Deborah J. Ossip-Klein

Running versus weight lifting in the treatment of depression.

We compared the effectiveness of an aerobic and nonaerobic exercise in the treatment of clinical depression in women. A total of 40 women, screened on the Research Diagnostic Criteria for major or minor depressive disorder, were randomly assigned to an 8-week running (aerobic), weight-lifting (nonaerobic), or wait-list control condition. Subjects were reassessed at mid- and posttreatment, and at 1-, 7-, and 12-month follow-ups. Depression was monitored by the Beck Depression Inventory, Lubins Depression Adjective Check List, and the Hamilton Rating Scale for Depression; fitness level was assessed using submaximal treadmill testing. Results were remarkably consistent across measures, with both exercise conditions significantly reducing depression compared with the waitlist control condition, and generally appearing indistinguishable from each other. No significant between-group fitness changes were noted. These findings indicate that both types of exercise conditions significantly reduce depression and that these results are not dependent on achieving an aerobic effect.

Quitlines in North America: Evidence Base and Applications

Quitlines provide a model for the translation of research findings to public health application. Quitlines are currently in operation in more than half of US states, in Canada, and in multiple countries globally. Overall, when implemented correctly, quitlines have been shown to be efficacious and effective. Multiple quitline models are in use, but there is no evidence on the relative effectiveness of one over the other. Differences have been demonstrated for the efficacy of quitlines for specific applications, with the strongest evidence base for application as a primary intervention or as follow-up for hospitalized patients and particularly for cardiac patients. The evidence base for both reactive and proactive services is reviewed, and future directions to continue to advance the field are discussed.

Effects of Running or Weight Lifting on Self-Concept in Clinically Depressed Women.

Forty clinically depressed women were randomized to a running, weight lifting, or delayed treatment condition. Self-concept was assessed at baseline, pre-, mid-, and posttreatment for all subjects and at 1, 7, and 12 months for exercise groups. Significant improvements in self-concept were found for exercise groups relative to control groups. No significant differences between exercise groups were found, and improvements were reasonably well-maintained over time. Differential changes on dimensions of self-concept were not demonstrated. These results suggest that both running and weight lifting exercise programs improve self-concept in clinically depressed women.

Smoking attitudes, beliefs, and readiness to change among acute and long term care inpatients with psychiatric diagnoses

The present study represents an initial assessment of barriers and motives for quitting, health risk knowledge, and readiness to change in a hospitalized acute and long term care population with psychiatric diagnoses, and dual diagnoses of substance abuse and psychiatric disorders. Ninety-two patients residing in admissions, long term care, and mentally impaired/chemically addicted (MICA) units of a VA Medical Center were interviewed by nursing staff. Among the 78% of patients who smoke (smokers), 68% believed smoking was harmful and quitting would benefit their health. The majority of smokers were in Precontemplation (53%) or Contemplation (24%). Smokers in the MICA unit were more similar to the general population in smoking related beliefs and were more likely than other smokers to be in Preparation. These results indicate a need for educational and motivational enhancement interventions for the majority of smokers hospitalized for psychiatric disorders.

Minimal dataset for quitlines: a best practice

Objectives: This paper discusses the development of a minimal dataset (MDS) for tobacco cessation quitlines across North America. The goal was to create a standardised instrument and protocol that would allow for comparisons and pooling of data across quitlines for evaluation and research purposes. Principles of utilisation focused evaluation were followed to achieve consensus across diverse stakeholder groups in two countries. Methods: The North American Quitline Consortium (NAQC) assembled a working group with representatives from quitline service providers, funders, evaluators and researchers from Canada and the United States. An extensive, iterative consultation process over two years led to consensus on the evaluation domains, indicators and specific items. Descriptive information on quitline service models, data collection protocols and methodological issues were addressed. Results: The resulting minimal dataset (MDS) includes 15 items collected from eligible callers at intake and eight items collected from smokers participating in evaluation. Recommendations for selecting evaluation participants, length of follow-up and repeat callers were developed. Full MDS questions and technical documents are available on the NAQC website. Conclusion: Adoption and implementation of the MDS occurred in the majority of North American quitlines by the end of 2006. Key success factors included a focus on utility and feasibility, a commitment to meeting multiple and varied needs, sensitivity to situational factors and investment in working interactively with stakeholders. The creation and implementation of a MDS across two countries is an important “first” in tobacco control which will help speed the creation of practice based evidence and facilitate practice based research.

Tobacco use in the Dominican Republic: understanding the culture first

Objective: To conduct formative research on the landscape of tobacco use to guide survey and subsequent intervention development in the Dominican Republic (DR). Design: Rapid Assessment Procedures, systematic qualitative methods (participant-observations, in-depth interviewing, focus groups) using bilingual mixed age and gendered teams from the United States and DR. Subjects: Over 160 adults (men and women), ages 18 to 90 years, current, former and never smokers, community members and leaders from six underserved, economically disadvantaged DR communities. Main outcome measures: Key domains: tobacco use patterns and attitudes; factors affecting smoking initiation, continuation, quitting; perceived risks/benefits/effects of smoking; and awareness/effects of advertising/regulations. Results: Perceptions of prevalence varied widely. While “everybody” smokes, smokers or ex-smokers were sometimes difficult to find. Knowledge of health risks was limited to the newly mandated statement “Fumar es prejudicial para la salud” [Smoking is harmful to your health]. Smokers started due to parents, peers, learned lifestyle, fashion or as something to do. Smoking served as an escape, relaxation or diversion. Quit attempts relied on personal will, primarily for religious or medical reasons. Social smoking (custom or habit) (< 10 cigarettes per day) was viewed as a lifestyle choice rather than a vice or addiction. Out of respect, smokers selected where they smoked and around whom. Health care providers typically were reactive relative to tobacco cessation, focusing on individuals with smoking related conditions. Tobacco advertising was virtually ubiquitous. Anti-tobacco messages were effectively absent. Cultures of smoking and not smoking coexisted absent a culture of quitting. Conclusions: Systematic qualitative methods provided pertinent information about tobacco attitudes and use to guide subsequent project steps. Integrating qualitative then quantitative research can be replicated in similar countries that lack empirical data on the cultural dimensions of tobacco use.

Tobacco Use in Six Economically Disadvantaged Communities in the Dominican Republic

The Dominican Republic is a tobacco-growing country, and tobacco control efforts there have been virtually nonexistent. This study provides a first systematic surveillance of tobacco use in six economically disadvantaged Dominican Republic communities (two small urban, two peri-urban, two rural; half were tobacco growing). Approximately 175 households were randomly selected in each community (total N = 1,048), and an adult household member reported on household demographics and resources (e.g., electricity), tobacco use and health conditions of household members, and household policies on tobacco use. Poverty and unemployment were high in all communities, and significant gaps in access to basic resources such as electricity, running water, telephones/cell phones, and secondary education were present. Exposure to tobacco smoke was high, with 38.4% of households reporting at least one tobacco user, and 75.5% allowing smoking in the home. Overall, 22.5% reported using tobacco, with commercial cigarettes (58.0%) or self-rolled cigarettes (20.1%) the most commonly used types. Considerable variability in prevalence and type of use was found across communities. Overall, tobacco use was higher in males, illiterate groups, those aged 45 or older, rural dwellers, and tobacco-growing communities. Based on reported health conditions, tobacco attributable risks, and World Health Organization mortality data, it is estimated that at least 2,254 lives could potentially be saved each year in the Dominican Republic with tobacco cessation. Although it is expected that the reported prevalence of tobacco use and health conditions represent underestimates, these figures provide a starting point for understanding tobacco use and its prevalence in the Dominican Republic.

Recruitment of physician offices for an office-based adolescent smoking cessation study.

Physician office settings play an important role in tobacco cessation intervention. However, few tobacco cessation trials are conducted at these sites, in part because of the many challenges associated with recruiting community physician offices into research. The present study identified and implemented strategies for recruiting physician offices into a randomized clinical trial of tobacco screening and cessation interventions with adolescent patients. A total of 30 community physicians participated in focus groups to elicit their perceptions of facilitators of and barriers to initial engagement of physician practices and the subsequent enrollment of the practices in long-term research projects. Physicians identified facilitators such as (a) the involvement of office staff in the recruitment process and (b) on-site presentations of the studys background and aims. Some of the barriers identified were time commitment concerns and the lack of incentives in exchange for participation. These focus group findings were then integrated with theory-based and empirically driven recruitment strategies for a 12-month randomized tobacco intervention trial with adolescent patients. Of 185 office practices approached to participate (screened from a pool of 273 practices), 103 agreed to on-site presentations of the study. Subsequently, almost all of the practices (101) that received the presentation agreed to enroll in the study. Conclusions are that (a) recruitment is a multicomponent process, (b) the processes of communication, engagement, and enrollment must be carefully planned and implemented to achieve maximal results, and (c) the development of effective strategies for recruiting health care provider practices presents an important infrastructure for testing adolescent smoking cessation interventions.

Bronchial Provocation Tests before and after Cessation of Smoking

We studied the effect of smoking cessation on airway reactivity. We recruited cigarette smokers who were attempting to stop smoking. Entry criteria required each subject to be smoking at least 10 cigarettes each day and report a chronic cough. Exclusion criteria included significant airflow obstruction or the presence of any medical condition contraindicating challenge testing. Carbachol challenge was performed to assess airway reactivity according to a standardized method. Baseline measurements of forced expiratory volume in 1 s (FEV1), specific airway conductance (SGaw) and the provocative dose of carbachol causing a 35% reduction in SGaw (PD35), and a 20% reduction in FEV1 (PD20) were established on entry while each subject was still smoking. Thereafter, repeat measurements were performed after 2 and 6 months of smoking cessation. Adherence to smoking cessation was checked by self-report and verified by measurement of alveolar carbon monoxide levels at each session. Of the 34 subjects who gave consent, 13 relapsed prior to the 2nd month and an additional 8 relapsed before the 6th month. Thirteen of the 34 remained abstinent throughout the 6-month study. All 13 subjects had complete resolution of their cough. The difference in reactivity on entry to that at the 2nd and 6th month was not significant. We conclude that (1) the symptom of chronic cough resolved completely after 2 months of smoking cessation, and (2) airway reactivity remained unchanged at 2 and 6 months of smoking cessation.

Youth tobacco control research and activities in the United States: The current national landscape

This paper highlights the increasing level of collaboration, resource sharing, and consensus building in youth tobacco control taking place in the United States. Better knowledge of current research, activities, and collaborations in this area will help in the planning of activities and the rational allocation of funds for tobacco control programs, research, advocacy, and the counter-advertising activities. We defined three general classifications for organizations that had national youth tobacco control activities: Government centers and institutes, government organizations, and bridging organizations. We asked national experts in our own organization and all other included organizations to suggest additional groups for inclusion. After gathering available public information on each organization from Web sites and printed materials, we than solicited additional information by personal communication with individuals in leadership positions for youth tobacco control within each group. We developed a uniform framework to present a clear picture of each group in the areas of institutional conception, general goals, youth tobacco control research, and youth tobacco control activities. The tables provide a helpful reference guide presenting the institutional conception, goals, funding for research, activities, and Web sites for the institutions and organizations discussed here. Many groups have current youth tobacco control priorities in the United States. This synthesis of current research, funding sources, programmatic activities, and collaborations in the United States will be a valuable resource for clinicians, tobacco control advocates, researchers, and program planners.