Arie Dijkstra

Negative life events and depressive symptoms in late adolescence: Bonding and cognitive coping as vulnerability factors?

The objective of the present study was to examine the effects of parental bonding and cognitive coping in the relationship between negative life events and depressive symptoms in adolescence. A sample of 1310 adolescents attending an intermediate vocational education school filled out a questionnaire. Adolescents with a poor parental bonding relationship seemed to be more vulnerable to depressive symptoms in the face of adverse life events than adolescents with more optimal bonding styles. Cognitive coping strategies seemed to play an even more important role. The use of self-blame, rumination, catastrophizing, positive refocusing, and positive reappraisal appeared to be related to depressive symptoms. In addition, self-blame, rumination, and positive reappraisal seemed to have a moderating role in the relationship between the amount of stress experienced and depressive symptoms. Developing prevention and intervention programs aimed at the formation of optimal bonding relationships and teaching adolescents adaptive cognitive coping strategies seems advisable.

The development of computer-generated tailored interventions

Tailoring information to individual characteristics of a person is a promising line of development of self-help interventions. This article presents a three-phase methodology for developing computer-generated tailored interventions. The first phase of the development concerns the formulation of intervention objectives on the basis of analyses of the cognitive determinants of behavior. The second phase concerns the core of the development of a tailored intervention. For each objective, a so-called tailoring matrix is developed which specifies the individual characteristics to which the message will be adapted to. The tailoring matrices are the basis of the tailored messages and the tailoring questionnaire which will assess the individual characteristics. In the third phase, all the separately written messages must be integrated to one coherent intervention text and the lay-out is designed. This methodology may result in largely different tailored interventions depending on the theoretical framework used, the adaptation of the messages and the inclusion of feedback.

Lung function decline in asthma: association with inhaled corticosteroids, smoking and sex

Background: Inhaled corticosteroids (ICS) provide short term benefits in asthma but the long term effects are still unknown. Methods: 281 patients diagnosed with moderate to severe asthma in 1963–75 were re-examined in 1991–9. Information was collected on forced expiratory volume in 1 second (FEV1), bronchial hyperresponsiveness, atopy, smoking, use and dosage of oral and ICS. Patients were included in the analyses if they had at least three FEV1 measurements during two consecutive years after the age of 30 and used ICS during follow up. Results: Analyses were performed on 122 patients. During a median follow up period of 23 years, 71 men and 51 women had on average 37 and 40 individual FEV1 measurements, respectively. Linear mixed effect models showed that men had a mean annual decline in FEV1 of 20.6 ml/year less after ICS initiation than before (p = 0.011), and in women the decline in FEV1 was 3.2 ml/year less (p = 0.73). In individuals with <5 pack years of smoking the decline in FEV1 was 36.8 ml/year less after ICS institution in men (p = 0.0097) and 0.8 ml/year less in women (p = 0.94), the difference between the sexes being significant (p = 0.045). These effects were not observed in those with ⩾5 pack years smoking. A higher daily dose of ICS was associated with a smaller decline in FEV1 in men (p = 0.006), an effect not observed in women. Conclusion: Treatment with ICS in adult patients with moderate to severe asthma was associated with a reduction in the decline in FEV1 over a 23 year follow up period in men who had smoked <5 pack years. This effect was dose dependent and was not present in women or in men with ⩾5 pack years of smoking at follow up. The lack of effect of ICS on the decline in FEV1 in women needs further study.

Effects of active and passive smoking on disease course of Crohn's disease and ulcerative colitis

Background: Smoking is a remarkable risk factor for inflammatory bowel disease (IBD), aggravating Crohns disease (CD) while having beneficial effects on ulcerative colitis (UC). We studied the effects of active and passive smoking in Dutch IBD patients. Methods: A questionnaire focusing on cigarette smoke exposure was sent to 820 IBD patients. Returned questionnaires were incorporated into a retrospective chart review, containing details about disease behavior and received therapy. Results: In all, 675 IBD patients (380 [56%] CD and 295 [44%] UC) responded. At diagnosis there were 52% smokers in CD, 41% in the general population, and 28% in UC. The number of present smokers in CD is lower than in the general population (26% versus 35%). No detrimental effects of active smoking on CD were observed, but passive smokers needed immunosuppressants and infliximab more frequently than nonpassive smokers. Active smoking had beneficial effects on UC, indicated by reduced rates of colectomy, primary sclerosing cholangitis, and backwash‐ileitis in active smokers compared to never smokers, and higher daily cigarette dose correlated with less extensive colitis and a lower need for therapy. Furthermore, smoking cessation after diagnosis was detrimental for UC patients, indicated by increased needs for steroids and hospitalizations for patients that stopped smoking after compared to before the diagnosis. Conclusions: Active smoking is a risk factor for CD, but does not affect the outcome; passive smoking is detrimental for the outcome of CD patients. In UC, active smoking shows dose‐dependent beneficial effects. Our data suggest that passive smoking is a novel risk factor for CD. (Inflamm Bowel Dis 2009)

TAILORING INFORMATION TO ENHANCE QUITTING IN SMOKERS WITH LOW MOTIVATION TO QUIT : THREE BASIC EFFICACY QUESTIONS

Tailoring information to a target individuals features is a promising line of development in self-help interventions. In this article, 752 smokers with explicit low intention to quit were randomly assigned to 1 of 5 conditions: (a) multiple tailored letters with self-help guide, (b) multiple tailored letters only, (c) a single tailored letter with a self-help guide, (d) a single tailored letter only, or (e) a nontailored intervention. Follow-up assessment took place 4 months after the intervention. Results indicated that the single tailored intervention only had no surplus value compared with a nontailored look-alike intervention. The addition of a self-help guide to a tailored intervention was only useful in highly dependent smokers, and multiple tailoring was more effective than single tailoring. It remains important to elucidate why and for whom certain tailored interventions are more effective.

CT-quantified emphysema in male heavy smokers: association with lung function decline

Background Emphysema and small airway disease both contribute to chronic obstructive pulmonary disease (COPD), a disease characterised by accelerated decline in lung function. The association between the extent of emphysema in male current and former smokers and lung function decline was investigated. Methods Current and former heavy smokers participating in a lung cancer screening trial were recruited to the study and all underwent CT. Spirometry was performed at baseline and at 3-year follow-up. The 15th percentile (Perc15) was used to assess the severity of emphysema. Results 2085 men of mean age 59.8 years participated in the study. Mean (SD) baseline Perc15 was −934.9 (19.5) HU. A lower Perc15 value correlated with a lower forced expiratory volume in 1 s (FEV1) at baseline (r=0.12, p<0.001). Linear mixed model analysis showed that a lower Perc15 was significantly related to a greater decline in FEV1 after follow-up (p<0.001). Participants without baseline airway obstruction who developed it after follow-up had significantly lower mean (SD) Perc15 values at baseline than those who did not develop obstruction (−934.2 (17.1) HU vs −930.2 (19.7) HU, p<0.001). Conclusion Greater baseline severity of CT-detected emphysema is related to lower baseline lung function and greater rates of lung function decline, even in those without airway obstruction. CT-detected emphysema aids in identifying non-obstructed male smokers who will develop airflow obstruction.

Worry about health in smoking behaviour change

Many smokers and ex-smokers worry about their health. Given that worry keeps attention focused on the threat, it was expected that worrying about health in smokers would motivate them to quit and in ex-smokers may prevent relapse. Furthermore, worry was expected to influence the process of smoking cessation in interaction with self-efficacy, which is a measure of control over smoking, and with disengagement beliefs, which distorts the threatening meaning of potential motivating information. In the present study 380 smokers and 324 ex-smokers were recruited to join a prospective study with a follow-up of eight months. At T1, smoking/quitting behavior, worry and the other psychological constructs were assessed. At T2 quitting activity in smokers and relapse in ex-smokers were assessed. As expected, smokers who worried about the health effects of smoking reported higher quitting activity at T2. The three-way interactions between worry, self-efficacy and disengagement beliefs in the prospective prediction of quitting activity and relapse were significant: Among smokers with high self-efficacy combined with strong disengagement beliefs, worry led to more quitting activity. Among ex-smokers with low self-efficacy combined with strong disengagement beliefs, worry led to more relapse. The present results suggest new ways of approaching the stimulation of quitting and the prevention of relapse.

Psychometric properties of Chronic Pain Acceptance Questionnaires: A systematic review

Background: Theoretically, acceptance of chronic pain (CP) is an important determinant in the functional status and well‐being of patients with CP. Several questionnaires that aim to measure acceptance of CP have been developed. An overview of the psychometric properties of these questionnaires is unavailable.

Subtypes within a sample of precontemplating smokers: a preliminary extension of the stages of change.

Precontemplating smokers are not planning to quit within the next 6 months. There are indications that this group is not homogeneous. The present investigation aimed at identifying relevant subgroups within this large group of smokers in order to refine stage-matched interventions. Precontemplators were asked whether they were planning to quit (1) within the next year. (2) within the next 5 years, (3) not within the next 5 years but sometime, (4) never, or (5) none of the above. Smokers who were planning to quit within 5 years (redefined precontemplators) differed from smokers who were not planning to quit within the next 5 years (immotives) on the pros of quitting but not on self-efficacy scores. Compared to smokers in the other groups, immotives scored significantly lower on specific factors within the pros of quitting.

Readiness to adopt the self-management approach to cope with chronic pain in fibromyalgic patients

&NA; The effectiveness of cognitive‐behavior therapy aimed at helping patients with the acquisition of self‐management skills to cope with pain, is thought to depend partly on the patients’ willingness to adopt a self‐management approach. Some patients may not believe that self‐management will be helpful while others have decided to adopt it and others already apply the self‐management skills in their daily lives. The present study explored the concept of ‘Readiness to change’ in a population of Dutch fibromyalgic patients. A self‐report questionnaire was completed by 321 patients. Factor analysis revealed three scales, each assessing the characteristic of one stage of readiness to change, the Precontemplation, Contemplation and Action scale. Firstly, the reliabilities of these scales were 0.61, 0.86 and 0.61, respectively, and only the latter two scales correlated significantly (r=0.14). Secondly, the scales were validated using subscales from the Multidimensional Pain Inventory, beliefs on the credibility of the self‐management approach and subscales from the Illness Perception Questionnaire. These subscales explained 5, 22 and 8% of the variance of the scores on the Precontemplation, Contemplation and the Action scales, respectively. Thirdly, on the basis of the three scale scores, over 80% of the fibromialgia patients could be classified into one of five potentially psychological relevant subgroups: Precontemplation, Contemplation, Preparation, Action and Relapse. The data suggest that improvements in operationalizations of the Precontemplation and Action dimensions of readiness to change are needed and that the theoretical foundation of readiness to change needs further development.