John E. Martin

Carbon monoxide and smoking behavior.

Abstract This paper reviews the health risks of carbon monoxide and its relationship to smoking behavior. Special emphasis is placed on behavioral determinants of carbon monoxide uptake. The role of carbon monoxide in measurement and modification of smoking risk is also discussed.

Assessment of smoking topography generalization across laboratory, clinical, and naturalistic settings☆

A three-study series was conducted to examine smoking topography across clinical, laboratory, and naturalistic settings for 24 smokers who were patients in an alcohol treatment program. Experiments 1 and 2 included surreptitious observation of smoking in group therapy sessions (naturalistic), and obtrusive observation of smoking in a smoking clinic setting. The third study added a laboratory smoking condition to the clinic and group conditions. Puffing patterns in clinical and laboratory settings tended to be similar, and both differed from smoking in the naturalistic setting. Subjects generally took more puffs, longer puffs, and had shorter cigarette durations in clinical and laboratory settings than in the naturalistic setting. The implications of these findings for assessment of intake and health risk are discussed.

An investigation of a minimal contact brand fading program for smoking treatment

Self-help methods are preferred by smokers over clinic-based treatments providing more traditional services. Unfortunately, these more popular methods have not been extremely successful in getting smokers to quit. The poor success rates may be partially related to the lack of structure inherent in these treatment approaches. The present study examined a self-help program delivered to smokers via a written manual and limited duration phone calls--the latter to add structure to the treatment procedures. The results, a 23% abstinent rate, indicate that this approach has some promise for treating chronic smokers.

Riboflavin as a tracer of medication compliance

Three experiments were conducted to evaluate the accuracy of urine ultraviolet fluorescent tests for riboflavin, which has been used as a tracer for medication compliance in several clinical drug trials. Observer accuracy in discriminating riboflavin-positive or negative urine samples was found to vary with the method of observation, dose of riboflavin, observer experience, and time postingestion. The results showed that, while the 5-mg dose used in previous clinical trials was too small to permit reliable assessment of compliance, larger doses of riboflavin could produce nearly 100% accuracy for minimally trained observers who used a matching-to-sample observation procedure. The findings are discussed in terms of the potential clinical and research applications of this type of simple but reliable compliance assessment procedure.

Assessing self-report of pain: A comparison of two recording procedures

Intensive vs. reduced demand self-monitored pain levels were compared in nine pain patients. Each patient self-monitored pain intensity on a 6-point scale every 2 hr. Overall, daily mean and maximum pain levels were calculated for each patient (1) across all intervals (intensive self-monitoring) and (2) four times per day, at meal times and bedtime (reduced-demand self-monitoring). Differences were found to be negligible. The reduced-demand procedure produced data that were closely representative of pain fluctuations indicated in the more intensive bihourly ratings. Results are discussed in terms of the representativeness and standardization in pain self-monitoring as well as possible enhancement of recording compliance through the use of the less demanding four times per day procedure.

Assessing compliance to home relaxation: A simple technology for a critical problem

A simple, low-cost, and reliable technology for assessing compliance with relaxation practice in the natural environment is presented. Brief, audible “cue” tones are overdubbed onto selected client relaxation tapes, which are ordered by the therapist and then played in sequence by the client. The presence/absence or number of cue tones on each tape in the sequence is self-monitored, thereby providing the therapist with a record for objectively assessing whether or not the tapes were used as instructed. A clinical case example is presented to illustrate use of the procedure. Finally, advantages and limitations of the procedure are discussed.

The reliability of Thiocyanate measurement of smoking exposure

Abstract Procedures for the determination of thiocyanate (SCN) levels in saliva samples were evaluated in a series of three experiments. Laboratory analysis procedures as well as sampling and storage conditions were examined to identify sources of measurement error in the assessment of SCN. The results of the study indicated that spectrophotometric analysis of saliva samples can be a reliable method of determining SCN levels. Also, storage containers, length of storage and storage temperatures can lead to critical differences in SCN level when saliva samples were not analyzed immediately after sampling. Guidelines for the assessment of saliva SCN are provided in a discussion of the results.

Highlighting Specific Patient Education Needs in an Aging Cardiac Population

Given the utility of a multifactoral approach to cardiac rehabilitation and the importance of tailoring such an approach to the needs of the specific cardiac population being treated, early assessment of targeted risk factors and health-related practices is becoming increasingly indi cated. The present article describes how, by using a paper-and-pencil multiple-risk-factor as sessment instrument referred to as the Heart Health Assessment Questionnaire, the specific educational needs of an aging veteran population were more clearly identified. Among the health areas found in need of particular attention were patient smoking behavior, medication education, and reported tension and worry over health problems. In addition, given the large unemployment rate within this population, the need for the adoption of activities such as physical exercise and hobbies that could have a positive impact on self-esteem and quality of life was strongly indicated. These and other findings are discussed in relation to the pivotal role of the health education professional for older cardiac populations.

The effects of graduated filters on smoking exposure: risk reduction or compensation?

Abstract Two experiments were conducted to determine the effects of (“One-Step”) graduated filters on smoking behavior and health risk. Experiment 1 assessed the effects of the four filters on CO uptake (boost) in a smoker consuming five different brands of cigarettes. Progressive reductions in CO boost were found across graduated filters in four brands of filtered cigarettes. A non-filtered brand of cigarette did not show CO changes across the filters. Experiment 2 consisted of an evaluation of the effects of the graduated filters on smoking rate, topography and CO levels in four current smokers. Clear reductions in smoking rate and CO levels were found. Also, no compensatory topography changes resulted from the use of filters. Results are discussed in terms of the potential for significantly reducing tobacco exposure and the consequent risk reduction through employment of graduated filters.

Compliance and Side Effects of Weight Regulation Groups

Data on compliance to instructions to self-monitor food intake, a common component of self-control weight programs, and the side effects of weight loss in terms of both changes in frequency of social behavior and blood pressure were collected during two weight regulation groups. The procedures used in the groups were standard behavioral techniques emphasizing decreasing caloric intake and increasing caloric expenditure. The self-monitoring data indicated good compliance if subjects were specifically trained in self-monitoring, and somewhat poorer compliance if they were simply instructed, but not trained to self-monitor. Effects of weight loss on blood pressure were uniformly positive, with decreases in all subjects including two whose baseline blood pressures were in the hypertensive range. The frequency of social contacts did not show any systematic change during weight loss. It was suggested that decreases in weight will not necessarily increase social interaction, and direct training in social skills may be necessary.