Norman Hymowitz

Baseline factors associated with smoking cessation and relapse. MRFIT Research Group

Background. Data on smoking cessation and relapse for 6 years of the Multiple Risk Factor Intervention Trial were evaluated in univariate and multivariate analyses to determine the relationship between variables measured at the beginning of the trial and smoking cessation and relapse for special intervention and usual care participants. Results. The variables positively associated with smoking cessation in both the SI and the UC groups included age, education, and past success in quitting; there was a negative association with the number of cigarettes smoked per day. The expectation of quitting was positively associated with cessation in the special intervention group only, while life events, alcohol, and the presence of a wife who smokes were significant predictors of reduced cessation for the usual care group. The special intervention program may have overcome obstacles which interfered with cessation among the usual care participants. Associations with relapse were generally stronger in the usual care group than in the special intervention group. For usual care participants, multivariate analyses showed that education, past success in quitting smoking, alcohol, and life events were associated with relapse rates. For special intervention participants, only alcohol emerged as a significant predictor. Conclusion. The data are relevant in terms of factors that govern smoking cessation and relapse for adult smokers who take part in formal intervention programs and for those who are left to modify their behavior on their own.BACKGROUND Data on smoking cessation and relapse for 6 yers of the Multiple Risk Factor Intervention Trial were evaluated in univariate and multivariate analyses to determine the relationship between variables measured at the beginning of the trial and smoking cessation and relapse for special intervention and usual care participants. RESULTS The variables positively associated with smoking cessation in both the SI and the UC groups included age, education, and past success in quitting; there was a negative association with the number of cigarettes smoked per day. The expectation of quitting was positively associated with cessation in the special intervention group only, while life events, alcohol, and the presence of a wife who smokes were significant predictors of reduced cessation for the usual care group. The special intervention program may have overcome obstacles which interfered with cessation among the usual care participants. Associations with relapse were generally stronger in the usual care group than in the special intervention group. For usual care participants, multivariate analyses showed that education, past success in quitting smoking, alcohol, and life events were associated with relapse rates. For special intervention participants, only alcohol emerged as a significant predictor. Conclusion. The data are relevant in terms of factors that govern smoking cessation and relapse for adult smokers who take part in formal intervention programs and for those who are left to modify their behavior on their own.

The multiple risk factor intervention trial (MRFIT). V. Intervention on smoking.

Abstract The development, implementation, and results of the smoking cessation program of the Multiple Risk Factor Intervention Trial (MRFIT) are presented. The MRFIT is a 6-year clinical trial designed to investigate the effects of reducing cardiovascular risk factors—elevated cholesterol, hypertension, and cigarette smoking—in a group of asymptomatic men at high risk of cardiovascular disease. The men participated in an integrated intervention program that offered both group and individual formats, a structured maintenance program for those who stopped smoking, and an extended intervention program for those unable to quit initially. Results among the original 4,103 smokers included a 47.3% quit rate 4 months after program initiation and a 45.9% quit rate after 4 years. Of those reporting no smoking at 4 months, 56% were abstinent at all visits through 48 months. Most recidivism occurred soon after initial cessation, with 17% of the men who reported quitting at 4 months reporting smoking 4 months later. The quit rates were strongly associated with the initial level of smoking, with light smokers reporting higher quit rates and lower recidivism rates at all visits through 4 years. Results exceed trial goals whether measured by self-reports or by thiocyanate levels, an objective assessment of smoking behavior. Discussion focuses on understanding the variables contributing to smoking cessation and to achieving the goals of reduction of risk of cardiovascular disease.

The Pediatrician's Role in Reducing Tobacco Exposure in Children

Objective. Pediatricians have a unique and important role to play in the prevention and treatment of childhood and adolescent tobacco use, the protection of patients from the harmful effects of environmental tobacco smoke, and the encouragement of smoking cessation among parents. However, because recent research indicates that physician training in tobacco dependence is woefully weak and lacks a model for training, this article constructs a useful approach to this problem. Methodology. A comprehensive review of the literature served as the basis for the development of a new model for pediatrician training in tobacco dependence. Results. A comprehensive model is presented for training pediatricians in the areas of reducing infant and child exposure to environmental tobacco smoke, preventing youth smoking initiation, and providing smoking cessation assistance for adolescents and parents. Conclusions. Pediatricians have been called on to play an active role in the antitobacco arena. Because of their unique opportunity to interact with children, adolescents, and parents, pediatricians can and should be antitobacco interventionists. For this to occur, however, additional guidance should be provided to pediatricians during their training to better prepare them to carry out effective assessment and intervention practices. smoking initiation, smoking prevention, smoking cessation, environmental tobacco smoke, pediatricians.

Comparison of patterns of smoking behavior change among smokers in the Multiple Risk Factor Intervention Trial (MRFIT)

Abstract The Multiple Risk Factor Intervention Trial (MRFIT) is a 6-year clinical trial for the study of the prevention of heart disease. Twelve thousand eight hundred and sixty-six men in the upper 10–15% of heart attack risk were randomly assigned to Special Intervention (SI) or Usual Care (UC). The SI participants received “risk factor” (hypertension, hypercholesterolemia, and cigarette smoking) intervention at the clinical centers; the UC participants were referred to their usual source of medical care for treatment. Forty percent of SI and 21% of UC smokers at entry reported not smoking at year 4, with lighter smokers in both treatment groups reporting significantly more cessation than heavier smokers. The greatest SI-UC difference in cessation rate was achieved during the first year of the program. The use of serum thiocyanate, an objective indicator of cigarette smoking, avoided problems inherent in self-reported data. Misreporting of smoking status was found in both groups with more occurring among the SI smokers. Cohort analysis revealed that of the smokers who stopped during the first year of the trial, 68% of SI and 57% of UC remained abstinent through the 4-year follow-up. Of the smokers who stopped later in the program the UC had better maintenance rates than the SI.

EFFECTS OF SCHEDULE, PERCENT BODY WEIGHT, AND MAGNITUDE OF REINFORCER ON ACQUISITION OF SCHEDULE-INDUCED POLYDIPSIA

Two experiments with 43 Charles River (cd) male rats investigated the effects of schedule, percent body weight, and magnitude of reinforcer on the acquisition of schedule-induced polydipsia. A leaner reinforcement schedule induced greater polydipsia as did two non-schedule variables, reduced body weight and small magnitude of reinforcer. These findings, related to contemporary theories of schedule-induced polydipsia, emphasize the role of non-schedule variables in this behavior.

ACQUISITION AND EXTINCTION OF SCHEDULE-INDUCED POLYDIPSIC CONSUMPTION OF ALCOHOL AND WATER

16 Charles River (cd) rats were trained to bar-press on an FI 60 schedule for varying number of days, half with water present and half with alcohol. Predictably, schedule-induced fluid consumption resulted. 10 days of extinction of bar-pressing followed. During FI 60 both groups bar-pressed approximately equally often but greater fluid consumption occurred in the group on water. During extinction, both groups showed reduced bar-pressing behavior. Whereas water consumption was extinguished in two days, alcohol consumption remained high and quite variable after bar-pressing had stopped. Results suggest that bar-pressing and fluid consumption are independent behaviors which finding argues against explanations of schedule-induced polydipsia based on adventitious reinforcement. For some rats, the termination of alcohol intake prior to the end of an FI 60 session without an associated cessation of bar-pressing suggested that schedule-induced polydipsia may have been a function of the aversiveness of the reinforcement schedule.

Health Care Providers as Key Change Agents in the Community Intervention Trial for Smoking Cessation (COMMIT).

The Community Intervention Trial for Smoking Cessation (COMMIT) is a multi-center collaborative trial sponsored by the National Cancer Institute. COMMIT utilizes multiple, community-based channels to facilitate quit attempts among heavy cigarette smokers. The “health care provider channel” is important, in that physicians, dentists, and other health care providers can effect changes in smoking behavior at both the individual and community level. There are over 1,600 primary care physicians and general practice dentists in the COMMIT intervention communities. This article describes the conceptual basis for the health care provider activities; results of a survey of Community attitudes and behaviors regarding smoking and health care; specific training and intervention activities; and the role of health care providers as community change agents in the smoking cessation arena.

Effect of soman on schedule-controlled behavior and brain acetylcholinesterase in rats

Rats were trained to press a lever under a multiple fixed-ratio 25 fixed-interval 50-second (FR25 FI50-sec) schedule of food reinforcement. Soman, 70-90 micrograms/kg, s.c., suppressed response rates in both components, with a slightly greater effect in the FI schedule. The pattern of responding under the FI schedule, however, was maintained until lever-pressing was nearly completely suppressed. At the highest doses, soman occasionally caused tremors or mild tonic seizures with hindlimb abduction. The suppression of response rate was correlated with inhibition of acetylcholinesterase (AChE) in all brain regions examined: cortex, striatum, hippocampus, hypothalamus and brainstem. Cortical AChE was inhibited to the highest degree, while striatal AChE was most resistant to inhibition by soman.

Family Rules About Exposure to Environmental Tobacco Smoke.

Environmental tobacco smoke (ETS) is detrimental to the health of children. It is important for families to implement rules that limit the exposure of children both within the home and in the community. The current study used a diverse sample of participants from pediatric clinics in a large metropolitan area to explore what restrictions families place on tobacco use in their home and in the community (e.g., restaurants, trains). In general, minority ethnic groups were less likely than their Caucasian peers to limit exposure to ETS outside of the home, even when income and education were taken into account. Income and education had a consistent inverse relationship to the endorsement of home smoking rules. It was not surprising that smoking status of the parents and the presence of smokers in the home were related to fewer home smoking rules. Implications for communitybased interventions on the dangers of ETS are discussed.

Comparison of smoking behavior change for SI and UC study groups. MRFIT Research Group

BACKGROUND The results of MRFIT smoking intervention program are presented for the 4,103 special intervention and 4,091 usual care men who reported smoking cigarettes at the first screening visit. RESULTS Among the special intervention men, the reported cessation rate increased from 43.1% at 12 months to 48.9% at 72 months. The reported cessation rate among the usual care men increased from 13.5% at 12 months to 28.8% at 72 months. Among smokers who reported cessation at 72 months, 51.3% of special intervention men and 22.7% of usual care men had quit smoking within the first year and remained abstinent thereafter. Average thiocyanate and expired-air carbon monoxide served as objective measures of smoking and were significantly lower among the special intervention men than among the usual care men over the entire follow-up period. The reported cessation rates at 72 months varied according to initial levels of smoking. Smokers reporting 1-19 cigarettes per day at entry were more likely to quit than heavier smokers. For each category of smoking at entry (1-19, 20-39, and 40 or more cigarettes per day) significantly more special intervention than usual care smokers reported cessation. CONCLUSION These results indicate that the MRFIT smoking intervention program was successful in promoting early cigarette smoking cessation and maintaining cessation over the entire trial for a large percentage of cigarette smokers.