Arthur J. Farkas

The effects of household and workplace smoking restrictions on quitting behaviours

OBJECTIVE To assess the association of household and workplace smoking restrictions with quit attempts, six month cessation, and light smoking. DESIGN Logistic regressions identified the association of household and workplace smoking restrictions with attempts to quit, six month cessation, and light smoking. SETTING Large population surveys, United States. SUBJECTS Respondents (n = 48 584) smoked during the year before interview in 1992–1993, lived with at least one other person, and were either current daily smokers or were former smokers when interviewed. MAIN OUTCOME MEASURES The outcome measures were an attempt to quit during the last 12 months, cessation for at least six months among those who made an attempt to quit, and light smoking (< 15 cigarettes a day). RESULTS Smokers who lived (odds ratio (OR) = 3.86; 95% confidence interval (CI) = 3.57 to 4.18) or worked (OR = 1.14; 95% CI = 1.05 to 1.24) under a total smoking ban were more likely to report a quit attempt in the previous year. Among those who made an attempt, those who lived (OR = 1.65, 95% CI = 1.43 to 1.91) or worked (OR = 1.21, 95% CI = 1.003 to 1.45) under a total smoking ban were more likely to be in cessation for at least six months. Current daily smokers who lived (OR = 2.73, 95% CI = 2.46 to 3.04) or worked (OR = 1.53, 95% CI = 1.38 to 1.70) under a total smoking ban were more likely to be light smokers. CONCLUSIONS Both workplace and household smoking restrictions were associated with higher rates of cessation attempts, lower rates of relapse in smokers who attempt to quit, and higher rates of light smoking among current daily smokers.

Nephrology consultation in acute renal failure ☆: Does timing matter?

PURPOSE Patients who develop acute renal failure in the intensive care unit (ICU) have extremely high rates of mortality and morbidity. The goals of this study were to identify correlates of the timing of nephrology consultation in acute renal failure, and to explore the relation between timing of consultation and outcomes. METHODS We explored associations among timing of nephrology consultation and in-hospital mortality, lengths of hospital and ICU stay, and recovery of renal function in 215 ICU patients with acute renal failure at four U.S. teaching hospitals. We used multivariable logistic regression and propensity scores to adjust for confounding and selection effects. RESULTS Nephrology consultation was delayed (>or=48 hours) in 61 patients (28%) (median time to consultation, 4 days). Lower serum creatinine levels (P <0.0001) and higher urine output (P = 0.002) were associated with delayed consultation. Delayed consultation was associated with increased mortality among dialyzed (31/42 [74%] vs. 50/103 [49%], P = 0.006) and nondialyzed patients (10/19 [53%] vs. 11/51 [22%], P = 0.01), and increases in lengths of hospital (median, 19 days vs. 16 days, P = 0.01) and ICU stay (17 days vs. 6 days, P <0.0001). The association between delayed consultation and mortality was attenuated by covariate adjustment, and was no longer statistically significant after adjustment for propensity score (odds ratio = 2.0; 95% confidence interval: 0.8 to 5.1). CONCLUSION In acute renal failure, delayed nephrology consultation was associated with increased mortality and morbidity, whether or not dialysis was ultimately required. Using observational data, we cannot determine whether these findings reflect residual confounding, selection bias, adverse effects of delayed recognition of acute renal failure, or the benefits of nephrology consultation.

Depressive symptoms in California adolescents: Family structure and parental support

PURPOSE To examine the relationship between family structure, parental social support, and depressive symptoms among California adolescents. METHODS The depressive symptom instrument consisted of a previously validated self-report scale. The sample was the 1993 California Youth Tobacco Survey respondents (N = 5,531). The analysis classified adolescents in the highest 15% on the depressive symptom scale as having notable depressive symptoms and related the prevalence of depression to family structure (two-parent, single-mother, single-father, and neither parent present) and to parental support (adolescents naming parents as someone they could talk to about problems). RESULTS Girls reported significantly higher rates of depressive symptoms than boys. Although adolescents in single-parent households tended to show slightly higher rates of depressive symptoms, these rates did not differ significantly across the four types of family structures for either sex. Significantly higher rates of depressive symptoms were found among both boys and girls who resided with parent(s) not named as supportive than those who lived with supportive parent(s). Girls appeared particularly vulnerable if they lived in a nonsupportive, single-father household. CONCLUSION Lack of perceived parental social support is highly related to depressive symptoms in California adolescents. Helping parents establish and maintain supportive relationships with the children in their household may decrease the likelihood of depressive symptoms among adolescents.

When does cigarette fading increase the likelihood of future cessation

Objective: To determine which smokers report cigarette fading, how much they fade, when fading leads to quitting, and, if not, whether it can be maintained. Methods: Subjects were 1,682 adult smokers interviewed by telephone in 1990 and 1992 as part of the California Tobacco Survey. Data from three timepoints in the same subjects were compared. At Time 1 (one year before the baseline survey), all respondents were daily smokers who recalled their average daily cigarette consumption retrospectively at baseline. At Time 2 (baseline survey), all respondents were current smokers who provided concurrent data on their average daily cigarette consumption. At Time 3 (follow-up), smoking status and current cigarette consumption among nonabstinent respondents were assessed. Results: Nearly 18% of smokers reduced consumption between Times 1 and 2. The mean reduction was 13 cigarettes per day. Only moderate to heavy smokers who reduced consumption to below 15 cigarettes per day were more likely to be in cessation at Time 3 (24.9% versus 5.8%, respectively). The cessation rate for moderate to heavy smokers that became light smokers by baseline was similar to that for smokers who were already light smokers 1 year before baseline. Continuing smokers who reduced consumption between Times 1 and 2 maintained a mean reduction of 11.4 cigarettes per day. Conclusions: Cigarette fading increases cessation among moderate to heavy smokers who become light smokers.

Clean Indoor Air: Advances in California, 1990–1999

OBJECTIVES This study assessed progress in achieving clean indoor air in California. METHODS Data were from large, cross-sectional population-based surveys (1990-1999). RESULTS Indoor workers reporting smoke-free workplaces increased from 35.0% (95% confidence interval [CI] = 33.7, 36.3) in 1990 to 93.4% (95% CI = 92.6, 94.2) in 1999. Exposure of nonsmoking indoor workers to secondhand tobacco smoke decreased from 29.0% (95% CI = 27.2, 30.8) to 15.6% (95% CI = 14.1, 17.1). Adults with smoke-free homes increased from 37.6 % (95% CI = 35.1, 40.1) in 1992 to 73.7% (95% CI = 73.2, 74.2) in 1999; nearly half of smokers in 1999 had smoke-free homes. In 1999, 82.2% (95% CI = 81.5, 82.9) of children and adolescents (0-17 years) had smoke-free homes, up from 38.0% (95% CI = 35.1, 40.9) in 1992. CONCLUSIONS Californias advances highlight an important opportunity for tobacco control.

Is stage-of-change a useful measure of the likelihood of smoking cessation?

We compared two stage-of-change models that differentiate smokers by their level in the quitting process. The original 1983 model by Prochaska and DiClemente (1) divided smokers first by relapse status and then by intention to quit; their revised 1991 model (2) reversed the primacy of these factors. No published data justify whether the revision improves prediction of cessation. We used data from a population-based panel of 1,921 smokers interviewed in 1990 and 1992 for the California Tobacco Surveys. Model variables (quitting intention and recent quitting history) were used in a logistic regression to predict 30-day or longer cessation at follow-up and quit attempts made during the year preceding the survey. Predictive power of the revised model was not better than predictive power of the original model. New approaches to differentiating smokers on likelihood to quit should emphasize quitting behavior rather than intention to quit.

Integration Theory Applied To Models of Inequity

Three algebraic models for inequity were shown to be simply testable in terms of their additivity structure. The model from integration theory correctly represented the sequence of comparisons, first between persons, then between input and outcome. Also, it gave a good though not perfect account of the additivity structure.

Integration Theory and Inoculation Theory as Explanations of the “Paper Tiger” Effect

Summary This experiment compared a weighted-average model from information integration theory with McGuires inoculation theory as explanations of the “paper tiger” effect. Ss were 24 male and 24 female American college students. Procedure and design were similar to that used by McGuire, and his messages were used verbatim. Each S indicated his attitude on each of four health issues and also made direct estimates of the weight and scale value of each piece of information upon his attitude. An apparent paper tiger effect was observed for some issues, but the opposite effect was observed for other issues. The predictions of the averaging model were quite good in six of eight cases. The two discrepancies seemed to reflect an underestimation of the importance of attacking message. Overall, the results were interpreted as supportive of the informational interpretation. No need was found for the motivational concepts of belief threat and refutational practice used in inoculation theory.