Patient non-compliance with paper diaries.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
Saul Shiffman
Publications and source records attributed to Saul Shiffman.
Psychosocial demands and ambulatory blood pressure: a field assessment approach.
Ambulatory blood pressure (ABP) has been shown to have independent prognostic value, over and beyond the effects of clinic blood pressure (CBP) measures. We have examined the role of psychosocial demands in understanding ABP, using an electronic diary to measure ongoing experience in the field at the time of each blood pressure reading (ecological momentary assessment). In our previous work, several psychosocial factors were shown to be associated, within-person, with acute fluctuations in ABP in a healthy adult sample. Here, we replicate these findings in a new sample, and we also examine associations of the same variables with mean ABP (between-person) over a 6-day period. Five measures assumed to be markers of psychosocial demands (negative affect, arousal, task demand, decisional control, and social conflict) were shown here to be independently associated with ABP fluctuations during daily life, after adjustment for posture, activity, and substance use. Two of these, measures of task demand and decisional control, were also associated with mean ambulatory systolic blood pressure (SBP), and these latter associations persisted after controlling for CBP. These results support the possibility that psychosocial factors may account for some of the unique predictive value associated with ABP, and they support the value of these field assessment methods.
Aged↗
Using qualitative research to inform survey development on nicotine dependence among adolescents.
Researchers interested in measuring tobacco use and dependence among youth face several formidable challenges. These challenges include: most existing measures have been developed for adult samples and may not be suitable for adolescent respondents; surveys must be relevant to different youth subcultures and to both genders; questions must be developmentally appropriate and not perceived as judgmental or condescending; and the multidimensional nature of nicotine dependence in youth must be recognized and measured. This paper demonstrates how researchers can address these challenges by using qualitative techniques to obtain information on youth tobacco consumption, and then using this information to inform the development of quantitative instruments. A case study is presented where a measure of tobacco dependence originally developed for adults is adapted for use with adolescents. A seven-step formative research process is outlined, consisting of gathering information in open-ended interviews, conducting follow-up research, modification of questionnaire items and addition of new items based on the information gathered, constructing a reliable instrument that is readable and acceptable to youth, reducing the length of this instrument without significantly hurting reliability and validity, conducting additional follow-up research involving case studies, and examining cultural differences. Following a formative research process like this one will help tobacco researchers gain a better understanding of how nicotine dependence develops.
Adolescent↗
Immediate antecedents of cigarette smoking: an analysis from ecological momentary assessment.
The authors assessed the association between smoking and situational cues, including affect, in real-world contexts. Using ecological momentary assessment, 304 smokers monitored ad-lib smoking for 1 week, recording each cigarette on palm-top computers. Generalized estimating equations contrasted 10,084 smoking and 11,155 nonsmoking situations. After controlling for smoking restrictions, smoking was strongly related to smoking urges and modestly related to consumption of coffee and food, the presence of other smokers, and several activities. Smoking was unrelated to negative or positive affect or to arousal, although it was associated with restlessness. Thus, in daily life, affect appears to exert little influence over ad-lib smoking in heavy smoking adults.
Adult↗
Using self-efficacy judgments to predict characteristics of lapses to smoking.
According to relapse prevention theory, abstinence self-efficacy judgments (ASE; confidence in ability to abstain from smoking) about particular affective and environmental contexts should predict behavior in those contexts. Low-ASE contexts should present challenges to abstinence. In this study, the authors used profile correlations to quantify the relationship between context-specific ASE ratings and the characteristics of lapse episodes. To assess the distinctiveness of this relationship, they also correlated the situations surrounding temptation and randomly selected (nontemptation) episodes with context-specific ASE. The ASE-first lapse profile correlation was significantly greater than zero and significantly greater than ASE-temptation and ASE-nontemptation correlations. This pattern of results remained when multiple lapse episodes were considered. Thus, low-ASE contexts tend to be associated with lapses to smoking.
Adult↗
Real-world efficacy of prescription and over-the-counter nicotine replacement therapy.
AIMS: To assess smoking cessation rates achieved with nicotine gum and patch in simulated over-the-counter (OTC) and actual prescription (Rx) settings. DESIGN: Separate open-label studies with gum and patch in OTC and Rx settings. PARTICIPANTS: There were multiple samples: OTC gum: 2981 smokers; OTC patch: 2367; Rx gum: 324; Rx patch: 669. INTERVENTIONS: All smokers received active nicotine replacement. In the OTC setting, smokers self-selected doses of nicotine gum (2 or 4 mg Nicorette) or patch (21, 14 or 7 mg NicoDerm CQ). No intervention was provided. In the Rx setting, smokers were prescribed gum or patch by their physician. MEASUREMENTS: Biochemically verified continuous smoking abstinence was assessed at 6 weeks (28-day abstinence) and 6 months. FINDINGS: OTC success rates were consistently higher than Rx rates: differences were significant at 6 weeks for both patch [OR = 1.45 (1.05-1.98)] and gum [OR 2.92 (1.58-5.40)], and remained significant at 6 months for patch [OR = 3.63: (1.74-7.61)] but not gum [OR = 1.37: (0.73-2.58)]. Among OTC gum users. 16.1% were abstinent at 6 weeks and 8.4% at 6 months. For Rx gum users, abstinence rates were 7.7% at 6 weeks and 7.7% at 6 months. With OTC patch, 19.0% were abstinent at 6 weeks and 9.2% at 6 months. With Rx patch. abstinence rates were 16.0% at 6 weeks and 3.0% at 6 months. CONCLUSIONS: Smoking cessation rates achieved with nicotine gum and patch under OTC conditions were as good as those under real-world prescribing conditions.
Adult↗
Efficacy of over-the-counter nicotine patch.
This study aimed to assess the efficacy of the nicotine patch for smoking cessation, under simulated conditions of over-the-counter sale, absent any direct instruction or behavioral treatment. In a randomized, double-blind, placebo-controlled, multicenter study, 567 smokers were randomized to an active nicotine patch (n = 283) or placebo (n = 284). Treatment followed a three-step program of 21 mg/day for 6 weeks, 14 mg/day for 2 weeks and 7 mg/day for 2 weeks. Participants received brief written instructions, an audiotape and a written User's Guide. There was no other intervention and no contact with participants between enrollment and the primary outcome assessment at 6 weeks. Analyses were based on intent to treat, with lost subjects counted as failures, and claimed abstinence was verified by carbon monoxide measures. Use of active patch produced significantly higher abstinence rates. Continuous abstinence rates (subject to a 2-week grace period) for nicotine and placebo were 19.4% and 7.0% at 6 weeks (OR = 3.2; 95% CI 1.8-5.4) and 15.2% and 5.3% at 10 weeks (OR = 3.2; 95% CI 1.7-5.9), respectively. Seven-day point-prevalence rates for nicotine and placebo patches were 26.1% and 7.7% at 6 weeks (OR = 4.2; 95% CI 2.5-7.0) and 23.3% and 7.7% at 10 weeks (OR = 3.6; 95% CI 2.2-6.1), respectively. Reported adverse events were mild and consistent with prior observations of nicotine patch use. The nicotine patch was safe and effective for smoking cessation at least during 10 weeks of treatment under open-sale conditions, without face-to-face instruction or counseling.
Administration, Topical↗
Tobacco harm reduction: conceptual structure and nomenclature for analysis and research.
The goal of tobacco control has always been to reduce death and disease due to tobacco use. Recent discussions have broadened the concept of tobacco control beyond cessation and prevention to include concepts such as the use of medications to achieve reduction in tobacco use, chemoprevention to reduce disease, modifications of tobacco products to reduce toxicity, and behavioral approaches to change smoking and tobacco use behavior. Within each of these broad domains, diverse approaches have been suggested. To facilitate clear discussion and analysis, and to avoid confusion among approaches, we catalog 19 approaches to harm reduction, distinguishing and discussing them on 11 dimensions, including their objectives, mechanisms, toxicology, expected population risks, and consumer appeal. Because there have also been so many suggested applications of medicinal nicotine to smoking intervention, we separately catalog and analyze nine applications, some of which constitute new approaches to harm reduction. The suggested framework is intended to clarify the debate, provide for common nomenclature, and facilitate analysis of diverse approaches to tobacco harm reduction.
Harm Reduction↗
Capturing momentary, self-report data: a proposal for reporting guidelines.
Self-report data are ubiquitous in behavioral and medical research. Retrospective assessment strategies are prone to recall bias and distortion. New techniques for assessing immediate experiences in respondents' natural environments (e.g., Ecological Momentary Assessment, Experience Sampling) are being used by many researchers to reduce reporting bias. This article discusses seven aspects of momentary research that are often overlooked or minimized in the presentation of momentary research reports, yet that are critical to the success of the research: (a) the rationale for the momentary sampling design, (b) the details of momentary sampling procedures, (c) the data acquisition interface, (d) rates of compliance with the sampling plan, (e) the procedures used to train and monitor participants, (f) data management procedures, and (g) the data analytic approach. Attention to these areas in both the design and reporting of momentary research studies will not only improve momentary research protocols but also allow for the successful replication of research findings by other investigators.
Guidelines as Topic↗
Hostility explains some of the discrepancy between daytime ambulatory and clinic blood pressures.
The authors examined whether hostility explained the discrepancy commonly observed between clinic and daytime ambulatory blood pressures. Daytime ambulatory blood pressure (DABP) was assessed every 45 min over 6 days in healthy adults (N = 120). After controlling for demographic variables, time-varying covariates such as position and activity level, and clinic blood pressure (CBP), the Cook-Medley Hostility Scale was significantly associated with daytime ambulatory diastolic blood pressure. No support was obtained for mediation by psychological factors. Discrepancies between DABP and CBP may be due, in part, to differences in the degree to which these 2 types of measures are associated with individual differences in hostility. These results suggest that the addition of hostility to CBP may improve its predictive power.
Adult↗
The effect of anticipatory strategies on the first day of smoking cessation.
The authors tested a model hypothesizing the predictors and the effects of anticipatory strategy use on the 1st day of smoking cessation using data from 63 participants in an ecological momentary assessment study of smoking cessation. Remaining abstinent on the 1st day of cessation was not associated with mean level of urges to smoke during tempting situations but was associated with anticipatory strategy use, which accounted for 18% of the variance. Getting rid of cigarettes contributed the most to this effect (beta = -.397). Getting rid of cigarettes was itself predicted by 2 variables, lower nicotine dependence (beta = -.264) and attending a formal smoking cessation class (beta = .305), which accounted for 15% of its variance.
Adult↗
Reactivity to ecological momentary assessment: an example using undergraduate problem drinkers.
A. A. Stone and S. Shiffman (1994) defined ecological momentary assessment (EMA) as monitoring or sampling strategies that assess phenomena at the moment they occur in natural settings, thus maximizing ecological validity while avoiding retrospective recall. To address the extent to which EMA affects the behaviors and cognitions under observation, the authors examined behavioral and motivational reactivity to EMA among male and female undergraduate problem drinkers (n = 33). Participants completed a 2-week monitoring protocol using palmtop computers as well as pre- and postmonitoring measures of their drinking behavior and motivation for change. The findings suggest that the magnitude of reactivity to EMA is small. Suggestions for future research are presented.
Adult↗
Tobacco withdrawal in women and menstrual cycle phase.
Because negative mood is a characteristic of both tobacco withdrawal and menstrual discomfort, withdrawal may vary by menstrual cycle phase. Tobacco withdrawal, mood, and menstrual discomfort were assessed in premenopausal women who quit smoking during either the follicular (Days 1-14 postmenstrual onset; n = 41) or luteal (Day 15 or longer postmenstrual onset; n = 37) phase of the menstrual cycle and maintained biochemically verified smoking abstinence during the postquit week. Women quitting during the luteal phase reported significantly greater increases in tobacco withdrawal and self-reported depressive symptoms than women quitting during the follicular phase. These results indicate that selecting a quit-smoking day early in the follicular phase may attenuate withdrawal and negative affect in premenopausal female smokers.
Adult↗
Frequency of spousal interaction and 3-year progression of carotid artery intima medial thickness: the Pittsburgh Healthy Heart Project.
OBJECTIVE: We employed Ecological Momentary Assessment (EMA) real-time recording in the natural setting to determine whether spousal interaction frequency predicts 3-year progression of carotid artery intima medial thickening (IMT). METHODS: Participants were 250 healthy, older adults (M age = 61, 48% female) who, at baseline, underwent 6 days of ambulatory monitoring using electronic diaries to collect data on mood, activity, and posture, as well as current or recent (past 10 minutes) social interactions. Participants also underwent ultrasound imaging of the carotid arteries at baseline and 3-year follow-up. Spousal interaction frequency was computed as the sum of total interactions with only the spouse during the 6 days of monitoring. RESULTS: Spousal interaction frequency did not predict IMT change in the sample as a whole (p = .87). However, a sex by spousal interaction by marital adjustment interaction (p = .02) indicated that more frequent spousal interaction was associated with less IMT progression among men with better marital adjustment (p = .03). In contrast, frequent spousal interaction predicted greater IMT progression among women with better martial adjustment (p < .01). This effect lost significance when women's total social interactions (sum of all interactions) were included in the model. Total social interaction frequency was an independent predictor of IMT among women but not men. CONCLUSIONS: These findings extend those of previous research by suggesting that frequent spousal interactions may be associated with long-term cardiovascular health among happily married older men and demonstrate how sampling daily experience may enhance our understanding of the possible health benefits of marriage.
Aged↗
Tobacco cessation and weight loss: trends in media coverage.
OBJECTIVE: To examine time trends in amount of media coverage on tobacco cessation versus weight loss and test whether the 2 topics compete for limited media attention. METHODS: Monthly print and broadcast media coverage from 1995 to 2003 was estimated. RESULTS: Tobacco and weight coverage were uncorrelated. Tobacco coverage peaked in 1997-98, whereas coverage of weight increased linearly between 1995 and 2003. CONCLUSION: Tobacco and weight topics do not appear to compete for media coverage. Interest in weight topics is rising, consistent with its growing public health importance. Coverage of tobacco is declining, suggesting a need to keep tobacco and cessation in the public eye.
Humans↗