heavy smokers and tobacco chippers, who were either deprived of smoking or not for 7 hours, were exposed to both smoking (a lit cigarette) and control cues. PARTICIPANTS: Smokers not currently interested in trying to quit smoking (n = 127) were recruited. Heavy smokers (n = 67) averaged smoking at least 21 cigarettes/day and tobacco chippers (n = 60) averaged 1-5 cigarettes on at least 2 days/week. MEASUREMENTS: Measures included urge rating scales and magnitude estimations, a rating of affective valence, a behavioral choice task that assessed perceived reinforcement value of smoking, several smoking-related judgement tasks and a measure of cognitive resource allocation. FINDINGS: Results indicated that both deprivation state and smoker type tended to affect responses across these measurement domains. CONCLUSIONS: Findings support the use of several novel measures of craving-related processes in smokers.

Adult↗
PubMed2001

Smokers' beliefs about "Light" and "Ultra Light" cigarettes.

OBJECTIVE: To assess beliefs about the tar and nicotine delivery characteristics and health benefits of Light and Ultra Light cigarettes among cigarette smokers. DESIGN: Random digit dialed telephone survey conducted in September 1999. SUBJECTS: Daily smokers (n = 2120) of Regular (46%), Light (39%), and Ultra Light (15%) cigarettes in the USA. The sample was weighted to match the US smoker population on age, sex, and ethnicity. MAIN OUTCOME MEASURES: Beliefs about Light and Ultra Light cigarettes were summarised on three dimensions: Safety (reduced health risk), Delivery (lowered tar and nicotine delivery), and Sensation (less harsh). RESULTS: Most smokers believed Lights and Ultra Lights were less harsh and delivered less tar and nicotine. On average, smokers believed that Lights afforded a 25% reduction in risk, and Ultra Lights a 33% reduction in risk. Light and Ultra Light cigarette smokers evaluated the risks of their own cigarette types more favourably. Light smokers had greater interest in quitting than Ultra Light smokers. Quitting intention was modestly related to beliefs about these cigarettes. Believing that Lights and Ultra Lights delivered less tar and nicotine and that they were less harsh each independently contributed to the belief that these cigarettes were safer. CONCLUSIONS: Many Light and Ultra Light smokers believe that smoking these cigarettes impart a substantial health benefit, due in part to their experience that these cigarettes are less harsh and the belief that these cigarettes deliver less tar.

Adult↗
PubMed2001

Effect of health messages about "Light" and "Ultra Light" cigarettes on beliefs and quitting intent.

OBJECTIVE: To test the impact of three health messages focusing on vent holes, sensory effects of Light and Ultra Light cigarettes, or health consequences of smoking, respectively, on beliefs and quitting intentions. DESIGN: In the course of a random digit dialed telephone survey, subjects were randomised to hear one of three messages. To test the effects of the messages, beliefs and quitting intentions were assessed both pre- and post-message. PARTICIPANTS: Daily smokers (n = 2120) of Regular (46%), Light (39%), and Ultra Light (15%) cigarettes in the USA. The sample was weighted to match the US smoker population on age, sex, and ethnicity. MAIN OUTCOME MEASURES: Beliefs were summarised on three dimensions: Safety (reduced health risk), Delivery (lower tar and nicotine delivery), and Sensation (less harsh). Quitting interest was captured by the "quit index", an aggregate measure of quitting interest and intent. RESULTS: The message focusing on smokers' sensory perceptions of Light and Ultra Light cigarettes resulted in the most positive change in beliefs about safety, delivery, and intent to quit, and was particularly effective among those who believed that these cigarettes were less harsh. The effect was most pronounced among young adults, and among smokers of Light and Ultra Light brands who most endorsed their sensory benefits. CONCLUSIONS: Addressing smokers' sensory experience that Light and Ultra Light cigarettes feel less harsh may be a promising strategy for changing their misconceptions about these cigarettes and enhancing their interest in quitting. Media counter-advertising on Lights and Ultra Lights, focusing on sensory aspects of these cigarettes, may be an important part of tobacco control efforts.

Adult↗
PubMed2001

Test of "Light" cigarette counter-advertising using a standard test of advertising effectiveness.

OBJECTIVE: To evaluate systematically the effectiveness of six advertising strategies (two message strategies presented in three different contexts) designed to promote smoking cessation by addressing smokers' misperceptions about Light cigarettes. DESIGN: Smokers viewed one of six, 30 second test television concept advertisements, which varied by message (one emphasising how the sensory effects of Lights can be deceptive, the other describing the effects of vent blocking) and by ad context (non-commercial public service announcement (PSA), promotion of unbranded nicotine replacement therapy (NRT), or promotion of branded NRT). The effectiveness of each advertisement was determined using a validated advertising testing system in which ads were viewed in the context of reviewing a pilot television programme. Response to ads is assessed through shifts in subject choices of products offered as prizes before and after viewing the test advertisements. Included among the possible prizes were cigarettes and various pharmacotherapies for smoking cessation. SUBJECTS: Daily smokers (n = 1890) of Regular (34%), Light (47%), and Ultra Light (19%) cigarettes recruited from eight US cities. MAIN OUTCOMES MEASURES: The primary outcome of interest was the shift away from cigarettes as the selected prize following exposure to the test advertisements. Secondary outcomes of interest included movement away from Light cigarettes and movement towards assisted quitting products. RESULTS: Smokers who saw the advertisement emphasising the sensory characteristics of Light cigarettes were more likely than subjects who saw the advertisement emphasising the effect of vent blocking to move away from cigarettes (OR = 1.97, 95% confidence interval CI 1.25 to 3.09; chi(2)(1) = 8.69, p = 0.003). Similarly, subjects who saw the advertisement framed as a PSA, rather than as a promotion for either a branded or unbranded NRT product, were also somewhat more likely to move away from cigarettes (OR = 1.51, 95% CI 0.94 to 2.40; chi(2)(1) = 2.97, p = 0.085). The effect was observed regardless of sex, age, or type of cigarette smoked. CONCLUSIONS: Addressing smokers' sensory perceptions of Light cigarettes and presenting this information in an impartial way is likely to be an effective communication strategy for counter-marketing Light cigarettes.

Adult↗
PubMed2001

Does smoking abstinence self-efficacy vary across situations? Identifying context-specificity within the Relapse Situation Efficacy Questionnaire.

According to self-efficacy and relapse theories. abstinence self-efficacy (ASE) ratings should be context-specific: they should vary across situations. This variability may be important, as it could signal high-risk for relapse situations. In this study, confirmatory factor analysis was used to identify situational variability in a novel ASE assessment (Relapse Situation Efficacy Questionnaire. or RSEQ). Results supported a hierarchical structure, where both context-specific and unidimensional measures of ASE exist within the assessment. Context-specific factors included Negative Affect, Positive Affect, Restrictive Situations (to smoking). Idle Time, Social-Food Situations, Low Arousal, and Craving. Multiple context-specific factors and the aggregate factor predicted cessation outcome, even after controlling for concurrent smoking rate. However, the context rated with the least confidence proved to be the best outcome predictor, suggesting the existence of "Achilles' heel" situations. These data indicate the internal and predictive validity of the RSEQ.

Adult↗
PubMed2001

Cognitive-behavioral therapy to reduce weight concerns improves smoking cessation outcome in weight-concerned women.

Women smokers concerned about weight gain (N = 219) were randomly assigned to 1 of 3 adjunct treatments accompanying group smoking cessation counseling: (a) behavioral weight control to prevent weight gain (weight control); (b) cognitive-behavioral therapy (CBT) to directly reduce weight concern, in which dieting was discouraged; and (c) standard counseling alone (standard), in which weight gain was not explicitly addressed. Ten sessions were conducted over 7 weeks, and no medication was provided. Continuous abstinence was significantly higher at posttreatment and at 6 and 12 months of follow-up for CBT (56%, 28%, and 21%, respectively), but not for weight control (44%, 18%, and 13%, respectively), relative to standard (31%, 12%, and 9%, respectively). However, weight control, and to a lesser extent CBT, was associated with attenuation of negative mood after quitting. Prequit body mass index, but not change in weight or in weight concerns postquit, predicted cessation outcome at 1 year. In sum, CBT to reduce weight concerns, but not behavioral weight control counseling to prevent weight gain, improves smoking cessation outcome in weight-concerned women.

Adolescent↗
PubMed2000

The efficacy of computer-tailored smoking cessation material as a supplement to nicotine polacrilex gum therapy.

BACKGROUND: Standard, generic self-help materials have been largely ineffective as behavioral treatments for smoking cessation. In contrast, self-help programs tailored to the needs of specific smokers have shown promise in facilitating quitting. OBJECTIVE: To evaluate the incremental efficacy of the Committed Quitters Program (CQP), a set of computer-tailored materials offered to purchasers of nicotine polacrilex gum, compared with a briefuntailored user's guide and audiotape, both as supplements to nicotine replacement therapy. METHODS: We conducted a randomized, open-label trial with 3 parallel arms. Subjects were smokers who purchased 2- or 4-mg nicotine polacrilex gum and called the CQP toll-free enrollment line. Three thousand six hundred twenty-seven subjects consented to participate in 1 of 3 study arms: (1) those receiving the CQP materials (CQP group, n= 1,217), (2) those receiving CQP materials and an outbound telephone call (CQP + C group, n= 1,207); and (3) those receiving no supplemental intervention beyond the user's guide and audiotape that were prepackaged with the nicotine polacrilex gum (UG group, n= 1,203). Twenty-eight-day continuous abstinence rates were assessed by telephone interviews at 6 weeks and 10-week continuous rates at 12 weeks into treatment. RESULTS: Abstinence rates among respondents at the 6- and 12-week assessments were significantly higher for the CQP (36.2% and 27.6%) and CQP + C (35.5% and 27.3%) groups compared with the UG group (24.7% and 17.7%) at both intervals. The quit rates for the CQP and CQP + C groups were almost identical. CONCLUSIONS: The CQP proved to be an effective behavioral treatment, enhancing quit rates over and above nicotine replacement therapy and a brief untailored written guide and audiotape.

Adult↗
PubMed2000

Current models of nicotine dependence: what is known and what is needed to advance understanding of tobacco etiology among youth.

Youth smoking has risen dramatically during the last 5 years, leading one to the conclusion that prevention interventions have not been particularly effective. This paper provides an examination of features that define adult nicotine dependence and argues that these features need to be considered in any studied examination of youth etiology and development to nicotine dependence. We review the historical context for the concept of nicotine dependence, features that define the concept and current models of substance dependence more generally. Recommendations for future research are provided.

Adolescent↗
PubMed2000

Measuring nicotine dependence among youth: a review of available approaches and instruments.

This paper reviews issues and concepts related to the measurement of nicotine dependence among youth. The primary objectives of this review are to: (1) review the measures of nicotine dependence currently being used; and (2) delineate a future research agenda in an attempt to advance the quality of measurement and instrumentation for this important research endeavor. Existing measures of nicotine dependence, including formal diagnostic interviews, related withdrawal assessments, brief self-report measures, and single-item indicators, are described. While formal diagnostic systems have been considered the 'gold standard' for evaluating dependence clinically, their specific limitations related to use for research purposes are outlined. Each broad class of measure is evaluated in terms of its rationale for use, strengths and limitations, and the extent to which it has successfully been applied to adolescent populations. A research agenda follows in the second section of the paper. In this section, the need for identification and inclusion of a standard set of optimal dependence measures, for enhancement of current measures, and for the onset of a new and comprehensive measures development program is outlined.

Adolescent↗
PubMed2000

Are adolescent smokers dependent on nicotine? A review of the evidence.

This paper reviews the empirical literature on adolescent nicotine dependence, withdrawal, and their associated features. Data documenting nicotine dependence scores, diagnoses, and individual features among adolescents are reviewed in detail and compared to observations based on adult smokers. These data are derived from a broad variety of sources, including national surveys, school-based surveys, and smoking cessation studies. Overall, results indicate that one to three out of five adolescent smokers is dependent on nicotine, with some adolescent groups clearly at higher risk for dependence (those who are incarcerated, in vocational schools, daily smokers, and/or heavy smokers). Across studies, data consistently indicate that a large majority (two-thirds or more) of adolescent smokers report experiencing withdrawal symptoms during attempts to quit or reduce their smoking. Craving or strong desire to smoke was the most commonly reported withdrawal symptom in every study reviewed. Although analyses of concurrent validity generally support the dependence and withdrawal findings among adolescents, data on the predictive validity of measures used are needed. Moreover, studies of adolescent tobacco withdrawal rely almost exclusively on retrospective self-report data. Recommendations for enhancing methodology and advancing our understanding of adolescent nicotine dependence and withdrawal are offered.

Adolescent↗
PubMed2000

Impact of gender and having children in the household on ambulatory blood pressure in work and nonwork settings: a partial replication and new findings.

Ambulatory blood pressure (ABP) has been shown to differ for men and women across work and nonwork settings. For men, ABP is higher at work than at home on workdays or on nonworkdays. For women, ABP levels in different settings depend on whether they have children in the household. Women without children at home exhibit the "male" pattern of higher ABP at work than at home. Women with children at home show either similar ABP levels in the two locations or higher ABP at home. These different patterns have been assumed to represent different stress levels in the two locations, but this assumption has rarely been tested. Also, few studies have examined ABP levels on a nonworkday in women or the effect of having children in the household for men. The present study monitored ABP in men and women during two workdays and one nonworkday. Comparisons were made between ABP levels in three settings (workday at work, workday at home, nonworkday) using mixed random effects regression models. Psychosocial variables (e.g. mood, stress) that might mediate the different ABP patterns were also assessed. ABP differences were analyzed by gender and whether children were living in the household using mixed random effects regression models. Results indicated that diastolic blood pressure was higher at work versus home for men with children and higher at work and on nonworkdays than at home for women without children. ABP did not differ across settings for women with children or men without children. These results were not mediated by mood or stress levels in the three settings.

Adult↗
PubMed2000

The effect of bupropion on nicotine craving and withdrawal.

RATIONALE AND OBJECTIVES: Bupropion has demonstrated efficacy for smoking cessation. Given the importance of nicotine craving and withdrawal in the smoking cessation process, the current study examined the effects of bupropion on these parameters during smoking abstinence. METHODS: During a 2-day Baseline phase with ad lib smoking, 91 non-depressed smokers (who were not trying to quit permanently) were administered measures of nicotine craving, withdrawal symptoms, and timed measures of cognitive performance five times daily. Participants were then assigned randomly to a 14-day treatment regimen with bupropion 300 mg/day, bupropion 150 mg/day, or placebo. Thereafter, the above measures were re-administered during 3 days of abstinence on a closed research ward. RESULTS: Relative to placebo, 300 mg bupropion significantly reduced abstinence-associated increases in rated depression, difficulty concentrating, and irritability, and attenuated a decrease in positive affect. The results also suggested that bupropion might have a positive effect on performance measures during the withdrawal period. No effects were observed on craving, anxiety, restlessness, or hunger. The lack of findings on craving measures may be explained by a floor effect; except on the first day of abstinence, neither drug nor placebo groups showed much craving elevation during abstinence. CONCLUSIONS: Study results indicate that bupropion ameliorates some nicotine withdrawal symptoms.

Adult↗
PubMed2000

A pharmacokinetic crossover study to compare the absorption characteristics of three transdermal nicotine patches.

We compared the pharmacokinetic profiles of the highest marketed doses of three different patch systems using a crossover study design. Specifically, each of the 25 subjects was assigned to receive the Pharmacia-Upjohn (McNeil) 15-mg, 16-h patch, the Novartis 21-mg, 24-h patch, and the Alza (SmithKline Beecham) 21-mg, 24-h patch. Subjects used each patch for 3 consecutive days, applying a new patch each morning. Plasma nicotine concentrations were measured 15 times during the first 24-h period and at 48, 48.5, 49.5, and 51 h following initial patch application. Measures of total nicotine absorbed (AUC), maximum plasma nicotine concentration (C(max)) and minimum plasma nicotine concentration (C(min)), were higher for the 21-mg, 24-h patches than for the 15-mg, 16-h patch during both the first day of dosing and during the modeled steady-state period (48-72 h after initial application). Within the 21-mg, 24-h patch systems, the Alza patch produced significantly higher AUC and C(max) values during acute dosing and during steady state, but there was no difference between C(min) values. The time to reach C(max) (T(max)) was fastest for the Alza patch system; the Pharmacia-Upjohn patch produced a faster T(max) than the Novartis patch. These results indicate that there are significant differences between the pharmacokinetics of the currently marketed patch systems, which may be important for effective relief of withdrawal symptoms and cigarette craving.

Administration, Cutaneous↗
PubMed2000

Dynamic effects of self-efficacy on smoking lapse and relapse.

Self-efficacy (SE) is thought to be critical to success in smoking cessation both as an individual difference and as a dynamic process after a quit attempt. In this study, 214 smokers used palm-top computers to record day-to-day variations in SE during 4 weeks after quitting. SE remained at high and stable levels prior to a 1st lapse but decreased and became more variable thereafter. The authors used event history models with time-varying covariates to assess the effect of daily SE on lapse and relapse risk. Daily SE measures predicted an initial lapse on the subsequent day. However, this relationship was accounted for by stable baseline differences in SE (assessed by questionnaire), rather than by day-to-day dynamics in SE. Progression from 1st lapse to relapse was also examined. In this instance, daily SE predicted subsequent relapse risk, even when baseline SE and concurrent smoking were accounted for, suggesting the importance of SE dynamics for this stage of the relapse process.

Adult↗
PubMed2000

Absentminded lapses during smoking cessation.

Although it is widely believed that drug cravings are responsible for drug use and relapse, S. T. Tiffany (1990) has proposed a cognitive model in which drug use is triggered not by craving but by the cuing of automatized action plans. The purpose of this study was to examine the lapse episodes from an ecological momentary assessment (EMA) study of smokers attempting to quit for evidence of automatic, or absentminded, lapses with slight or no urges to smoke, in keeping with S. T. Tiffany's (1990) model. Qualitative analysis of 270 EMA reports made by 41 smokers during the first 14 days of quitting identified 15 (6%) absentminded lapses. Quantitative urge levels were significantly lower during absentminded lapses compared with nonabsentminded lapses; however, urges were not very low. Results indicate that absentminded lapses may occur but are probably relatively rare.

Adult↗