Joseph A. Istvan

Levels of cotinine associated with long-term ad-libitum nicotine polacrilex use in a clinical trial

Studies of nicotine replacement by 2 mg nicotine polacrilex gum (NG) have typically found that one half to one third of plasma nicotine in recent smokers is replaced. This 5-year study sought to find the extent of nicotine replacement among ex-smokers in the longer term and to identify a mechanism for this relationship. The sample was the special intervention group (N = 3923) in the Lung Health Study, a controlled clinical trial involving smoking cessation. The extent of nicotine replacement was assessed by levels of salivary cotinine. Cotinine levels of ex-smokers using NG after 1 year (219 +/- 149 ng/ml) were similar to those in continuing smokers (290 +/- 159 ng/ml). After 5 years, cotinine levels were the same for NG-using ex-smokers (316 +/- 276 ng/ml), NG-using smokers (309 +/- 240 ng/ml), and NG-non-using smokers (311 +/- 198 ng/ml). Salivary cotinine among NG users at 1 year was only weakly correlated with baseline cotinine levels prior to smoking cessation. Although NG users appear to re-establish cotinine levels characteristic of their smoking, the mechanism by which this occurs remains unclear.

Effects of Sexual Orientation on Interpersonal Judgment

Gagnon and Simon (1973) and Kinsey, Pomeroy, Martin, and Gebhard (1953) have suggested that homosexuals are perceived by heterosexuals as being obsessed with sexual matters and that derogation of homosexuals extends to those with relatively minimal proportions of homosexual experience. These notions were examined by exposing male and female subjects to same-sex or opposite-sex stimulus persons varying in their proportion of heterosexual/homosexual experience and self-rated sexual orientation. All persons were evaluated with regard to likability, work partner desirability, intelligence, morality, and adjustment, and rated along a number of dimensions assessing perceptions of sexuality. Results were that exclusive heterosexuals were seen as more likable, moral, and well-adjusted than all persons with homosexual experience, but bisexuals with less than half total homosexual outlet were regarded as more likable and as more desirable work partners than persons with more homosexual experience. Exclusive heterosexuals, and bisexuals with up to half of their total sexual outlet being homosexual outlet, were rated higher on factors tapping perceived sexual desirability and sexual activity than persons with a greater proportion of homosexual experience. Results were discussed with respect to the meaning of homosexual experience in interpersonal perception.

Relation of salivary cotinine to blood pressure in middle-aged cigarette smokers

BACKGROUND In laboratory research, nicotine administration is associated with increases in blood pressure. In epidemiologic research, however, the amount of reported cigarette smoking has no consistent relation with blood pressure. The objective of this study was to examine the relation of a nicotine metabolite (salivary cotinine) to systolic and diastolic blood pressure in current smokers being screened for entry to a clinical trial. METHODS AND RESULTS Data were obtained from 5164 middle-aged cigarette smokers during screening for the Lung Health Study. Multiple linear regression was used to examine the association of salivary cotinine and number of cigarettes smoked per day to systolic and diastolic blood pressure with age, body mass, years of education, alcohol intake, and recent caffeinated beverage use controlled in all analyses. Although smoking frequency was unrelated to blood pressure, salivary cotinine was related to greater systolic blood pressure in both men and women and greater diastolic blood pressure in men. CONCLUSIONS The association between salivary cotinine and blood pressure in these analyses suggests that long-term nicotine exposure may be related to modest elevations in blood pressure in cigarette smokers.

The “worth” of routine spirometry in a cystic fibrosis clinic

In our cystic fibrosis clinic, all patients older than 6 years perform spirometry at each visit just before being seen by the health care team. Upon review, we determined that our perceived rationale for this practice was that the medical history fails to detect deterioration in a sizable minority of patients whose pulmonary decline can be detected by spirometry. Furthermore, the literature and our own experience indicates that physical examination frequently will not detect changes in pulmonary status until the changes are advanced. As part of an ongoing quality/cost assessment, we decided to challenge our rationale for performing routine spirometry. Using standard methodology, we developed a six‐item Likert style questionnaire, the purpose of which was to assess perceived changes in pulmonary symptoms since the last clinic visit. The questionnaire had an acceptable degree of internal consistency (Cronbachs alpha = 0.92), although the question about sputum production showed the least correlation with responses to other items. We administered the questionnaire to 103 consecutive different patients and examined the association between reported changes in symptoms and actual changes in spirometric outcomes.

Smoking rate, carboxyhemoglobin, and body mass in the Second National Health and Nutrition Examination Survey (NHANES II)

The relationship of body mass and triceps skinfold thickness to both reported number of cigarettes smoked per day and carboxyhemoglobin levels was examined in healthy cigarette smokers in the NHANES II. Among both men and women, higher carboxyhemoglobin levels were related to lower body mass and thinner skinfolds, whereas higher levels of reported daily cigarette smoking were related to increased body mass and thicker skinfolds among men only. These relationships were independent of age, education, caloric intake, physical activity, and exercise. The opposite effects of number of cigarettes smoked per day and a biological index of cigarette smoke exposure on body mass suggest that increased cigarette smoking may covary with factors that would favor increased body weight among men, whereas decreases in body weight with increases in carboxyhemoglobin may reflect the effects of nicotine exposure on energy expenditure in both men and women.

Graduate Education and Training in Health Psychology

Few fields of study in psychology have experienced as explosive a growth of interest during the past decade as health psychology. Demonstration of the interest in this emergent field can be found on a variety of fronts—in the growth of discipline-specific journals, in the award of increasing amounts of federal and private monies for health psychology research, and in the establishment of graduate programs that attempt to train students in the expanding field. It is this last area of development of this subdiscipline that is the primary focus of the present chapter.