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Biomedical subjects

S Shiffman

Publications and source records attributed to S Shiffman.

At least 55 records · Page 3Linked to original sources
PubMed1998

Tobacco dependence treatments: review and prospectus.

Cigarette smoking continues to place an enormous burden on US health systems. The treatment of tobacco-dependent persons is vital to the public health, since unmitigated smoking could lead to the development of disease and premature death in as many as 20 million current smokers in the United States. Much of this tobacco-related morbidity and mortality could be prevented by the application of existing treatments, as well as newer ones. Access to safe and effective treatments was significantly expanded in 1996, when two forms of nicotine replacement therapy (NRT), the nicotine gum and patch, became available for over-the-counter sale. Expanded access has led to significantly increased utilization and quitting. Even with these advances, however, the scope of this tobacco dependence demands that we explore alternative treatment strategies, including exposure reduction therapy (ERT) as a possible option for smokers not currently making quit attempts. In this review, we present principles to guide the development of such a therapy, and for its application, should it be proven effective.

Health Education↗
PubMed1997

A day at a time: predicting smoking lapse from daily urge.

Smokers who recently quit (N = 214) monitored smoking urges for up to 26 days after quitting. Computers administered 4-5 assessments daily at random times; participants rated urges on waking and when they experienced temptation episodes. Urge intensity after cessation did not generally exceed urges reported during baseline ad lib smoking. Urge intensity and temptation frequency consistently declined over the quit period. Controlling for urge intensity at baseline, all daily urge intensity measures predicted lapse the following day in proportional hazards survival analyses. Average duration of temptation episodes also predicted lapses; frequency of temptation did not. To isolate the effect of day-to-day variations in urges, participants' nicotine dependence and urge intensity on quit day were controlled for. Only urge intensity at waking still predicted lapse risk; this was not because of this measured being closer in time to the day's lapses. Among lapsers, urge intensity at waking and in temptations rose preceding a lapse.

Adult↗
PubMed1997

Attentional mediation of cigarette smoking's effect on anxiety.

It was hypothesized that smoking's calming effects are cognitively mediated and depend on the presence of a benign distractor, smoking narrows the focus of attention, thereby reducing anxiety by facilitating distraction from stressful cognitions (cf. C. M. Steele & R. A. Josephs's [1988] attention-allocation model of alcohol reinforcement). This notion was tested by examining the effect of smoking (vs. not smoking) on anxiety with and without a concurrent distraction in 82 smokers; distraction effects were also assessed in 42 nonsmokers. As predicted, smoking reduced anxiety only when paired with a distractor. Further, these findings could not be explained by direct nicotine effects or nicotine withdrawal. Several measures of attention allocation failed to confirm the hypothesized cognitive mechanisms, however. Implications of the findings are discussed.

Adolescent↗
PubMed1997

Remember that? A comparison of real-time versus retrospective recall of smoking lapses.

Research and treatment assessments often rely on retrospective recall of events. The accuracy of recall was tested using accounts of smoking lapse episodes from 127 participants who had quit smoking, and lapses and temptations were recorded in near-real time using a hand-held computer. These computer records were compared with retrospective accounts elicited 12 weeks later, with a focus on recall of lapses in 4 content domains: mood, activity, episode Triggers, and abstinence violation effects. Recall of lapses was quite poor: Average kappas for items ranged from 0.18 to 0.27. Mean profile rs assessing recall for the overall pattern of behavior were .36, .30, .33, and .44 for these domains, respectively. In recall, participants overestimated their negative affect and the number of cigarettes they had smoked during the lapse, and their recall was influenced by current smoking status. The findings suggest caution in the use of recall in research and intervention.

Adult↗
PubMed1997

Public health benefit of over-the-counter nicotine medications.

OBJECTIVE: To estimate the impact of allowing non-prescription sales of nicotine medications in the United States on increasing the numbers of smokers quitting. DESIGN: Sales and marketing data were used to compare the use of nicotine medications before and after non-prescription sales, and to estimate the impact of non-prescription sales on quit rates. SETTING: United States. MAIN OUTCOME MEASURES: Number of quit attempts using nicotine replacement therapy (NRT) products, number of smokers who quit smoking with over-the-counter (OTC) NRT or with NRT still sold by prescription, and incremental quits attributable to OTC NRT. RESULTS: Since the US Food and Drug Administration approved nicotine medications for OTC sale in 1996, use of the medications has increased by 152% compared with prior prescription use. With increased use of an efficacious treatment, OTC nicotine medications are estimated to yield from 114,000-304,000 new former smokers annually in the United States. CONCLUSIONS: The broader availability and promotion of effective treatments for tobacco dependence, specifically nicotine gum and patch, increase the number of smokers availing themselves of the medications. This increased use is estimated to contribute substantially to the number of former smokers in the United States.

Health Promotion↗
PubMed1996

First lapses to smoking: within-subjects analysis of real-time reports.

Studies of smoking relapse and temptation episodes have relied on retrospective recall and confounded between- and within-subject variability. Real-time data on temptations and lapses to smoke were gathered using palm-top computers. We made within-subject comparisons of the initial lapse, a temptation episode, and base rate data obtained through randomly scheduled assessments. Negative affect discriminated all three situations, with lapses worse than temptations, and temptations worse than random situations. Participants attributed lapses to negative mood and smoking cues, whereas temptations were more often attributed to behavioral transitions. Participants were 12 times more likely to report coping in temptations than in lapses. However, only cognitive (vs. behavioral) coping strategies were effective. Lapses (vs. the other situations) were more likely to occur when smoking was permitted, when cigarettes were easily available, and in the presence of other smokers. The results have clinical implications, and the computerized monitoring methods may be applicable to an array of clinical research problems.

Adult↗
PubMed1996

Progression from a smoking lapse to relapse: prediction from abstinence violation effects, nicotine dependence, and lapse characteristics.

Determinants of progression from an initial smoking lapse to relapse, using prospective data from 133 participants were examined. Participants used palm-top computers to record their first lapse, and their reaction to it, within minutes of the event, and were followed for 3 months to assess subsequent smoking. Indicators of the Abstinence Violation Effect--self-efficacy, attributions, and affective reactions to the lapse--generally failed to predict progression to relapse, but participants who felt like giving up after the first lapse progressed more rapidly to a second lapse. Participants who attempted restorative coping were less likely to progress to another lapse on the same day. Those whose lapses were triggered by stress progressed more quickly, whereas those triggered by eating and drinking or accompanied by alcohol consumption progressed more slowly. More nicotine-dependent participants progressed more rapidly toward relapse, but neither the amount smoked in the first lapse nor its subjective reinforcement predicted progression.

Adult↗
PubMed1996

Temptations to smoke after quitting: a comparison of lapsers and maintainers.

This study addresses whether characteristics of temptations to smoke differ for participants who quit smoking and maintain abstinence compared to those who quit and then lapse. Participants used hand-held computers to record temptations and were beeped at random for base-rate assessments. We used generalized estimating equations to compare 1,851 temptation episodes and 5,192 random assessments recorded by 151 participants (116 lapsers, 35 maintainers) over 1-23 days of abstinence. Compared to randomly sampled occasions, temptations were marked by greater negative affect, restlessness, attention disturbance, and exposure to smoking cues; participants were also more likely to be eating or drinking during temptations. Temptations reported by lapsers and maintainers did not differ in any respect, including their reported coping. The results highlight situational variance over individual differences.

Adaptation, Psychological↗
PubMed1996

Effect of the number of high-fat and low-fat cues on food choice.

This study examined the effects on food choice of increasing the number of healthy items available (fruit) and decreasing the number of unhealthy items available (candy bars). A similar choice, involving nonfood items, was also examined. Two hundred eighty-nine men and women were randomly assigned to 1 of 4 experimental groups: (a) control group, (b) increased number of fruits, (c) decreased number of candy bars, and (d) combination. Between 30% and 40% of participants chose fruit regardless of the amount of fruit and candy presented: there was no effect of increasing fruit or decreasing candy bars. However, restrained participants and current dieters were more likely to choose fruit. In contrast, both stimulus control techniques were effective in increasing the percentage of participants choosing a nonfood item. These results suggest that stimulus control may not be sufficient to modify food choice: other powerful factors affect eating behavior, and these must be considered.

Journal Article↗
PubMed1995

Nicotine withdrawal in chippers and regular smokers: subjective and cognitive effects.

From previous studies, chippers (very light, long-time cigarette smokers) seem not to be nicotine dependent, despite decades of smoking. The effect of tobacco deprivation on chippers' withdrawal reactions was examined. Matched groups of 26 chippers and 25 regular smokers were studied while abstaining or smoking for 2-day blocks, with assessments administered 5 times daily by palm-top computers. As hypothesized, chippers showed no changes as a result of nicotine deprivation. In contrast, regular smokers demonstrated distinct changes in craving, mood, arousal, and sleep disturbance. The computers also tested participants' cognitive performance. Unlike chippers, regular smokers' performance on complex tasks was slower under deprivation; the effect could not be explained by changes in motor performance or simple reaction time. Results suggest performance may have been improved by nicotine rather than by worsened by withdrawal.

Adult↗
PubMed1995

Responses to hypothetical high risk situations: do they predict weight loss in a behavioral treatment program or the context of dietary lapses?

Before starting a behavioral weight control program and after 6 months of treatment, 93 participants were asked to listen to 4 scenarios describing typical high risk situations for dieters (family celebration, watching TV, tension at work, argument). The number of coping responses generated, latency of responses, and perceived risk of lapsing were assessed; participants also identified which situation would be most difficult for them. Telephone interviews were conducted during the weight loss program to assess situations surrounding actual dietary lapses. Participants who rated the negative affect situations as most difficult were more likely to lapse in situations involving negative affect; 87% of these participants lapsed in association with negative affect. Moreover, participants who generated coping responses to more of the situations subsequently lost more weight. Thus, baseline performance on a hypothetical high risk task predicts subsequent performances in a behavioral weight loss program.

Adult↗
PubMed1994

Predictors of smoking cessation after coronary artery bypass graft surgery. Results of a randomized trial with 5-year follow-up.

OBJECTIVE: To test the efficacy of a smoking cessation program for inpatients recovering from coronary artery bypass graft surgery and to identify predictors of cessation. DESIGN: Randomized, controlled clinical trial. SETTING: Postoperative cardiac surgery unit of a large teaching hospital. PATIENTS: Patients scheduled for coronary artery bypass surgery by participating surgeons between 1 July 1986 and 1 July 1987 who had smoked 1 or more packs of cigarettes in the 6 months before admission. Of 120 eligible patients, 93 enrolled and 87 were discharged alive. All survivors were followed for at least 1 year; 94% were followed for a median of 5.5 years. INTERVENTION: A three-session, nurse-delivered behavior modification program using a videotape and face-to-face counseling was compared to usual care. MEASUREMENTS: Smoking status was assessed six times in the year after surgery and 5.5 years after surgery. Self-reported nonsmoking was validated by saliva cotinine assay 1 and 5.5 years after surgery. RESULTS: No statistically significant differences were found between control (n = 43) and intervention (n = 44) groups at baseline. One and 5.5 years after hospital discharge, validated continuous nonsmoking rates were identical in intervention and control groups (51% at 1 year; 44% at 5.5 years). Multiple logistic regression identified four factors that were independently associated with nonsmoking for 1 year: fewer than 3 previous attempts to quit (odds ratio, 7.4; 95% Cl, 1.9 to 29.1); more than 1 week of preoperative nonsmoking (odds ratio, 10.0; Cl, 2.0 to 50.2); definite intention to quit smoking (odds ratio, 12.0; Cl, 2.6 to 55.1); and no difficulty not smoking in the hospital (odds ratio, 9.6; Cl, 1.8 to 52.2). Nonsmoking for 5.5 years was independently associated with two of these factors: fewer than three previous attempts to quit and intention to quit smoking after surgery. Cessation was not related to demographic factors, daily cigarette consumption, disease severity, hospital course, social support, or beliefs and attitudes. CONCLUSIONS: Even without specific intervention, nearly one half of smokers quit for 5 years after coronary artery bypass surgery. A short inpatient education program did not increase this rate. Future efforts should target the time after discharge and focus on increasing motivation in patients who have repeatedly failed to quit.

Attitude to Health↗
PubMed1994

Binge eating antecedents in normal-weight nonpurging females: is there consistency?

We examined the situational antecedents of binge eating episodes and tested for consistency in the antecedents. We evaluated the antecedents of two successive binges via structured interviews with 50 normal-weight nonpurging females who regularly binge. Cluster analysis yielded two categories of binge-promoting situations: solitary negative affect situations and social eating situations. When this empirically derived classification of binge situations was used, the two successively occurring binges did not systematically fall into the same cluster. Consistency on other measures was also modest. Implications of these findings for conceptual models of binge eating and treatment, including the prospect of individually tailored interventions, are discussed.

Adult↗
PubMed1994

Smoking typology profiles of chippers and regular smokers.

This study examined smoking patterns among chippers--light, nondependent cigarette smokers--by contrasting their smoking motives (Russell's Reasons for Smoking) and patterns (McKennell's Smoking Occasions) with those of a matched group of regular smokers. Differences between group profiles were initially confounded by differences in overall level of item endorsement, which obscured meaningful interpretation of group differences in smoking patterns. Group differences were clarified by correcting for profile elevation and scatter, as suggested by Cronbach and Gleser (1953). As expected, chippers' subscale profiles deemphasized pharmacological and addiction-related motives such as craving and habit, while emphasizing appetitive and sensory motives such as handling and pleasurable smoking. Social motives for smoking were also more prominent in chippers' smoking profiles.

Adult↗
PubMed1994

Longitudinal investigation of the abstinence violation effect in binge eaters.

This study, guided in part by G. A. Marlatt and J. R. Gordon's (1985) abstinence violation effect (AVE) model, examined whether variability in cognitive and emotional reactions to binges accounts for recurrence of binge eating. Attributional, cognitive, and affective reactions to two successive binges, as well as the latencies between each binge and a subsequent binge, were evaluated through a series of structured phone interviews with 50 nonpurging normal-weight female bingers. Reported mood after binging was unrelated to binge latency. However, when Ss made more intense internal, global, and uncontrollable causal attributions for a binge, a subsequent binge followed significantly sooner. Within-subject variations in AVEs across binges prospectively predicted within-subject variations in the speed with which another binge followed. Analyses suggested that cognitive states (e.g., AVE and guilt) evoked by particular events were better predictors of how quickly binging repeats than were stable differences in attributional style.

Adolescent↗
PubMed1994

Individual differences in intraperson variability in mood.

The experience sampling method and palm-top computers were used to obtain 75-100 randomly timed in situ assessments of 11 mood-related items from 54 Ss over 12-14 days. The variability in the distribution of an S's responses to each item was used as an estimate of intrasubject mood variability. Mood variability was stable across time (average r > .58) and across situations (average r = .51). The intercorrelations among the individual item variabilities were also substantial (average r = .41); when the items were combined into a mood variability scale, the coefficient alpha was .84. The stability and internal consistency of mood variability could not be reasonably attributed to similarity in item valences, differences among the Ss in the situations they encountered, response biases, or response errors. It was concluded that mood variability is a stable personal characteristic, but additional analyses suggested that it may be independent from other kinds of intraperson variability.

Adult↗
PubMed1993

Smoking cessation treatment: any progress?

This article argues that, although smoking rates are declining and quit rates are rising, research on behavioral approaches to smoking cessation is stagnant. Despite an increase in publications on smoking cessation, few innovative approaches have been introduced in the past decade. Furthermore, average treatment outcomes have not improved over this period. Treatment innovations may come from research that aims at fundamental new insights regarding smoking behavior and smoking behavior change rather than from incremental improvements of current approaches.

Cross-Sectional Studies↗