Biomedical subjects

Saul Shiffman

Publications and source records attributed to Saul Shiffman.

At least 37 records · Page 2Linked to original sources

PubMed2005

Validation of the nicotine dependence syndrome scale (NDSS): a criterion-group design contrasting chippers and regular smokers.

The nicotine dependence syndrome scale (NDSS) is a new multi-dimensional measure of nicotine dependence, yielding five scores for different aspects of dependence as well as a total score. In this study, we tested the NDSS in a young adult sample (mean age=24), using an extreme-groups comparison between non-dependent smokers (chippers, n=123) and regular smokers (n=130). Scores on each NDSS subscale strongly discriminated between the groups, with the NDSS-total discriminating them almost perfectly. The subscales were generally independent discriminators, demonstrating the discriminant validity of the subscales. NDSS scales also discriminated levels of intake and dependence within the chippers group, suggesting that the scales were sensitive to individual differences even at the very low end of the dependence continuum.

Adult↗

PubMed2005

Consumers appropriately self-treat based on labeling for over-the-counter hydrocortisone.

BACKGROUND: Over-the-counter (OTC) topical corticosteroids, such as hydrocortisone cream (HC), are commonly used for the treatment of minor dermatological conditions. The safety and efficacy of such products are well documented, but details on patterns of use and self-treatment with HC in the OTC environment remain scarce. OBJECTIVE: We sought to determine compliance with label directions of OTC HCs by examining self-reported patterns of OTC HC use in adults and children. METHODS: A random digit-dialed telephone survey was conducted with 2000 US adults. Following identification of users of OTC HC in the last 6 months, respondents were asked questions about the conditions being treated with OTC HC and the frequency and duration of use in both adults and children. RESULTS: Of adults completing the survey, 20% (n = 396) had used OTC HC. In 83% of cases, the conditions treated were consistent with the OTC label. Use was limited; HC was applied < or =4 times daily in 98% of adult users and lasted < or =7 days in 92%. Patterns of pediatric use were similar and almost always consistent with the labeling. Of households with children, 25% (n = 168) had used OTC HC to treat pediatric dermatological conditions. Of child users, 93% were 2 years of age or older, treatment was limited (97% applied HC < or =4 times daily and 94% of treatments lasted < or =7 days), and the conditions treated were appropriate in 86% of cases. LIMITATIONS: This telephone survey relied on respondents' recall and self-reporting. Our data on pediatric use of OTC HC are skewed toward treatment of younger children. CONCLUSION: The data suggest that OTC HC products are used for self-treatment in a limited and appropriate fashion that is likely to be safe in both adults and children.

Adolescent↗

PubMed2005

The effectiveness of nicotine patch and nicotine lozenge in very heavy smokers.

The efficacy of nicotine replacement therapy (NRT) among very heavy and highly dependent smokers was examined in a secondary analysis of two randomized clinical trials of NRT. In the first trial, smokers were assigned to active patch (n=249) or placebo (n=253) plus intensive behavioral treatment. In the second trial, smokers were assigned to active 4-mg nicotine lozenge (n=450) or placebo (n=451) plus brief behavioral treatment. Nicotine patch and lozenge significantly increased 6-month continuous abstinence quit rates in both very heavy (>or=40 cigarettes per day) and highly dependent (Fagerström Tolerance Questionnaire or Fagerström Test for Nicotine Dependence score >7) smokers. The effect of active NRT treatment did not differ significantly by smoking rate or nicotine dependence, with the exception that the nicotine patch was significantly more effective than placebo in highly dependent smokers. The nicotine patch and lozenge are effective (vs. placebo) even in heavy and highly dependent smokers.

Administration, Cutaneous↗

PubMed2005

Situational correlates of abstinence self-efficacy.

Little is known about the situations that are associated with changes in self-efficacy during an attempt to quit smoking. In this study, 214 smokers used palmtop computers to record momentary self-efficacy ratings and situational context during a quit attempt. Higher urge to smoke and negative affect were associated with reduced self-efficacy. Although alcohol and coffee consumption are associated with heightened lapse risk, they were unrelated to abstinence self-efficacy. Individuals with low baseline self-efficacy generally reported lower self-efficacy across situations, but these differences were more pronounced under conditions of high urge and negative affect. These results suggest that self-efficacy may be reactive to affect-motivational states during a quit attempt. Whether these influences represent cognitive biases or objective risk assessments is not known.

Adult↗

PubMed2005

Dynamic self-efficacy and outcome expectancies: prediction of smoking lapse and relapse.

According to social learning models of drug relapse, decreases in abstinence self-efficacy (ASE) and increases in positive smoking outcome expectancies (POEs) should foreshadow lapses and relapse. In this study, the authors examined this hypothesis by using ecological momentary assessment data from 305 smokers who achieved initial abstinence from smoking and monitored their smoking and their ASE and POEs by using palmtop computers. Daily ASE and POEs predicted the occurrence of a 1st lapse on the following day. Following a lapse, variations in daily ASE predicted the onset of relapse, even after controlling for concurrent smoking. ASE and POEs generally neither mediated nor moderated each other's effects. These data emphasize the role of dynamic factors in the relapse process.

Adult↗

PubMed2005

Daily fluctuations in self-control demands and alcohol intake.

Predictions made by the self-control strength model were tested in a sample of underage social drinkers using ecological momentary assessment methodology. On days that participants experienced more self-control demands than average, they were more likely to violate their self-imposed drinking limit after controlling for mood and urge to drink. There was no relationship between self-control demands and urge or intention to drink, nor were self-control demands related to plans to limit drinking. When individuals planned to limit their alcohol intake, they were more affected by self-control demands than when they did not plan to limit their alcohol intake. Trait self-control moderated these relationships. Consistent with the self-control strength model, it appears that exerting self-control in nondrinking areas undermines individuals' capacity to exert self-control of drinking in daily life.

Adolescent↗

PubMed2005

The morning after: limit violations and the self-regulation of alcohol consumption.

The authors examined whether the reciprocal relationship between alcohol consumption and distress unfolded over time in 2 samples of social drinkers. Participants monitored their alcohol intake and their cognitive and emotional responses to that drinking on hand-held computers. On mornings after drinking, those who had violated their self-imposed limits the day before reported more guilt, even after controlling for acute negative symptoms of drinking and amount consumed. Reciprocally, guilt led to poorer self-regulation of alcohol intake: Greater distress over alcohol consumption was linked to more intake, intoxication, and more limit violations. Individual differences moderated the relationships among limit violations, distress, and drinking. Consistent with the limit violation effect, violating a limit produced distress over consumption among social drinkers, and they responded to that distress by drinking more.

Adult↗

PubMed2005

One too many: predicting future alcohol consumption following heavy drinking.

Adult social drinkers used handheld computers to monitor alcohol intake as well as the precursors and consequences of drinking over a 2-week period. The within-person relationship between mood and amount of alcohol consumed was examined, as well as the role of individual differences. When individuals made internal attributions for their greater than average consumption, they were in a more negative mood after drinking. Individuals who experienced a negative mood after drinking consumed more subsequently. This dysregulatory process may help explain the progression from social drinking to more problematic drinking; indeed, the relationship between mood and alcohol intake was stronger for heavier drinkers. Likewise, gender and trait temptation and restriction moderated this process. The results are consistent with the Limit Violation Effect model (R. L. Collins, 1993) of mood and regulation of alcohol intake.

Adult↗

PubMed2005

Nicotine patch and lozenge are effective for women.

It has been hypothesized that women may be less likely to obtain therapeutic benefit from nicotine replacement therapy (NRT). The present study tested this hypothesis, using two different types of NRT medications. A secondary analysis of two randomized clinical trials was performed: One compared active 21-mg nicotine patch with placebo among 193 men and 309 women, and the other compared active 2-mg or 4-mg nicotine lozenge with placebo among 788 men and 1,030 women. Using logistic regression analysis of 6-month continuous abstinence and survival analysis, we assessed the efficacy of patch and lozenge among women and tested for a gender x treatment interaction. Active NRT was more effective than placebo among women, for both patch and lozenge. In the lozenge trial, women were less successful than men. The gender x treatment interaction was not significant in either study, whether assessed by logistic regression or survival analysis. In the lozenge trial, gender moderated the effects of smoking rate and dependence (but not treatment) on outcome: These variables affected success rates only among women. Treatment with nicotine patch or lozenge is effective for women, and the analysis did not reveal significant gender differences in efficacy. Gender differences in outcome may be moderated by nicotine dependence.

Administration, Cutaneous↗

PubMed2005

Dynamic influences on smoking relapse process.

This article describes a program of research applying Ecological Momentary Assessment (EMA) methods to study relapse to cigarette smoking, with a particular focus on the role of negative affect (NA) and self-efficacy (SE). Day-to-day changes in mood and stress did not predict lapse risk, but more proximal changes in affect were associated with lapses: Many lapses were marked by intense NA and by NA increases in the preceding hours. Individual differences in baseline SE predicted lapse risk, but daily SE was relatively stable during abstinence and did not influence lapse risk. However, lapses resulted in immediate drops in SE, and day-to-day changes in postlapse SE predicted progression to relapse, even after accounting for concurrent smoking. SE showed momentary drops associated with NA, but only among smokers with low baseline SE. Individual differences in baseline SE were only expressed situationally under conditions of NA. The findings highlight the importance of dynamic changes in background conditions and in immediate states as important influences on lapses and relapse and also suggest the importance of considering person by situation interactions.

Affect↗

PubMed2005

Psychosocial stress and cardiovascular risk: what is the role of daily experience?

We describe an ecological momentary assessment (EMA) protocol designed to measure daily life experiences along several psychosocial dimensions (Social Conflict, Task Demand, Decisional Control, Negative Affect, and Arousal) hypothesized to be relevant for cardiovascular disease risk. In a large community sample, these assessments have been administered in conjunction with ambulatory blood pressure (ABP) monitoring and measures of subclinical cardiovascular disease. Several results have emerged that support the promise of this approach. First of all, each of these dimensions of experience appears to be a trigger for cardiovascular activation, with movement on each scale being associated with significant within-person changes in heart rate and blood pressure in the natural environment. Second, there appear to be individual differences in physiological responsiveness to these dimensions of daily experience, with such differences being associated in some cases with laboratory-based assessments of cardiovascular reactivity, as might be expected. Third, EMA ratings are associated in several instances with (between-person) stable individual differences in ABP readings. And finally, we have found that some of the characteristics defined by our EMA ratings are related to measures of subclinical atherosclerosis. Such effects appear to be mediated, in part, by ABP. The advantages of using EMA measures for capturing the effects of psychosocial stressors are highlighted by comparing the predictive validity of these daily life assessments to traditional global self-reports. We conclude by describing future plans for use of this type of assessment protocol for helping us to characterize psychosocial characteristics relevant to cardiovascular disease risk. Personality and social processes during daily living may have an important impact not only on psychological functioning but also on physical health and disease. In this article we review our recent work involving the assessment of daily experience as a means of better understanding the role of psychosocial stress in cardiovascular disease risk. First, we outline the rationale for our interest in daily experience sampling for examining these processes, and we describe the methods we have adopted for this purpose. Next, we review findings from a recent study in which we have used these approaches to examine the role of psychosocial stress on ABP and atherosclerosis in a community-dwelling sample. We compare our approach to more traditional (global self-report and laboratory-observation) methods for examining these relationships in humans, and we discuss potential future directions for use of daily experience sampling in studies of health and behavior.

Adaptation, Psychological↗

PubMed2005

Randomized controlled trial of a web-based computer-tailored smoking cessation program as a supplement to nicotine patch therapy.

AIM: To assess the efficacy of World Wide Web-based tailored behavioral smoking cessation materials among nicotine patch users. DESIGN: Two-group randomized controlled trial. SETTING: World Wide Web in England and Republic of Ireland. PARTICIPANTS: A total of 3971 subjects who purchased a particular brand of nicotine patch and logged-on to use a free web-based behavioral support program. INTERVENTION: Web-based tailored behavioral smoking cessation materials or web-based non-tailored materials. MEASUREMENTS: Twenty-eight-day continuous abstinence rates were assessed by internet-based survey at 6-week follow-up and 10-week continuous rates at 12-week follow-up. FINDINGS: Using three approaches to the analyses of 6- and 12-week outcomes, participants in the tailored condition reported clinically and statistically significantly higher continuous abstinence rates than participants in the non-tailored condition. In our primary analyses using as a denominator all subjects who logged-on to the treatment site at least once, continuous abstinence rates at 6 weeks were 29.0% in the tailored condition versus 23.9% in the non-tailored condition (OR = 1.30; P = 0.0006); at 12 weeks continuous abstinence rates were 22.8% versus 18.1%, respectively (OR = 1.34; P = 0.0006). Moreover, satisfaction with the program was significantly higher in the tailored than in the non-tailored condition. CONCLUSIONS: The results of this study demonstrate a benefit of the web-based tailored behavioral support materials used in conjunction with nicotine replacement therapy. A web-based program that collects relevant information from users and tailors the intervention to their specific needs had significant advantages over a web-based non-tailored cessation program.

Administration, Cutaneous↗

PubMed2005

Comparative efficacy of rapid-release nicotine gum versus nicotine polacrilex gum in relieving smoking cue-provoked craving.

AIMS: Most relapse episodes occur when smokers are confronted with craving provoked by situational cues. Current nicotine gum can help relieve cue-provoked cravings, but faster effects may result in more rapid relief. We tested a prototype formulation of a new rapid-release nicotine gum (RRNG) that provides more rapid release and absorption of nicotine, for its ability to provide faster and better craving relief compared to current nicotine polacrilex gum (NPG). DESIGN: Random assignment to RRNG or NPG, used during a smoking cue provocation procedure. Participants and setting A total of 319 smokers were exposed to a smoking cue in the laboratory by being asked to light but not smoke a cigarette of their preferred brand. Subjects then chewed a piece of 2 mg RRNG (n = 159) or 2 mg NPG (n = 160) according to randomized assignment. MEASUREMENTS: Craving assessments were completed at regular intervals before and after cue exposure (baseline, pre-cue, and 3, 6, 9, 12, 15, 18, 21, 25, 30 and 35 minutes after the cue). FINDINGS: Smokers chewing RRNG showed significantly lower craving than NPG subjects starting with the first assessment at 3 minutes (P < 0.025). Repeated-measures ANOVA revealed a significant treatment x time interaction (P < 0.05)-craving scores dropped more rapidly in RRNG subjects compared to NPG subjects. Survival analyses also indicated superiority of RRNG in achieving more rapid self-reported meaningful relief (P < 0.05) and complete relief (P < 0.05) of craving. CONCLUSIONS: Rapid-release nicotine gum reduced cue-provoked craving more rapidly compared to NPG, and thus merits further study in cessation efficacy trials.

Adolescent↗

PubMed2005

Nicotine delivery systems.

Over the past 20 years, medicinal nicotine has been used to aid smoking cessation, and has led to a significant increase in the number of smokers who successfully quit. This review describes currently available medicinal nicotine products, which include nicotine patch, gum, lozenge, nasal spray, inhaler and sublingual tablet, including their pharmacokinetics and recommended dosing. New developments in nicotine delivery that could further increase cessation rates include high-dose patches, rapid release gum, combined patch and acute forms, and several novel channels for nicotine delivery, such as nicotine drink, straw, lollipop and a pulmonary inhaler. New applications of existing and novel medicinal nicotine products may include relapse prevention, nicotine maintenance, temporary withdrawal management, reduced smoking and gradual quitting.

Area Under Curve↗

PubMed2005

Non-medical use of OxyContin Tablets in the United States.

The non-medical use of OxyContin (controlled release oxycodone HCl) Tablets has been widely cited in media reports often leaving the impression that OxyContin was a source of primary or new onset drug abuse. However, no published research to date has examined the drug use history of those reporting non-medical use of OxyContin. This study examined rates of non-medical OxyContin use in the United States and the demographic and drug use profiles of those reporting such use, based on data from the 1999, 2000, and 2001 Substance Abuse and Mental Health Services Administration National Household Survey on Drug Abuse. Reported lifetime non-medical OxyContin use in the United States increased from 0.1% to 0.2% to 0.4% in 1999, 2000, and 2001 suggesting new incidence of 0.1%-0.2% per year. Compared to those reporting non-medical use of prescription analgesics other than OxyContin, non-medical OxyContin users were more likely to show a pattern of more serious drug abuse: they used multiple drugs, used needles for drug injection, and had higher rates of abuse and dependence. Approximately 83% of non-medical OxyContin users reported having used illicit drugs or other prescription medications non-medically prior to their first non-medical use of prescription analgesics. Even compared to those who reported non-medical use of other prescription analgesics, non-medical OxyContin users already had a more significant pattern of drug abuse before they began using prescription analgesics for non-medical purposes, suggesting that non-medical use of OxyContin is rarely the initiating factor leading to the abuse of other drugs.

Adolescent↗

PubMed2004

Negative affect and smoking lapses: a prospective analysis.

Relapse is a central problem in smoking treatment. Data collected at the time of relapse episodes indicate that stress and negative affect (NA) promote relapse, but retrospective data are potentially biased. The authors performed a prospective analysis of stress and NA prior to initial lapses in smokers (N = 215). Day-to-day changes in stress (daily negative and positive events and Perceived Stress Scale scores) and NA (multiple momentary affect ratings) did not predict lapse risk on the following day. However, within the lapse day itself, NA was already significantly increasing hours before lapses, but only for episodes attributed to stress or bad mood. Thus, rapid increases in NA, but not slow-changing shifts in stress and NA, were associated with relapse.

Adult↗

PubMed2004

Cue-provoked craving and nicotine replacement therapy in smoking cessation.

Cue exposure paradigms have been used to examine reactivity to smoking cues. However, it is not known whether cue-provoked craving is associated with smoking cessation outcomes or whether cue reactivity can be attenuated by nicotine replacement therapy (NRT) in clinical samples. Cue-provoked craving ratings and reaction time responses were measured on the 1st day of abstinence among 158 smokers who had been randomized to high-dose nicotine (35 mg) or placebo patch. The nicotine patch reduced overall levels of craving but did not attenuate cue-provoked craving increases or reaction time responses. Cue-provoked craving predicted relapse among participants on the nicotine patch but not among those on placebo. In summary, NRT users could benefit from treatment that attenuates cue-provoked craving.

Administration, Cutaneous↗

PubMed2004

Experiences of demand and control in daily life as correlates of subclinical carotid atherosclerosis in a healthy older sample.

Daily experiences of demand and control were examined as correlates of carotid artery atherosclerosis among healthy adults (ages 50-70). Mediating effects of ambulatory blood pressure (ABP) were also explored. Participants (n=337) collected ABP and recorded daily experiences, using electronic diaries, over two 3-day periods. Carotid artery intima-medial thickness (IMT) was assessed using ultrasonography. Participants reporting higher task demands during daily life showed larger IMT, after adjustment for demographic covariates. This association was not limited to workplace ratings or to employed individuals. The association was mediated, in part, by daytime systolic blood pressure. Previous findings linking job stress with cardiovascular disease may reflect the broader impact of daily psychological demands, not necessarily associated with the workplace.

Activities of Daily Living↗