Patient characteristics and the effect of three physician-delivered smoking interventions.

Background: This paper investigates individual patient characteristics predicting differential response to each of three physician-delivered smoking interventions after 6 months.

Methods: Participants were 1,286 currently smoking patients seen by 196 medical and family practice residents in five primary care clinics affiliated with the University of Massachusetts Medical School. Of the participants, 57% were female, 92% were white, their average age was 35 years, and they smoked an average of 23 cigarettes per day.

Heavy smoking among a sample of employed women.

Understanding the phenomenon of heavy smoking among women and factors related to it is of considerable public health importance. Whereas lighter smokers have been more successful in their cessation attempts, the percentage of smokers who smoke more than 25 cigarettes per day has increased in recent years. This article examines the hypothesis that, compared to lighter smokers, female heavy smokers will report more responsiveness to internal cues to smoke, less interest in quitting, more difficulty with previous cessation attempts, more uncertainty about cessation strategies, and more concern about weight gain as a result of quitting.

Work-site nutrition intervention and employees' dietary habits: the Treatwell program.

In a randomized, controlled study of the Treatwell work-site nutrition intervention program, which focused on promoting eating patterns low in fat and high in fiber, 16 work sites from Massachusetts and Rhode Island were recruited to participate and randomly assigned to either an intervention or a control condition. The intervention included direct education and environmental programming tailored to each work site; control work sites received no intervention. A cohort of workers randomly sampled from each site was surveyed both prior to and following the intervention.

Smoking cessation and severity of disease: the Coronary Artery Smoking Intervention Study.

We tested the effectiveness of an individually delivered behavioral multicomponent smoking intervention (SI) against offering advice only (AO) to 267 patients after coronary arteriography. After 6 months, 51% of AO patients and 62% of SI patients reported abstinence. Validated rates were 34% and 45% for AO and SI patients, respectively.

Processes of change in smoking cessation: a cross-validation study in cardiac patients.

The processes of change associated with smoking cessation were examined for 213 smokers and recent exsmokers who were scheduled for cardiac catheterization and compared to the processes reported by a sample of 180 nonmedical smokers and exsmokers. Subjects were classified into one of three stages of change depending on their readiness to quit smoking: precontemplation, contemplation, and action. The cardiac sample employed the processes of change more frequently than the nonmedical sample in all stages, but the functional relationship between the stages and processes of change was generally similar for the two groups.

Are we pushing the limits of public health interventions for smoking cessation?

The phenomenon of smoking cessation that takes place outside formal programs, which serve a small proportion of smokers, is an important public health issue. Self-help strategies represent an approach to potentially cost-effective smoking intervention that can be conveniently used by large groups of smokers. In this issue of Health Psychology, Gritz, Berman, Bastani, and Wu (1992) demonstrate that the mailing of self-help smoking cessation materials to nonvolunteer women in a health maintenance organization, without any personal contact, produces little behavior change beyond what occurs in the environment without such distribution.

Cigarette smoking and mortality. MRFIT Research Group.

Methods: The relationship of cigarette smoking and smoking cessation to mortality was investigated among men screened for and also among those randomized to the Multiple Risk Factor Intervention Trial (MRFIT).

Results: Among the 361,662 men screened for the MRFIT, cigarette smoking was an important risk factor for all-cause, coronary heart disease (CHD), stroke, and cancer mortality. These risks, on the log relative scale, were strongest for cancers of the lung, mouth, and larynx.

Smoking cessation and change in diastolic blood pressure, body weight, and plasma lipids. MRFIT Research Group.

Cigarette smoking cessation was examined for its impact on diastolic blood pressure, weight, and plasma lipids in 3,470 special intervention males in the Multiple Risk Factor Intervention Trial. Change in smoking status (quitters vs nonquitters) was not independently associated with change in diastolic blood pressure or the subsequent use of antihypertensive medication for smokers who were normotensive at entry. More quitters (35%) became hypertensive than nonquitters (27%, P less than 0.

Baseline factors associated with smoking cessation and relapse. MRFIT Research Group.

Background: Data on smoking cessation and relapse for 6 yers of the Multiple Risk Factor Intervention Trial were evaluated in univariate and multivariate analyses to determine the relationship between variables measured at the beginning of the trial and smoking cessation and relapse for special intervention and usual care participants.

Results: The variables positively associated with smoking cessation in both the SI and the UC groups included age, education, and past success in quitting; there was a negative association with the number of cigarettes smoked per day. The expectation of quitting was positively associated with cessation in the special intervention group only, while life events, alcohol, and the presence of a wife who smokes were significant predictors of reduced cessation for the usual care group.

Comparison of smoking behavior change for SI and UC study groups. MRFIT Research Group.

Background: The results of MRFIT smoking intervention program are presented for the 4,103 special intervention and 4,091 usual care men who reported smoking cigarettes at the first screening visit.

Results: Among the special intervention men, the reported cessation rate increased from 43.1% at 12 months to 48.

Severity of angiographically proven coronary artery disease predicts smoking cessation.

We investigated the relationship between the extent of coronary artery disease (CAD) and the likelihood of cigarette smoking cessation in a population of 84 smokers between 21 and 75 years of age undergoing elective or urgent coronary angiography at the University of Massachusetts Medical Center. The smokers were enrolled in a pilot study investigating the relationship of hospitalization and coronary arteriography for coronary artery disease to subsequent smoking cessation and were scored at baseline as having none, one-, two-, or three-vessel disease. Smoking status at a mean follow-up time of 11 months was obtained by telephone interview, at which point 50% reported not smoking.

Training family practice and internal medicine residents to counsel patients who smoke: improvement and retention of counseling skills.

This investigation builds on an earlier study by describing the final results of a training program that teaches internal medicine and family practice residents to counsel patients to stop smoking. In this study, 198 residents participated in a three-hour training program which included small group discussion and role-playing exercises. Videotaped observations of role-playing performances were used to assess behavioral outcomes related to counseling skills for 104 residents who completed pre-, immediate post-, and long-term follow-up testing.

Community Intervention Trial for Smoking Cessation (COMMIT): opportunities for community psychologists in chronic disease prevention.

Opportunities for participation in chronic disease prevention programs are discussed in the context of a description and analysis of the National Cancer Institute's Community Intervention Trial for Smoking Cessation (COMMIT). COMMIT involves 11 matched pairs of communities with random assignment to the intervention condition within each pair. The 4-year intervention is guided by a partly standardized protocol and embodies a number of community psychology principles.

Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial.

Objective: To assess the relative impacts of three physician-delivered smoking interventions in combination with follow-up contact from behavioral counselors.

Design: Randomized controlled trial with pre- post measures of smoking rates. This paper reports six-month outcome data.

Reducing the risk of cancer through worksite intervention.

This chapter examines existing activities reported in the literature in the areas of smoking, nutrition, and screening; explores the prominent theories of behavior change that have guided some of these activities; and presents a model for worksite cancer prevention programs that is currently being tested in a large trial. A major theme of this chapter is the need for simultaneous changes in individual behaviors and the worksite environment. For each factor (smoking, nutrition, and screening) the discussion is divided into interventions for individuals and those for the environment or organization.

Relation of forced expiratory volume in one second (FEV1) to lung cancer mortality in the Multiple Risk Factor Intervention Trial (MRFIT).

For men participating in the Multiple Risk Factor Intervention Trial, the authors evaluated the relation between the baseline forced expiratory volume in one second and lung cancer mortality among smokers between the third and tenth years of follow-up (1973-1974 to 1984). This measure of ventilatory function was a powerful predictor of lung cancer deaths, with rates that increased from 3.02 per 1,000 person-years in the lowest quintile of forced expiratory volume to 0.

The relationship of smoking cessation to coronary heart disease and lung cancer in the Multiple Risk Factor Intervention Trial (MRFIT).

The impact of smoking cessation on coronary heart disease (CHD) and lung cancer was assessed after 10.5 years of follow-up in the 12,866 men in the Multiple Risk Factor Intervention Trial (MRFIT). Those men who died of lung cancer (n = 119) were either cigarette smokers at entry or ex-smokers; no lung cancer deaths occurred among the 1,859 men who reported never smoking cigarettes.

Health Care Providers as Key Change Agents in the Community Intervention Trial for Smoking Cessation (COMMIT).

The Community Intervention Trial for Smoking Cessation (COMMIT) is a multi-center collaborative trial sponsored by the National Cancer Institute. COMMIT utilizes multiple, community-based channels to facilitate quit attempts among heavy cigarette smokers. The "health care provider channel" is important, in that physicians, dentists, and other health care providers can effect changes in smoking behavior at both the individual and community level.

Teaching risk-factor counseling skills to medical students, house staff, and fellows.

It is important to teach risk-factor counseling skills to medical students, primary care residents, and fellows in cardiovascular medicine. To do this, it is necessary to teach assessment and intervention skills based on the theory and techniques of preventive and behavioral medicine. Physicians should be taught to think in terms of the patient in the context of his or her lifestyle and other interacting factors affecting health and disease, and should develop a new medical "culture" within which the risk-factor and lifestyle antecedents and correlates of illness can be recognized, discussed, and approached therapeutically.

The epidemiology of pulmonary function and COPD mortality in the multiple risk factor intervention trial.

The potential determinants of the changes in chronic obstructive pulmonary disease (COPD) mortality were evaluated using both the Multiple Risk Factor Intervention Trial (MRFIT) screenees, the longitudinal analysis of the participants, and the differences in special intervention (SI) and usual care (UC) groups. COPD was the underlying cause for only one third of all death certificates listing COPD. Small changes in classification will have a major impact on reported COPD death rates.