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Biomedical subjects

T B Baker

Publications and source records attributed to T B Baker.

At least 37 records · Page 2Linked to original sources
PubMed1995

Varying nicotine patch dose and type of smoking cessation counseling.

OBJECTIVE: To compare the efficacy and safety of 22-mg and 44-mg doses of transdermal nicotine therapy when it is paired with minimal, individual, or group counseling to improve smoking cessation rates. DESIGN: An 8-week clinical trial (4 weeks double-blind followed by 4 weeks open label) using random assignment of participants to both dose (22 or 44 mg) and counseling (minimal, individual, or group) conditions. PARTICIPANTS: Daily cigarette smokers (> or = 15 cigarettes per day for at least 1 year) who volunteered to participate in a study of smoking cessation treatment. A total of 504 participants were enrolled at two sites. INTERVENTION: Four weeks of 22- or 44-mg transdermal nicotine therapy followed by 4 weeks of dosage reduction (2 weeks of 22 mg followed by 2 weeks of 11 mg). Counseling consisted of a self-help pamphlet (minimal); a self-help pamphlet, a brief physician motivational message, and three brief (< 15 minutes) follow-up visits with a nurse (individual); or the pamphlet, the motivational message, and eight weekly 1-hour group smoking cessation counseling visits (group). All participants returned weekly to turn in questionnaires and for assessment of their smoking status. MAIN OUTCOME MEASURES: Abstinence from smoking was based on self-report, confirmed by an expired carbon monoxide concentration lower than 10 ppm. Withdrawal severity was assessed by means of an eight-item self-report questionnaire completed daily. RESULTS: Smoking cessation rates for the two nicotine patch doses and three levels of counseling did not differ significantly at either 8 weeks or 26 weeks following the quit date. Among those receiving minimal contact, the 44-mg dose produced greater abstinence at 4 weeks than did the 22-mg dose (68% vs 45%; P < .01). Participants receiving minimal-contact adjuvant treatment were less likely to be abstinent at the end of 4 weeks than those receiving individual or group counseling (56% vs 67%; P < .05). The 44-mg dose decreased desire to smoke more than the 22-mg dose, but this effect was not related to success in quitting smoking. Transdermal nicotine therapy at doses of 44 mg produced a significantly greater frequency of nausea (28%), vomiting (10%), and erythema with edema at the patch site (30%) than did a 22-mg dose (10%, 2%, and 13%, respectively; P < .01 for each adverse effect). Three serious adverse events occurred during use of the 44-mg patch dose. CONCLUSIONS: There does not appear to be any general, sustained benefit of initiating transdermal nicotine therapy with a 44-mg patch dose or of providing intense adjuvant smoking cessation treatment. The two doses and all adjuvant treatments produced equivalent effects at the 26-week follow-up, and the higher patch dose produced more adverse effects. Higher-dose (44-mg) nicotine replacement does not appear to be indicated for general clinical populations, although it may provide short-term benefit to some smokers attempting to quit with minimal adjuvant treatment.

Administration, Cutaneous↗
PubMed1995

Tobacco withdrawal and nicotine replacement influence objective measures of sleep.

Research has not adequately characterized the impact of tobacco withdrawal on objectively assessed sleep parameters despite the recent inclusion of insomnia as a nicotine withdrawal sign in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Moreover, whether 24-hr nicotine replacement aids or interferes with sleep during withdrawal is unknown. In a double-masked, randomized clinical trial, 34 cigarette smokers who were motivated to quit received either active nicotine patches or placebo patches while quitting. Sleep was polysomnographically monitored for 2 precessation nights and 3 postcessation nights. The study demonstrates that among dependent smokers (a) tobacco withdrawal increases objectively assessed sleep disturbance (sleep fragmentation) and (b) nicotine replacement results in postcessation improvements in important polysomnographic measures of sleep quality (sleep fragmentation, Stage 3 and Stage 4 sleep).

Double-Blind Method↗
PubMed1995

Smoking status as the new vital sign: effect on assessment and intervention in patients who smoke.

OBJECTIVE: To assess the effect of expanding the vital signs to include smoking status. DESIGN: We prospectively conducted exit interviews with patients at a general internal medicine clinic in Madison, Wisconsin, during a 16-month period from 1991 to 1993. METHODS: Patients were surveyed briefly before (N = 870) and after (N = 994) the implementation of a simple institutional change in clinical practice. This change involved training the staff in how to use progress notepaper with a vital sign stamp that included smoking status (current, former, or never) along with the traditional vital signs. Included in the survey were questions about whether the patient smoked, whether the patient was asked that day about smoking status (by a clinician or other staff), and, for smokers, whether they were urged to quit smoking and given specific advice on how to do so. RESULTS: After expansion of the vital signs, patients were much more likely to report inquiries about their smoking status on the day of a clinic visit (an increase from approximately 58% at baseline to 81% at intervention; P < 0.0001). The vital sign intervention was associated with significant increases in the percentage of smokers who reported that their clinician advised them that day to quit smoking (from approximately 49% at baseline to 70% during the intervention; P < 0.01) and in the percentage who reported that their clinician gave them specific advice that day on how to stop smoking (from approximately 24% at baseline to 43% during the intervention; P < 0.01). CONCLUSION: Expanding the vital signs to include smoking status was associated with a dramatic increase in the rate of identifying patients who smoke and of intervening to encourage and assist with smoking cessation. This simple, low-cost intervention may effectively prompt clinicians to inquire about use of tobacco and offer recommendations to smokers.

Adult↗
PubMed1994

Predicting smoking cessation. Who will quit with and without the nicotine patch.

OBJECTIVE: To identify predictors of smoking cessation success or failure with and without transdermal nicotine patch treatment. DESIGN: Two independent randomized, double-blind, placebo-controlled studies using the nicotine patch assessing outcome at the end of treatment and at 6-month follow-up; each study used a different mode of adjuvant counseling. PATIENTS: Subjects were daily smokers (> or = 15 cigarettes per day), aged 21 to 65 years with expired air carbon monoxide levels of at least 10 ppm, and motivated to quit. Eighty-eight subjects participated in study 1, and 112 subjects participated in study 2. INTERVENTION: Study 1 consisted of 8 weeks of 22-mg nicotine patch therapy with intensive group counseling. Study 2 consisted of 4 weeks of 22-mg nicotine patch therapy and 2 weeks of 11-mg nicotine patch therapy with brief individual counseling. MAIN OUTCOME MEASURES: The prediction of smoking cessation (at end of treatment and after 6 months) based on pretreatment and intratreatment measures in smokers using active or placebo nicotine patches. RESULTS: Pretreatment markers, such as the Fagerstrom Tolerance Questionnaire score, number of cigarettes smoked per day, years smoked, expired air carbon monoxide level, or baseline blood nicotine and cotinine levels, showed no consistent relationship with successful smoking cessation across both studies. Of the intratreatment markers examined, withdrawal severity and nicotine replacement levels also were not consistently predictive of cessation success. However, any smoking during the second week of treatment was a consistent and powerful predictor of failure at the end of treatment and after 6 months. Among active nicotine patch patients who smoked at all during week 2 after quitting, 83% and 97% (studies 1 and 2, respectively) were smoking at 6-month follow-up. Conversely, abstinence during the second week of treatment predicted successful smoking cessation. Among active nicotine patch patients who were totally abstinent during week 2 after quitting, 46% and 41% (studies 1 and 2, respectively) were abstinent at 6-month follow-up. Of all nicotine patch patients in both studies who were smoking at 6-month follow-up, 74% began smoking during week 1 or 2. Among all placebo patch patients who were smoking at 6-month follow-up, 86% began smoking during week 1 or 2. CONCLUSIONS: Smoking status (abstinent or smoking) during the first 2 weeks of nicotine patch therapy, particularly week 2, was highly correlated with clinical outcome and can serve as a powerful predictor of smoking cessation. Early smoking behavior also predicted outcome among placebo patch users. Traditional measures of dependence are not consistently predictive of cessation success. Clinicians are advised to emphasize the importance of total abstinence after a quit attempt and to follow-up with patients within the first 2 weeks of quitting; smoking during this critical time should be assessed and treatment may be altered as appropriate.

Administration, Cutaneous↗
PubMed1994

Smoking outcome expectancies: factor structure, predictive validity, and discriminant validity.

Recent models of addiction posit that drug outcome expectancies are influential determinants of drug use. The current research examines the dimensional structure, predictive validity, and discriminant validity of expectancies for cigarette smoking in a prospective study. There was a good fit between the factor structure of the Smoking Consequences Questionnaire and the observed data. In addition, the internal consistency of each scale was satisfactory. Moreover, there was considerable evidence for the predictive and discriminant validity of expectancies. Expectancies of positive outcomes (positive reinforcement, negative reinforcement, and appetite-weight control) predicted withdrawal severity. Negative reinforcement expectancies and expectancies of negative consequences predicted cessation success. Predictive relations remained significant after controlling for related constructs: negative affect, stress, and dependence measures.

Adult↗
PubMed1994

Two studies of the clinical effectiveness of the nicotine patch with different counseling treatments.

OBJECTIVE: To assess the effectiveness of transdermal nicotine therapy for smoking cessation and suppression of withdrawal severity in conjunction with two different adjuvant counseling treatments. DESIGN: Two independent randomized placebo-controlled double-blind trials. SETTING: Smoking cessation clinic. SUBJECTS: Eighty-eight (study 1) and 112 (study 2) adult volunteers motivated to quit smoking. INTERVENTIONS: Eight weeks of 22-mg transdermal nicotine therapy with group counseling (study 1); 4 weeks of 22 mg followed by 2 weeks of 11-mg transdermal nicotine therapy with brief individual counseling (study 2). MAIN OUTCOME MEASURES: Modified point prevalence (7 consecutive days of nonsmoking) at the end of patch treatment and 6 months after treatment initiation was assessed by self-report and biochemically confirmed; survival analyses were also conducted for both studies to compare treatment efficacy. Also, we examined the impact of the nicotine patch on specific withdrawal symptoms (anger, anxiety, awakening, difficulty concentrating, depression, hunger, impatience, and craving). RESULTS: Transdermal nicotine treatment produced higher cessation rates at the end of treatment than did placebo with both adjuvant counseling interventions: 59 percent vs 40 percent (p < 0.05 in study 1) and 37 percent vs 20 percent (p < 0.05 in study 2), respectively. Smoking cessation efficacy was maintained 6 months after initiation of treatment: 34 percent vs 21 percent (p = 0.08 in study 1) and 18 percent vs 7 percent (p = 0.05 in study 2). Survival analyses also revealed significant group differences in efficacy in both studies. Nicotine patches also suppressed a variety of withdrawal symptoms, including craving in the first weeks after patients quit smoking. CONCLUSION: Transdermal nicotine effectively augments smoking cessation rates with two different types of counseling treatment. Overall, the nicotine patch approximately doubles the sustained rate of smoking cessation. Additionally, the nicotine patch provides relief from some tobacco withdrawal symptoms.

Administration, Cutaneous↗
PubMed1993

Prevalence of daily and experimental smoking among University of Wisconsin-Madison undergraduates, 1989-1993.

Limited information is available on smoking among college students. This study surveyed smoking prevalence and frequency among University of Wisconsin-Madison undergraduates aged 17 to 22 (n = 6,069) during the years 1989 through 1993. Sampling was conducted before and after the implementation of a smoke-free campus policy. Daily smoking remained constant across the 5 years at just under 10% of the sample; males showed a trend toward increased daily smoking (7.8% to 11.7%), while females showed a declining trend (10.2% to 8.4%). Additionally, 27% engaged in experimental smoking (smoking every few days, weeks, or months), resulting in a disturbing overall rate of tobacco use: about 37% of all students. These data indicate a need for more directed efforts to help university students overcome the threat of tobacco addiction.

Adolescent↗
PubMed1992

Tobacco dependence and the nicotine patch. Clinical guidelines for effective use.

OBJECTIVE: A comprehensive review of transdermal nicotine treatment for tobacco dependence, with recommendations derived from the research literature. DATA SOURCES: English-language clinical trials. STUDY SELECTION: Clinical trials using placebo-controlled, double-blind methodology (11 studies) with at least 6 months of follow-up after treatment (eight studies) and biochemical verification of smoking status. DATA SYNTHESIS: Nicotine patches produce end-of-treatment smoking cessation rates that range from 18% to 77%; these rates are about twice those of placebo-treated subjects. Nicotine patches produced 6-month abstinence rates of 22% to 42%, while placebo patches produced quit rates of 5% to 28%. Nicotine patches appear to reduce some, but not all, nicotine withdrawal symptoms. For instance, while the patch reduces craving for cigarettes and negative moods, it does not appear to reduce hunger or weight gain. The clinical trials literature suggests that proper adjuvant smoking cessation counseling is crucial in determining successful long-term outcome with the nicotine patch, and suggests that 6 to 8 weeks of patch therapy may be an adequate duration for most patients. CONCLUSIONS: Nicotine patches are an effective aid to tobacco dependence treatment. However, success rates vary greatly across research studies and may be influenced highly by the nature and intensity of adjuvant smoking cessation counseling. More research is needed to identify optimal duration, dosage, and individualization of patch therapy. The impact of nicotine patches (more than 5 million users with $1 billion in sales for 1992) also raises important ethical and public health issues.

Administration, Cutaneous↗
PubMed1992

Relation between self-reported affect and drug urges and cravings in continuing and withdrawing smokers.

In 2 experiments we investigated the effects of withdrawal and stress on the affective correlates of urges to smoke. In both, habitual cigarette smokers were divided into continuing and withdrawing smoker groups. In the 1st study, 44 adults reported current mood, urge, and expectations over a 24-hr period. In the 2nd, a controlled laboratory study, urge, affect, and physiological data were obtained from continuing and withdrawing groups (N = 64) exposed to high- or low-stress conditions. Urges among withdrawing smokers were positively associated with negative affect and negatively associated with positive affect; continuing smokers reported urges that were directly associated with positive affect and unrelated to negative affect. Stress and withdrawal produced urge self-reports that were related to negative affect. Moreover, subjects who smoked after exposure to withdrawal and stress reported greater pleasure and arousal than did other subjects.

Adult↗
PubMed1992

Measures of affect and nicotine dependence predict differential response to smoking cessation treatments.

Smokers (N = 126) were randomly assigned to 6-session smoking cessation treatments consisting of 1 of 2 counseling strategies (skills training or support) and 1 of 2 nicotine exposure strategies (nicotine gum or rapid smoking). Counseling and nicotine strategies were completely crossed; all four combinations resulted in equivalent 1-year abstinence rates. Skills training produced higher initial cessation and more coping responses posttreatment than did support. Rapid smoking, but not nicotine gum, produced tachycardia to the taste of cigarettes posttreatment, consistent with cigarette aversion. The treatments were differentially effective among subpopulations of smokers: Subjects high in pretreatment negative affect responded best to support counseling; those low in pretreatment negative affect responded best to skills training. Self-reports of pretreatment craving predicted response to the nicotine exposure treatments.

Affect↗
PubMed1990

Aversion instead of preference learning indicated by nicotine place conditioning in rats.

Although nicotine is a drug of abuse for millions of smokers, it has been difficult to demonstrate clearly the motivational properties of nicotine with rats using the conditioned place preference (CPP) paradigm. The first experiment attempted to replicate CPPs reported by other researchers using nicotine doses of 0.4, 0.8, and 1.2 mg/kg. There was a trend for all three doses to produce aversions, but it was significant only for the 0.8 mg/kg dose. Exposures to the CS alone extinguished aversions, but a "priming" dose (0.2 mg/kg) of nicotine given after extinction produced aversions only in animals exposed to 1.2 mg/kg. Experiment 2 tested whether preexposure to morphine or nicotine would sensitize animals to nicotine's reinforcing effects. In this experiment, rats were exposed to either six nicotine (0.6 mg/kg) or morphine (1.0 mg/kg) dosings prior to preference conditioning. Neither preferences nor aversions were observed in any group following subsequent conditioning with 0.6 mg/kg nicotine. The results suggest that previous observations of preference effects may have been due to specific procedural factors or may have depended on negative reinforcement due to stress reduction.

Animals↗
PubMed1990

Postcessation cigarette use: the process of relapse.

One hundred twenty-nine chronic smokers successfully completed a smoking cessation program composed of behavioral counseling and aversive smoking. During the two-year follow-up period, 92 of these subjects reported smoking. The progression from subjects' first cigarette to full relapse was examined via standardized telephone interviews. The latency between subjects' initial postcessation smoking episode and subsequent return to daily smoking was related to pretreatment confidence level, affective state at the time of the first cigarette, and origin of the first cigarette. Neither affective reaction nor coping response execution after the initial cigarette was related to the rate of relapse. Results are discussed in terms of current theory and treatment implications.

Adaptation, Psychological↗
PubMed1990

Principal components analysis of the inventory of drinking situations: empirical categories of drinking by alcoholics.

Male alcoholics (n = 336) were given the Inventory of Drinking Situations (IDS), a 100-item questionnaire that asks subjects to rate the frequency with which they drank in various situations during the previous year. A principal components analysis of the responses suggests there are three major categories of situations in which alcoholics are likely to drink: negative affect states, positive affect states combined with social cues to drink, and attempts to test one's ability to control one's drinking. These categories are compared with recent empirical attempts to define categories of alcohol and smoking relapse.

Adult↗
PubMed1989

Effects of dose on effector mechanisms in morphine-induced hyperthermia and poikilothermia.

The effect of a variety of morphine doses on thermoregulatory effector systems was examined in ambient temperatures of 27.0 degrees C and 4.0 degrees C. Rats were given saline or morphine sulfate (5, 15, or 25 mg/kg); their core temperature, oxygen consumption, and activity were monitored for 4 or 6 h post-injection. The results suggest two distinct actions of morphine, possibly mediated by two opiate receptors. Low doses of morphine produce hyperthermia that is the result of a direct activation of activity and whole body heat production. High doses produce effects dependent on ambient temperature: hypermetabolism and hyperthermia in the 27.0 degrees C environment; hypometabolism, vasodilation, and hypothermia in the 4.0 degrees C environment. The findings suggest limitations in current set-point theories of morphine's thermic actions.

Animals↗
PubMed1989

Subjective dimensions of heroin urges: influence of heroin-related and affectively negative stimuli.

Thirty-five male drug-free heroin addicts rated their affect, craving, and withdrawal in response to boring, anxiety-eliciting, and heroin stimuli. Results revealed that: (a) heroin cues were more effective than boring or anxiety-eliciting cues in prompting self-reports of craving or withdrawal; (b) heroin cues produced an affective state characterized by self-reported low-pleasure and high anxiety/tension; (c) craving was not correlated with any particular affective state, but rather was associated with a variety of negative affects--anxiety, depression, fatigue, anger; (d) the coherence (intercorrelations) of affective, craving, and withdrawal measures was greatest when addicts made their self-ratings immediately after exposure to drug stimuli; and (e) while addicts routinely reported craving without withdrawal sickness, they virtually never reported withdrawal sickness without reporting craving. These results suggested that the potential for negative reinforcement subserved stimulus elicited craving and that craving involved cognitive appraisal processes (attributions, expectations).

Adult↗
PubMed1988

Characterization of morphine's excitatory effects.

Although the excitatory effects of opiates have assumed greater importance in theories of compulsive drug use, the nature and time course of these effects remains unclear. The authors attempted to characterize the excitatory effects of morphine by administering doses of 5 mg/kg and 20 mg/kg in both warm and cold environments and by undertaking simultaneous assessments of core temperature, locomotor activity, and oxygen consumption. The results argue for a two receptor model to account for morphine's thermic effects: a high-affinity receptor that activates thermogenic systems, and a low-affinity receptor that mediates a poikilothermic response.

Animals↗