Donald M. Prue

A critical evaluation of thiocyanate as a biochemical index of smoking exposure

The present paper reviews the literature on thiocyanate as a biochemical index of smoking exposure. A description of thiocyanate is provided, including its characteristic effects on health, relationship to cigarette smoking, and uses in smoking research. The paper critically evaluates the various methods of measuring thiocyanate. The evaluation of different sampling methods concludes that saliva thiocyanate is the most promising method of measuring smoking exposure. Saliva thiocyanate sampling, factors which may increase measurement error, and directions for further research are discussed.

Research on nicotine regulation

An important issue of present interest in smoking research is whether smokers regulate nicotine to maintain plasma nicotine levels. Yet, investigations of nicotine titration have provided contradictory results. The present paper attempts to clarify the current status of the nicotine titration hypothesis by critically reviewing research in this area. Following a brief discussion of the various techniques employed in the study of nicotine titration, studies are evaluated and methodological weaknesses noted. The review concludes that methodological problems make it impossible to draw firm conclusions as to the acceptability of the nicotine titration hypothesis at this time. Guidelines for correcting these methodological problems in future research are outlined.

Behavioral contracting to improve dietary compliance in chronic renal dialysis patients

End stage renal disease is the most severe stage of kidney failure. Hemodialysis or kidney transplants are required to insure patient survival. When dialysis treatment is used, patients experience dietary restrictions and consequently must limit fluid and food intake to compensate for the lack of kidney functioning. Two case studies are presented to demonstrate the effectiveness of behavioral procedures in improving compliance to dietary restrictions in chronic fluid overloaders. A contracting procedure between medical staff and the patients, and contingent staff praise for meeting weight standards, led to lower intersession weight gain. Continuous follow-up assessment indicated long term maintenance of treatment effects for these patients.

An Analysis of Distance Variables that Affect Aftercare Attendance

Recent research has examined variables related to attendance at aftercare services because of the correlation between aftercare and posthospitalization treatment success. The present study, which examined aftercare attendance for 40 randomly selected subjects following discharge from an inpatient alcohol treatment program, extends the list of variables found to influence attendance. A multiple-regression analysis of subject demographic variables and variables of a more programmatic nature found that distance variables (e.g., number of miles to an aftercare agency) significantly influenced aftercare attendance. The results are discussed with respect to aftercare program decisions.

Brand fading: The effects of gradual changes to low tar and nicotine cigarettes on smoking rate, carbon monoxide, and thiocyanate levels**

Recently, health service providers have been concerned with alternatives to abstinence as goals for the treatment of smoking. One alternative, low tar and nicotine cigarette smoking, has been examined at length, but evidence on the health effects of this alternative for the individual smoker has been contradictory. Further, the majority of studies which have examined low tar and nicotine smoking have been primarily laboratory-based studies and have not resembled more practical strategies for changing to low tar and nicotine cigarettes. The present study examined the effects of progressive reductions in the tar and nicotine content of cigarettes consumed by individuals in a smoking treatment program. Carbon monoxide levels, thiocyanate levels, and rate of consumption were monitored in nine single subject replications of the tar and nicotine reduction procedure. Data from the majority of smokers indicated decreased risk on both direct (alveolar carbon monoxide and saliva thiocyanate levels) and indirect (rate of consumption) measures of tobacco exposure. Thus, the reduction procedure has important implications for smoking treatment and decreased health risk.

Behavioral treatment of the geriatric alcohol abuser: A long term follow-up study

The present study represents a long-term follow-up of elderly persons who completed a behavioral treatment program for alcohol problems. Subjects over the age of 60 at the time they obtained treatment for alcohol abuse were contacted two to four years after discharge. Interviews with the alcohol abuser and a significant other were conducted in an effort to identify the percentage of persons for whom treatment had sustained beneficial effects, differences in outcome for early-versus late-onset alcohol abusers, and demographic and daily activity variables that distinguish abstinent from nonabstinent individuals. Results suggest that beneficial effects of the program maintained for 50% of the patients two or more years following completion of the program. An additional 12% reported significant modification of their drinking. Directions for future research are suggested.

Determinants of disulfiram acceptance among alcohol patients: a test of the theory of reasoned action

The utility of disulfiram in the treatment of alcohol abuse has been limited by the high frequency with which clients refuse the regimen. The present study identified variables influencing disulfiram acceptance/rejection within the framework of the theory of reasoned action. Eighty male inpatients on an alcohol treatment unit completed a questionnaire operationalizing the components of the model. The theoretical components were then used to predict requests for the drug. Multiple regression analyses revealed significant correlations among components of the model consistent with the assumptions of the theory. In addition, significant differences were found between disulfiram requestors and rejectors in terms of behavioral and normative beliefs about the consequences of being placed on the drug. Implications of these results for the design of effective interventions are discussed.

A conceptual critique of leisure assessment and therapy: an added dimension to behavioral medicine and substance abuse treatment

Abstract Leisure behavior has not been addressed in the psychology research literature despite tentative evidence of a relationship between this class of behavior, normal adjustment, and psychological problems. The reasons for this neglect are discussed with reference to extant assessment and treatment research studies. Some suggestions for studying leisure behaviors are then proposed which emphasize the importance of assessment issues informative research. The final section makes some tentative suggestions for changing leisure behaviors of individuals with deficiencies in this area of human functioning.

Health Marketing in a Hospital Setting

In recent years, there has been a proliferation of research indicating that the main health problems in the United States today are chronic diseases of regulation, such as coronary heart disease and hypertension, which may be prevented or improved through behavioral treatment of risk factors (e.g., smoking treatment). Partly in response to this growing body of epidemiological and treatment research (Levy & Moskowitz, 1982; Matarazzo & Carmody, 1982; Pomerleau & Brady, 1979) a greater number of medical centers are now acknowledging the need for behavioral medicine services within the confines of the hospital.