Christi A. Patten

Cigarette smoking predicts development of depressive symptoms among U.S. Adolescents

To examine whether adolescent cigarette smoking predicts the development of depressive symptoms, we used a longitudinal follow-up survey of 6,863 adolescents ages 12 to 18 in the U.S. who did not report notable depressive symptoms at baseline. This study used a self-report measure of six depressive symptoms experienced within the past twelve months at follow-up as the outcome of interest. Results indicated that 11.5% developed notable depressive symptoms at follow-up. There were marked gender differences with 15.3% of girls developing notable depressive symptoms compared to 8.1% of boys. Gender differences in depressive symptoms were consistent across all age groups and were apparent by the age of twelve. For both genders, smoking status was the most significant predictor of developing notable depressive symptoms. Several other risk factors including involvement in organized athletics, availability of social support, and personality characteristics were also found to be associated with development of depressive symptoms. Adolescent cigarette smoking may have marked health consequences in terms of depressive symptoms. The reduction of cigarette smoking among adolescents should be a focus of depression prevention interventions. In addition, the development of gender-specific components of prevention interventions may be warranted.

Predictors of 6-month tobacco abstinence among 1224 cigarette smokers treated for nicotine dependence

This study examined baseline characteristics associated with abstinence from tobacco 6 months after treatment for nicotine dependence. A total of 1224 cigarette smokers (619 females, 605 males) receiving clinical services for treatment of nicotine dependence between January 1, 1995 and June 30, 1997 were studied. The intervention involves a 45-min consultation with a nicotine dependence counselor. A treatment plan individualized to the patients needs is then developed. The main outcome measure was the self-reported 7-day point prevalence abstinence from tobacco obtained by telephone interview 6-months after the consultation. A bootstrap resampling methodology for predictor variable selection was used to identify a set of multivariate predictors of 6-month tobacco abstinence. Five variables were multivariately associated with tobacco abstinence: male gender, no current psychiatric diagnosis, higher stage of change, longest duration of previous abstinence from tobacco of <1 or > or =30 days, and Fagerström Test for Nicotine Dependence (FTND) score of < or =5. Assessment of these variables may be useful clinically by assisting health care providers in tailoring nicotine dependence interventions to enhance outcomes.

Methodological issues in measuring treatment outcome in adolescent smoking cessation studies

As the prevalence of adolescent smoking and, notably, regular smoking has increased over the last decade, researchers and practitioners have called for a consideration of treatment programs to promote cessation among adolescents who smoke. The adolescent smoking cessation treatment field is still in its infancy, though. The literature addressing adolescent cessation is rather limited to date, often plagued by methodological problems and characterized by little success. Many basic methodological questions remain for researchers to address before we will be able to answer questions such as which treatment approaches work best for which adolescent smokers. The purpose of this paper is to review briefly what is known about adolescent smoking cessation, to identify some important methodological issues to consider in treatment outcome studies, and to make recommendations to researchers to help provide a common ground for future comparisons of results across studies. We will address the natural history of adolescent smoking cessation, treatment outcomes, validity of self-reports and biochemical validation, and research recommendations.

Response to nicotine dependence treatment in smokers with current and past alcohol problems

Smoking prevalence among alcoholics is high, and evidence indicates that smokers with a history of alcohol abuse may have more difficulty quitting cigarette smoking. This study is a post hoc analysis comparing the smoking cessation rates of smokers with active or past alcohol problems to the rates in smokers with no history of alcohol problems who were participants in a randomized, controlled trial of smoking cessation therapy. Subjects received either 44 mg/24 hour or 22 mg/24 hour nicotine patch for 4 or 6 weeks, respectively, followed by a tapering schedule to complete 8 weeks of therapy and a randomly assigned behavioral intervention (minimal, brief individual counseling, group therapy). The Self-Administered Alcoholism Screening Test (SAAST) score was used to determine alcohol group assignment (no alcohol problems <7; active alcohol problems ≥7 and still drinking; past alcohol problems if not drinking due to a past history of alcohol problems). Among 382 subjects (171 men and 211 women), 281 had no alcohol problems (74%), 53 had past alcohol problems (14%), and 48 had active alcohol problems (13%). Smoking cessation rates assessed at both weeks 4 and 8 were significantly different across groups (p=0.026 and 0.002 at weeks 4 and 8, respectively) with lower rates in the groups with past and active alcohol problems when compared to the “no problem” group. At week 26, subjects with past alcohol problems were less likely to be abstinent from smoking than no problem group subjects, but this was not statistically significant (odds ratio =0.49, 95% confidence interval 0.22→1.08). In the short term, smokers with past or active alcohol problems are less likely to quit smoking compared to those with no alcohol problems when treated with nicotine patch therapy for smoking cessation.

Tobacco Use Outcomes Among Patients With Lung Cancer Treated for Nicotine Dependence

PURPOSE There is a current lack of consensus about the effectiveness of nicotine dependence treatment for cancer patients. This retrospective study examined the 6-month tobacco abstinence rate among lung cancer patients treated clinically for nicotine dependence. PATIENTS AND METHODS A date-of-treatment matched case control design was used to compare lung cancer patients (201 lung cancer patients, 41% female) and nonlung cancer patients (201 controls, 45% female) treated in the Mayo Clinic Nicotine Dependence Center between 1988 and 2000. The intervention involves a brief consultation with a nicotine dependence counselor. A treatment plan individualized to the patients needs is then developed. The primary end point was the self-reported, 7-day point prevalence abstinence from tobacco at 6-month follow-up. RESULTS At baseline, compared with the controls, the lung cancer patients were significantly older (P <.001), reported higher motivation to stop smoking (P =.003), and were at a higher stage of change (P =.002). The 6-month tobacco abstinence rate was 22% for the lung cancer patients compared with 14% of the control patients (P =.024). After adjusting for age, sex, baseline cigarettes smoked per day, and stage of change, no significant difference was detected between lung cancer patients and controls on the tobacco abstinence rate. CONCLUSION The results suggest that nicotine dependence treatment is effective for patients with a diagnosis of lung cancer. The majority of lung cancer patients were motivated to stop smoking.

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.

Cost-Effectiveness of Treating Nicotine Dependence: The Mayo Clinic Experience

OBJECTIVE To estimate the cost-effectiveness of treating nicotine dependence, expressed as cost per net year of life gained by smoking cessation. DESIGN A cost-effectiveness analysis was conducted of a cohort of consecutive adult patients treated for nicotine dependence from April 1988 through December 1992 at the Mayo Clinic Nicotine Dependence Center (NDC). MATERIAL AND METHODS The study cohort consisted of 5,544 patients (50.8% female; mean age, 47.8 years) with a mean baseline smoking rate of 25.4 cigarettes per day. After an initial consultation, a nonphysician counselor developed an individual nicotine dependence treatment plan, which could include follow-up counseling, nicotine replacement therapy (patches or gum), group therapy, or an inpatient program. A relapse-prevention program included telephone calls and a series of letters to the patient. We computed the years of life gained for each person specific to age, gender, smoking rate at entry, and 6-month smoking status by using published mortality rates for current and former cigarette smokers. The 6-month smoking status was assumed to be applicable at 1 year. For subsequent determinations, we modeled by computer simulation the year-by-year (to age 100) smoking status by using published relapse and late cessation rates. Coupled with treatment costs, this information allowed the expression of cost per net year of life gained by stopping smoking. Net years of life gained, discounted 0, 3, and 5%, were computed with use of cessation and relapse rates expected for patients not seen in the NDC. Treatment costs were based on 1993 rates for the intervention services but did not include any tobacco product cost savings associated with smoking cessation. RESULTS The 1-year smoking-cessation rate was 22.2%. With all NDC patients included, the estimated net years of life gained, with use of a 5% rate of discount for benefits, was 0.058, and the corresponding cost was

Efficacy of Bupropion for Relapse Prevention in Smokers With and Without a Past History of Major Depression

6,828 per net year of life gained. CONCLUSION In comparison with the cost-effectiveness of other medical services, the cost of

Smoking Behavior and Perceived Stress in Cigarette Smokers Undergoing Elective Surgery

6,828 per net year of life gained by treatment of nicotine dependence is relatively inexpensive. Such cost-outcome data are important as economic considerations are applied for optimal allocation of limited health-care resources. Nonphysician health-care professionals can assume a key role in the provision of cost-effective nicotine dependence intervention.

Motivational readiness for physical activity and quality of life in long-term lung cancer survivors

AbstractBACKGROUND: This study evaluated the efficacy of bupropion for relapse prevention in smokers with and without a past history of major depressive disorder. Changes in depressive symptoms were also examined. DESIGN: Data were gathered prospectively from a randomized, double-blind relapse prevention trial of bupropion conducted at five study sites. A total of 784 smokers (54% female, 97% white) were enrolled. Using the Structured Clinical Interview for Depression, 17% of the subjects reported a past history of major depressive disorder at baseline. All subjects received open-label bupropion SR (300 mg/d) for 7 weeks. Subjects abstinent from smoking at the end of 7 weeks (N=429) were randomized to bupropion SR (300 mg/d) or placebo for the remainder of the year and followed for 1 year off medication. The primary outcome measures were median time to relapse to smoking and the 7-day point-prevalence smoking abstinence rate. Self-reported abstinence from smoking was verified by expired air carbon monoxide. The Beck Depression Inventory was used to assess depressive symptoms at baseline and at weeks 8 and 12. RESULTS: Median time to relapse did not differ by past history of major depressive disorder. Bupropion was associated with higher point-prevalence smoking abstinence at the end of medication compared to placebo (P=.007), independent of a past history of major depressive disorder. Moreover, change in depressive symptoms during the double-blind phase did not differ for those with and without a past history of major depressive disorder. CONCLUSIONS: Extended use of bupropion for relapse prevention is effective for smokers with and without a history of major depression.