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Natural History of Smoking & Quitting: Longterm Outcomes
A. Specific Aims
At present, some 50 million Americans smoke, these individuals are routinely encouraged to quit, and millions try to quit each year. A great deal is known about how quitting smoking affects a limited set of outcomes. For instance, it is well known that cessation affects the likelihood of lung cancer and heart disease. However, our knowledge of the effects of cessation is narrow. There are major gaps in our understanding of how cessation affects disease processes, mental health, psychosocial adjustment and life satisfaction. Also, little is known about the potential costs or adverse impacts of cessation. Finally, little is known about the precipitants of late relapse. The proposed research is aimed at addressing these gaps in our knowledge. Our cardinal goals are:
1. To determine the effects of cessation and continued smoking on physiological mechanisms of cardiovascular disease. We will use state-of-the-art assays such as carotid intima-media thickness, brachial artery endothelial function, and advanced lipoprotein testing to identify the mechanisms via which cessation leads to reduction of cardiovascular disease. We hypothesize that cessation will be followed by an arrest or reversal of atherosclerosis, but that this benefit will also be influenced by other modifiable risk factors (e.g., weight gain, diet, sedentariness, high stress). Our transdisciplinary assessment plan will allow us to produce new knowledge on the impact of cessation on atherosclerosis, and how cessation exerts its effects. ADDIN EN.CITE Howard1998225802258Howard, G.Wagenknecht, L. E.Burke, G. L.Diez-Roux, A.Evans, G. W.McGovern, P.Nieto, F. J.Tell, G. S.1998Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) StudyJAMA2792119-124Jan 149440661Arteriosclerosis/epidemiology/pathology/*physiopathology/ultrasonographyCarotid Arteries/*pathology/ultrasonographyCohort StudiesDisease ProgressionFemaleHumanLife StyleLinear ModelsLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9440661Department of Public Health Sciences of Wake Forest University, Winston-Salem, NC 27157-1063, USA. ghoward@rc.phs.bgsm.eduBarefoot1996275102751864097193111996Jun 1Symptoms of depression, acute myocardial infarction, and total mortality in a community sample1976-80Behavioral Medicine Research Center, Duke University Medical Center, Durham, NC 27710, USA. foot@acpub.duke.eduBarefoot, J. C.Schroll, M.CirculationAgedAged, 80 and overCause of DeathCohort StudiesCross-Sectional StudiesDenmark/epidemiologyDepression/complications/*epidemiologyFemaleForced Expiratory VolumeHumanMmpiMale*MortalityMyocardial Infarction/*epidemiology/etiology/prevention & controlMyocardial Ischemia/epidemiologyProportional Hazards ModelsRiskRisk FactorsSupport, U.S. Gov't, P.H.S.Survival Analysishttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8640971Matthews20022753027531182292316232002Feb 11Chronic work stress and marital dissolution increase risk of posttrial mortality in men from the Multiple Risk Factor Intervention Trial309-15Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Pittsburgh, PA 15213, USA. matthewska@msx.upmc.eduMatthews, K. A.Gump, B. B.Arch Intern MedAdultAnalysis of VarianceCohort StudiesComparative StudyConfidence IntervalsDivorce/*psychology/*statistics & numerical dataHumanInterpersonal RelationsIntervention StudiesLife Change EventsLinear ModelsMaleMarital StatusMiddle AgedProportional Hazards ModelsRisk AssessmentRisk FactorsSensitivity and SpecificityStress, Psychological/*mortalitySupport, U.S. Gov't, P.H.S.Time FactorsUnited States/epidemiologyWorkload/*psychology/statistics & numerical datahttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11822923Smith2002271002710120903697032002JunPsychosocial influences on the development and course of coronary heart disease: current status and implications for research and practice548-68Department of Psychology, University of Utah, Salt Lake City 84112, USA. tim.smith@psych.utah.eduSmith, T. W.Ruiz, J. M.J Consult Clin PsycholCoronary Disease/*etiology/prevention & controlHumanRisk FactorsSocial DominanceSocial EnvironmentStress, Psychological/psychologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12090369Lacy199527540275478639987571995Mar 1Coronary vasoconstriction induced by mental stress (simulated public speaking)503-5Department of Medicine, UMDNJ-Robert Wood Johnson Medical School.Lacy, C. R.Contrada, R. J.Robbins, M. L.Tannenbaum, A. K.Moreyra, A. E.Chelton, S.Kostis, J. B.Am J CardiolAgedBlood PressureCoronary Disease/physiopathologyCoronary Vessels/*physiopathologyFemaleHeart RateHumanMaleMiddle AgedStress, Psychological/*physiopathology*Vasoconstrictionhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7863998von Kanel20012755027551139736587122001Jun 15Effect of acute psychological stress on the hypercoagulable state in subjects (spousal caregivers of patients with Alzheimer's disease) with coronary or cerebrovascular disease and/or systemic hypertension1405-8Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA.von Kanel, R.Dimsdale, J. E.Ziegler, M. G.Mills, P. J.Patterson, T. L.Lee, S. K.Grant, I.Am J CardiolAgedAged, 80 and overAlzheimer Disease/blood/*psychologyAntithrombin III/metabolismCaregivers/*psychologyCatecholamines/bloodCoronary Thrombosis/blood/*psychologyFemaleFibrin Fibrinogen Degradation Products/metabolismHemodynamic Processes/physiologyHumanHypertension/blood/*psychologyIntracranial Embolism/blood/*psychologyMaleMiddle AgedPeptide Hydrolases/metabolismRisk FactorsStress, Psychological/blood/*complicationsSupport, Non-U.S. Gov'tThrombophilia/blood/*psychologyvon Willebrand Factor/metabolismhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11397365Whiteman2000275902759110201016252000Sep-OctPersonality and social predictors of atherosclerotic progression: Edinburgh Artery Study703-14Wolfson Unit for Prevention of Peripheral Vascular Diseases, Public Health Sciences, University of Edinburgh, Scotland.Whiteman, M. C.Deary, I. J.Fowkes, F. G.Psychosom MedAgedAnkle/blood supplyAnxiety Disorders/diagnosisArteriosclerosis/*diagnosis/epidemiology/*etiologyBrachial Artery/physiologyCross-Sectional StudiesDisease ProgressionFemaleFollow-Up StudiesHostilityHumanMaleMiddle AgedPeripheral Vascular Diseases/*diagnosis/*etiologyPersonality Disorders/*diagnosis/*psychologyPredictive Value of TestsPressurePrevalenceProspective StudiesReference ValuesSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11020101Goodman199627600276086918927181996AugHostility predicts restenosis after percutaneous transluminal coronary angioplasty729-34Department of Psychiatry and Behavioral Medicine, Union Memorial Hospital, Baltimore, Maryland, USA.Goodman, M.Quigley, J.Moran, G.Meilman, H.Sherman, M.Mayo Clin ProcAged*Angioplasty, Transluminal, Percutaneous CoronaryCoronary Disease/*psychology/therapyFemale*HostilityHumanLogistic ModelsMaleMiddle AgedPredictive Value of TestsPrognosisProspective StudiesRecurrenceRetrospective StudiesRisk FactorsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=86918921-8
2. To determine the relation between cessation and mental health outcomes. While cessation may exacerbate psychiatric symptoms in the short run (e.g., increased depression in the first year post-quit) we hypothesize that, over time, it will lead to decreased symptoms and a reduced likelihood of psychiatric diagnosis. These benefits may occur because smoking per se is a stressor ADDIN EN.CITE Parrott1999163401634Parrott, A. C.1999Does cigarette smoking cause stress?American Psychologist5410817-20Oct10540594AdolescentAdultAffectHumanPatient EducationSmoking/*psychology*Stress, PsychologicalTobacco Use Disorder/*psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10540594Department of Psychology, University of East London, Great Britain. andy2@uel.ac.uk9 because opponent-processes oppose the euphorogenic effects of nicotine ADDIN EN.CITE Solomon1977274272742Solomon, R. L.1977An opponent-process theory of acquired motivation: The affective dynamics of addictionJ.D Maser and M.E.P. SeligmanPsychopathology: Experimental modelsSan FranciscoWitt Freeman66-10310 or for other reasons. In sum we believe that our data will show that quitting smoking is the best thing that people can do to improve their mental health.
3. To assess the impact of cessation on quality of life (QOL). We hypothesize that cessation will significantly benefit QOL, but that the extent of benefit will be highly variable across individuals. Most will report enhanced QOL, but a minority will report reductions (e.g., weight gain, ADDIN EN.CITE Department of Health and Human Services2001269412694Department of Health and Human Services,2001Women and smoking: A report of the Surgeon GeneralRockville, MDU.S. Department of Health and Human Services11 prolonged depression and/or chronic craving could trump the benefits of quitting).
4. To identify factors associated with late-occurring relapse. We hypothesize that late relapse (>1 yr postquit) will be related to presence of tobacco in the persons social network and to lifestyle factors (e.g., a spouse who smokes, time in smokefree environments, alcohol use). We also hypothesize that late relapse will be unrelated to factors that typically predict short-term relapse (e.g., nicotine dependence, withdrawal symptoms, stressors). While much is known about early relapse, little is known about subsequent relapse. Such late relapse has great public health significance since about 1/3rd ADDIN EN.CITE Krall20027760776Krall,E.AGarvey,A.JGarcia,R.I2002Smoking relapse after 2 years of abstinence: Findings from the VA Normative Aging StudyNicotine & Tobacco Research495-100abstinencealcoholcessationmodelrelapserisksmokingGilpin199745045Gilpin,E.APierce,J.P1997Duration of smoking abstinence and success in quittingJournal of the National Cancer Institute898572-577Aprabstinencesmokingrelapseinterventionssmoking cessationsurveyadultssmoking statuscigarettesEisinger197120380203851300381241971DecPsychosocial predictors of smoking recidivism355-62Eisinger, R. A.J Health Soc BehavAge FactorsAttitude to HealthEducational StatusFemaleHumanMaleProspective StudiesSex Factors*SmokingSocioeconomic FactorsTime FactorsUnited Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=513003812-14 of those who abstain for one year eventually relapse.
5. To characterize better the long-term interdependence between smoking and alcohol use and their relations with important health and adjustment domains. We hypothesize that there will be a relation between smoking and drinking after a quit attempt with heavier drinking predicting a heightened tendency to relapse. We also hypothesize that successful smoking cessation will produce a reduction in drinking frequency. These hypotheses are based on the recognition that tobacco use and alcohol use often co-occur within contexts and within social groups, and the pharmacologic effects of alcohol may foster behavioral dysregulation (e.g., temporal discounting, reduction of executive control, priming of incentive systems). ADDIN EN.CITE Curtin20032761027611294302111232003AugAlcohol and cognitive control: implications for regulation of behavior during response conflict424-36Department of Psychology, University of Wisconsin-Madison, 53706, USA. jjcurtin@facstaff.wisc.eduCurtin, J. J.Fairchild, B. A.J Abnorm PsycholAlcoholism/*complicationsCognition Disorders/diagnosis/*etiology*Conflict (Psychology)ElectroencephalographyEvoked Potentials/physiologyFemaleHumanMaleSeverity of Illness Index*Social Control, Informalhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12943021Robinson199318910189184015951831993Sep-DecThe neural basis of drug craving: an incentive-sensitization theory of addiction247-91Department of Psychology, University of Michigan, Ann Arbor 48104-1687.Robinson, T. E.Berridge, K. C.Brain Res Brain Res Rev*Adaptation, PhysiologicalAnimalsBrain/*physiopathologyConditioning (Psychology)Corpus Striatum/physiopathologyDopamine/physiologyHuman*Models, NeurologicalMotivationNucleus Accumbens/physiopathologyRecurrenceReinforcement (Psychology)Substance-Related Disorders/*physiopathology/therapySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=840159515,16
These goals are part of a research program that has three overarching aims: (1) To provide a broader, more complete view of the long-term effects of quitting and quitting failure than has been available thus far; (2) To reveal the extent to which other modifiable risk factors such as drinking, weight gain, diet and exercise contribute to observed outcomes; and (3) To identify which smokers are most likely to develop positive and negative outcomes. Such information should prompt greater quit rates and ensure that each smoker enjoys the full benefits of quitting. In addition, this research will identify individual difference variables (e.g., genotypes) and other modifiable risk factors that predict important physical health, mental health, smoking, and drinking outcomes. This information should be of great benefit in devising preventive interventions.
B. Background and Significance
This proposal is intended to reveal how successful, and unsuccessful attempts to quit smoking are related to important physiologic and psychosocial outcomes, and how such outcomes may also reflect the influence of individual differences and other modifiable risk factors. As a field we have gathered a tremendous amount of data on how various treatments affect cessation rates. However, we have largely neglected the question of how cessation affects peoples lives and functional status outside of achieving abstinence. Moreover, our window of inquiry is typically limited to one year or less, leaving unknown the long-term consequences of a quit attempt. We also have largely neglected the question of how cessation failure, and consequent continuation of smoking, affects individuals across broad life domains.
This proposal addresses the natural histories of both the successful quitter and the relapsed smoker focusing on several key questions. First, what are the different long-term, physiological, medical, and psychosocial fates of those who are successful and unsuccessful in quitting? Second, how do other modifiable risk factors contribute to these outcomes? Third, are there individual differences, especially genetic characteristics, that correlate with the important physiologic and psychosocial outcomes under study? This proposal is not intended merely to characterize important outcomes associated with quitting or not quitting. Rather, it is intended to use a transdisciplinary approach to tobacco science to explore processes or mechanisms responsible for important long-term physiologic and psychosocial endpoints of a quit attempt, and to determine how these endpoints and associated processes are interrelated. The key measures that will be used to assess these processes and mechanisms are listed in Table 1.
There is a compelling rationale for exploring the long-term outcomes associated with cessation and cessation failure. Millions of smokers are encouraged to stop smoking each year. Yet, little is known about how the quit attempt, whether successful or unsuccessful, is associated with later events in peoples lives. Whether tobacco cessation should be recommended is not a question of this research. The data documenting the extraordinary burden of illness and death resulting from tobacco use is indisputable. Rather, this research is intended to provide a more comprehensive and fundamental understanding of both cessation and relapse so that smokers can achieve greater quitting success and achieve maximal long-term benefits from quit attempts.
We believe that these questions can be answered only in a transdisciplinary, inclusive manner. This is because smoking is impressively sticky; tobacco use is associated with diverse interrelated behaviors and physiologic processes that can be captured adequately only via a synthesis of data derived from diverse but complementary assessment methods that are generated by distinct scientific disciplines and perspectives. In the next section we summarize what is already known about life after a quit attempt.
Life After a Quit Attempt - Physiologic Outcomes
An overwhelming body of research shows that tobacco kills more Americans than any other preventable cause. ADDIN EN.CITE 200284208422002Annual smoking-attributable mortality, years of potential life lost, and economic costs--United States, 1995-1999MMWR5114300-312002168mortality, cost of illness, life tables, lung cancer, pregnancy, pulmonary disease, adverse effects, United Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1200216817 While some ultimate health impacts of tobacco use have been well documented, relatively little is known about the impacts of cessation or continued smoking on other specific physiologic outcomes such as atherosclerotic progression. This knowledge deficit stems, in part, from a failure to use state-of-the-art assessments from different fields, and then integrate the resultant information. Newer assessments such as carotid intima-media thickness measures (Carotid IMT) ADDIN EN.CITE Fathi20012147021471132035514152001MayNoninvasive tests of vascular function and structure: why and how to perform them694-703University of Queensland, Brisbane, Australia.Fathi, R.Marwick, T. H.Am Heart JArteries/pathology/*physiopathology/ultrasonographyArteriosclerosis/*diagnosis/physiopathologyBlood Flow VelocityEndothelium, Vascular/physiopathology/ultrasonographyHumanMagnetic Resonance Imaging/*methodsPlethysmography/*methodsReproducibility of ResultsSupport, Non-U.S. Gov'tUltrasonography/*methodsVascular ResistanceVasodilationhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11320355Crouse200121480214811473742882A2001Jul 19Predictive value of carotid 2-dimensional ultrasound27E-30EDepartment of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.Crouse, J. R., 3rdAm J CardiolCarotid Arteries/*ultrasonographyCarotid Stenosis/etiology/*ultrasonography*Coronary AngiographyHumanPredictive Value of TestsRisk FactorsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11473742Chambless2000214902149Chambless, L. E.Folsom, A. R.Clegg, L. X.Sharrett, A. R.Shahar, E.Nieto, F. J.Rosamond, W. D.Evans, G.2000Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) studyAmerican Journal of Epidemiology1515478-87Mar 110707916Carotid Arteries/*pathology/ultrasonographyCarotid Artery Diseases/*complications/ultrasonographyCerebrovascular Accident/*epidemiology/etiologyComparative StudyCoronary Arteriosclerosis/*complications/ultrasonographyFemaleHumanIncidenceMaleMiddle AgedPredictive Value of TestsProportional Hazards ModelsProspective StudiesRisk FactorsSupport, U.S. Gov't, P.H.S.Tunica Intima/*pathology/ultrasonographyUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10707916Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill 27514, USA.Howard1998225802258Howard, G.Wagenknecht, L. E.Burke, G. L.Diez-Roux, A.Evans, G. W.McGovern, P.Nieto, F. J.Tell, G. S.1998Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) StudyJAMA2792119-124Jan 149440661Arteriosclerosis/epidemiology/pathology/*physiopathology/ultrasonographyCarotid Arteries/*pathology/ultrasonographyCohort StudiesDisease ProgressionFemaleHumanLife StyleLinear ModelsLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9440661Department of Public Health Sciences of Wake Forest University, Winston-Salem, NC 27157-1063, USA. ghoward@rc.phs.bgsm.edu1,18-20 that quantify real-time risk for adverse atherosclerotic outcomes such as heart attack and stroke ADDIN EN.CITE Salonen1993220802208Salonen, J. T.Salonen, R.1993Ultrasound B-mode imaging in observational studies of atherosclerotic progressionCirculation873 SupplII56-1165Mar8443925Arteries/ultrasonographyArteriosclerosis/*ultrasonographyCarotid Arteries/ultrasonographyCoronary Disease/etiologyCoronary Vessels/ultrasonographyFemoral ArteryHumanMaleObserver VariationPredictive Value of TestsRisk FactorsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Ultrasonography/*methodshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8443925Research Institute of Public Health, University of Kuopio, Finland.Burke1995220902209Burke, G. L.Evans, G. W.Riley, W. A.Sharrett, A. R.Howard, G.Barnes, R. W.Rosamond, W.Crow, R. S.Rautaharju, P. M.Heiss, G.1995Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. The Atherosclerosis Risk in Communities (ARIC) StudyStroke263386-391Mar7886711African Continental Ancestry GroupAge FactorsAngina Pectoris/epidemiologyArteriosclerosis/*epidemiologyCardiovascular Diseases/*epidemiologyCarotid Arteries/*pathology/ultrasonographyCerebral Arteries/pathologyCerebrovascular Disorders/epidemiologyCohort StudiesCoronary Disease/epidemiologyCoronary Vessels/pathologyEuropean Continental Ancestry GroupFemaleHumanMaleMiddle AgedMyocardial Infarction/epidemiologyPeripheral Vascular Diseases/epidemiologyPopliteal Artery/*pathology/ultrasonographyPrevalenceRisk FactorsSex FactorsSupport, U.S. Gov't, P.H.S.Tunica Intima/pathology/ultrasonographyTunica Media/pathology/ultrasonographyUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7886711Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC 27157.Chambless1997221002210Chambless, L. E.Heiss, G.Folsom, A. R.Rosamond, W.Szklo, M.Sharrett, A. R.Clegg, L. X.1997Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: The Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993American Journal of Epidemiology1466483-494Sep 159290509Age DistributionArteriosclerosis/complications/*pathologyCarotid Arteries/*pathologyCoronary Disease/*epidemiology/ethnology/*etiology/pathologyFemaleHumanIncidenceMaleMiddle AgedMinnesota/epidemiologyProportional Hazards ModelsRisk FactorsSex DistributionSupport, U.S. Gov't, P.H.S.Tunica Intima/pathologyTunica Media/pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9290509Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill 27514, USA.O'Leary1999221102211O'Leary, D. H.Polak, J. F.Kronmal, R. A.Manolio, T. A.Burke, G. L.Wolfson, S. K., Jr.1999Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research GroupNew England Journal of Medicine340114-22Jan 79878640AgedCarotid Arteries/*pathology/ultrasonographyCerebrovascular Disorders/epidemiology/etiology/*pathologyDisease-Free SurvivalFemaleHumanIncidenceMaleMyocardial Infarction/epidemiology/etiology/*pathologyProportional Hazards ModelsProspective StudiesRisk FactorsSupport, U.S. Gov't, P.H.S.Tunica Intima/*pathology/ultrasonographyTunica Media/*pathology/ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9878640Department of Radiology, Tufts-New England Medical Center, Boston, MA, USA. daniel.oleary@es.nemc.orgHodis1998221202212Hodis, H. N.Mack, W. J.LaBree, L.Selzer, R. H.Liu, C. R.Liu, C. H.Azen, S. 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L.1993Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. ARIC InvestigatorsStroke2491297-1304Sep8362421African Continental Ancestry GroupArteriosclerosis/epidemiology/*ultrasonographyCarotid Artery Diseases/epidemiology/*ultrasonographyCarotid Artery, Common/ultrasonographyCarotid Artery, Internal/ultrasonographyEuropean Continental Ancestry GroupFemaleHumanMaleMiddle AgedSex CharacteristicsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8362421Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1063.Greenland20002214022141061831810112000Jan 4Prevention Conference V: Beyond secondary prevention: identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden: Writing Group IIIE16-22Greenland, P.Abrams, J.Aurigemma, G. P.Bond, M. G.Clark, L. T.Criqui, M. H.Crouse, J. 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J.Malmejac, A.Guize, L.1991Risk factors for early carotid atherosclerosis in middle-aged French womenArteriosclerosis and Thrombosis114966-972Jul-Aug2065047Age FactorsApolipoproteins B/bloodArteriosclerosis/*epidemiology/etiology/ultrasonographyBlood PressureCarotid Artery Diseases/*epidemiology/etiology/ultrasonographyCholesterol/bloodFemaleFrance/epidemiologyHumanLipoproteins, LDL Cholesterol/bloodMenopauseMiddle AgedPrevalenceRegression AnalysisRisk FactorsSmoking/adverse effectsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=2065047Unite de Recherche d'Epidemiologie Cardiovasculaire, INSERM U 258, Hopital Broussais, Paris, France.O'Leary1992221702217O'Leary, D. H.Polak, J. F.Kronmal, R. A.Kittner, S. J.Bond, M. G.Wolfson, S. K., Jr.Bommer, W.Price, T. R.Gardin, J. M.Savage, P. J.1992Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research GroupStroke23121752-1760Dec1448826AgedArteriosclerosis/complications/epidemiology/*ultrasonographyCardiomegaly/complications/ultrasonographyCarotid Artery Diseases/complications/epidemiology/*ultrasonographyCerebrovascular Disorders/complicationsCoronary Disease/*complicationsFemaleHumanMaleMedical RecordsPrevalenceRegression AnalysisRisk FactorsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1448826Division of Radiology, Geisinger Medical Center, Danville, Pa.Bonithon-Kopp1996221802218Bonithon-Kopp, C.Touboul, P. J.Berr, C.Leroux, C.Mainard, F.Courbon, D.Ducimetiere, P.1996Relation of intima-media thickness to atherosclerotic plaques in carotid arteries. The Vascular Aging (EVA) StudyArteriosclerosis, Thrombosis, and Vascular Biology162310-316Feb8620348AgedAging/*physiologyArteriosclerosis/*ultrasonographyCarotid Arteries/*ultrasonographyCarotid Artery Diseases/*ultrasonographyCross-Sectional StudiesFemaleHumanMaleMiddle AgedOdds RatioRisk FactorsTunica Intima/*ultrasonographyTunica Media/*ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8620348INSERM U258, Hopital Broussais, Paris, France.Howard1994221902219Howard, G.Burke, G. L.Szklo, M.Tell, G. S.Eckfeldt, J.Evans, G.Heiss, G.1994Active and passive smoking are associated with increased carotid wall thickness. The Atherosclerosis Risk in Communities StudyArchives of Internal Medicine154111277-1282Jun 138203995AgedArteriosclerosis/*etiology/pathologyCarotid Arteries/*pathology/ultrasonographyCarotid Artery Diseases/etiology/pathologyFemaleHumanMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/pathologyTunica Media/pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8203995Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC.Salonen1990222002220Salonen, R.Salonen, J. T.1990Progression of carotid atherosclerosis and its determinants: A population-based ultrasonography studyAtherosclerosis81133-40Feb2407252AdultArteriosclerosis/diagnosis/*physiopathologyCarotid Artery Diseases/diagnosis/*physiopathologyHumanMaleMiddle AgedPlatelet AggregationRisk FactorsSmoking/adverse effectsSupport, Non-U.S. Gov't*Ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=2407252Research Institute of Public Health, University of Kuopio, Finland.21-33 can help answer these questions.
Atherosclerosis and cardiovascular disease. Tobacco use is a major modifiable risk factor for atherosclerosis, ADDIN EN.CITE Thomson2003276902769Thomson, C.CRigotti, N.A2003Hospital- and clinic-based smoking cessation interventions for smokers with cardiovascular diseaseProgress in Cardiovascular Diseases456459-79May-JunYusuf20022766027661244430511 Suppl 22002The global epidemic of atherosclerotic cardiovascular disease3-8Population Health Research Institute and Division of Cardiology, McMaster University, Hamilton, Ont., Canada. yusufs@fhs.mcmaster.caYusuf, S.Ounpuu, S.Anand, S.Med Princ PractArteriosclerosis/*epidemiology/ethnologyDeveloping CountriesFemaleHumanMalePrevalenceRisk FactorsSupport, Non-U.S. Gov't*World Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12444305Jabbour200227670276712419555862-32002DecCardiovascular disease and the global tobacco epidemic: a wake-up call for cardiologists185-92Faculties of Health Sciences and Medicine, American University of Beirut, Van Dyck Hall, Beirut, Lebanon. sjabbour@aub.edu.lbJabbour, S.Reddy, K. S.Muna, W. F.Achutti, A.Int J Cardiol*CardiologyCardiovascular Diseases/epidemiology/*etiology/*prevention & controlDisease Outbreaks/*prevention & controlFemaleHumanMale*Physician's RoleTobacco Use Disorder/*complications/epidemiology/*prevention & control*World Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12419555Bernhard20032768027681452594017152003DecDisruption of vascular endothelial homeostasis by tobacco smoke: impact on atherosclerosis2302-4Institute for Biomedical Aging Research, Austrian Academy of Sciences, Innsbruck, Austria. Bernhard@uibk.ac.atBernhard, D.Pfister, G.Huck, C. W.Kind, M.Salvenmoser, W.Bonn, G. K.Wick, G.Faseb JAcetylcysteine/pharmacologyArteriosclerosis/etiologyEndothelium, Vascular/*cytology/drug effects/pathologyHomeostasisHydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacologyModels, BiologicalNecrosis*Smokinghttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1452594034-37 the underlying pathological process leading to myocardial infarction and stroke, the first and third leading causes of death in America. Almost half of the 440,000 deaths caused by tobacco use each year in the United States are the result of cardiovascular diseases. ADDIN EN.CITE 200284208422002Annual smoking-attributable mortality, years of potential life lost, and economic costs--United States, 1995-1999MMWR5114300-312002168mortality, cost of illness, life tables, lung cancer, pregnancy, pulmonary disease, adverse effects, United Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1200216817 However, atherosclerosis has other known risk factors that may be influenced by a quit attempt. These include weight-gain induced type II diabetes mellitus, dyslipidemia, hypertension, and physical inactivity. ADDIN EN.CITE Kannel1986215002150353274411241986OctOverall and coronary heart disease mortality rates in relation to major risk factors in 325,348 men screened for the MRFIT. Multiple Risk Factor Intervention Trial825-36Kannel, W. B.Neaton, J. D.Wentworth, D.Thomas, H. E.Stamler, J.Hulley, S. B.Kjelsberg, M. O.Am Heart JAdultAge FactorsBlood PressureCholesterol/bloodClinical TrialsCoronary Disease/*mortalityHumanMaleMass ScreeningMiddle AgedRiskSmokingUnited Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3532744Braunwald19972190021909358131337191997Nov 6Shattuck lecture--cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities1360-9Partners Health Care System and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, USA.Braunwald, E.N Engl J MedCardiovascular Diseases/*history/therapyCoronary Disease/diagnosis/historyHistory of Medicine, 20th Cent.HumanHypercholesterolemia/historyHypertension/historyMyocardial Infarction/historyRisk Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=935813138,39 To assess sensitively the global physiologic risk trajectory for atherosclerosis among smokers and quitters, such individuals must be followed in a prospective, long-term way with periodic assessments across diverse modifiable risk domains including blood pressure, lipid status, hyperglycemia, weight, exercise, diet, and others.
Importantly, we now have highly quantifiable measures (e.g., Carotid IMT) that can, in an accurate and reproducible manner, document atherosclerotic progression or regression. These measures document the anatomical basis for the cardiovascular benefits of smoking cessation reported in epidemiologic studies. ADDIN EN.CITE Freund1992200102001159569413591992May 1Predictors of smoking cessation: the Framingham Study957-64Evans Department of Clinical Research, University Hospital, Boston University Medical Center, MA.Freund, K. M.D'Agostino, R. B.Belanger, A. J.Kannel, W. B.Stokes, J., 3rdAm J EpidemiolCoronary Disease/diagnosis/psychologyEducational StatusFemaleHealth Behavior*Health Status IndicatorsHospitalization/statistics & numerical dataHumanLogistic ModelsMaleMarriage/statistics & numerical dataMassachusetts/epidemiologyNeoplasms/diagnosis/psychologyOccupations/statistics & numerical dataPredictive Value of TestsProportional Hazards ModelsRespiratory Function TestsSex FactorsSmoking/epidemiology/prevention & control/*psychologySmoking Cessation/*psychologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1595694Steenland199627720277287726809441996Aug 15Environmental tobacco smoke and coronary heart disease in the American Cancer Society CPS-II cohort622-8National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA. knsl@nioshel.em.cdc.govSteenland, K.Thun, M.Lally, C.Heath, C., Jr.CirculationAdultAir Pollution, Indoor/*adverse effectsCohort StudiesComparative StudyCoronary Disease/*epidemiology/mortalityDemographyFemaleHumanMaleMiddle AgedOccupational Exposure/adverse effectsProspective StudiesRisk Factors*SpousesTobacco Smoke Pollution/*adverse effectsUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8772680Kawachi1997277472774Kawachi, I.Colditz, G.AStampfer, M.JWillett, W.C.Manson, J.ERosner, B.Hunter, D.J.Hennekens, C.HSpeizer, F.E1997Smoking cessation and decreased risks of total mortality, stroke, and coronary heart disease incidence among women: A prospective cohort studyBurns, D.MGarfinkel, L.Samet, J.MChanges in cigarette-related disease risks and their implications for prevention and controlBethesda, MDNational Cancer Institute Monograph531-56540-42 Such measures will also permit insight into the mechanisms of health outcomes, interactions among risk factors, and the subpopulations most affected by particular outcomes. Specifically, we need to know more about how cessations relation to atherosclerosis is influenced by individual differences such as gender, level of nicotine dependence and genotype ADDIN EN.CITE Mowbray199727140271491436412321997MayCharacteristics of dual diagnosis patients admitted to an urban, public psychiatric hospital: an examination of individual, social, and community domains309-26University of Michigan, School of Social Work, Ann Arbor 48109-1285, USA.Mowbray, C. T.Ribisl, K. M.Solomon, M.Luke, D. A.Kewson, T. P.Am J Drug Alcohol AbuseAdultAfrican Americans/statistics & numerical dataAge FactorsData CollectionDiagnosis, Dual (Psychiatry)/*psychologyEuropean Continental Ancestry Group/statistics & numerical dataFemale*Hospitals, Psychiatric/utilizationHospitals, PublicHospitals, UrbanHumanMaleMarriageMental Disorders/psychology/rehabilitationPersonality Assessment/statistics & numerical dataPsychiatric Status Rating ScalesPsychometricsSex FactorsSocioeconomic FactorsSubstance-Related Disorders/rehabilitationSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=914364143 and how cessations impact is related to changes in other modifiable risk factors such as diet, weight gain, exposure to environmental tobacco smoke, and exercise, which themselves may be affected by cessation. ADDIN EN.CITE Flegal19952151021517565970333181995Nov 2The influence of smoking cessation on the prevalence of overweight in the United States1165-70National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA.Flegal, K. M.Troiano, R. P.Pamuk, E. R.Kuczmarski, R. J.Campbell, S. M.N Engl J MedAdultAgedBody Mass IndexFemaleHealth SurveysHumanMaleMiddle AgedObesity/*epidemiologyOdds RatioPrevalenceSmoking/epidemiology/*physiopathology*Smoking Cessation/statistics & numerical dataUnited States/epidemiology*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=756597044 For instance, cessation induced weight gain might increase the risk of hypertension, insulin resistance, and hyperlipidemia, all important risk factors for atherosclerosis. Some data do address the impacts of such risk factors, ADDIN EN.CITE Howard199823420234295962342951998MayCigarette smoking and other risk factors for silent cerebral infarction in the general population913-7Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA. ghoward@rc.phs.wfubmc.eduHoward, G.Wagenknecht, L. E.Cai, J.Cooper, L.Kraut, M. A.Toole, J. F.StrokeAge FactorsAgedCerebral Infarction/epidemiology/*etiologyCohort StudiesData Interpretation, StatisticalDietary Fats/administration & dosageFemaleHumanHypertensionLife StyleLipoproteins, HDL Cholesterol/bloodMaleMiddle AgedProspective StudiesQuestionnairesRisk FactorsSex FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/adverse effects/statistics & numerical dataTriglycerides/bloodhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=959623445 but most data in this area are from cross-sectional or short-term cohort studies. ADDIN EN.CITE Heiss1991215202152187758413431991Aug 1Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study250-6Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill.Heiss, G.Sharrett, A. R.Barnes, R.Chambless, L. E.Szklo, M.Alzola, C.Am J EpidemiolArteriosclerosis/complications/pathology/*ultrasonographyCardiovascular Diseases/blood/epidemiology/*etiologyCarotid Artery Diseases/complications/pathology/*ultrasonographyCase-Control StudiesCholesterol/bloodFemaleHumanLipoproteins, HDL Cholesterol/bloodLipoproteins, LDL Cholesterol/bloodLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/epidemiologySupport, U.S. Gov't, P.H.S.Triglycerides/bloodUltrasonography/methods/*standardsUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1877584Bonithon-Kopp1991221602216Bonithon-Kopp, C.Scarabin, P. Y.Taquet, A.Touboul, P. J.Malmejac, A.Guize, L.1991Risk factors for early carotid atherosclerosis in middle-aged French womenArteriosclerosis and Thrombosis114966-972Jul-Aug2065047Age FactorsApolipoproteins B/bloodArteriosclerosis/*epidemiology/etiology/ultrasonographyBlood PressureCarotid Artery Diseases/*epidemiology/etiology/ultrasonographyCholesterol/bloodFemaleFrance/epidemiologyHumanLipoproteins, LDL Cholesterol/bloodMenopauseMiddle AgedPrevalenceRegression AnalysisRisk FactorsSmoking/adverse effectsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=2065047Unite de Recherche d'Epidemiologie Cardiovasculaire, INSERM U 258, Hopital Broussais, Paris, France.O'Leary1992221702217O'Leary, D. H.Polak, J. F.Kronmal, R. A.Kittner, S. J.Bond, M. G.Wolfson, S. K., Jr.Bommer, W.Price, T. R.Gardin, J. M.Savage, P. J.1992Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research GroupStroke23121752-1760Dec1448826AgedArteriosclerosis/complications/epidemiology/*ultrasonographyCardiomegaly/complications/ultrasonographyCarotid Artery Diseases/complications/epidemiology/*ultrasonographyCerebrovascular Disorders/complicationsCoronary Disease/*complicationsFemaleHumanMaleMedical RecordsPrevalenceRegression AnalysisRisk FactorsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1448826Division of Radiology, Geisinger Medical Center, Danville, Pa.Howard1994221902219Howard, G.Burke, G. L.Szklo, M.Tell, G. S.Eckfeldt, J.Evans, G.Heiss, G.1994Active and passive smoking are associated with increased carotid wall thickness. The Atherosclerosis Risk in Communities StudyArchives of Internal Medicine154111277-1282Jun 138203995AgedArteriosclerosis/*etiology/pathologyCarotid Arteries/*pathology/ultrasonographyCarotid Artery Diseases/etiology/pathologyFemaleHumanMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/pathologyTunica Media/pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8203995Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC.Salonen1993220802208Salonen, J. T.Salonen, R.1993Ultrasound B-mode imaging in observational studies of atherosclerotic progressionCirculation873 SupplII56-1165Mar8443925Arteries/ultrasonographyArteriosclerosis/*ultrasonographyCarotid Arteries/ultrasonographyCoronary Disease/etiologyCoronary Vessels/ultrasonographyFemoral ArteryHumanMaleObserver VariationPredictive Value of TestsRisk FactorsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Ultrasonography/*methodshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8443925Research Institute of Public Health, University of Kuopio, Finland.Belcaro199521570215776767302431995Progression of subclinical atherosclerosis in 6 years. Ultrasound evaluation of the average, combined femoral and carotid bifurcation intima-media thickness227-32Cardiovascular Institute, Chieti University, Italy.Belcaro, G.Laurora, G.Cesarone, M. R.De Sanctis, M. T.Incandela, L.Barsotti, A.VasaAdultAge FactorsArteriosclerosis/*ultrasonographyCarotid Artery, Common/*ultrasonographyCarotid Stenosis/*ultrasonographyFemaleFemoral Artery/*ultrasonographyFollow-Up StudiesHumanImage Interpretation, Computer-AssistedMaleMiddle AgedSmoking/adverse effectsTunica Intima/*ultrasonographyTunica Media/*ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7676730Howard1998225802258Howard, G.Wagenknecht, L. E.Burke, G. L.Diez-Roux, A.Evans, G. W.McGovern, P.Nieto, F. J.Tell, G. S.1998Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) StudyJAMA2792119-124Jan 149440661Arteriosclerosis/epidemiology/pathology/*physiopathology/ultrasonographyCarotid Arteries/*pathology/ultrasonographyCohort StudiesDisease ProgressionFemaleHumanLife StyleLinear ModelsLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9440661Department of Public Health Sciences of Wake Forest University, Winston-Salem, NC 27157-1063, USA. ghoward@rc.phs.bgsm.eduBonithon-Kopp1996221802218Bonithon-Kopp, C.Touboul, P. J.Berr, C.Leroux, C.Mainard, F.Courbon, D.Ducimetiere, P.1996Relation of intima-media thickness to atherosclerotic plaques in carotid arteries. The Vascular Aging (EVA) StudyArteriosclerosis, Thrombosis, and Vascular Biology162310-316Feb8620348AgedAging/*physiologyArteriosclerosis/*ultrasonographyCarotid Arteries/*ultrasonographyCarotid Artery Diseases/*ultrasonographyCross-Sectional StudiesFemaleHumanMaleMiddle AgedOdds RatioRisk FactorsTunica Intima/*ultrasonographyTunica Media/*ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8620348INSERM U258, Hopital Broussais, Paris, France.1,21,29-32,46,47 Thus, measures such as Carotid IMT and flow-mediated vasodilatation of the brachial artery have rarely been studied prospectively with rich measures of individual differences and other risk factors.
While earlier data on cessations impact on carotid IMT showed arrest of carotid IMT over three years, ADDIN EN.CITE Howard1998225802258Howard, G.Wagenknecht, L. E.Burke, G. L.Diez-Roux, A.Evans, G. W.McGovern, P.Nieto, F. J.Tell, G. S.1998Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) StudyJAMA2792119-124Jan 149440661Arteriosclerosis/epidemiology/pathology/*physiopathology/ultrasonographyCarotid Arteries/*pathology/ultrasonographyCohort StudiesDisease ProgressionFemaleHumanLife StyleLinear ModelsLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9440661Department of Public Health Sciences of Wake Forest University, Winston-Salem, NC 27157-1063, USA. ghoward@rc.phs.bgsm.edu1 we believe that more careful assessment of other risk factors may reveal regression. Such data have the potential to induce clinicians to change fundamentally their practice patterns. For example, data documenting the arrest of atherosclerotic progression resulting from hyperlipidemia has been associated with an explosive increase in the rate of prescribing statin agents. ADDIN EN.CITE Bonithon-Kopp1996221802218Bonithon-Kopp, C.Touboul, P. J.Berr, C.Leroux, C.Mainard, F.Courbon, D.Ducimetiere, P.1996Relation of intima-media thickness to atherosclerotic plaques in carotid arteries. The Vascular Aging (EVA) StudyArteriosclerosis, Thrombosis, and Vascular Biology162310-316Feb8620348AgedAging/*physiologyArteriosclerosis/*ultrasonographyCarotid Arteries/*ultrasonographyCarotid Artery Diseases/*ultrasonographyCross-Sectional StudiesFemaleHumanMaleMiddle AgedOdds RatioRisk FactorsTunica Intima/*ultrasonographyTunica Media/*ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8620348INSERM U258, Hopital Broussais, Paris, France.31 If tobacco cessation produces similar results, clinicians may be motivated to treat tobacco dependence more consistently and intensively. Of course, such data may also motivate more smokers to quit pictures of atherosclerotic pathology and its arrest due to cessation could powerfully affect smokers motivation to quit. ADDIN EN.CITE Bovet2002268502685118179173422002FebImproved smoking cessation in smokers given ultrasound photographs of their own atherosclerotic plaques215-20University Institute of Social and Preventive Medicine, Bugnon 17, 1011 Lausanne, Switzerland.Bovet, P.Perret, F.Cornuz, J.Quilindo, J.Paccaud, F.Prev MedAdultArteriosclerosis/*ultrasonography*Audiovisual AidsCounselingFemale*Health BehaviorHumanMaleMiddle AgedPatient Education/*methodsSeychelles*Smoking CessationSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1181791748 By integrating prospectively data on changes in smoking habits as well as other key risk factors and objective measures of atherosclerosis, we hope to clarify mechanisms and identify those at greatest risk.
Metabolic/Anthropometric data. Research has documented that smokers tend to weigh less than non-smokers and gain weight when they quit, and recent research shows that the weight gain is greater than once thought, averaging 10-20 lbs depending on gender and time since quitting. ADDIN EN.CITE Department of Health and Human Services2001269412694Department of Health and Human Services,2001Women and smoking: A report of the Surgeon GeneralRockville, MDU.S. Department of Health and Human ServicesKlesges199721810218190866926521997AprHow much weight gain occurs following smoking cessation? A comparison of weight gain using both continuous and point prevalence abstinence286-91Department of Psychology, University of Memphis, Tennessee 38152, USA.Klesges, R. C.Winders, S. E.Meyers, A. W.Eck, L. H.Ward, K. D.Hultquist, C. M.Ray, J. W.Shadish, W. R.J Consult Clin PsycholAdultAnalysis of VarianceChi-Square DistributionConfidence IntervalsFemaleHumanMaleMiddle AgedProspective StudiesRecurrence*Smoking CessationSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Time Factors*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9086692O'Hara1998268902689980101114891998Nov 1Early and late weight gain following smoking cessation in the Lung Health Study821-30Department of Epidemiology and Public Health, University of Miami School of Medicine, FL, USA.O'Hara, P.Connett, J. E.Lee, W. W.Nides, M.Murray, R.Wise, R.Am J EpidemiolAdultBehavior TherapyBody WeightBronchodilator Agents/therapeutic useChewing GumComparative StudyFemaleFollow-Up StudiesHumanLung Diseases, Obstructive/drug therapy/*physiopathologyMaleMiddle AgedRespiratory Function TestsRetrospective StudiesSmoking/physiopathology/therapy*Smoking Cessation/methodsSupport, U.S. Gov't, P.H.S.*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=980101111,49,50 The relative risk of major weight gain has been estimated as 5.8 comparing women who quit with those continuing to smoke. ADDIN EN.CITE Williamson19912690026901997840324111991Mar 14Smoking cessation and severity of weight gain in a national cohort739-45Division of Nutrition, Centers for Disease Control, Atlanta, GA 30333.Williamson, D. F.Madans, J.Anda, R. F.Kleinman, J. C.Giovino, G. A.Byers, T.N Engl J MedAdultAgedBody Mass IndexCohort StudiesFemaleFollow-Up StudiesHealth SurveysHumanMaleMiddle AgedNutrition SurveysOdds RatioParityPregnancyProspective StudiesRegression AnalysisSex CharacteristicsSmoking/epidemiology/*prevention & controlUnited States/epidemiology*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=199784051 Most post-quit weight gain occurs in the first three years after quitting. ADDIN EN.CITE Department of Health and Human Services2001269412694Department of Health and Human Services,2001Women and smoking: A report of the Surgeon GeneralRockville, MDU.S. Department of Health and Human Services11 For both sexes, African Americans, people under age 55, and heavy smokers (25+ cigarettes/day) are at elevated risk for major weight gain. ADDIN EN.CITE Froom199827170271796381094661998JunSmoking cessation and weight gain460-4Occupational Health Institute, Raanana, Israel.Froom, P.Melamed, S.Benbassat, J.J Fam PractBody WeightHumanSmoking/physiopathology*Smoking CessationSupport, Non-U.S. Gov'tTime Factors*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9638109Klesges199721810218190866926521997AprHow much weight gain occurs following smoking cessation? A comparison of weight gain using both continuous and point prevalence abstinence286-91Department of Psychology, University of Memphis, Tennessee 38152, USA.Klesges, R. C.Winders, S. E.Meyers, A. W.Eck, L. H.Ward, K. D.Hultquist, C. M.Ray, J. W.Shadish, W. R.J Consult Clin PsycholAdultAnalysis of VarianceChi-Square DistributionConfidence IntervalsFemaleHumanMaleMiddle AgedProspective StudiesRecurrence*Smoking CessationSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Time Factors*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9086692Williamson19912690026901997840324111991Mar 14Smoking cessation and severity of weight gain in a national cohort739-45Division of Nutrition, Centers for Disease Control, Atlanta, GA 30333.Williamson, D. F.Madans, J.Anda, R. F.Kleinman, J. C.Giovino, G. A.Byers, T.N Engl J MedAdultAgedBody Mass IndexCohort StudiesFemaleFollow-Up StudiesHealth SurveysHumanMaleMiddle AgedNutrition SurveysOdds RatioParityPregnancyProspective StudiesRegression AnalysisSex CharacteristicsSmoking/epidemiology/*prevention & controlUnited States/epidemiology*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1997840Burnette199827180271895840418811998JanSmoking cessation, weight gain, and changes in cardiovascular risk factors during menopause: the Healthy Women Study93-6Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pa, USA.Burnette, M. M.Meilahn, E.Wing, R. R.Kuller, L. H.Am J Public HealthAlcohol Drinking/epidemiologyBlood Glucose/analysisBlood PressureCardiovascular Diseases/*epidemiologyCholesterol/bloodFemaleHumanInsulin/bloodLongitudinal StudiesMenopause/blood/*physiologyMiddle AgedPremenopause/blood/physiologyRisk Factors*Smoking CessationTriglycerides/blood*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9584041Becona19982719027199676511823 Pt 11998JunSmoking cessation and weight gain in smokers participating in a behavioral treatment at 3-year follow-up999-1005University of Santiago de Compostela, Facultad de Psicologia, Departamento de Psicologia Clinica y Psicobiologia, Galicia, Spain. pcelisar@usc.esBecona, E.Vazquez, F. L.Psychol RepAdult*Behavior TherapyFemaleFollow-Up StudiesHumanMaleMiddle AgedSmoking Cessation/*psychologyTreatment Outcome*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9676511Caan1996272002720890614096111996NovWomen gain weight 1 year after smoking cessation while dietary intake temporarily increases1150-5Kaiser Permanente Medical Care Program of Northern California, Division of Research, Oakland 94611, USA.Caan, B.Coates, A.Schaefer, C.Finkler, L.Sternfeld, B.Corbett, K.J Am Diet AssocAdultDiet RecordsDietary Carbohydrates/administration & dosageDietary Fats/administration & dosageDietary Sucrose/administration & dosageEating/*physiologyEnergy IntakeEnergy MetabolismFemaleHumanLinear ModelsMiddle Aged*Smoking CessationWeight Gain/*physiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8906140Emont198727210272136308011221987Weight gain following smoking cessation: a possible role for nicotine replacement in weight management151-5Emont, S. L.Cummings, K. M.Addict BehavAdultAgedBody Weight/*drug effects*Chewing GumFemaleHumanMaleMiddle AgedNicotine/*adverse effects/therapeutic useSubstance Withdrawal Syndrome/*drug therapyTobacco Use Disorder/therapyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3630801Frederick1996272202722Frederick, S.L, Hall, S.M., Fumfleet G.L., Munoz, R.F.1996Sex differences in the relation of mood to weight gain after quitting smokingExp Clin Psychopharmacol42178-85Klesges199827230272398749126661998DecThe prospective relationships between smoking and weight in a young, biracial cohort: the Coronary Artery Risk Development in Young Adults Study987-93Department of Psychology, University of Memphis Prevention Center, Tennessee 38119, USA. bklesges@cc.memphis.eduKlesges, R. C.Ward, K. D.Ray, J. W.Cutter, G.Jacobs, D. R., Jr.Wagenknecht, L. E.J Consult Clin PsycholAdolescentAdultAfrican Americans/statistics & numerical dataAge DistributionAnalysis of VarianceBody Mass IndexCohort StudiesComparative StudyCross-Sectional StudiesDemographyEuropean Continental Ancestry Group/statistics & numerical dataFemaleHumanMalePrevalenceProspective StudiesSex DistributionSmoking/*epidemiologySmoking Cessation/statistics & numerical dataSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.United States/epidemiology*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=987491249,51-58
Smoking cessation is also associated with increased risk of central adiposity ADDIN EN.CITE Stamford198626870268739629014341986AprEffects of smoking cessation on weight gain, metabolic rate, caloric consumption, and blood lipids486-94Stamford, B. A.Matter, S.Fell, R. D.Papanek, P.Am J Clin NutrAdipose TissueAdultAnalysis of Variance*Body WeightDietEnergy IntakeFemaleFollow-Up StudiesHumanLipoproteins, HDL Cholesterol/*bloodMenopauseMenstruationMiddle AgedOxygen Consumption*SmokingSupport, Non-U.S. Gov'tTime FactorsTriglycerides/bloodhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=396290159 which places individuals at increased risk of metabolic syndrome, a major risk factor for adverse cardiovascular outcomes. According to the National Cholesterol Education Program Adult Treatment Panel III, patients are diagnosed with Metabolic Syndrome if they fulfill 3 of 5 following factors: waist circumference, triglycerides, HDL-C, blood pressure, and fasting plasma glucose. ADDIN EN.CITE Expert Panel on Detection2001269312693Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults,2001National cholesterol education program: Adult treatment panel III report. Publication no. 01-3095Bethesda, MDNational Heart, Lung, and Blood Institute60 Metabolic syndrome and visceral obesity are associated with many other metabolic abnormalities that contribute to cardiovascular disease, including insulin resistance, glucose intolerance, hypertension, abnormal lipoprotein densities, and a prothrombotic state. In cross-sectional studies, smoking itself is associated with the deposition of visceral fat, or central adiposity, and smoking cessation is linked to further central adiposity. ADDIN EN.CITE Barrett-Connor19892686026862817625111101989Nov 15Cigarette smoking and increased central adiposity783-7University of California School of Medicine, La Jolla.Barrett-Connor, E.Khaw, K. T.Ann Intern MedAbdomenAdipose Tissue/*anatomy & histologyAgedAging/pathology*Body ConstitutionBody Mass IndexCross-Sectional StudiesFemaleHumanMaleMiddle AgedSex FactorsSmoking/*pathologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=281762561
Little is known regarding the progression of central adiposity and the development of the metabolic syndrome in cohorts of smokers and quitters who are followed prospectively, particularly for more than one year. Moreover, little is known about how these metabolic outcomes of cessation are related to individual differences (e.g., nicotine dependence) and other modifiable risk factors. Routine measurement of waist circumference at the iliac crest among smokers and quitters would provide information on the prospective risk of the metabolic syndrome. Among successful quitters, this risk can be assessed in the context of the beneficial metabolic effects associated with smoking cessation including improved glucose tolerance and lipid profile. ADDIN EN.CITE Stamford198626870268739629014341986AprEffects of smoking cessation on weight gain, metabolic rate, caloric consumption, and blood lipids486-94Stamford, B. A.Matter, S.Fell, R. D.Papanek, P.Am J Clin NutrAdipose TissueAdultAnalysis of Variance*Body WeightDietEnergy IntakeFemaleFollow-Up StudiesHumanLipoproteins, HDL Cholesterol/*bloodMenopauseMenstruationMiddle AgedOxygen Consumption*SmokingSupport, Non-U.S. Gov'tTime FactorsTriglycerides/bloodhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=396290159
Life After The Quit Attempt - Lifestyle
Physical activity & fitness. Cross-sectionally, both male and female smokers report lower levels of leisure-time physical activity and exercise compared to non-smokers. ADDIN EN.CITE Revicki199120480204818849312351991JulSmoking status and the practice of other unhealthy behaviors361-4Battelle Human Affairs Research Centers, Washington, D.C. 20024.Revicki, D.Sobal, J.DeForge, B.Fam MedAdultChi-Square DistributionDrinkingExerciseFeeding BehaviorFemale*Health BehaviorHumanMaleMiddle AgedSleep*Smokinghttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1884931French199620490204989739251561996NovSmoking status, dietary intake, and physical activity in a sample of working adults448-54Division of Epidemiology, School of Public Health University of Minnesota, Minneapolis 55454-1015, USA. french@epivax.epi.umn.eduFrench, S. A.Hennrikus, D. J.Jeffery, R. W.Health PsycholAdultCross-Sectional StudiesDiet Surveys*ExerciseFemaleFollow-Up Studies*Food HabitsHumanMaleOccupational Health ServicesPredictive Value of TestsSmoking/*psychologySmoking Cessation/psychologySupport, U.S. Gov't, P.H.S.Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8973925McTiernan19982050020509689203521998SummerPrevalence and correlates of recreational physical activity in women aged 50-64 years95-101Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington 98104, USA.McTiernan, A.Stanford, J. L.Daling, J. R.Voigt, L. F.MenopauseAge FactorsAlcohol Drinking/epidemiologyBody Mass IndexDietEducational StatusEmployment/statistics & numerical dataEstrogen Replacement Therapy/statistics & numerical data*ExerciseFemale*Health BehaviorHumanIncomeInterviews*Life StyleLogistic ModelsMiddle AgedObesity/epidemiologyOdds RatioPostmenopauseQuestionnaires*RecreationSmoking/epidemiologySupport, U.S. Gov't, P.H.S.TelephoneWashington*Women's Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9689203Britton200020510205111289687312-32000Characteristics associated with recent recreational exercise among women 20 to 44 years of age81-96Division of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY 10032, USA.Britton, J. A.Gammon, M. D.Kelsey, J. L.Brogan, D. J.Coates, R. J.Schoenberg, J. B.Potischman, N.Swanson, C. A.Stanford, J. L.Brinton, L. A.Women HealthAdultAge Distribution*Exercise/physiologyFemaleGeorgia/epidemiology*Health BehaviorHumanModels, StatisticalNew Jersey/epidemiologyQuestionnaires*Recreation/physiologySocioeconomic FactorsWashington/epidemiology*Women's Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1128968762-65 Former smokers typically have leisure-time activity levels closer to those of never smokers, than current smokers. ADDIN EN.CITE Britton200020510205111289687312-32000Characteristics associated with recent recreational exercise among women 20 to 44 years of age81-96Division of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY 10032, USA.Britton, J. A.Gammon, M. D.Kelsey, J. L.Brogan, D. J.Coates, R. J.Schoenberg, J. B.Potischman, N.Swanson, C. A.Stanford, J. L.Brinton, L. A.Women HealthAdultAge Distribution*Exercise/physiologyFemaleGeorgia/epidemiology*Health BehaviorHumanModels, StatisticalNew Jersey/epidemiologyQuestionnaires*Recreation/physiologySocioeconomic FactorsWashington/epidemiology*Women's Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11289687French199620490204989739251561996NovSmoking status, dietary intake, and physical activity in a sample of working adults448-54Division of Epidemiology, School of Public Health University of Minnesota, Minneapolis 55454-1015, USA. french@epivax.epi.umn.eduFrench, S. A.Hennrikus, D. J.Jeffery, R. W.Health PsycholAdultCross-Sectional StudiesDiet Surveys*ExerciseFemaleFollow-Up Studies*Food HabitsHumanMaleOccupational Health ServicesPredictive Value of TestsSmoking/*psychologySmoking Cessation/psychologySupport, U.S. Gov't, P.H.S.Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8973925Perkins199321800218082452746151993OctWeight gain following smoking cessation768-77Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pennsylvania 15213.Perkins, K. A.J Consult Clin PsycholAnimalsEnergy Metabolism/drug effects/physiologyHumanSmoking/*adverse effects/physiopathology/psychology*Smoking Cessation/psychologySubstance Withdrawal Syndrome/*physiopathology/psychologySupport, U.S. Gov't, P.H.S.Weight Gain/*drug effects/physiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=824527463,65,66 Conversely, current smokers tend to have higher levels of occupational activity, ADDIN EN.CITE Sternfeld1999205302053100727512831999MarPhysical activity patterns in a diverse population of women313-23Department of Epidemiology and Biostatistics, Division of Research, Kaiser Permanente Medical Care Program, 3505 Broadway, Oakland, California, 94611, USA. bxs@dor.kaiser.orgSternfeld, B.Ainsworth, B. E.Quesenberry, C. P.Prev MedAdultAge FactorsAgedBody Mass IndexCaliforniaCross-Sectional StudiesExercise/*psychologyFemale*Health Knowledge, Attitudes, PracticeHumanLeisure ActivitiesLogistic ModelsMiddle AgedMultivariate AnalysisOccupations/statistics & numerical dataQuestionnairesSocial SupportSupport, Non-U.S. Gov'tWomen/*education/*psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10072751French199620490204989739251561996NovSmoking status, dietary intake, and physical activity in a sample of working adults448-54Division of Epidemiology, School of Public Health University of Minnesota, Minneapolis 55454-1015, USA. french@epivax.epi.umn.eduFrench, S. A.Hennrikus, D. J.Jeffery, R. W.Health PsycholAdultCross-Sectional StudiesDiet Surveys*ExerciseFemaleFollow-Up Studies*Food HabitsHumanMaleOccupational Health ServicesPredictive Value of TestsSmoking/*psychologySmoking Cessation/psychologySupport, U.S. Gov't, P.H.S.Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=897392563,67 which may be due, in part, to socioeconomic status. Moreover, there is evidence that women who quit smoking adopt a more active lifestyle. ADDIN EN.CITE Perkins199320520205282233661251993SepDiet, alcohol, and physical activity as a function of smoking status in middle-aged women410-5Department of Psychiatry, University of Pittsburgh, Pennsylvania.Perkins, K. A.Rohay, J.Meilahn, E. N.Wing, R. R.Matthews, K. A.Kuller, L. H.Health PsycholAge Factors*Alcohol DrinkingAttitude to HealthBody Mass IndexComparative StudyCross-Sectional Studies*DietEnergy IntakeFemaleHuman*Leisure ActivitiesMiddle Aged*SmokingSupport, U.S. Gov't, P.H.S.*Womenhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=822336668 Additionally, even modest amounts of exercise appear to reduce post-quit weight gain ADDIN EN.CITE Kawachi199620540205486695258671996JulCan physical activity minimize weight gain in women after smoking cessation?999-1004Channing Laboratory, Harvard University, Boston, Mass. 02115-5899, USA.Kawachi, I.Troisi, R. J.Rotnitzky, A. G.Coakley, E. H.Colditz, G. A.Am J Public HealthAdultAgedDiet SurveysEnergy Metabolism*ExerciseFemaleHumanMiddle AgedNursesObesity/etiology/metabolism/*prevention & controlProspective StudiesQuestionnaires*Smoking CessationSupport, U.S. Gov't, P.H.S.Time FactorsUnited States*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=866952569 and enhance functional capacity. ADDIN EN.CITE Marcus199920560205610371231159111999Jun 14The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial1229-34Center for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University School of Medicine, Providence, RI 02906, USA.Marcus, B. H.Albrecht, A. E.King, T. K.Parisi, A. F.Pinto, B. M.Roberts, M.Niaura, R. S.Abrams, D. B.Arch Intern MedAdult*ExerciseFemaleHumanMiddle AgedSmoking Cessation/*methodsSupport, U.S. Gov't, P.H.S.Treatment Outcome*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1037123170 These findings suggest that modest amounts of exercise may mitigate potential adverse effects of cessation. Collectively, they suggest that physical activity co-varies with smoking status, and that exercise may be beneficial, at least in women, during quit attempts. Lacking is similar data in men, as well as an understanding of the mechanism by which activity, cessation, and physiological processes lead to vital health outcomes.
Cardiorespiratory fitness is lower in smokers than in non-smokers. ADDIN EN.CITE McHenry1977206002060McHenry, P. L.Faris, J. V.Jordan, J. W.Morris, S. N.1977Comparative study of cardiovascular function and ventricular premature complexes in smokers and nonsmokers during maximal treadmill exerciseAmerican Journal of Cardiology394493-498Apr848432AdultAge FactorsArrhythmia/*etiologyBlood PressureBody WeightExercise Test*ExertionHeart/*physiopathologyHeart RateHumanMaleMiddle AgedPhysical EnduranceSmoking/*physiopathologySupport, U.S. Gov't, Non-P.H.S.Support, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=848432Leon1981206102061Leon, A. S.Jacobs, D. R., Jr.DeBacker, G.Taylor, H. L.1981Relationship of physical characteristics and life habits to treadmill exercise capacityAmerican Journal of Epidemiology1136653-660Jun7234853AdultAnthropometry*Disability EvaluationExercise TestHuman*Life StyleMaleMiddle AgedOxygenSmokingSupport, U.S. Gov't, P.H.S.*Work Capacity Evaluationhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7234853Lochan1992206502065Lochan, ML, Rasmussen, K1992The Tromso study: Physical fitness, self reported phusical activity, and their relationship to other coronary risk factorsJournal of Epidemiology and Community Health46103-107Conway1992206202062Conway, T. L.Cronan, T. A.1992Smoking, exercise, and physical fitnessPreventive Medicine216723-734Nov1438118AdolescentAdultBody Composition*ExerciseFemaleHealth SurveysHumanMaleMiddle AgedMilitary Personnel/*statistics & numerical data*Physical FitnessRegression AnalysisSmoking/*adverse effects/epidemiologySupport, U.S. Gov't, Non-P.H.S.United States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1438118Health Sciences and Epidemiology Department, Naval Health Research Center, San Diego, California 92186-5122.Sandvik1995206302063Sandvik, L.Erikssen, G.Thaulow, E.1995Long term effects of smoking on physical fitness and lung function: a longitudinal study of 1393 middle aged Norwegian men for seven yearsBritish Medcial Journal3117007715-718Sep 167549684AdultExercise TestForced Expiratory VolumeHumanLongitudinal StudiesLung/*physiopathologyMaleMiddle AgedMultivariate AnalysisNorwayPhysical Fitness/*physiologyProspective StudiesSmoking/*physiopathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7549684Department of Medicine, Central Hospital of Akershus, Norway.Sidney1992206402064Sidney, S.Haskell, W. L.Crow, R.Sternfeld, B.Oberman, A.Armstrong, M. A.Cutter, G. R.Jacobs, D. R.Savage, P. J.Van Horn, L.1992Symptom-limited graded treadmill exercise testing in young adults in the CARDIA studyMedicine and Science in Sports and Exercise242177-183Feb1549006AdolescentAdultAge FactorsBlood PressureContinental Population GroupsCoronary Disease/*prevention & control*Exercise TestFemaleForced Expiratory VolumeHeart RateHumanMaleRegression AnalysisRisk FactorsSex FactorsSmoking/physiopathologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1549006Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94611.71-76 This association is mediated by acute and chronic physiological effects of smoking and a tendency for smokers to be less physically active than non-smokers. However, smokings impact on fitness cannot be explained completely by differences in physical activity. Longitudinal data suggest that cardiorespiratory fitness recovers following cessation, and that recovery is greater among men than among women. ADDIN EN.CITE Albrecht1998219102191Albrecht, A. E.Marcus, B. H.Roberts, M.Forman, D. E.Parisi, A. F.1998Effect of smoking cessation on exercise performance in female smokers participating in exercise trainingAmerican Journal of Cardiology828950-95Oct 159794350AdultBehavior TherapyExercise Test*Exercise Therapy*Exercise ToleranceFemaleHumanMiddle AgedOxygen ConsumptionProspective StudiesSmoking/*physiopathology*Smoking CessationSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9794350Center for Behavioral and Preventive Medicine and Division of Cardiology, The Miriam Hospital and Brown University School of Medicine, Providence, Rhode Island 02906, USA.Sandvik1995206302063Sandvik, L.Erikssen, G.Thaulow, E.1995Long term effects of smoking on physical fitness and lung function: a longitudinal study of 1393 middle aged Norwegian men for seven yearsBritish Medcial Journal3117007715-718Sep 167549684AdultExercise TestForced Expiratory VolumeHumanLongitudinal StudiesLung/*physiopathologyMaleMiddle AgedMultivariate AnalysisNorwayPhysical Fitness/*physiologyProspective StudiesSmoking/*physiopathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7549684Department of Medicine, Central Hospital of Akershus, Norway.75,77 Chronotropic incompetence, or an attenuated heart rate response to exercise, also has been associated with smoking among otherwise healthy adults ADDIN EN.CITE Lauer199721920219292644989631997Aug 5Association of cigarette smoking with chronotropic incompetence and prognosis in the Framingham Heart Study897-903Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA. lauerm@cesmtp.ccf.orgLauer, M. S.Pashkow, F. J.Larson, M. G.Levy, D.CirculationAdultCohort StudiesCoronary Disease/epidemiology/mortality*ExertionFemale*Heart RateHumanIncidenceMaleMiddle AgedMultivariate AnalysisPrognosisSex Characteristics*SmokingSurvival Analysishttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9264498Gordon1987219302193Gordon, D. J.Leon, A. S.Ekelund, L. G.Sopko, G.Probstfield, J. L.Rubenstein, C.Sheffield, L. T.1987Smoking, physical activity, and other predictors of endurance and heart rate response to exercise in asymptomatic hypercholesterolemic men. The Lipid Research Clinics Coronary Primary Prevention TrialAmerican Journal of Epidemiology1254587-600Apr3826039AdultBlood PressureCholesterol/bloodCoronary Disease/*etiology/prevention & controlExercise Test*ExertionHeart RateHumanHypercholesterolemia/*etiology/prevention & controlMaleMiddle Aged*Physical EnduranceRisk*SmokingSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3826039Srivastava2000219402194Srivastava, R.Blackstone, E. H.Lauer, M. S.2000Association of smoking with abnormal exercise heart rate responses and long-term prognosis in a healthy, population-based cohortAmerican Journal of Medicine109120-26Jul10936474AdultCanada/epidemiologyCardiovascular Diseases/*epidemiology/etiology/physiopathologyCircadian Rhythm/*physiologyComparative StudyElectrocardiography*ExerciseExercise TestFemaleFollow-Up StudiesHeart Rate/*physiologyHumanIncidenceMaleMiddle AgedPrognosisReference ValuesRetrospective StudiesRisk FactorsSmoking/*adverse effects/epidemiology/physiopathologySupport, Non-U.S. Gov'tSurvival RateUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10936474Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.78-80 and may identify smokers with a particularly high mortality rate. ADDIN EN.CITE Srivastava2000219402194Srivastava, R.Blackstone, E. H.Lauer, M. S.2000Association of smoking with abnormal exercise heart rate responses and long-term prognosis in a healthy, population-based cohortAmerican Journal of Medicine109120-26Jul10936474AdultCanada/epidemiologyCardiovascular Diseases/*epidemiology/etiology/physiopathologyCircadian Rhythm/*physiologyComparative StudyElectrocardiography*ExerciseExercise TestFemaleFollow-Up StudiesHeart Rate/*physiologyHumanIncidenceMaleMiddle AgedPrognosisReference ValuesRetrospective StudiesRisk FactorsSmoking/*adverse effects/epidemiology/physiopathologySupport, Non-U.S. Gov'tSurvival RateUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10936474Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.80 Blunted heart rate responses have also been identified in young adult smokers undergoing symptom-limited exercise testing/ ADDIN EN.CITE Sidney1993219502195Sidney, S.Sternfeld, B.Gidding, S. S.Jacobs, D. R., Jr.Bild, D. E.Oberman, A.Haskell, W. L.Crow, R. S.Gardin, J. M.1993Cigarette smoking and submaximal exercise test duration in a biracial population of young adults: The CARDIA studyMedicine and Science in Sports and Exercise258911-916Aug8371651AdolescentAdultAfrican Continental Ancestry GroupBody Mass IndexCotinine/bloodEuropean Continental Ancestry GroupExercise TestExercise Tolerance/*physiologyExertion/*physiologyFemaleForced Expiratory Volume/physiologyHeart Rate/physiologyHemoglobins/analysisHumanMalePhysical Fitness/physiologySex FactorsSkinfold ThicknessSmoking/*physiopathologySupport, U.S. Gov't, P.H.S.Time FactorsWorkloadhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8371651Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94611.81 Thus, smoking and smoking cessation appear to be significantly related to physical activity and cardiovascular fitness, but the potentially complex interplay of smoking/cessation, weight gain, physical activity, and fitness has not been characterized.
Diet. Diet may be influenced by smoking and smoking cessation and may serve as an explanatory variable for other outcomes associated with cessation, such as changes in blood lipids, glucose control, endothelial dysfunction, and Carotid IMT. Much research has assessed the short-term effects of smoking cessation on diet, ADDIN EN.CITE Perkins199226810268115549968721992FebEffects of tobacco smoking on caloric intake193-205Western Psychiatric Institute & Clinic, University of Pittsburgh School of Medicine, PA 15213.Perkins, K. A.Br J Addict*Energy IntakeFollow-Up StudiesHumanSmoking/*psychologySmoking Cessation/*psychologySupport, U.S. Gov't, P.H.S.*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1554996Hall198926820268229259775711989FebChanges in food intake and activity after quitting smoking81-6Hall, S. M.McGee, R.Tunstall, C.Duffy, J.Benowitz, N.J Consult Clin PsycholAdult*Energy IntakeFemaleFollow-Up StudiesFood HabitsHumanMaleSmoking/psychology/*therapySupport, U.S. Gov't, P.H.S.Taste*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=292597782,83 however, most such data are limited to 6 months post-quit. It is unclear whether there are long-term impacts of quitting on diet, and how quitting and diet operate together to influence health endpoints. While short-term dietary effects may reflect body weight set-point perturbations, ADDIN EN.CITE Perkins199226810268115549968721992FebEffects of tobacco smoking on caloric intake193-205Western Psychiatric Institute & Clinic, University of Pittsburgh School of Medicine, PA 15213.Perkins, K. A.Br J Addict*Energy IntakeFollow-Up StudiesHumanSmoking/*psychologySmoking Cessation/*psychologySupport, U.S. Gov't, P.H.S.*Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=155499682 long-term effects could reflect changes in response to weight gain or greater health consciousness among quitters.
Life After The Quit Attempt - Psychosocial Status
Psychiatric symptoms & comorbidity. The evidence is compelling that smokers have higher rates of psychiatric comorbidities than do nonsmokers. Data show that psychiatric disorders such as depression, anxiety disorders, and antisocial personality disorder are more prevalent among smokers than nonsmokers. ADDIN EN.CITE Breslau19991992019921059129256121999DecSmoking and panic attacks: an epidemiologic investigation1141-7Department of Psychiatry, Henry Ford Health System, Detroit, Mich 48202-3450, USA. nbresla1@hfhs.orgBreslau, N.Klein, D. F.Arch Gen PsychiatryAdultAlcohol Drinking/epidemiologyComorbidityComparative StudyEpidemiologic StudiesFemaleHealth SurveysHumanLung Diseases/epidemiologyMaleMichigan/epidemiologyPanic Disorder/diagnosis/*epidemiology/etiologyPrevalenceProportional Hazards ModelsPsychiatric Status Rating Scales/statistics & numerical dataRandom AllocationRisk FactorsSmoking/*epidemiologySmoking Cessation/statistics & numerical dataSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10591292Johnson20002730273Johnson, J. G.Cohen, P.Pine, D. S.Klein, D. F.Kasen, S.Brook, J. S.2000Association between cigarette smoking and anxiety disorders during adolescence and early adulthoodJAMA284182348-51Nov 811066185AdolescentAdultAnxiety Disorders/diagnosis/epidemiology/*etiologyConfidence IntervalsFemaleHumanLongitudinal StudiesMaleOdds RatioRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11066185Box 60, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA. jjohnso@pi.cpmc.columbia.eduJorm1999199601996103881662331999JunAssociation between smoking and mental disorders: results from an Australian National Prevalence Survey245-8NHMRC Psychiatric Epidemiology Research Centre, Australian National University, Canberra, ACT. Anthony.Jorm@anu.edu.auJorm, A. F.Aust N Z J Public HealthAdultAustralia/epidemiologyFemaleHumanMaleMental Disorders/*epidemiologyMiddle AgedPrevalenceSmoking/*epidemiology/psychologySupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10388166Lasser2000173401734Lasser, K.Boyd, J. W.Woolhandler, S.Himmelstein, D. U.McCormick, D.Bor, D. H.2000Smoking and mental illness: A population-based prevalence studyJAMA284202606-10Nov 22-2911086367AdolescentAdultComorbidityFemaleHumanLogistic ModelsMaleMental Disorders/*epidemiologyMiddle AgePopulation SurveillancePrevalenceSmoking/*epidemiologySmoking Cessation/*statistics & numerical dataSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.United States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11086367Department of Medicine, Cambridge Hospital, Macht Bldg, 1493 Cambridge St, Cambridge, MA 02139, USA. klasser@massmed.org84-87 However, many unanswered questions remain about this association. For instance, does quitting smoking reduce or increase the likelihood that a person will experience a psychiatric disorder over the long-term?
Some data suggest that quitting can exacerbate psychiatric comorbidities. About 5-7% of smokers experience a new bout of depression within a few months of a quit attempt. ADDIN EN.CITE Borrelli19962380238Borrelli, B.Abrams, DB.Niaura, R.Keuthen, NJ.Goldstein, MG.DePue, JD.Murphy, C.1996Development of major depressive disorder during smoking-cessation treatmentJournal of Clinical Psychiatry5711534-538Novdepressive disordermajor depressive disordersmoking cessationtreatmentCovey1997202402024901627915421997FebMajor depression following smoking cessation263-5Department of Psychiatry, College of Physicians and Surgeons, Columbia, University, New York, NY, USA.Covey, L. S.Glassman, A. H.Stetner, F.Am J PsychiatryDepressive Disorder/diagnosis/epidemiology/*etiologyFemaleFollow-Up StudiesHumanIncidenceMaleMiddle AgedNicotine/adverse effectsOdds RatioPersonality InventoryRecurrence*Smoking CessationSubstance Withdrawal Syndrome/epidemiology/*etiologySupport, U.S. Gov't, P.H.S.Tobacco Use Disorder/rehabilitationhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9016279Killen2003111101111Killen, J. D.Fortmann, S. P.Schatzberg, A.Hayward, C.Varady, A.2003Onset of major depression during treatment for nicotine dependenceAddictive Behaviors283461-70Apr12628619depression, nicotine dependence, major depression, treatment, cessationhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12628619Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1000 Welch Road, Palo Alto, CA 94304, USA. jkillen@stanford.eduTsoh20003190319Tsoh,J.YHumfleet,G.LMunoz,R.FReus,V.IHartz,D.THall,S.M2000Development of major depression after treatment for smoking cessationThe American Journal of Psychiatry1573368-374Marcessationdepressionsmokingsmoking cessationtreatmentabstinencewomennicotinenortriptylinerisk88-91 This is a high rate of depression considering the short timeframe (and a major depression new-incidence over 12 months of about 1-3%. ADDIN EN.CITE Eaton1997280502805936665554111997NovNatural history of Diagnostic Interview Schedule/DSM-IV major depression. The Baltimore Epidemiologic Catchment Area follow-up993-9Department of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Md., USA.Eaton, W. W.Anthony, J. C.Gallo, J.Cai, G.Tien, A.Romanoski, A.Lyketsos, C.Chen, L. S.Arch Gen PsychiatryAdolescentAdultAge DistributionAge of OnsetAgedBaltimore/epidemiologyCatchment Area (Health)Depressive Disorder/*diagnosis/epidemiologyFemaleFollow-Up StudiesHumanIncidenceMaleMiddle AgedPrevalenceProportional Hazards ModelsPsychiatric Status Rating Scales/*statistics & numerical dataRecurrenceSex FactorsSupport, U.S. Gov't, P.H.S.Survival Analysishttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9366655Regier199328650286584275585021993FebThe de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services85-94Division of Epidemiology and Services Research, National Institute of Mental Health, National Institutes of Health, Rockville, Md.Regier, D. A.Narrow, W. E.Rae, D. S.Manderscheid, R. W.Locke, B. Z.Goodwin, F. K.Arch Gen PsychiatryAdolescentAdultAge FactorsAgedAmbulatory CareCatchment Area (Health)Delivery of Health Care/statistics & numerical dataFemaleHealth PolicyHospitalizationHumanIncidenceMaleMental Disorders/*epidemiology/therapyMental Health Services/*utilizationMiddle AgedNational Health ProgramsPatient Acceptance of Health CarePrevalenceProspective StudiesRecurrenceSelf-Help Groups/utilizationSocial SupportSubstance-Related Disorders/*epidemiology/therapyUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=842755892,93 Other data suggest that psychiatric symptoms and comorbidities may decline due to cessation. For instance, some cross-sectional studies ADDIN EN.CITE Mulder200186086Mulder,I.Tijhuis,M.Smit,H.A.Kromhout,D.2001Smoking cessation and quality of life: The effect of amount of smoking and time since quittingPreventive Medicine336653-660cessation, mental health, quality of life, smoking status, smoking, womenTillmann199720130201393474491931997SepA comparison of smokers' and ex-smokers' health-related quality of life268-73Postgraduate Studies in Pharmaceutical Technology, University of Bradford, UK.Tillmann, M.Silcock, J.J Public Health MedAdultAgedAged, 80 and overFemale*Health StatusHumanMaleMiddle Aged*Quality of LifeRegression AnalysisRespiration Disorders/epidemiologyScotland/epidemiologySmoking/adverse effects/epidemiology*Smoking CessationSocioeconomic FactorsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9347449Stewart1995207102071Stewart, A. L., King, A. C., Killen, J. D., & Ritter, P.L.1995Does smoking cessation improve health-related quality of life?Annals of Behavioral Medicine17331-33894-96 have found that cessation is related to improved perceptions of mental health and mental health quality of life. In a rare longitudinal study in this area, Mino et al. ADDIN EN.CITE Mino2000201102011108038115422000AprDoes smoking cessation improve mental health?169-72Department of Hygiene and Preventive Medicine, Okayama University Medical School, Japan. yoshmino@med.okayama-u.ac.jpMino, Y.Shigemi, J.Otsu, T.Tsuda, T.Babazono, A.Psychiatry Clin NeurosciAdultCohort StudiesHumanJapanMale*Mental HealthMiddle AgedPersonality Inventory/statistics & numerical dataPsychometricsSmoking/adverse effects/psychologySmoking Cessation/*psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1080381197 found sizable decreases in psychiatric symptoms over 1 year in a very small sample of quitters (n = 18).
Perhaps quitting has been associated with both decreases and increases in symptoms because cessation produces both an initial increase in symptoms, and also a subsequent and sustained decline. Also, it may be that different outcomes are found in different subgroups of individuals (e.g., those with a prior history of depression. ADDIN EN.CITE Borrelli19962380238Borrelli, B.Abrams, DB.Niaura, R.Keuthen, NJ.Goldstein, MG.DePue, JD.Murphy, C.1996Development of major depressive disorder during smoking-cessation treatmentJournal of Clinical Psychiatry5711534-538Novdepressive disordermajor depressive disordersmoking cessationtreatmentTsoh20003190319Tsoh,J.YHumfleet,G.LMunoz,R.FReus,V.IHartz,D.THall,S.M2000Development of major depression after treatment for smoking cessationThe American Journal of Psychiatry1573368-374Marcessationdepressionsmokingsmoking cessationtreatmentabstinencewomennicotinenortriptylinerisk88,91 Only a large sample longitudinal study that collects diagnostic information as well as broader mental health information, both before and after cessation, will be able to address adequately the mental health consequences of quitting and failing to quit. Further knowledge gaps include little evidence on the long-term impact of quit attempts on psychiatric comorbidities/symptoms other than depression (e.g., anxiety symptoms; although cf. Breslau ADDIN EN.CITE Breslau19952170217Breslau,N1995Psychiatric comorbidity of smoking and nicotine dependenceBehavior Genetics25295-1011995comorbiditynicotinesmokingpsychiatric disordersadultsalcoholdepressionanxiety98) and whether mental health outcomes associated with quitting reflect quitting per se versus other changes associated with quitting (e.g., physical health status, alcohol consumption).
Alcohol use. There is a well-documented dose-response relation between smoking and drinking: heavy smoking is associated with heavy drinking. ADDIN EN.CITE Batel19952010201Batel,PPessione,FMaitre,CRueff,B1995Relationship between alcohol and tobacco dependencies among alcoholics who smokeAddiction90977-9801995alcoholalcoholicstobaccosmokingnicotinetobacco dependenceBurling19882230223Tobacco smoking: a comparison between alcohol and drug abuse inpatientsBurling,T.A.Ziff,DC19881988abusealcoholinpatientsmokingtobaccocigarettesnicotine185-190Addictive Behaviors132McClure2002163001630McClure, J. B.Wetter, D. W.de Moor, C.Cinciripini, P. M.Gritz, E. R.2002The relation between alcohol consumption and smoking abstinence: Results from the Working Well TrialAddictive Behaviors273367-79May-Jun12125663AdultAlcohol Drinking/*epidemiologyCommunity Mental Health ServicesFemaleFollow-Up StudiesHealth BehaviorHumanMaleSmoking/epidemiologySmoking Cessation/*statistics & numerical dataSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12125663Group Health Cooperative, Center for Health Studies, Seattle, WA 98101, USA. mcclure.j@ghc.org99-101 In fact, while only 10% or less of the general population qualifies for the diagnosis of alcohol abuse or dependence, the figure stands at 30% among smokers. ADDIN EN.CITE Miller199820190201995496031711998Comorbid cigarette and alcohol addiction: epidemiology and treatment55-66Department of Psychiatry, University of Illinois at Chicago 60612, USA.Miller, N. S.Gold, M. S.J Addict DisComorbidityDepressive Disorder/*epidemiologyHumanPrevalenceRisk FactorsSmoking/*epidemiologySmoking Cessation/methods/psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9549603102 There is also evidence that alcohol use may interfere with the ability to quit smoking or stay quit. For instance, heavy drinkers are less likely to try to quit smoking and are less successful when they do try. ADDIN EN.CITE Breslau1996188501885Breslau, N.Peterson, E.Schultz, L.Andreski, P.Chilcoat, H.1996Are smokers with alcohol disorders less likely to quit?American Journal of Public Health867985-90Jul8669523AdultAlcoholism/epidemiology/*psychologyFemaleHealth Maintenance OrganizationsHumanIncidenceMaleMichigan/epidemiologyOdds RatioProportional Hazards ModelsRecurrenceRisk FactorsSmoking Cessation/*psychology/statistics & numerical dataSupport, U.S. Gov't, P.H.S.Survival Analysishttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8669523Department of Psychiatry, Henry Ford Health Sciences Center, Detroit, Mich 48202, USA.103 In general, cross-sectional data suggest a strong link between smoking and drinking. ADDIN EN.CITE McClure2002163001630McClure, J. B.Wetter, D. W.de Moor, C.Cinciripini, P. M.Gritz, E. R.2002The relation between alcohol consumption and smoking abstinence: Results from the Working Well TrialAddictive Behaviors273367-79May-Jun12125663AdultAlcohol Drinking/*epidemiologyCommunity Mental Health ServicesFemaleFollow-Up StudiesHealth BehaviorHumanMaleSmoking/epidemiologySmoking Cessation/*statistics & numerical dataSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12125663Group Health Cooperative, Center for Health Studies, Seattle, WA 98101, USA. mcclure.j@ghc.orgJohn2003183801838John, U.Hanke, M.2003Tobacco-smoking prevalence among physicians and nurses in countries with different tobacco-control activitiesEuropean Journal of Cancer Prevention123235-7Jun12771563http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12771563Ernst-Moritz-Arndt University, Medical Faculty, Institute of Epidemiology and Social Medicine, Greifswald, Germany. ujohn@uni-greifswald.de101,104 There are also data suggesting linkages between the two behaviors within individuals, across time. ADDIN EN.CITE Carmelli19932683026838400834521993The relationship between quitting smoking and changes in drinking in World War II veteran twins103-16Health Sciences Program, SRI International, Menlo Park, CA 94025.Carmelli, D.Swan, G. E.Robinette, D.J Subst AbuseAdultAlcohol Drinking/*epidemiology/genetics/psychologyAlcoholism/*epidemiology/genetics/rehabilitationCohort StudiesComorbidityCross-Sectional StudiesDiseases in TwinsFollow-Up StudiesHumanIncidenceMaleMiddle AgedNicotine/adverse effectsSmoking Cessation/psychology/*statistics & numerical dataSubstance Withdrawal Syndrome/epidemiology/genetics/rehabilitationSupport, U.S. Gov't, P.H.S.Veterans/psychology/*statistics & numerical datahttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8400834Murray199526840268477526375611995JanLevel of involvement with alcohol and success at smoking cessation in the lung health study74-82Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.Murray, R. P.Istvan, J. A.Voelker, H. T.Rigdon, M. A.Wallace, M. D.J Stud AlcoholAdultAlcohol Drinking/*adverse effects/psychologyCombined Modality TherapyFemaleFollow-Up StudiesHumanIpratropium/administration & dosageLung Diseases, Obstructive/rehabilitationMaleMiddle AgedPatient Compliance/psychologyRecurrenceSmoking Cessation/*psychologySupport, U.S. Gov't, P.H.S.Treatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7752637105,106 However, conflicting data show little relation across time between cessation of one substance and intake of the other. ADDIN EN.CITE Keenan1990188001880Keenan, R. M.Hatsukami, D. K.Pickens, R. W.Gust, S. W.Strelow, L. J.1990The relationship between chronic ethanol exposure and cigarette smoking in the laboratory and the natural environmentPsychopharmacology100177-832296630AdultAgedAlcoholism/*psychologyDrug InteractionsEnvironmentEthanol/*pharmacologyFemaleHumanMaleMiddle AgedSmoking/*psychologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=2296630Department of Psychiatry, University of Minesota Medical School, Minneapolis 55455.Maletsky1974207202072Maletsky, B. M., & Klotter, J.1974Smoking and alcoholismAmerican Journal of Psychiatry131445-447Murray2002187401874Murray, R. P.Cribbie, R. A.Istvan, J. A.Barnes, G. E.2002Longitudinal analysis of the relationship between changes in smoking and changes in drinking in a community sample: The Winnipeg Health and Drinking SurveyHealth Psychology213237-43May12027029AdolescentAdultAgedAlcohol Drinking/*epidemiologyCanada/epidemiologyCatchment Area (Health)FemaleFollow-Up StudiesHumanMaleMiddle Aged*QuestionnairesResidence CharacteristicsSmoking/*epidemiologySupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12027029Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada. rmurray@hsc.mb.caNothwehr1995187901879Nothwehr, F.Lando, H. A.Bobo, J. K.1995Alcohol and tobacco use in the Minnesota Heart Health ProgramAddictive Behaviors204463-70Jul-Aug7484327AdultAgedAlcohol Drinking/adverse effects/*epidemiologyCohort StudiesCoronary Disease/*prevention & controlCross-Sectional StudiesFemaleFollow-Up StudiesHealth EducationHumanMaleMiddle AgedMinnesota/epidemiologyRisk FactorsSmoking/adverse effects/*epidemiologySmoking CessationSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7484327Department of Health Behavior and Health Education, University of Michigan, Ann Arbor 48109-2029, USA.Carmelli19932683026838400834521993The relationship between quitting smoking and changes in drinking in World War II veteran twins103-16Health Sciences Program, SRI International, Menlo Park, CA 94025.Carmelli, D.Swan, G. E.Robinette, D.J Subst AbuseAdultAlcohol Drinking/*epidemiology/genetics/psychologyAlcoholism/*epidemiology/genetics/rehabilitationCohort StudiesComorbidityCross-Sectional StudiesDiseases in TwinsFollow-Up StudiesHumanIncidenceMaleMiddle AgedNicotine/adverse effectsSmoking Cessation/psychology/*statistics & numerical dataSubstance Withdrawal Syndrome/epidemiology/genetics/rehabilitationSupport, U.S. Gov't, P.H.S.Veterans/psychology/*statistics & numerical datahttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8400834Murray199526840268477526375611995JanLevel of involvement with alcohol and success at smoking cessation in the lung health study74-82Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.Murray, R. P.Istvan, J. A.Voelker, H. T.Rigdon, M. A.Wallace, M. D.J Stud AlcoholAdultAlcohol Drinking/*adverse effects/psychologyCombined Modality TherapyFemaleFollow-Up StudiesHumanIpratropium/administration & dosageLung Diseases, Obstructive/rehabilitationMaleMiddle AgedPatient Compliance/psychologyRecurrenceSmoking Cessation/*psychologySupport, U.S. Gov't, P.H.S.Treatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7752637105-110
The relation between drinking and smoking remains unclear for a variety of reasons. For instance, smoking status was not biochemically confirmed in many relevant studies. In addition, drinking measures often do not target heavy drinking, problems from drinking, or formal diagnoses of abuse and dependence. Finally, as McClure et al. ADDIN EN.CITE McClure2002163001630McClure, J. B.Wetter, D. W.de Moor, C.Cinciripini, P. M.Gritz, E. R.2002The relation between alcohol consumption and smoking abstinence: Results from the Working Well TrialAddictive Behaviors273367-79May-Jun12125663AdultAlcohol Drinking/*epidemiologyCommunity Mental Health ServicesFemaleFollow-Up StudiesHealth BehaviorHumanMaleSmoking/epidemiologySmoking Cessation/*statistics & numerical dataSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12125663Group Health Cooperative, Center for Health Studies, Seattle, WA 98101, USA. mcclure.j@ghc.org101 acknowledged, in some of the studies, the retrospective nature of some of the measures, makes it unclear whether quitting smoking precedes a decrease in drinking, or vice versa. In addition, some studies comprise very few data points and a small number of quitters. ADDIN EN.CITE Murray2002187401874Murray, R. P.Cribbie, R. A.Istvan, J. A.Barnes, G. E.2002Longitudinal analysis of the relationship between changes in smoking and changes in drinking in a community sample: The Winnipeg Health and Drinking SurveyHealth Psychology213237-43May12027029AdolescentAdultAgedAlcohol Drinking/*epidemiologyCanada/epidemiologyCatchment Area (Health)FemaleFollow-Up StudiesHumanMaleMiddle Aged*QuestionnairesResidence CharacteristicsSmoking/*epidemiologySupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12027029Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada. rmurray@hsc.mb.ca109 Moreover, if smoking and drinking are highly correlated across people, but not across time within the same person, ADDIN EN.CITE Murray2002187401874Murray, R. P.Cribbie, R. A.Istvan, J. A.Barnes, G. E.2002Longitudinal analysis of the relationship between changes in smoking and changes in drinking in a community sample: The Winnipeg Health and Drinking SurveyHealth Psychology213237-43May12027029AdolescentAdultAgedAlcohol Drinking/*epidemiologyCanada/epidemiologyCatchment Area (Health)FemaleFollow-Up StudiesHumanMaleMiddle Aged*QuestionnairesResidence CharacteristicsSmoking/*epidemiologySupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12027029Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada. rmurray@hsc.mb.ca109 it is likely that the association is produced by common risk factors such as genes or personality factors (e.g., behavioral undercontrol; ADDIN EN.CITE Slutske20022728027281187137711112002FebPersonality and the genetic risk for alcohol dependence124-33Department of Psychological Sciences and Missouri Alcoholism Research Center, University of Missouri--Columbia, 65211, USA. SlutskeW@missouri.eduSlutske, W. S.Heath, A. C.Madden, P. A.Bucholz, K. K.Statham, D. J.Martin, N. G.J Abnorm PsycholAdultAgedAged, 80 and overAlcoholism/*geneticsFemaleHumanMaleMiddle AgedPersonality Disorders/*diagnosis/epidemiology/psychologyPersonality InventoryRisk FactorsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Twins/genetics/psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11871377111 also see Bierut et al. ADDIN EN.CITE Bierut200427460274614679582124A12004Jan 1A genomic scan for habitual smoking in families of alcoholics: common and specific genetic factors in substance dependence19-27School of Medicine, Washington University School of Medicine, 4940 Children's Place, St. Louis, MO 63110, USA. bierutl@psychiatry.wustl.eduBierut, L. J.Rice, J. P.Goate, A.Hinrichs, A. L.Saccone, N. L.Foroud, T.Edenberg, H. J.Cloninger, C. R.Begleiter, H.Conneally, P. M.Crowe, R. R.Hesselbrock, V.Li, T. K.Nurnberger, J. I., Jr.Porjesz, B.Schuckit, M. A.Reich, T.Am J Med Genethttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14679582112 for evidence of a common genetic diathesis). The proposed research would provide an ideal opportunity to explore such common risk factors. There is a need for high quality longitudinal data that can further clarify how and why these two behaviors are interrelated, and how they contribute to other important health outcomes (e.g., health QOL, mental health outcomes).
Social relationships. Relatively little is known about how quitting smoking affects social relationships (e.g., marital satisfaction, or satisfaction with, or structure of, a persons social network ADDIN EN.CITE Franks200242042Franks, M. M.Pienta, A. M.Wray, L. A.2002It takes two: Marriage and smoking cessation in the middle yearsJournal of Aging and Health143336-54Aug12146510FemaleHealth BehaviorHumanMale*Marital StatusMarriageMiddle Age*Smoking Cessation/methods/psychology*Social Support*Spouses/psychologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12146510Wayne State University, Detroit, MI, USA. m.m.franks@wayne.edu113). For example, it is not known whether quitting smoking changes the nature of social networks or satisfaction with such networks. Does quitting, in fact, cause smokers to lose smoking friends, or does a smokers quitting cause friends to be more likely to quit themselves? An important and related question is whether cessation has long-lasting effects on marital/partner relationships. To the extent that quitting affects mental health status (or stress level) it may indirectly affect marital/partner relationships. Also, while it is clear that having a smoking spouse makes it more likely that a person will relapse, it is unclear whether one spouse successfully quitting increases the likelihood that his/her partner will quit. Finally, it is important to assess social relationship factors because they can play such a strong role in influencing risk and progression for other disorders. For instance, supportive relationships such as marriage are associated with longer life and less severe disease. ADDIN EN.CITE Burman1992199401994152903911211992JulAnalysis of the association between marital relationships and health problems: an interactional perspective39-63School of Social Welfare, University of California, Los Angeles 90024-1452.Burman, B.Margolin, G.Psychol BullFemale*Health StatusHumanMale*Marriage/psychologyModels, PsychologicalRisk FactorsSocial SupportStress, PsychologicalSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1529039Coyne1994273202732Coyne, J. C., Smith, D.A. F.1994Couples coping with a myocardialo infarction: contextual perspective on self-efficacyJournal of Family Psychology81-13Ross1990225202252Ross, C.EMirowsky, JGoldsteen, K1990The impact of the family on health: The decade in reviewJournal of Marriage and the Family521059-1078114-116 Many of these questions can be best addressed through a prospective study of social networks.
Stress. Some information shows that although smokers report more stress than nonsmokers, their stress levels fall once they quit smoking. ADDIN EN.CITE Chassin2002202802028122115102152002SepLong-term psychological sequelae of smoking cessation and relapse438-43Department of Psychology, Arizona State University, Tempe 85287-1104, USA. laurie.chassin@asu.eduChassin, L.Presson, C. C.Sherman, S. J.Kim, K.Health PsycholAdultAffective Symptoms/*psychology*Attitude to HealthFemaleHumanInternal-External ControlLongitudinal StudiesMaleMotivationRecurrenceSmoking/*psychologySmoking Cessation/*psychologyStress, Psychological/*complications/psychologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12211510Cohen19901997019972373070941990Perceived stress, quitting smoking, and smoking relapse466-78Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213-3890.Cohen, S.Lichtenstein, E.Health PsycholAdultFemaleFollow-Up StudiesHumanMalePersonality TestsRecurrenceRisk FactorsSmoking/prevention & control/*psychologyStress, Psychological/*complicationsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=2373070117,118 Chassin et al. ADDIN EN.CITE Chassin2000274702747108687661932000MayThe natural history of cigarette smoking from adolescence to adulthood in a midwestern community sample: multiple trajectories and their psychosocial correlates223-31Department of Psychology, Arizona State University, Tempe 85287-1104, USA. laurie.chassin@asu.eduChassin, L.Presson, C. C.Pitts, S. C.Sherman, S. J.Health PsycholAdolescent*Adolescent BehaviorAdultChildCohort StudiesFemaleForecastingHumanInterpersonal RelationsMaleSmoking/*psychologySocial ConditionsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10868766119 examined self-reports of stress among those who successfully quit smoking (n = 88) in a cohort study. In comparison to continuing smokers, quitters showed decreased stress from pre- to post-quit. Cessation may reduce stress because smoking is associated with social stigma, opponent-processes that may produce acute stress, ADDIN EN.CITE Baker(in press)207402074Baker, T.BPiper, M.EMcCarthy, D.EMajeskie, M.RFiore, M.C(in press)Addiction motivation reformulated: An affective processing model of negative reinforcementPsychological ReviewParrott1999163401634Parrott, A. C.1999Does cigarette smoking cause stress?American Psychologist5410817-20Oct10540594AdolescentAdultAffectHumanPatient EducationSmoking/*psychology*Stress, PsychologicalTobacco Use Disorder/*psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10540594Department of Psychology, University of East London, Great Britain. andy2@uel.ac.uk9,120 worries about disease, and the prospect of having to quit.
The Chassin et al. ADDIN EN.CITE Chassin2000274702747108687661932000MayThe natural history of cigarette smoking from adolescence to adulthood in a midwestern community sample: multiple trajectories and their psychosocial correlates223-31Department of Psychology, Arizona State University, Tempe 85287-1104, USA. laurie.chassin@asu.eduChassin, L.Presson, C. C.Pitts, S. C.Sherman, S. J.Health PsycholAdolescent*Adolescent BehaviorAdultChildCohort StudiesFemaleForecastingHumanInterpersonal RelationsMaleSmoking/*psychologySocial ConditionsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10868766119 study yielded important data that might be very useful in encouraging more smokers to try to quit. However, that study did not address some important questions. For instance, are there gender differences in reported declines in stress? (The number of successful quitters did not permit evaluation of this issue.) Also, perceived stress was measured with only a composite, retrospective stress variable rated with respect to the past year. We have no idea how this is related to actual stress or stressors experienced in daily life, and we dont know why quitters might have reported less stress. Thus, we do not know if quitters reported less stress because they actually encountered fewer stressors, or because of declines in psychiatric symptoms or physical disease. In short, there are intriguing suggestions that quitters lead less stressful lives than those who continue smoking - - but we dont know why this occurs or what its consequences might be.
Quality of life. Quality of life (QOL) refers to a persons net appraisal of the positive and negative aspects of life with respect to such important domains as health, physical functioning, emotional functioning, and vitality. Very few studies have assessed quality of life as a function of quitting, and most were cross-sectional. This is unfortunate since QOL is a valuable, global measure of life satisfaction. Evidence currently shows that smoking is related to poor QOL and that exsmokers report QOL that is similar to that of nonsmokers. ADDIN EN.CITE Wilson1999201602016104795992931999SepThe health-related quality-of-life of never smokers, ex-smokers, and light, moderate, and heavy smokers139-44South Australian Department of Human Services, Centre for Population Studies, Epidemiology Branch, Rundle Mall SA, 5000, Australia. david.wilson@dhs.sa.gov.auWilson, D.Parsons, J.Wakefield, M.Prev MedAdolescentAdultAgedFemale*Health StatusHealth SurveysHumanMaleMiddle Aged*Quality of LifeSampling StudiesSeverity of Illness IndexSmoking/*epidemiologySmoking Cessation/*statistics & numerical dataSouth Australia/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10479599Woolf1999201702017104900561721999AugIs cigarette smoking associated with impaired physical and mental functional status? An office-based survey of primary care patients134-7Department of Family Practice, Medical College of Virginia at Virginia Commonwealth University, Richmond, USA. shwoolf@aol.comWoolf, S. H.Rothemich, S. F.Johnson, R. E.Marsland, D. W.Am J Prev MedAdolescentAdultAge DistributionComparative StudyCross-Sectional StudiesData CollectionFemale*Health StatusHumanLogistic ModelsMale*Mental HealthMiddle AgedMultivariate AnalysisPrimary Health CareReference ValuesRisk AssessmentSex DistributionSmoking/*adverse effects/*epidemiologyVirginia/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10490056121,122 For instance, Mulder et al. ADDIN EN.CITE Mulder200186086Mulder,I.Tijhuis,M.Smit,H.A.Kromhout,D.2001Smoking cessation and quality of life: The effect of amount of smoking and time since quittingPreventive Medicine336653-660cessation, mental health, quality of life, smoking status, smoking, women94 performed a cross-sectional study in a Dutch population aged 20-59. They reported that current smokers reported lower QOL than ex- or never-smokers. Differences were especially pronounced on QOL domains related to mental health. This finding agrees with other cross-sectional research showing ex-smokers having greater perceived mental health than continuing smokers. ADDIN EN.CITE Mino2000201102011108038115422000AprDoes smoking cessation improve mental health?169-72Department of Hygiene and Preventive Medicine, Okayama University Medical School, Japan. yoshmino@med.okayama-u.ac.jpMino, Y.Shigemi, J.Otsu, T.Tsuda, T.Babazono, A.Psychiatry Clin NeurosciAdultCohort StudiesHumanJapanMale*Mental HealthMiddle AgedPersonality Inventory/statistics & numerical dataPsychometricsSmoking/adverse effects/psychologySmoking Cessation/*psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10803811Tillmann199720130201393474491931997SepA comparison of smokers' and ex-smokers' health-related quality of life268-73Postgraduate Studies in Pharmaceutical Technology, University of Bradford, UK.Tillmann, M.Silcock, J.J Public Health MedAdultAgedAged, 80 and overFemale*Health StatusHumanMaleMiddle Aged*Quality of LifeRegression AnalysisRespiration Disorders/epidemiologyScotland/epidemiologySmoking/adverse effects/epidemiology*Smoking CessationSocioeconomic FactorsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=934744995,97
Previous research shows that smokers, when compared to nonsmokers and ex-smokers, have significantly higher rates of psychiatric co-morbidity, higher stress levels, and worse QOL - - especially mental health QOL. ADDIN EN.CITE Mulder200186086Mulder,I.Tijhuis,M.Smit,H.A.Kromhout,D.2001Smoking cessation and quality of life: The effect of amount of smoking and time since quittingPreventive Medicine336653-660cessation, mental health, quality of life, smoking status, smoking, womenWilson1999201602016104795992931999SepThe health-related quality-of-life of never smokers, ex-smokers, and light, moderate, and heavy smokers139-44South Australian Department of Human Services, Centre for Population Studies, Epidemiology Branch, Rundle Mall SA, 5000, Australia. david.wilson@dhs.sa.gov.auWilson, D.Parsons, J.Wakefield, M.Prev MedAdolescentAdultAgedFemale*Health StatusHealth SurveysHumanMaleMiddle Aged*Quality of LifeSampling StudiesSeverity of Illness IndexSmoking/*epidemiologySmoking Cessation/*statistics & numerical dataSouth Australia/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1047959994,121 Moreover, some evidence suggests that smoking causes or exacerbates perceived stress and mental disorders, and that quitting alleviates these effects. ADDIN EN.CITE Chassin2002202802028122115102152002SepLong-term psychological sequelae of smoking cessation and relapse438-43Department of Psychology, Arizona State University, Tempe 85287-1104, USA. laurie.chassin@asu.eduChassin, L.Presson, C. C.Sherman, S. J.Kim, K.Health PsycholAdultAffective Symptoms/*psychology*Attitude to HealthFemaleHumanInternal-External ControlLongitudinal StudiesMaleMotivationRecurrenceSmoking/*psychologySmoking Cessation/*psychologyStress, Psychological/*complications/psychologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12211510Breslau19991992019921059129256121999DecSmoking and panic attacks: an epidemiologic investigation1141-7Department of Psychiatry, Henry Ford Health System, Detroit, Mich 48202-3450, USA. nbresla1@hfhs.orgBreslau, N.Klein, D. F.Arch Gen PsychiatryAdultAlcohol Drinking/epidemiologyComorbidityComparative StudyEpidemiologic StudiesFemaleHealth SurveysHumanLung Diseases/epidemiologyMaleMichigan/epidemiologyPanic Disorder/diagnosis/*epidemiology/etiologyPrevalenceProportional Hazards ModelsPsychiatric Status Rating Scales/statistics & numerical dataRandom AllocationRisk FactorsSmoking/*epidemiologySmoking Cessation/statistics & numerical dataSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1059129284,117 This suggests that QOL improvements may be secondary to improvements in psychiatric symptomatology; i.e., smokers can meaningfully reduce feelings of worry, anxiety, and sadness by quitting. Such an effect could have considerable public health significance, and could motivate a greater number of smokers to try to quit. It would be of great importance to be able to assert that quitting smoking is the single most important thing that smokers can do, not only for their physical health, but for their mental health as well.
Unfortunately, limitations in current research preclude strong conclusions. For example, much of the research is cross-sectional and thus cannot reveal the directionality of the relation between quitting success and QOL; viz. are those with the best QOL more able to quit, or does quitting promote better QOL? Also, this research does not reveal which smokers do not experience QOL enhancements after quitting (e.g., the most dependent or those who gain weight?).
Life After The Quit Attempt Smoking, Dependence, and Delayed Relapse
Smoking and dependence-related phenomena. It is important to determine how quitting affects phenomena related to dependence. For instance, how quickly do smoking motives, urges, and withdrawal symptoms decline after quitting? Smokers contemplating quitting often report stories of urges and relapse after years of abstinence. It is important to determine the trajectories of urges long after quitting. The little research in this area suggests that smoking-related beliefs change as a function of successful cessation. For instance, successful quitters show decreases in smoking motives. ADDIN EN.CITE Chassin2002202802028122115102152002SepLong-term psychological sequelae of smoking cessation and relapse438-43Department of Psychology, Arizona State University, Tempe 85287-1104, USA. laurie.chassin@asu.eduChassin, L.Presson, C. C.Sherman, S. J.Kim, K.Health PsycholAdultAffective Symptoms/*psychology*Attitude to HealthFemaleHumanInternal-External ControlLongitudinal StudiesMaleMotivationRecurrenceSmoking/*psychologySmoking Cessation/*psychologyStress, Psychological/*complications/psychologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12211510117 However, little or no research has been conducted on this issue beyond one year post-quit, and it is unknown whether such attitudinal changes are related to late relapse.
Late relapse. The proposed research will provide new information on the predictors of late relapse (( 1yr post-quit). Among former smokers who have been abstinent for a year, about 1/3rd eventually relapse. ADDIN EN.CITE Krall20027760776Krall,E.AGarvey,A.JGarcia,R.I2002Smoking relapse after 2 years of abstinence: Findings from the VA Normative Aging StudyNicotine & Tobacco Research495-100abstinencealcoholcessationmodelrelapserisksmokingGilpin199745045Gilpin,E.APierce,J.P1997Duration of smoking abstinence and success in quittingJournal of the National Cancer Institute898572-577Aprabstinencesmokingrelapseinterventionssmoking cessationsurveyadultssmoking statuscigarettesEisinger197120380203851300381241971DecPsychosocial predictors of smoking recidivism355-62Eisinger, R. A.J Health Soc BehavAge FactorsAttitude to HealthEducational StatusFemaleHumanMaleProspective StudiesSex Factors*SmokingSocioeconomic FactorsTime FactorsUnited Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=513003812-14 We know very little about what causes such delayed relapse and the proposed research will help us identify factors associated with it and whether these factors are distinct from those associated with early relapse. Such information should be critical to developing new, effective interventions to prevent late relapse.
Early relapse is associated with severe withdrawal, heightened negative affect, early morning craving, and environmental stressors. ADDIN EN.CITE Kenford2002160901609Kenford, S. L.Smith, S. S.Wetter, D. W.Jorenby, D. E.Fiore, M. C.Baker, T. B.2002Predicting relapse back to smoking: Contrasting affective and physical models of dependenceJournal of Consulting and Clinical Psychology701216-27Feb11860048Adult*AffectAgedFemaleHumanMaleMiddle AgeProspective StudiesRecurrence*Smoking CessationSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Tobacco Use Disorder/*psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11860048Department of Psychology, Xavier University, Cincinnati, Ohio 45207-6511, USA. kenford@xavier.xu.eduPiasecki2003111801118Piasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.2003Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relationsJournal of Abnormal Psychology112114-27Feb12653410AdultBupropion/therapeutic useDopamine Uptake Inhibitors/therapeutic useDouble-Blind MethodFemaleFollow-Up StudiesHumanMaleNicotine/*adverse effectsRecurrenceSeverity of Illness IndexSmoking/drug therapy/*prevention & controlSmoking Cessation/*methods*Substance Withdrawal Syndrome/diagnosis/etiology/prevention & controlSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12653410Department of Psychological Sciences, University of Missouri-Columbia 65211, USA. PiaseckiT@missouri.eduPiasecki2003111901119Piasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.2003Smoking withdrawal dynamics: I. Abstinence distress in lapsers and abstainersJournal of Abnormal Psychology11213-13Feb12653409Administration, CutaneousDouble-Blind MethodHumanNicotine/administration & dosage/*adverse effectsRecurrenceSmoking/*prevention & controlSmoking Cessation/*methodsSubstance Withdrawal Syndrome/diagnosis/*etiologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12653409Department of Psychological Sciences, University of Missouri-Columbia 65211, USA. PiaseckiT@missouri.eduShiffman1996169501695Shiffman, S.Gnys, M.Richards, T. J.Paty, J. A.Hickcox, M.Kassel, J. D.1996Temptations to smoke after quitting: A comparison of lapsers and maintainersHealth Psychology156455-61Nov8973926*Adaptation, PsychologicalAdultBehavior TherapyBehavior, Addictive/*psychologyComparative StudyCuesFemaleFollow-Up StudiesHumanMaleRecurrenceRisk FactorsSmoking/*prevention & control/*psychologySmoking Cessation/methods/*psychologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8973926Department of Psychology, University of Pittsburgh, Pennsylvania 15260, USA. shiffman+@pitt.edu123-126 However, there is reason to believe that long-term relapse is precipitated by different factors. In our research we discovered that early relapse was associated with elevated craving. ADDIN EN.CITE Piper2004263802638Piper, M.ECurtin, J. J.2004The effects of withdrawal on voluntary affect regulationTalk presented at the 10th Annual Meeting of the Society for Research on Nicotine and Tobacco, Scottsdale, AZ,127 However, later relapse (> 3 months post-quit) was associated with the density of smokers in an individuals environment. Other research also supports interpersonal/social and associative factors in precipitating later relapse. ADDIN EN.CITE Mermelstein198685085Mermelstein,R.Cohen,S.Lichtenstein,E.Baer,J.S.Kamarck,T.1986Social support and smoking cessation and maintenanceJournal of Consulting & Clinical Psychology544447-453Augabstinencecessationmaintenancerelapse preventionsmokingsocial networkssupport128 These findings support the model of relapse articulated previously by our research group ADDIN EN.CITE Piasecki2003111801118Piasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.2003Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relationsJournal of Abnormal Psychology112114-27Feb12653410AdultBupropion/therapeutic useDopamine Uptake Inhibitors/therapeutic useDouble-Blind MethodFemaleFollow-Up StudiesHumanMaleNicotine/*adverse effectsRecurrenceSeverity of Illness IndexSmoking/drug therapy/*prevention & controlSmoking Cessation/*methods*Substance Withdrawal Syndrome/diagnosis/etiology/prevention & controlSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12653410Department of Psychological Sciences, University of Missouri-Columbia 65211, USA. PiaseckiT@missouri.eduPiasecki2003111901119Piasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.2003Smoking withdrawal dynamics: I. Abstinence distress in lapsers and abstainersJournal of Abnormal Psychology11213-13Feb12653409Administration, CutaneousDouble-Blind MethodHumanNicotine/administration & dosage/*adverse effectsRecurrenceSmoking/*prevention & controlSmoking Cessation/*methodsSubstance Withdrawal Syndrome/diagnosis/*etiologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12653409Department of Psychological Sciences, University of Missouri-Columbia 65211, USA. PiaseckiT@missouri.edu124,125 that holds that different factors influence relapse vulnerability across the post-quit period.
The present research will address relapse that occurs across a 5-year span (at least 3 years being funded by this application). In one of the few studies on this topic, Killen et al. ADDIN EN.CITE Killen1996155501555Killen, J. D.Fortmann, S. P.Kraemer, H. C.Varady, A. N.Davis, L.Newman, B.1996Interactive effects of depression symptoms, nicotine dependence, and weight change on late smoking relapseJournal of Consulting and Clinical Psychology6451060-7Oct8916636AlgorithmsBehavior TherapyBody Weight/*drug effectsChewing GumComparative StudyDepression/*psychologyFollow-Up StudiesHuman*Nicotine/administration & dosage/adverse effectsRecurrenceRisk FactorsSmoking/adverse effects/*psychologySmoking Cessation/*psychologySubstance Withdrawal Syndrome/psychologySubstance-Related Disorders/*psychologySupport, U.S. Gov't, P.H.S.Survival AnalysisTreatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8916636Center for Research in Disease Prevention, Stanford University School of Medicine, California 94304, USA. Killen@scrdp.stanford.edu129 explored the predictors of relapse among 420 individuals who had remained abstinent for at least 3 months post-treatment. This research suggested that the development of depression over the first three months post-quit was predictive of later relapse, as were lower BMI gain and higher nicotine dependence among subgroups of subjects. While these findings are of interest, more research is clearly needed because: (1) Some measures were not optimal (e.g., craving was assessed at a single point in time, psychiatric diagnoses were not obtained); (2) No measures were collected post-treatment; and, (3) Only a very narrow range of assessments was used (four variables); and so on. Other research in this area suffers from similar limitations. ADDIN EN.CITE Swan198822350223531770691331988Risk factors for late relapse in male and female ex-smokers253-66Department of Behavioral Medicine, SRI International, Menlo Park, California 94025.Swan, G. E.Denk, C. E.Parker, S. D.Carmelli, D.Furze, C. T.Rosenman, R. H.Addict BehavAdultBehavior TherapyFemaleFollow-Up StudiesHumanMaleMiddle AgedProspective StudiesRecurrenceRisk FactorsSex FactorsSmoking/psychology/*therapySocioeconomic FactorsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3177069130 After surveying available research in this area Ockene et al. ADDIN EN.CITE Ockene20016240624Ockene,J.K.Emmons,K.M.Mermelstein,R.J.Perkins,K.A.Bonollo,D.S.Voorhees,C.C.Hollis,J.F.2001Relapse and maintenance issues for smoking cessationHealth Psychology191 (Suppl)17-31Jancessationcounselinglong-term maintenancemaintenancepharmacologyrelapsereviewsmokingtelephone counseling131 concluded that very little could be discerned about late relapse from available research because studies typically used only a small number of parochial variables as predictors.
In the present research we will be able to contrast distinct models of late relapse: viz. is late relapse related to: (a) Initial level of dependence, (b) Withdrawal severity, (c) Chronic distress (e.g., levels of negative affect, psychiatric symptoms/co-morbidity, reduced QOL, fatigue) (d) Stressful events (e) Environmental context & lifestyle (e.g., alcohol intake, time spent with smokers, sedentariness, weight gain), and
(f) Overconfidence. ADDIN EN.CITE Hall200119690196911506764332001AugStatistical analysis of randomized trials in tobacco treatment: longitudinal designs with dichotomous outcome193-202Department of Psychiatry, University of California, San Francisco, 94143, USA. smh@itsa.ucsf.eduHall, S. M.Delucchi, K. L.Velicer, W. F.Kahler, C. W.Ranger-Moore, J.Hedeker, D.Tsoh, J. Y.Niaura, R.Nicotine Tob ResHuman*Longitudinal StudiesRandomized Controlled Trials/*statistics & numerical dataSoftwareSupport, U.S. Gov't, P.H.S.Tobacco Use Disorder/*therapyTreatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11506764Piasecki2002145501455Piasecki, T. M.Fiore, M. C.McCarthy, D. E.Baker, T. B.2002Have we lost our way? The need for dynamic formulations of smoking relapse pronenessAddiction9791093-1108Sep12199822Administration, CutaneousFatigue/etiologyForecastingHumanMotivationNicotine/administration & dosageRecurrence/prevention & controlRisk FactorsSmoking/*prevention & controlSmoking Cessation/*methods/psychologyStress, Psychological/etiologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12199822Department of Psychological Sciences, University of Missouri-Columbia, 65211, USA. piaseckit@missouri.edu132,133 This data will allow us not only to understand the process of relapse, but also, perhaps, to identify those at heightened risk for relapse and aid in the design of effective interventions. For instance, it may be that an effective relapse intervention program should really concentrate not on the abstinent smoker, but instead on his/her environment.
Summary: Life After The Quit Attempt
Our review indicates that too little is known about important long-term consequences of quitting and failing to quit smoking (e.g., mental health status, atherosclerosis progression, QOL). In addition, little is known about the roles of other modifiable risk factors in these outcomes, and about how individual differences identify those at greatest risk for outcomes. How are modifiable risk factors associated with one another? Is the likelihood of exercise related to the magnitude of weight gain over the long-term? How are all of these related to important physical outcomes such as central adiposity, diabetes, or atherosclerotic progression? For instance, there is suggestive evidence from a cross-sectional study ADDIN EN.CITE Luedemann20022749027491246879333122002DecAssociation between behavior-dependent cardiovascular risk factors and asymptomatic carotid atherosclerosis in a general population2929-35Institute of Epidemiology and Social Medicine, Department of Neurology, Ernst-Moritz-Arndt University of Greifswald, Germany.Luedemann, J.Schminke, U.Berger, K.Piek, M.Willich, S. N.Doring, A.John, U.Kessler, C.StrokeAged*Behavior/classificationCarotid Artery Diseases/*epidemiology/ultrasonographyCarotid Artery, Common/ultrasonographyCausalityComorbidityCross-Sectional StudiesDiet/*statistics & numerical data*ExerciseFemaleFood Habits/classificationGermany/epidemiologyHumanLife StyleMaleMiddle AgedOdds RatioPhysical FitnessRisk AssessmentRisk FactorsSmoking/*epidemiologySupport, Non-U.S. Gov'tTunica Intima/ultrasonographyTunica Media/ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12468793134 that physical activity and a healthy diet reduce atherosclerosis, but not among people who smoke; i.e., smoking trumps positive lifestyle factors. It is important to explore such relations in a more inclusive longitudinal study, and determine whether such relations differ by gender, race, or level of nicotine dependence. ADDIN EN.CITE Mowbray199727140271491436412321997MayCharacteristics of dual diagnosis patients admitted to an urban, public psychiatric hospital: an examination of individual, social, and community domains309-26University of Michigan, School of Social Work, Ann Arbor 48109-1285, USA.Mowbray, C. T.Ribisl, K. M.Solomon, M.Luke, D. A.Kewson, T. P.Am J Drug Alcohol AbuseAdultAfrican Americans/statistics & numerical dataAge FactorsData CollectionDiagnosis, Dual (Psychiatry)/*psychologyEuropean Continental Ancestry Group/statistics & numerical dataFemale*Hospitals, Psychiatric/utilizationHospitals, PublicHospitals, UrbanHumanMaleMarriageMental Disorders/psychology/rehabilitationPersonality Assessment/statistics & numerical dataPsychiatric Status Rating ScalesPsychometricsSex FactorsSocioeconomic FactorsSubstance-Related Disorders/rehabilitationSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=914364143
Extant studies addressing questions such as those listed above tend to have significant limitations: (1) Inadequate, brief follow-up: the follow-up is too brief and often does not include both prequit and postquit measurement; (2) Inadequate measurement: measures are often global and impressionistic and convergent measures are rarely used; (3) Cross-sectional designs: many studies are cross-sectional rather than longitudinal or prospective in design (e.g., ADDIN EN.CITE Mino2000201102011108038115422000AprDoes smoking cessation improve mental health?169-72Department of Hygiene and Preventive Medicine, Okayama University Medical School, Japan. yoshmino@med.okayama-u.ac.jpMino, Y.Shigemi, J.Otsu, T.Tsuda, T.Babazono, A.Psychiatry Clin NeurosciAdultCohort StudiesHumanJapanMale*Mental HealthMiddle AgedPersonality Inventory/statistics & numerical dataPsychometricsSmoking/adverse effects/psychologySmoking Cessation/*psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10803811Mulder200186086Mulder,I.Tijhuis,M.Smit,H.A.Kromhout,D.2001Smoking cessation and quality of life: The effect of amount of smoking and time since quittingPreventive Medicine336653-660cessation, mental health, quality of life, smoking status, smoking, womenSchmitz20032029020291294434416092003SepDisabilities, quality of life, and mental disorders associated with smoking and nicotine dependence1670-6Clinic for Psychosomatic Medicine and Psychotherapy, Heinrich-Heine-University, Bergisch Landstrasse 2, H19, D-40605 Duesseldorf, Germany. schmitzn@uni-duesseldorf.deSchmitz, N.Kruse, J.Kugler, J.Am J PsychiatryAdolescentAdultAgedChronic Disease/epidemiologyComorbidityComparative StudyDisabled Persons/psychology/*statistics & numerical dataFemaleGermany/epidemiologyHealth StatusHealth SurveysHumanMaleMental Disorders/*epidemiologyMiddle AgedPrevalencePsychiatric Status Rating Scales*Quality of LifeSmoking/*epidemiologyTobacco Use Disorder/*epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12944344Tillmann199720130201393474491931997SepA comparison of smokers' and ex-smokers' health-related quality of life268-73Postgraduate Studies in Pharmaceutical Technology, University of Bradford, UK.Tillmann, M.Silcock, J.J Public Health MedAdultAgedAged, 80 and overFemale*Health StatusHumanMaleMiddle Aged*Quality of LifeRegression AnalysisRespiration Disorders/epidemiologyScotland/epidemiologySmoking/adverse effects/epidemiology*Smoking CessationSocioeconomic FactorsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=934744994,95,97,135), making it difficult to determine causal relations and directionality; and (4) Narrow, parochial focus: for instance, studies may focus on smoking behaviors and attitudes, but not health and genotype. Or, they may focus on health, but not psychosocial factors. An informed and complete picture of the fate of the quitting smoker can be gleaned only from a synthesis of information and theory across diverse disciplines.
Individual Differences Genes and Personality
Genotype. There is a growing literature linking nicotine dependence with genetic variation. ADDIN EN.CITE Batra20032862028621274029412352003MayThe genetic determinants of smoking1730-9Department of Medicine, Division of Critical Care, Pulmonary, Allergic and Immunologic Diseases, Thomas Jefferson University, Philadelphia, USA.Batra, V.Patkar, A. A.Berrettini, W. H.Weinstein, S. P.Leone, F. T.ChestAnimalsCarrier Proteins/geneticsCytochrome P-450 Enzyme System/geneticsDopamine/geneticsGenetic Predisposition to DiseaseHumanLinkage (Genetics)Membrane Glycoproteins/geneticsMembrane Transport Proteins/geneticsNicotine/metabolismPolymorphism (Genetics)Smoking/geneticsTobacco Use Disorder/*genetics/metabolismTwin Studieshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12740294Rossing1998279002790964789310651998MayGenetic influences on smoking: candidate genes231-8Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle WA 98109, USA.Rossing, M. A.Environ Health PerspectBehavior, AddictiveDopamine/physiologyHumanNicotine/pharmacologyPolymorphism (Genetics)/geneticsReceptors, Dopamine/geneticsRewardSmoking/*geneticsTwin Studieshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9647893136,137 The proposed research would add to this literature by examining a rich array of physiologic, addictive, and psychsocial phenotypic measures over an extended period of time and their relations with promising candidate genes. In this research, outcomes will be related to genotype and personality (in addition to other individual differences: gender, psychiatric diagnostic history, nicotine dependence). As discussed more fully in Project 1, genotype will be related to diverse measures of nicotine dependence: e.g., multivariate questionnaire measures, ADDIN EN.CITE Piper(in press)193701937Piper, M.EPiasecki, T. M.Federman, E.BBolt, D.MSmith, S.S.Fiore, M.CBaker, T.B(in press)A multiple motives approach to tobacco dependence: The Wisconsin Inventory of Smoking Dependence Motives (WISDM-68)Journal of Consulting & Clinical Psychology138 relapse latency, and withdrawal. ADDIN EN.CITE Piasecki2003111801118Piasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.2003Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relationsJournal of Abnormal Psychology112114-27Feb12653410AdultBupropion/therapeutic useDopamine Uptake Inhibitors/therapeutic useDouble-Blind MethodFemaleFollow-Up StudiesHumanMaleNicotine/*adverse effectsRecurrenceSeverity of Illness IndexSmoking/drug therapy/*prevention & controlSmoking Cessation/*methods*Substance Withdrawal Syndrome/diagnosis/etiology/prevention & controlSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12653410Department of Psychological Sciences, University of Missouri-Columbia 65211, USA. PiaseckiT@missouri.eduPiasecki2003111901119Piasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.2003Smoking withdrawal dynamics: I. Abstinence distress in lapsers and abstainersJournal of Abnormal Psychology11213-13Feb12653409Administration, CutaneousDouble-Blind MethodHumanNicotine/administration & dosage/*adverse effectsRecurrenceSmoking/*prevention & controlSmoking Cessation/*methodsSubstance Withdrawal Syndrome/diagnosis/*etiologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12653409Department of Psychological Sciences, University of Missouri-Columbia 65211, USA. PiaseckiT@missouri.edu124,125 In the current project genotypes will be related to measures of dependence over the 3-year study period (e.g., pack-years of smoking/long-term trajectories of smoking). Previous research ADDIN EN.CITE Arinami2000286102861111346714102-32000Dec 27Polymorphisms in genes involved in neurotransmission in relation to smoking215-226Department of Medical Genetics, Institute of Basic Medical Sciences, University of Tsukuba, Ibaraki 305-8575, Tsukuba, Japan. tarinami@md.tsukuba.ac.jpArinami, T.Ishiguro, H.Onaivi, E. S.Eur J PharmacolAnimalsHumanLinkage (Genetics)/geneticsNeurotransmitters/genetics/metabolismNicotine/metabolismPolymorphism (Genetics)/*geneticsReceptors, Neurotransmitter/geneticsSmoking/*genetics/physiopathologySynaptic Transmission/*geneticshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11134671Batra20032862028621274029412352003MayThe genetic determinants of smoking1730-9Department of Medicine, Division of Critical Care, Pulmonary, Allergic and Immunologic Diseases, Thomas Jefferson University, Philadelphia, USA.Batra, V.Patkar, A. A.Berrettini, W. H.Weinstein, S. P.Leone, F. T.ChestAnimalsCarrier Proteins/geneticsCytochrome P-450 Enzyme System/geneticsDopamine/geneticsGenetic Predisposition to DiseaseHumanLinkage (Genetics)Membrane Glycoproteins/geneticsMembrane Transport Proteins/geneticsNicotine/metabolismPolymorphism (Genetics)Smoking/geneticsTobacco Use Disorder/*genetics/metabolismTwin Studieshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12740294Lerman199927830278399250411811999JanEvidence suggesting the role of specific genetic factors in cigarette smoking14-20Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC 20007-4104, USA. lermanc@gunet.georgetown.eduLerman, C.Caporaso, N. E.Audrain, J.Main, D.Bowman, E. D.Lockshin, B.Boyd, N. R.Shields, P. G.Health PsycholAdultAfrican Continental Ancestry Group/geneticsAge of OnsetAgedAllelesCarrier Proteins/*geneticsCase-Control StudiesEuropean Continental Ancestry Group/geneticsFemaleGenetic Predisposition to DiseaseGenotypeHumanMale*Membrane Transport ProteinsMiddle AgedReceptors, Dopamine D2/*geneticsSmoking/*geneticsSmoking Cessation/statistics & numerical dataStatisticsSupport, U.S. Gov't, Non-P.H.S.Support, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9925041Rossing1998279002790964789310651998MayGenetic influences on smoking: candidate genes231-8Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle WA 98109, USA.Rossing, M. A.Environ Health PerspectBehavior, AddictiveDopamine/physiologyHumanNicotine/pharmacologyPolymorphism (Genetics)/geneticsReceptors, Dopamine/geneticsRewardSmoking/*geneticsTwin Studieshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9647893136,137,139,140 suggests targeting candidate genes coding for nicotinic receptors, nicotine metabolism, dopamine synthesis, dopamine re-uptake, dopamine receptors and function, acetylcholine re-uptake & metabolism, and positional candidates. Genotypes will also be related to alcohol use/abuse and comorbidity with smoking (e.g., ADDIN EN.CITE Bierut200427460274614679582124A12004Jan 1A genomic scan for habitual smoking in families of alcoholics: common and specific genetic factors in substance dependence19-27School of Medicine, Washington University School of Medicine, 4940 Children's Place, St. Louis, MO 63110, USA. bierutl@psychiatry.wustl.eduBierut, L. J.Rice, J. P.Goate, A.Hinrichs, A. L.Saccone, N. L.Foroud, T.Edenberg, H. J.Cloninger, C. R.Begleiter, H.Conneally, P. M.Crowe, R. R.Hesselbrock, V.Li, T. K.Nurnberger, J. I., Jr.Porjesz, B.Schuckit, M. A.Reich, T.Am J Med Genethttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14679582112). Some candidate genes in these relations will be ADH, ALDH, dopamine, and GABA genes. ADDIN EN.CITE Dick2003284802848127666332752003MayCandidate genes for alcohol dependence: a review of genetic evidence from human studies868-79Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street, Indianapolis, IN 46202-0525, USA.Dick, D. M.Foroud, T.Alcohol Clin Exp ResAlcohol Dehydrogenase/geneticsAlcoholism/*geneticsGenetic Predisposition to DiseaseHumanMembrane Transport Proteins/geneticsNeuropeptide Y/geneticsReceptors, Dopamine/geneticsReceptors, GABA/geneticsSerotonin/geneticsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12766633141 Comorbidity of smoking with affective disorder will also be examined. Genotype will also be related to atherosclerotic progression among smokers (e.g., 5A/6A polymorphism of the stromelysin-1 promoter; ADDIN EN.CITE Rauramaa20002849028491111606820122000DecStromelysin-1 and interleukin-6 gene promoter polymorphisms are determinants of asymptomatic carotid artery atherosclerosis2657-62Kuopio Research Institute of Exercise Medicine and the Department of Physiology, University of Kuopio (Finland). rainer.rauramaa@messi.uku.fiRauramaa, R.Vaisanen, S. B.Luong, L. A.Schmidt-Trucksass, A.Penttila, I. M.Bouchard, C.Toyry, J.Humphries, S. E.Arterioscler Thromb Vasc BiolCarotid Stenosis/epidemiology/*genetics/ultrasonographyComparative StudyElectrocardiographyExercise TestFinland/epidemiology*GenotypeHomozygoteHumanInterleukin-6/*geneticsMaleMiddle AgedPolymorphism (Genetics)Promoter Regions (Genetics)Stromelysin 1/*geneticsSupport, Non-U.S. Gov'tVariation (Genetics)http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11116068142 leucine7 to-proline7 polymorphism in preproneuropeptide Y gene signal peptide ADDIN EN.CITE Karvonen20012850028501168921615912001NovLeucine7 to proline7 polymorphism in the preproneuropeptide Y is associated with the progression of carotid atherosclerosis, blood pressure and serum lipids in Finnish men145-51Department of Pharmacology and Clinical Pharmacology, University of Turku, Turku, Finland.Karvonen, M. K.Valkonen, V. P.Lakka, T. A.Salonen, R.Koulu, M.Pesonen, U.Tuomainen, T. P.Kauhanen, J.Nyyssonen, K.Lakka, H. M.Uusitupa, M. I.Salonen, J. T.AtherosclerosisAdult*Blood PressureCarotid Artery Diseases/blood/*genetics/physiopathologyDisease ProgressionFinlandHumanLeucine/*geneticsLipids/*bloodMaleMiddle AgedNeuropeptide Y/*genetics*Polymorphism (Genetics)Proline/*geneticsProtein Precursors/*geneticsRisk FactorsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11689216143 & glutathione S-transferase M1; ADDIN EN.CITE de Waart20012851028511150019515812001SepEffect of glutathione S-transferase M1 genotype on progression of atherosclerosis in lifelong male smokers227-31Division of Human Nutrition and Epidemiology, Wageningen University and Research Center, Dreijenlaan 1, Bodenr 154, 6703 HA Wageningen, The Netherlands. frouwkje.hans@consunet.nlde Waart, F. G.Kok, F. J.Smilde, T. J.Hijmans, A.Wollersheim, H.Stalenhoef, A. F.AtherosclerosisArteriosclerosis/*genetics/pathology/ultrasonographyCarotid Artery, Common/pathology/ultrasonographyDisease ProgressionGenotypeGlutathione Transferase/*geneticsHumanMaleMiddle AgedRandomized Controlled TrialsRisk FactorsSmoking/*adverse effects/geneticsSupport, Non-U.S. Gov'tTunica Intima/pathologyTunica Media/pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11500195144 endotoxin receptor polymorphism CD14 ADDIN EN.CITE Risley2003275002750126242783432003MarPromoter polymorphism in the endotoxin receptor (CD14) is associated with increased carotid atherosclerosis only in smokers: the Carotid Atherosclerosis Progression Study (CAPS)600-4Department of Clinical Neurosciences, St George's Hospital Medical School, Cranmer Terr, Tooting, London SW17 0RE, UK. prisley@sghms.ac.ukRisley, P.Jerrard-Dunne, P.Sitzer, M.Buehler, A.von Kegler, S.Markus, H. S.StrokeAgedAlcohol Drinking/epidemiologyAllelesAntigens, CD14/*geneticsCarotid Arteries/ultrasonographyCarotid Artery Diseases/epidemiology/*genetics/ultrasonographyComorbidityDisease ProgressionFemaleGenetic Predisposition to DiseaseGenetic ScreeningGermany/epidemiologyHumanMaleMiddle AgedMultivariate AnalysisOdds Ratio*Polymorphism (Genetics)Polymorphism, Restriction Fragment LengthReceptors, Immunologic/*geneticsRisk AssessmentRisk Factors*Smoking/epidemiologySupport, Non-U.S. Gov'tTunica Intima/ultrasonographyTunica Media/ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12624278145).
Personality. A considerable body of research links both negative affectivity and disinhibition/behavioral undercontrol with addictive disorders. ADDIN EN.CITE Krueger20022729027291215041711132002AugEtiologic connections among substance dependence, antisocial behavior, and personality: modeling the externalizing spectrum411-24Department of Psychology, University of Minnesota, Minneapolis 55455-0344, USA. krueg038@umn.eduKrueger, R. F.Hicks, B. M.Patrick, C. J.Carlson, S. R.Iacono, W. G.McGue, M.J Abnorm PsycholAdolescentAdolescent Behavior/*physiology/*psychologyAdultAlcoholism/genetics/psychologyAntisocial Personality Disorder/*genetics/*psychologyChild Behavior Disorders/*genetics/*psychologyComorbidityDiagnosis, Dual (Psychiatry)FemaleHumanInhibition (Psychology)InterviewsMale*Models, PsychologicalPersonality/*genetics/*physiologyPersonality AssessmentPersonality Disorders/*genetics/*psychologyPsychiatric Status Rating ScalesSelf DisclosureSubstance-Related Disorders/*genetics/*psychologySupport, U.S. Gov't, P.H.S.Twins/genetics/psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12150417Slutske20022728027281187137711112002FebPersonality and the genetic risk for alcohol dependence124-33Department of Psychological Sciences and Missouri Alcoholism Research Center, University of Missouri--Columbia, 65211, USA. SlutskeW@missouri.eduSlutske, W. S.Heath, A. C.Madden, P. A.Bucholz, K. K.Statham, D. J.Martin, N. G.J Abnorm PsycholAdultAgedAged, 80 and overAlcoholism/*geneticsFemaleHumanMaleMiddle AgedPersonality Disorders/*diagnosis/epidemiology/psychologyPersonality InventoryRisk FactorsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Twins/genetics/psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11871377111,146 Therefore, BF/MPQ ADDIN EN.CITE Patrick2002194301943120560771422002JunDevelopment and validation of a brief form of the Multidimensional Personality Questionnaire150-63Department of Psychology, University of Minnesota, Twin Cities Campus, Elliott Hall, 75 East River Road, Minneapolis, Minnesota 55455, USA. cpatrick@tc.umn.eduPatrick, C. J.Curtin, J. J.Tellegen, A.Psychol AssessAdolescentAdultAgedFemaleHumanMaleMiddle AgedPersonality Disorders/*diagnosis*Personality InventoryReproducibility of ResultsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12056077147 Negative Emotionality and Constraint higher order factors will be related to both smoking and alcohol trajectories and outcomes, and analyses will determine whether personality mediates genetic effects on these outcomes. ADDIN EN.CITE Slutske20022728027281187137711112002FebPersonality and the genetic risk for alcohol dependence124-33Department of Psychological Sciences and Missouri Alcoholism Research Center, University of Missouri--Columbia, 65211, USA. SlutskeW@missouri.eduSlutske, W. S.Heath, A. C.Madden, P. A.Bucholz, K. K.Statham, D. J.Martin, N. G.J Abnorm PsycholAdultAgedAged, 80 and overAlcoholism/*geneticsFemaleHumanMaleMiddle AgedPersonality Disorders/*diagnosis/epidemiology/psychologyPersonality InventoryRisk FactorsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Twins/genetics/psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11871377111 Negative Emotionality will also be related to measures of atherosclerosis and its progression given the links between negative affectivity and cardiovascular disease. ADDIN EN.CITE Barefoot1996275102751864097193111996Jun 1Symptoms of depression, acute myocardial infarction, and total mortality in a community sample1976-80Behavioral Medicine Research Center, Duke University Medical Center, Durham, NC 27710, USA. foot@acpub.duke.eduBarefoot, J. C.Schroll, M.CirculationAgedAged, 80 and overCause of DeathCohort StudiesCross-Sectional StudiesDenmark/epidemiologyDepression/complications/*epidemiologyFemaleForced Expiratory VolumeHumanMmpiMale*MortalityMyocardial Infarction/*epidemiology/etiology/prevention & controlMyocardial Ischemia/epidemiologyProportional Hazards ModelsRiskRisk FactorsSupport, U.S. Gov't, P.H.S.Survival Analysishttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8640971Goodman199627600276086918927181996AugHostility predicts restenosis after percutaneous transluminal coronary angioplasty729-34Department of Psychiatry and Behavioral Medicine, Union Memorial Hospital, Baltimore, Maryland, USA.Goodman, M.Quigley, J.Moran, G.Meilman, H.Sherman, M.Mayo Clin ProcAged*Angioplasty, Transluminal, Percutaneous CoronaryCoronary Disease/*psychology/therapyFemale*HostilityHumanLogistic ModelsMaleMiddle AgedPredictive Value of TestsPrognosisProspective StudiesRecurrenceRetrospective StudiesRisk FactorsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8691892Smith2002271002710120903697032002JunPsychosocial influences on the development and course of coronary heart disease: current status and implications for research and practice548-68Department of Psychology, University of Utah, Salt Lake City 84112, USA. tim.smith@psych.utah.eduSmith, T. W.Ruiz, J. M.J Consult Clin PsycholCoronary Disease/*etiology/prevention & controlHumanRisk FactorsSocial DominanceSocial EnvironmentStress, Psychological/psychologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=120903692,4,8
Importance of the Proposed Research to Science and the Public Health
This research may yield the best long-term information to date on both the physiologic benefits and costs of successful and unsuccessful attempts to quit smoking. It will make important contributions to descriptive psychopathology. It will provide the most fine-grained and accurate information to date on the histories of quitters and relapsers after a quit attempt.
This research will not only characterize the fates of smokers who are successful and unsuccessful in a quit attempt, but will also shed light on mechanisms that mediate observed outcomes. Observed mediational relations may suggest the importance of comprehensive interventions ADDIN EN.CITE Ory2002286602866124081951752002OctThe Behavior Change Consortium: setting the stage for a new century of health behavior-change research500-11School of Rural Public Health, Texas A & M University System, College Station 77840, USA.Ory, M. G.Jordan, P. J.Bazzarre, T.Health Educ Res*Health Behavior*Health PromotionHumanNational Health Programs/*organization & administration*National Institutes of Health (U.S.)Program DevelopmentPublic HealthSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.United Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12408195Sobell20022867028671250012726122002DecSelf-change and dual recoveries among individuals with alcohol and tobacco problems: current knowledge and future directions1936-8Nova Southeastern University, Center for Phychological Studies, Fort Lauderdale, Florida 33314, USA. sobelll@nova.eduSobell, L. C.Sobell, M. B.Agrawal, S.Alcohol Clin Exp ResAlcoholism/*psychology/therapyAnimalsHumanSelf Care/methods/*psychologySmoking Cessation/methods/*psychologySupport, U.S. Gov't, P.H.S.Tobacco Use Disorder/*psychology/therapyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12500127Strecher2002286802868124082061752002OctTailored interventions for multiple risk behaviors619-26Strecher, V.Wang, C.Derry, H.Wildenhaus, K.Johnson, C.Health Educ ResAdultAgedComputer-Assisted InstructionCounselingFemaleHealth BehaviorHealth Education*Health PromotionHumanMaleMichiganMiddle Aged*Models, TheoreticalRandomized Controlled Trials*Research DesignRisk FactorsTelephonehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12408206148-150 that can mitigate or prevent negative outcomes of cessation, or enhance positive outcomes. Application of such interventions would be greatly aided by identification of individuals most likely to experience important outcomes of cessation or continued smoking.
This research will also elucidate the precipitants of late relapse - - relapse occurring after the first year of abstinence. Additionally, this research will examine genetic correlates of outcomes such as ability to quit smoking and remain smoke-free, severity of nicotine dependence, severity and patterning of withdrawal symptoms, weight gain, psychiatric diagnoses/symptom profiles, and progression/status of smoking-related disease. Finally, this research may yield information that enhances smokers motivation to quit. Smokers may be more likely to make a quit attempt if they believe that smoking cessation will lead to greater life satisfaction, reduced sadness and worry, improved social relations and clinically significant reductions in risk of heart attack and stroke.
It is clear that the information to be gathered is of substantial public health importance. Since 50 million current tobacco users in America are encouraged to quit and approximately 20 million try to quit each year, it is essential to learn how quitting and continued smoking are related to mental health status, disease status and progression, quality of life, and late relapse. It is equally important to be able to identify risk factors for these important outcomes so we can better assist smokers to successfully quit, prevent relapse, and improve mental and physical health.
Preliminary Studies
The UW-TTURC research team at UW-CTRI has extensive experience in tobacco intervention research. Since 1992, CTRI has conducted more than 20 randomized smoking cessation clinical trials, including trials of pharmacotherapies ADDIN EN.CITE Jorenby1999208602086Jorenby, D. E.Leischow, S. J.Nides, M. A.Rennard, S. I.Johnston, J. A.Hughes, A. R.Smith, S. S.Muramoto, M. L.Daughton, D. M.Doan, K.Fiore, M. C.Baker, T. B.1999A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessationNew England Journal of Medicine3409685-691Mar 410053177Administration, CutaneousAdultAntidepressive Agents, Second-Generation/adverse effects/*therapeutic useBupropion/adverse effects/*therapeutic useDelayed-Action PreparationsDrug Therapy, CombinationFemaleHumanMaleNicotine/adverse effects/*therapeutic useSmoking Cessation/*methods/psychology/statistics & numerical dataSubstance Withdrawal SyndromeSupport, Non-U.S. Gov'tWeight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10053177Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison, USA.Piper2004263902639Piper, M.EFederman, E.BSmith, S.S.Fiore, M.CBaker, T.B2004Efficacy of bupropion SR alone and combined with 4-mg nicotine gum.Talk to be presented at the 10th Annual Meeting of the Society for Research on Nicotine and Tobacco, Scottsdale, AZ,151,152 and psychosocial treatments. ADDIN EN.CITE Fiore(in press)192701927Fiore, M.CMcCarthy, D.EJackson, T.CZehner, M.E.Jorenby, D.EMielke, M.M.Smith, SSGuiliani, T.ABaker, T.B(in press)Integrating smoking cessation treatment into primary care: An effectiveness studyPreventive MedicineSmith20016440644Smith,S.S.Jorenby,D.EFiore,M.C.Anderson,J.E.Mielke,M.M.Beach,K.E.Piasecki,T.M.Baker,T.B.2001Strike while the iron is hot: Can stepped-care treatments resurrect relapsing smokers?Journal of Consulting & Clinical Psychology693429-439abstinencecessationcounselingefficacyintervention practicesrelapserelapse preventionrisksmokingsupport153,154 Of particular relevance to the current proposal is UW-CTRIs demonstrated ability to recruit large numbers of smokers for clinical trials. More than 1500 community smokers enrolled in the first UW-TTURC studies, and more than 1500 additional primary care clinic patients enrolled in a cessation effectiveness trial. ADDIN EN.CITE Fiore(in press)192701927Fiore, M.CMcCarthy, D.EJackson, T.CZehner, M.E.Jorenby, D.EMielke, M.M.Smith, SSGuiliani, T.ABaker, T.B(in press)Integrating smoking cessation treatment into primary care: An effectiveness studyPreventive Medicine153 Recently, CTRI has demonstrated an ability to recruit minority smokers at meaningful levels; 22% of participants in a combination pharmacotherapy clinical trial were African American, ADDIN EN.CITE Piper2004263902639Piper, M.EFederman, E.BSmith, S.S.Fiore, M.CBaker, T.B2004Efficacy of bupropion SR alone and combined with 4-mg nicotine gum.Talk to be presented at the 10th Annual Meeting of the Society for Research on Nicotine and Tobacco, Scottsdale, AZ,152 as were 27% of participants in a primary care effectiveness study. ADDIN EN.CITE Fiore(in press)192701927Fiore, M.CMcCarthy, D.EJackson, T.CZehner, M.E.Jorenby, D.EMielke, M.M.Smith, SSGuiliani, T.ABaker, T.B(in press)Integrating smoking cessation treatment into primary care: An effectiveness studyPreventive Medicine153 CTRI has also achieved impressive retention rates in studies. For example, in a clinical trial requiring very extensive assessments 82% of 608 enrolled smokers were successfully followed up for one-year. ADDIN EN.CITE Piper2004263902639Piper, M.EFederman, E.BSmith, S.S.Fiore, M.CBaker, T.B2004Efficacy of bupropion SR alone and combined with 4-mg nicotine gum.Talk to be presented at the 10th Annual Meeting of the Society for Research on Nicotine and Tobacco, Scottsdale, AZ,152
Recent research emerging from CTRI reflects significant methodological advances. For example, UW-CTRI researchers have adopted state-of-the-art psychophysiological (e.g., electromyography) ADDIN EN.CITE Piper2004263802638Piper, M.ECurtin, J. J.2004The effects of withdrawal on voluntary affect regulationTalk presented at the 10th Annual Meeting of the Society for Research on Nicotine and Tobacco, Scottsdale, AZ,127 and real-time self-report assessments (e.g., palmtop computers for ecological momentary assessment) ADDIN EN.CITE McCarthy(under review)248502485McCarthy, D>EFiore, M.CPiasecki, T.M.Baker, T.B(under review)Life before and after quitting smokingJournal of Abnormal Psychology155 to sensitively detect changes associated with cessation. With regards to assessment, the research team has developed and validated the WISDM-68, a multidimensional research measure of smoking dependence motives that predicts heavy use, withdrawal and relapse. ADDIN EN.CITE Piper(in press)193701937Piper, M.EPiasecki, T. M.Federman, E.BBolt, D.MSmith, S.S.Fiore, M.CBaker, T.B(in press)A multiple motives approach to tobacco dependence: The Wisconsin Inventory of Smoking Dependence Motives (WISDM-68)Journal of Consulting & Clinical Psychology138 The WI-PRISM is a brief clinical measure of relapse proneness that appears useful for treatment matching, as well as predicting early and late relapse as well or better than other dependence scales. ADDIN EN.CITE Piper(in preparation)228102281Piper, M.EMa, G.XBolt, D.MMcCarthy, D. E.Baker, T.B(in preparation)The Wisconsin Predicting Relapse in Smoking Measure (WI-PRISM) - A new measure of relapse pronenessPoster presented at the 10th Annual Meeting of the Society for Research on Nicotine and Tobacco. Scottsdale, Az156 The WSWS ADDIN EN.CITE Welsch1999195601956Welsch, S. K.Smith, S. S.Wetter, D. W.Jorenby, D. E.Fiore, M. C.Baker, T. B.1999Development and validation of the Wisconsin Smoking Withdrawal ScaleExperimental and Clinical Psychopharmacology74354-61Nov10609970AdultAgedDouble-Blind MethodFactor Analysis, StatisticalFemaleHumanMaleMiddle AgedPredictive Value of TestsPsychological Tests/*standardsQuestionnairesReproducibility of ResultsSmoking Cessation/*psychologySubstance Withdrawal Syndrome/*psychologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10609970Center for Tobacco Research and Intervention and University of Wisconsin--Madison, 53706, USA. skw@ctri.medicine.wisc.edu157 is a 28-item multi-dimensional measure of nicotine withdrawal containing a craving scale that was found to mediate bupropion and counseling effects in our first TTURC research.
Researchers at CTRI have also demonstrated an ability to analyze data from clinical trials in novel, sophisticated ways. For example, researchers have published papers on innovative ways (e.g., hierarchical linear modeling) to analyze nicotine withdrawal symptom data. These analyses have revealed that withdrawal experiences are not as transient as previously thought and that symptom ratings over time can be parsed into multiple dimensions (e.g., elevation, trajectory, volatility) that significantly and independently predict relapse. ADDIN EN.CITE McCarthy(under review)248502485McCarthy, D>EFiore, M.CPiasecki, T.M.Baker, T.B(under review)Life before and after quitting smokingJournal of Abnormal PsychologyPiasecki2003111801118Piasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.2003Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relationsJournal of Abnormal Psychology112114-27Feb12653410AdultBupropion/therapeutic useDopamine Uptake Inhibitors/therapeutic useDouble-Blind MethodFemaleFollow-Up StudiesHumanMaleNicotine/*adverse effectsRecurrenceSeverity of Illness IndexSmoking/drug therapy/*prevention & controlSmoking Cessation/*methods*Substance Withdrawal Syndrome/diagnosis/etiology/prevention & controlSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12653410Department of Psychological Sciences, University of Missouri-Columbia 65211, USA. PiaseckiT@missouri.eduPiasecki2003111901119Piasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.2003Smoking withdrawal dynamics: I. Abstinence distress in lapsers and abstainersJournal of Abnormal Psychology11213-13Feb12653409Administration, CutaneousDouble-Blind MethodHumanNicotine/administration & dosage/*adverse effectsRecurrenceSmoking/*prevention & controlSmoking Cessation/*methodsSubstance Withdrawal Syndrome/diagnosis/*etiologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12653409Department of Psychological Sciences, University of Missouri-Columbia 65211, USA. PiaseckiT@missouri.eduPiasecki2003175001750145992611142003NovSmoking Withdrawal Dynamics: III. Correlates of Withdrawal Heterogeneity276-85Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, US. piaseckit@missouri.eduPiasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.Exp Clin Psychopharmacolhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14599261124,125,155,158 Researchers at CTRI recently conducted mediational analyses using data derived from individual withdrawal symptom growth curves. Results suggest that the effects of bupropion and individual counseling on cessation success are partially mediated by reductions in the severity of cigarette cravings and changes in the linear slope in craving ratings over time. Past CTRI research has also identified moderators of treatment effects that may be included in a treatment assignment algorithm developed through the proposed TTURC research. Our research showed that women and persons with a history of depression are particularly aided by bupropion as opposed to NRT. ADDIN EN.CITE Smith2003189901899Smith, S. S.Jorenby, D. E.Leischow, S. J.Nides, M. A.Rennard, S. I.Johnston, J. A.Jamerson, B.Fiore, M. C.Baker, T. B.2003Targeting smokers at increased risk for relapse: Treating women and those with a history of depressionNicotine & Tobacco Research5199-109Feb12745511Administration, CutaneousBupropion/administration & dosageDepression/epidemiology/*psychologyDopamine Uptake Inhibitors/administration & dosageFemaleHumanMaleNicotine/administration & dosageRecurrenceRisk FactorsSmoking/epidemiology/*prevention & controlSmoking Cessation/*methods/statistics & numerical dataSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12745511Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin 53711-2027, USA. sss@ctri.medicine.wisc.edu159
During initial TTURC funding, CTRI researchers established links with the University of Utah Huntsman Cancer Institute. Wisconsin has sent over 1100 DNA samples of smokers and community controls to Utah. All samples have undergone quality control at Utah and have been diluted to 200 mg/ml, to facilitate subsequent DNA sequencing and SNP genotyping. After identification of common haplotypes in the nicotinic subunits in a subset of these smokers and controls, we will identify tagged SNPs and genotype them in the remaining samples. A total of 192 samples from smokers and nonsmokers (two trays of 96) have been defined. Amplification and sequencing has begun on the first tray of 96 samples for the CHRNA3 and CHRNB4 genes.
In addition to the experience in conducting tobacco research, the UW-CTRI has a long history of linking with researchers across the UW campus and beyond to address vital tobacco science and policy challenges. The proposed UW-TTURC, and specifically this research project will advance our scientific collaboration to a new level bringing together a team of co-investigators each with considerable relevant expertise from diverse disciplines. Some of our collaborators in the proposed research are:
Lisa Colbert, PhD, MPH is a kinesiologist with expert knowledge in the assessment of physical activity and exercise. She has conducted extensive research on the relationship between physical activity and health outcomes, including longitudinal research ADDIN EN.CITE Colbert2000282002820110867511042000OctPhysical activity-related injuries in walkers and runners in the aerobics center longitudinal study259-63Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.Colbert, L. H.Hootman, J. M.Macera, C. A.Clin J Sport MedAdultAthletic Injuries/epidemiology/etiologyCase-Control StudiesFemaleHumanLogistic ModelsLongitudinal StudiesMaleMiddle AgedQuestionnairesRisk FactorsRunning/*injuriesSupport, U.S. Gov't, P.H.S.Walking/*injurieshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11086751Colbert2003282302823129482871462003AugPhysical activity and risk of endometrial cancer in a prospective cohort study (United States)559-67Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, MD, USA. lisa.colbert@att.netColbert, L. H.Lacey, J. V., Jr.Schairer, C.Albert, P.Schatzkin, A.Albanes, D.Cancer Causes ControlAgedBreast Neoplasms/*epidemiology/*prevention & controlCohort StudiesEndometrial Neoplasms/*epidemiology/*prevention & control*ExerciseFemaleFollow-Up StudiesHumanMiddle AgedPhysical FitnessProspective StudiesRisk AssessmentSupport, U.S. Gov't, P.H.S.United States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12948287160,161 and research with smokers. ADDIN EN.CITE Colbert2001285202852113035971032001MarPhysical activity in relation to cancer of the colon and rectum in a cohort of male smokers265-8Division of Clinical Sciences, National Cancer Institute, NIH, Bethesda, Maryland 20892-7058, USA.Colbert, L. H.Hartman, T. J.Malila, N.Limburg, P. J.Pietinen, P.Virtamo, J.Taylor, P. R.Albanes, D.Cancer Epidemiol Biomarkers PrevAge DistributionAgedCohort StudiesColonic Neoplasms/diagnosis/*epidemiologyComorbidityComparative StudyConfidence IntervalsConfounding Factors (Epidemiology)*ExerciseFinland/epidemiologyHealth BehaviorHumanIncidence*Life StyleMaleMiddle AgedProbabilityPrognosisRectal Neoplasms/diagnosis/*epidemiologyRisk AssessmentRisk FactorsSmoking/*epidemiologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11303597Colbert2002282202822119206499852002Apr 10Physical activity and lung cancer risk in male smokers770-3Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA. COLBERTL@mail.nih.govColbert, L. H.Hartman, T. J.Tangrea, J. A.Pietinen, P.Virtamo, J.Taylor, P. R.Albanes, D.Int J CancerAge FactorsAgedCohort StudiesEmployment*ExerciseFinland/epidemiologyHumanLeisure ActivitiesLife StyleLung Neoplasms/*epidemiology/etiologyMaleMiddle AgedProspective StudiesRecreationRisk FactorsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11920649Limburg2002162801628Limburg, P. J.Stolzenberg-Solomon, R. Z.Colbert, L. H.Perez-Perez, G. I.Blaser, M. J.Taylor, P. R.Virtamo, J.Albanes, D.2002Helicobacter pylori seropositivity and colorectal cancer risk: A prospective study of male smokersCancer Epidemiology Biomarkers & Prevention1110 Pt 11095-9Oct12376513Adenocarcinoma/etiology/*microbiologyAgedAntibodies, Bacterial/analysisCase-Control StudiesColorectal Neoplasms/etiology/*microbiologyHelicobacter Infections/*complications/immunologyHumanLife StyleMaleMiddle AgeProspective StudiesRisk FactorsSerologic TestsSupport, U.S. Gov't, Non-P.H.S.Support, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12376513Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.162-164
Michael Fleming, MD, MPH is a nationally recognized leader in the assessment and treatment of alcoholism and alcohol abuse. ADDIN EN.CITE Fleming200328130281312638647162003Brief interventions and the treatment of alcohol use disorders: current evidence375-90Department of Family Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53715, USA.Fleming, M. F.Recent Dev AlcoholAlcoholism/*rehabilitationClinical TrialsHumanOutcome and Process Assessment (Health Care)*Psychotherapy, Briefhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12638647Fleming200128530285311449755152001Screening and brief interventions for alcohol use disorders in managed care settings393-416Department of Family Medicine, University of Wisconsin, Madison, Wisconsin 53715, USA.Fleming, M. F.Graham, A. W.Recent Dev AlcoholAdolescentAdultAgedAlcoholism/*diagnosis/epidemiology/rehabilitationClinical TrialsCross-Sectional StudiesFemaleHealth Maintenance Organizations/statistics & numerical dataHumanMale*Managed Care Programs*Mass ScreeningMiddle AgedOutcome and Process Assessment (Health Care)*Psychotherapy, BriefReferral and Consultation/statistics & numerical datahttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11449755Fleming199828150281595840408811998JanAt-risk drinking in an HMO primary care sample: prevalence and health policy implications90-3Center for Addiction Research and Education, University of Wisconsin-Madison, USA.Fleming, M. F.Manwell, L. B.Barry, K. L.Johnson, K.Am J Public HealthAdultAlcoholic Intoxication/epidemiologyAlcoholism/*epidemiologyFemaleHealth Maintenance OrganizationsHumanLogistic ModelsMalePrevalencePrimary Health CareRisk FactorsSmokingSocioeconomic FactorsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Wisconsin/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9584040Fleming2002281402814118216522612002JanBrief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis36-43Department of Family Medicine, University of Wisconsin-Madison Medical School, Madison, Wisconsin 53715, USA. mfleming@fammed.wisc.eduFleming, M. F.Mundt, M. P.French, M. T.Manwell, L. B.Stauffacher, E. A.Barry, K. L.Alcohol Clin Exp ResAdolescentAdultAgedAlcohol Drinking/*economics/mortality/therapyAnalysis of VarianceComparative StudyCost-Benefit Analysis/methods/statistics & numerical dataFemaleFollow-Up StudiesHumanMaleMiddle Aged*Physician-Patient RelationsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Time FactorsTreatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11821652Murray1996281902819921750971111996NovPrevention and treatment of alcohol-related problems: an international medical education model1204-10International Research and Training Program, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-7033, USA. pmurray@willco.niaaa.nih.govMurray, M.Fleming, M.Acad MedAlcoholism/*prevention & control/*therapyCurriculum*Education, MedicalHuman*International Cooperation*Models, EducationalNational Institutes of Health (U.S.)PolandUnited Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9217509Brown199828160281696176532811998Training the trainers: substance abuse screening and intervention137-46Department of Family Medicine, University of Wisconsin Medical School, Madison 53715, USA.Brown, R. L.Fleming, M. F.Int J Psychiatry MedAdultCurriculumEducation*Education, Medical, Continuing/methodsEducational TechnologyFaculty, MedicalFamily Practice/educationFemaleHumanInternship and ResidencyMalePhysicians, Family/*educationSubstance-Related Disorders/*diagnosis/prevention & control/*therapy*Teaching/methodshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9617653165-170 In addition, he has expertise in the assessment of alcohol use in longitudinal research. ADDIN EN.CITE Fleming19972817028179091691277131997Apr 2Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices1039-45Department of Family Medicine, University of Wisconsin Medical School, Madison, USA.Fleming, M. F.Barry, K. L.Manwell, L. B.Johnson, K.London, R.JamaAdultAlcoholism/*prevention & controlAlgorithms*CounselingEmergency Service, Hospital/utilizationEthanol/poisoning*Family PracticeFemaleHealth Resources/utilizationHealth StatusHospitalization/statistics & numerical dataHumanInternal MedicineLogistic ModelsMaleMiddle Aged*Physician's RolePhysicians, FamilySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Wisconsinhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9091691Fleming2002281402814118216522612002JanBrief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis36-43Department of Family Medicine, University of Wisconsin-Madison Medical School, Madison, Wisconsin 53715, USA. mfleming@fammed.wisc.eduFleming, M. F.Mundt, M. P.French, M. T.Manwell, L. B.Stauffacher, E. A.Barry, K. L.Alcohol Clin Exp ResAdolescentAdultAgedAlcohol Drinking/*economics/mortality/therapyAnalysis of VarianceComparative StudyCost-Benefit Analysis/methods/statistics & numerical dataFemaleFollow-Up StudiesHumanMaleMiddle Aged*Physician-Patient RelationsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Time FactorsTreatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11821652168,171
Patrick McBride, MD, MPH is an expert in all areas of preventive cardiology, especially cholesterol, exercise, and exercise testing. ADDIN EN.CITE Adams1999285502855104981156031999Sep 1Antioxidant vitamins and the prevention of coronary heart disease895-904University of Wisconsin Medical School, Madison 53792-3248, USA.Adams, A. K.Wermuth, E. O.McBride, P. E.Am Fam PhysicianAntioxidants/adverse effects/*therapeutic useAscorbic Acid/therapeutic useCoronary Disease/*prevention & controlHumanPatient EducationRandomized Controlled TrialsTeaching MaterialsVitamin E/therapeutic useVitamins/adverse effects/*therapeutic usebeta Carotene/adverse effectshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10498115Keevil2002282702827125299042932002SepCardiovascular disease prevention667-96Department of Medicine, Section of Cardiovascular Medicine, University of Wisconsin Medical School, #3248 600 Highland Avenue H6/349, Madison, WI 53792, USA. jgk@medicine.wisc.eduKeevil, J. G.Stein, J. H.McBride, P. E.Prim CareCardiovascular Diseases/diagnosis/etiology/*prevention & controlCoronary Disease/etiology/prevention & controlDiabetes Mellitus/complications/diagnosis/therapyHealth BehaviorHealth PromotionHumanLife StyleLipids/bloodPreventive Health Services*Primary PreventionRisk AssessmentRisk Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12529904Stein1999282802828Stein, J. H.McBride, P. E.1999Screening and managing patients with lipoprotein (a) excessInternal Medicine2069-21172-174 He has served on the NCEP ATP III, AACVPR Cardiac Rehabilitation, and AHA Preventive Cardiology for Women Expert Panels. He has also conducted research on the role of lipoproteins and emerging risk factors in atherosclerosis. ADDIN EN.CITE Schauer1998282402824Schauer, J.EStein, J. H.McBride, P.E.1998Atherosclerotic vascular disease prevention: Advances in risk factor managementFamily Practice Recertification201013-35Stein19982825028259645823158121998Jun 22Hyperhomocysteinemia and atherosclerotic vascular disease: pathophysiology, screening, and treatment. off1301-6Preventive Cardiology Program, Department of Medicine, University of Wisconsin Medical School, Madison 53792, USA. jhs@medicine.wisc.eduStein, J. H.McBride, P. E.Arch Intern MedArteriosclerosis/blood/*etiology/prevention & control/therapyHomocysteine/*bloodHumanMass ScreeningRisk Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9645823Stein199828560285694564521111998Jan-FebBenefits of cholesterol screening and therapy for primary prevention of cardiovascular disease: a new paradigm72-7Stein, J. H.McBride, P. E.J Am Board Fam PractAnticholesteremic Agents/*therapeutic useCardiovascular Diseases/blood/drug therapy/*prevention & controlCholesterol/*bloodCost-Benefit AnalysisHumanhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9456452Fallest-Strobl199728260282693514295661997Oct 15Homocysteine: a new risk factor for atherosclerosis1607-12, 1615-6University of Wisconsin-Madison Medical School, USA.Fallest-Strobl, P. C.Koch, D. D.Stein, J. H.McBride, P. E.Am Fam PhysicianAlgorithmsArteriosclerosis/*blood/*etiology/prevention & controlHomocysteine/*bloodHumanMaleMiddle AgedRisk Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9351429175-178
F. Javier Nieto, MD, PhD is a physician epidemiologist with expertise in carotid ultrasound measures of artherosclerotic progression ADDIN EN.CITE Chambless2003283002830145057745692003SepCoronary heart disease risk prediction in the Atherosclerosis Risk in Communities (ARIC) study880-90Department of Biostatistics, University of North Carolina, CB #8300, 137 East Franklin Street, Suite 400, Bank of America Center, Chapel Hill, NC 27514-4145, USA. wchambless@unc.eduChambless, L. E.Folsom, A. R.Sharrett, A. R.Sorlie, P.Couper, D.Szklo, M.Nieto, F. J.J Clin EpidemiolAge FactorsAgedBiological Markers/bloodBlood Coagulation Factors/analysisCarotid ArteriesContinental Population GroupsCoronary Disease/blood/*etiology/pathologyDiabetes Mellitus/complicationsFemaleHealth SurveysHumanHypertension/complicationsLipoprotein(a)/analysisMaleMiddle AgedObesity/complicationsPredictive Value of TestsProspective StudiesROC CurveRisk AssessmentRisk FactorsSex FactorsSmoking/adverse effectsSupport, U.S. Gov't, P.H.S.Tunica Intima/pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14505774179 and the study of endothelial function. ADDIN EN.CITE Nieto2003282902829145511662003Oct 9Sleep apnea and markers of vascular endothelial function in a large community sample of older adultsPopulation Health Sciences, University of Wisconsin Medical School, Madison, WI, USA.Nieto, F. J.Harrington, D. M.Redline, S.Benjamin, E. J.Robbins, J. A.Am J Respir Crit Care Medhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14551166180 He has also examined racial disparities in health outcomes ADDIN EN.CITE Ding20032831028311294736314632003SepRacial disparity in long-term mortality rate after hospitalization for myocardial infarction: the Atherosclerosis Risk in Communities study459-64Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md 21205, USA. jding@jhsph.eduDing, J.Diez Roux, A. V.Nieto, F. J.McNamara, R. L.Hetmanski, J. B.Taylor, H. A., Jr.Tyroler, H. A.Am Heart JAfrican Americans/*statistics & numerical dataAge FactorsEuropean Continental Ancestry Group/*statistics & numerical dataFemaleHospitalizationHumanIncidenceMaleMiddle AgedMyocardial Infarction/epidemiology/ethnology/*mortalityProportional Hazards ModelsProspective StudiesRisk FactorsSex FactorsSocioeconomic FactorsSupport, U.S. Gov't, P.H.S.United States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12947363181 and served on quality control committees for large-scale studies. ADDIN EN.CITE Quan2002283202832124898892582002Dec15Short-term variablility of respiration and sleep during unattended nonlaboratory polysomnogaphy--the Sleep Heart Health Study843-9Arizona Respiratory Center and Department of Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA. squan@resp-sci.arizona.eduQuan, S. F.Griswold, M. E.Iber, C.Nieto, F. J.Rapoport, D. M.Redline, S.Sanders, M.Young, T.SleepAdultAgedAged, 80 and overApnea/*diagnosisArousal/physiologyBody Mass IndexCircadian Rhythm/physiologyElectrocardiographyElectromyographyElectrooculographyFemaleHumanMaleMiddle AgedOxygen ConsumptionPolysomnography/*methods*RespirationSleep Apnea Syndromes/*diagnosisSleep Stages/physiologySupport, U.S. Gov't, P.H.S.Time Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12489889182
Linda Roberts, PhD has great expertise in social network, social mapping and couples research. ADDIN EN.CITE Leonard1998283302833983024810741998NovThe effects of alcohol on the marital interactions of aggressive and nonaggressive husbands and their wives602-15Research Institute on Addictions, Buffalo, New York 14203-1016, USA. leonard@ria.orgLeonard, K. E.Roberts, L. J.J Abnorm PsycholAdolescentAdultAggression/drug effects/*psychologyAlcoholic Intoxication/*psychologyAnalysis of VarianceComparative StudyConflict (Psychology)Domestic Violence/*psychologyEthanol/pharmacologyFemaleHuman*Interpersonal RelationsInterview, PsychologicalMalePlacebosProblem Solving/drug effectsPsychological TestsSpouses/*psychologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9830248Roberts2002283772837Roberts, L. J.Greenberg, D.R2002Observational windows to intimacy processes in marriageNoller, PFeeny, JUnderstanding marriage: Developments in the study of couple interactionNew YorkCambridge University Press118-149183,184 She also has expertise in how social relationships are affected by substance use (especially alcohol). ADDIN EN.CITE Roberts1997283572835Roberts, L.JLeonard, K. E.1997Gender differences and similarities in the alcohol and marriage relationshipWisnack, SWilsnack, RGender and alcohol: Individual and social perspectivesNew Brunswick, NJRutgers Center of Alcohol Studies289-311Leonard1998283302833983024810741998NovThe effects of alcohol on the marital interactions of aggressive and nonaggressive husbands and their wives602-15Research Institute on Addictions, Buffalo, New York 14203-1016, USA. leonard@ria.orgLeonard, K. E.Roberts, L. J.J Abnorm PsycholAdolescentAdultAggression/drug effects/*psychologyAlcoholic Intoxication/*psychologyAnalysis of VarianceComparative StudyConflict (Psychology)Domestic Violence/*psychologyEthanol/pharmacologyFemaleHuman*Interpersonal RelationsInterview, PsychologicalMalePlacebosProblem Solving/drug effectsPsychological TestsSpouses/*psychologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9830248Roberts2000283472834Roberts, L.JLinney, K.D2000Alcohol problems and couples: Drinking in an intimate, relational contextSchmaling, KGoldman Sher, TThe psychology of couples and illnessWashington, D.CAmerican Psychological Association269-310Roberts2003228212282Roberts, L.JMcCrady, B.S2003Alcohol problems in intimate relationships: Identification and intervention (NIH publication number 03-5284)Washington, D.C.U.S. Government Printing Office183,185-187.
James Stein, MD is an expert in preventive cardiology, with particular knowledge of the ultrasound assessment of atherosclerosis ADDIN EN.CITE Stein2001219702197Stein, J. H.Carlsson, C. M.Papcke-Benson, K.Aeschlimann, S. E.Bodemer, A.Carnes, M.McBride, P. E.2001The effects of lipid-lowering and antioxidant vitamin therapies on flow-mediated vasodilation of the brachial artery in older adults with hypercholesterolemiaJournal of the American College of Cardiology3871806-1813Dec11738278AgedAged, 80 and overAscorbic Acid/*administration & dosageBrachial Artery/drug effectsComparative StudyDouble-Blind MethodDrug Therapy, CombinationEndothelium, Vascular/drug effectsFemaleHumanHypercholesterolemia/blood/*drug therapyLipoproteins, LDL Cholesterol/bloodLong-Term CareMalePravastatin/*administration & dosageSimvastatin/*administration & dosageSupport, Non-U.S. Gov'tVasodilation/*drug effectsVitamin A/*administration & dosagehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11738278University of Wisconsin Medical School, Madison, Wisconsin, USA. jhs@medicine.wisc.edu188 and the study of endothelial function. ADDIN EN.CITE Stein(in press)2225142225Stein, J.HFraizer, M.CAeschlimann, S. E.Nelson-Worel, JMcBride, P.E.Douglas, P.S(in press)Individualizing coronary risk assessment using carotid intima media thickness measurements to estimate vascular ageClinical CardiologyChuang2002219902199Chuang, M. L.Douglas, P. S.Bisinov, E. A.Stein, J. H.2002Effect of cardiac cycle on ultrasound assessment of endothelial functionVascular Medicine72103-108May12402990AgedAged, 80 and overBlood Flow Velocity/drug effects/*physiologyBrachial Artery/ultrasonographyComparative StudyCoronary Arteriosclerosis/physiopathology/ultrasonographyDiagnostic ErrorsEndothelium, Vascular/drug effects/*physiology/*ultrasonographyFemaleHumanHyperemia/physiopathology/ultrasonographyMaleMiddle AgedNitroglycerin/therapeutic useObserver VariationPredictive Value of TestsProspective StudiesStroke Volume/drug effects/physiologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Systole/drug effects/physiology*Ultrasonography, InterventionalVasodilation/drug effects/physiologyVasodilator Agents/therapeutic useVentricular Function, Left/drug effects/physiologyWisconsinhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12402990University of Wisconsin Atherosclerosis Imaging Research Program, University of Wisconsin Medical School, Madison 53792, USA.189,190 He has pioneered work using carotid intima-media thickness measures to determine cardiovascular age and predict cardiovascular risk. ADDIN EN.CITE Stein(in press)2225142225Stein, J.HFraizer, M.CAeschlimann, S. E.Nelson-Worel, JMcBride, P.E.Douglas, P.S(in press)Individualizing coronary risk assessment using carotid intima media thickness measurements to estimate vascular ageClinical CardiologyStein199925740257410477529100101999Sep 7Purple grape juice improves endothelial function and reduces the susceptibility of LDL cholesterol to oxidation in patients with coronary artery disease1050-5University of Wisconsin Medical School, Madison, WI 53792-3982, USA.Stein, J. H.Keevil, J. G.Wiebe, D. A.Aeschlimann, S.Folts, J. D.CirculationAged*BeveragesBrachial Artery/physiopathologyCoronary Disease/blood/*physiopathologyEndothelium, Vascular/*physiopathologyFemaleHumanInsulin/bloodLipids/bloodLipoproteins, LDL Cholesterol/*metabolismMaleMiddle AgedOxidation-Reduction*Rosaleshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10477529Stein20012575025751145774110432001Jul 17Use of human immunodeficiency virus-1 protease inhibitors is associated with atherogenic lipoprotein changes and endothelial dysfunction257-62Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin, USA.Stein, J. H.Klein, M. A.Bellehumeur, J. L.McBride, P. E.Wiebe, D. A.Otvos, J. D.Sosman, J. M.CirculationAdultBlood Flow Velocity/drug effectsBrachial Artery/drug effects/physiopathology/ultrasonographyCholesterol/bloodCross-Sectional StudiesEndothelium, Vascular/*drug effects/physiopathologyFemaleHIV Infections/*blood/drug therapyHIV Protease Inhibitors/*adverse effectsHumanHyperlipidemia/blood/*chemically induced/diagnosisLipoproteins/*bloodLipoproteins, HDL Cholesterol/bloodMaleReverse Transcriptase Inhibitors/therapeutic useRisk FactorsTriglycerides/bloodVasodilation/drug effectshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11457741189,191,192
Walter Willett, MD, DrPH is a researcher of international stature who has expertise in the assessment of diet and nutrition and their relations with other modifiable risk factors and important health outcomes. ADDIN EN.CITE Hu2002283902839120870092572002JulElevated risk of cardiovascular disease prior to clinical diagnosis of type 2 diabetes1129-34Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA. frank.hu@channing.harvard.eduHu, F. B.Stampfer, M. J.Haffner, S. M.Solomon, C. G.Willett, W. C.Manson, J. E.Diabetes CareAdultAge of OnsetCardiovascular Diseases/*epidemiologyCerebrovascular Accident/epidemiology/mortalityCohort StudiesCoronary Disease/epidemiologyDiabetes Mellitus, Type II/*epidemiologyFemaleFollow-Up StudiesHumanLongitudinal StudiesMiddle AgedMultivariate AnalysisMyocardial Infarction/epidemiologyNursesRisk AssessmentSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Time Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12087009Fung2002284102841121979967632002SepWhole-grain intake and the risk of type 2 diabetes: a prospective study in men535-40Programs in Nutrition, Simmons College, Boston, MA 02115, USA. fung@simmons.eduFung, T. T.Hu, F. B.Pereira, M. A.Liu, S.Stampfer, M. J.Colditz, G. A.Willett, W. C.Am J Clin NutrAdultAgedAnalysis of VarianceBlood Glucose/metabolism*CerealsCohort StudiesDiabetes Mellitus, Type II/*epidemiology/prevention & control*DietDietary Fiber/administration & dosageHumanMagnesium/administration & dosageMaleMiddle AgedProspective StudiesRiskRisk FactorsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12197996Osganian2003284602846127916157762003JunDietary carotenoids and risk of coronary artery disease in women1390-9Children's Hospital, Department of Medicine, Boston, MA 02115, USA. stavroula.osganian@tch.harvard.eduOsganian, S. K.Stampfer, M. J.Rimm, E.Spiegelman, D.Manson, J. E.Willett, W. C.Am J Clin NutrAdultAntioxidants/*administration & dosageCarotenoids/*administration & dosageCoronary Disease/epidemiology/*prevention & controlDietDose-Response Relationship, DrugFemaleFollow-Up StudiesHumanMiddle AgedProspective StudiesRiskSupport, U.S. Gov't, P.H.S.beta Carotene/administration & dosagehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12791615McCullough2002284302843124508927662002DecDiet quality and major chronic disease risk in men and women: moving toward improved dietary guidance1261-71American Cancer Society, Atlanta, GA 30329, USA. mmccullo@cancer.orgMcCullough, M. L.Feskanich, D.Stampfer, M. J.Giovannucci, E. L.Rimm, E. B.Hu, F. B.Spiegelman, D.Hunter, D. J.Colditz, G. A.Willett, W. C.Am J Clin NutrAdultAgedCardiovascular Diseases/epidemiology*Chronic Disease*DietFemale*Health PromotionHumanMaleMiddle AgedNeoplasms/epidemiologyNursesNutritionNutrition Policy*Patient EducationQuestionnairesRisk FactorsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12450892193-196 In addition, he has significant expertise in longitudinal research methods. ADDIN EN.CITE Cho2002284002840120870112572002JulA prospective study of obesity and risk of coronary heart disease among diabetic women1142-8Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA. eunyoung.cho@channing.harvard.eduCho, E.Manson, J. E.Stampfer, M. J.Solomon, C. G.Colditz, G. A.Speizer, F. E.Willett, W. C.Hu, F. B.Diabetes CareAdultAgedBody HeightBody Mass IndexBody WeightCoronary Disease/*epidemiologyDiabetic Angiopathies/*epidemiologyEstrogen Replacement TherapyFemaleHumanHypercholesterolemia/epidemiologyHypertension/epidemiologyIncidenceMassachusetts/epidemiologyMiddle AgedNursesObesity in Diabetes/*complicationsProspective StudiesRisk FactorsSmokingSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Weight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12087011Wu20022842028421243370611112002NovA prospective study on supplemental vitamin e intake and risk of colon cancer in women and men1298-304Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA. kana.wu@channing.harvard.eduWu, K.Willett, W. C.Chan, J. M.Fuchs, C. S.Colditz, G. A.Rimm, E. B.Giovannucci, E. L.Cancer Epidemiol Biomarkers PrevAdultAgedAntioxidants/*administration & dosageAscorbic Acid/administration & dosageCarotenoids/administration & dosageCohort StudiesColonic Neoplasms/*diet therapy/*epidemiologyComparative Study*Dietary SupplementsDose-Response Relationship, DrugFemaleFollow-Up StudiesHumanMaleMenopause/drug effectsMiddle AgedMultivariate AnalysisProspective StudiesRisk FactorsSupport, U.S. Gov't, P.H.S.Treatment OutcomeUnited States/epidemiologyVitamin D/administration & dosageVitamin E/*administration & dosagehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12433706Al-Delaimy2003284502845126632777742003AprA prospective study of calcium intake from diet and supplements and risk of ischemic heart disease among men814-8Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. wael@hsph.harvard.eduAl-Delaimy, W. K.Rimm, E.Willett, W. C.Stampfer, M. J.Hu, F. B.Am J Clin NutrAdultAgedCalcium, Dietary/*administration & dosageCohort StudiesDairy ProductsDietDietary SupplementsHumanMaleMiddle AgedMyocardial Infarction/epidemiologyMyocardial Ischemia/*epidemiology/mortalityProspective StudiesQuestionnairesRiskRisk FactorsSupport, U.S. Gov't, P.H.S.Vitamin D/administration & dosagehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12663277Michaud200328470284712796048157122003Jun 15Dietary meat, dairy products, fat, and cholesterol and pancreatic cancer risk in a prospective study1115-25Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA. michaudd@mail.nih.govMichaud, D. S.Giovannucci, E.Willett, W. C.Colditz, G. A.Fuchs, C. S.Am J EpidemiolAdultCholesterol/*blood*Dairy ProductsDietary Fats/*administration & dosageFemale*Food HabitsHumanIncidence*MeatMiddle AgedMultivariate AnalysisNurses/statistics & numerical dataNutrition SurveysPancreatic Neoplasms/blood/*epidemiology/*etiologyProspective StudiesRisk AssessmentRisk FactorsSupport, U.S. Gov't, P.H.S.United States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12796048Feskanich2003284402844125404147722003FebCalcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women504-11Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. diane.feskanich@channing.harvard.eduFeskanich, D.Willett, W. C.Colditz, G. A.Am J Clin NutrAnimalsBone Density/*drug effectsCalcium, Dietary/*administration & dosageCohort StudiesDietDietary SupplementsFemaleHip Fractures/*epidemiology/prevention & controlHumanLongitudinal StudiesMiddle Aged*Milk/chemistryOsteoporosis, Postmenopausal/epidemiology/prevention & controlPostmenopauseProportional Hazards ModelsProspective StudiesQuestionnairesRisk FactorsSupport, U.S. Gov't, P.H.S.Vitamin D/*administration & dosagehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12540414197-201
Finally, UW-CTRI researchers have made significant theoretical contributions to the tobacco control field. During the first UW-TTURC, researchers developed a sophisticated model of addiction motivation with heuristic value, ADDIN EN.CITE Baker(in press)207402074Baker, T.BPiper, M.EMcCarthy, D.EMajeskie, M.RFiore, M.C(in press)Addiction motivation reformulated: An affective processing model of negative reinforcementPsychological Review120 proposed a data-based model for the study of relapse proneness, ADDIN EN.CITE Piasecki2002145501455Piasecki, T. M.Fiore, M. C.McCarthy, D. E.Baker, T. B.2002Have we lost our way? The need for dynamic formulations of smoking relapse pronenessAddiction9791093-1108Sep12199822Administration, CutaneousFatigue/etiologyForecastingHumanMotivationNicotine/administration & dosageRecurrence/prevention & controlRisk FactorsSmoking/*prevention & controlSmoking Cessation/*methods/psychologyStress, Psychological/etiologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12199822Department of Psychological Sciences, University of Missouri-Columbia, 65211, USA. piaseckit@missouri.edu133 and contributed to the development of a model for the transdisciplinary evaluation of tobacco dependence treatments. ADDIN EN.CITE Baker2003207902079Baker, T.Hatsukami, D.Lerman, C.O'Malley, S.Shields, A.Fiore, M.2003Transdisciplinary science applied to the evaluation of treatments for tobacco useNicotine & Tobacco Research5Suppl 1S89-9914668089http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14668089University of Wisconsin Medical School.202
D. Research Design And Methods
Recruitment and Enrollment
Recruitment. Subjects in the current study will be recruited from participants from Project 1: Efficacy. To provide the reader with necessary context, we will describe the randomization plan and cessation treatments used in that study (Figure 1). Each pharmacotherapy will be used in a manner consistent with recommendations from the PHS Guideline, Treating Tobacco Use and Dependence ADDIN EN.CITE Fiore2000188811888Fiore, M.CBailey, W.C.Cohen, S.J2000Treating tobacco use and dependence: Clinical Practice GuidelineRockville, MDU.S. Department of Health and Human Services, U.S. Public Health Service203 or with package insert instructions (lozenge). Pharmacotherapy for this study will be made available as an unrestricted gift from GlaxoSmithKline to the University of Wisconsin contingent on NIH funding. In addition to pharmacotherapy, subjects will receive brief in-person counseling (4 sessions).
Participants who volunteer for Project 1 will simultaneously volunteer for this follow-up study (Project 2: Longterm Outcomes) that is intended to last five years (although only three years will be funded by this TTURC application). During recruitment, prospective subjects will be told of the long-term nature of the study, and will be given explicit information on study requirements. Researchers will stress the vital importance of a firm commitment to participate in the entirety of the study (although we will note their right to withdraw at any point). Subjects will be told that the study has two aims: (1) to determine which medicines are most helpful to smokers trying to quit, and (2) to study the long-term effects of quitting and not quitting on health, behavior, and life satisfaction. They will be told that it is as vital for everyone to remain in the study regardless of success. In addition, subjects will be fully informed of the potential risks and benefits of participation and will be provided appropriate HIPAA information. Thus, this project is described in a separate application from Project 1, the two projects will share the same subjects.
Individuals may be included who: report smoking at least 10 cigarettes/day for the previous six months, produce a breath sample with a CO level > 9 ppm, report being motivated to quit, and are able to read and write English. Medical screening at baseline will ensure that participants can safely be prescribed any of the included medications (e.g., no uncontrolled hypertension, history of bipolar illness, recent myocardial infarction, current alcohol dependence with risk of seizure, seizure history, history of bulimia or anorexia nervosa, or current use of a MAO inhibitor). In addition, any individual who reports regular thoughts of suicide or self-harm will be assessed by a clinical psychologist, and those judged to be at risk for suicide will be excluded and offered referrals to appropriate treatment resources.
Figure 1: Treatments for the 1,520 study participants randomized to Project 1: Efficacy For the purposes of this grant application, participants will be considered part of Project 1: Efficacy from the time of their enrollment and completion of pre-quit assessments until their one-year post-quit anniversary date. They will be considered part of the current project (Project 2: Longterm Outcomes) from their one-year post-quit anniversary date until at least three years after the quit attempt anniversary date. Enrollment for Project 1 will take place over the first two years of this five-year TTURC grant. Enrollment in Project 1 will commence about six months after the start of grant funding and will continue for approximately 18 months.
Enrollment. Enrollment for Project 2 (Longterm Outcomes) will begin at around 18 months (when the first participant in Project 1 reaches his/her 12 month quit date anniversary) and continues through month 36 (when the last participant in Project 1 reaches his/her 12 month quit date anniversary). The end of Project 1 and the start of Project 2 are designed to be seamless for participants. Based upon cost considerations and power, we will invite only 900 Subjects from Project 1 to participate in Project 2.
Participants will be enrolled in Project 2 in the following manner. All Project 1 participants will be contacted by telephone around 12 months after the quit attempt and queried regarding their smoking status. At that 12 month phone contact, all abstinent individuals (estimate = 360, see expected abstinence rates and attrition below) will be enrolled in Project 2 and scheduled for the one-year, post-quit in-person assessments. Additionally, we will enroll relapsers until approximately 540 have been scheduled for the one-year in-person assessments. The estimated 360 abstinent and 540 continuing smokers will serve as the total cohort (N=900) to be followed for two additional years in Project 2. These figures are inexact since they depend on abstinence rates. Subject enrollment will continue until the 900 sample size target is met. Selection of relapsers for Project 2 will be random with one constraint: ethnic minorities will be over-recruited since evidence suggests that these individuals tend to attrit at a higher rate than other subjects ADDIN EN.CITE McKenzie1999204502045105818851041999NovTracking and follow-up of marginalized populations: a review409-29Department of Medicine/Immunology, Miriam Hospital, Providence, RI 02906, USA.McKenzie, M.Tulsky, J. P.Long, H. L.Chesney, M.Moss, A.J Health Care Poor UnderservedAdolescentAdultCommunicationFemaleHomeless Persons/*statistics & numerical dataHumanMalePopulation Surveillance/*methods*Poverty*Residential MobilitySan Francisco/epidemiologySubstance-Related Disorders/epidemiologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10581885204. Project 2 is designed so that all essential physiologic and psychosocial outcomes are collected at the two-year follow-up point (three years from the quit date).
Additional details of our recruitment plan are in Project 1 and will be based on our successful recruiting strategies used during the first UW-TTURC when more than 1,500 participants were enrolled. Participants for this study will be recruited in both Madison and Milwaukee to increase diversity (with at least 50% of subjects recruited in Milwaukee). Based upon our previous research, the overall induction effort will yield the following approximate percentage of subjects: female = 56%, White = 79%, African-American = 17%, and other ethnic minorities = 4%.
Expected Abstinence Rates and Attrition
Based on projections detailed in Project 1, we expect the overall biochemically-confirmed one-week pointprevalence abstinence rates to be 27.6% at six months and 23.6% at 12 months. A survey of some dozen clinical trials (e.g., ADDIN EN.CITE Jorenby1999208502085104362852631999SepThe Agency for Health Care Policy and Research smoking cessation clinical practice guideline: basics and beyond513-28Department of Medicine, Section of General Internal Medicine, and Director of Clinical Services, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison, Wisconsin, USA.Jorenby, D. E.Fiore, M. C.Prim CareFemaleHumanMalePrimary Health CareSmoking Cessation/*methodsUnited Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10436285Smith20016440644Smith,S.S.Jorenby,D.EFiore,M.C.Anderson,J.E.Mielke,M.M.Beach,K.E.Piasecki,T.M.Baker,T.B.2001Strike while the iron is hot: Can stepped-care treatments resurrect relapsing smokers?Journal of Consulting & Clinical Psychology693429-439abstinencecessationcounselingefficacyintervention practicesrelapserelapse preventionrisksmokingsupportBohadana200019020190211074742160202000Nov 13Nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo-controlled trial3128-34INSERM Unite 420, Epidemiologie Sante Travail, Faculte de Medecine, BP 184-54505 Vandoeuvre-Cedex, France. bohadana@u420.nancy.inserm.frBohadana, A.Nilsson, F.Rasmussen, T.Martinet, Y.Arch Intern MedAdministration, InhalationAdministration, TopicalAdultCombined Modality TherapyComparative StudyDouble-Blind MethodFemaleHumanMaleNicotine/*administration & dosage/adverse effectsSmoking Cessation/*methodsSubstance Withdrawal Syndrome/epidemiologySupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11074742Blondal1999286902869992405231871791999Jan 30Nicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow up285-8Reykjavik Health Care Centre, Baronstigur 47, 101 Reykjavik and National University Hospital, Iceland. blondal@hr.isBlondal, T.Gudmundsson, L. J.Olafsdottir, I.Gustavsson, G.Westin, A.BmjAdministration, CutaneousAdministration, IntranasalAdultAgedDouble-Blind MethodFemaleFollow-Up StudiesHumanMaleMiddle AgedNicotine/*administration & dosageNicotinic Agonists/*administration & dosageSmoking Cessation/*methodsSupport, Non-U.S. Gov'tTreatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9924052Jorenby1999208602086Jorenby, D. E.Leischow, S. J.Nides, M. A.Rennard, S. I.Johnston, J. A.Hughes, A. R.Smith, S. S.Muramoto, M. L.Daughton, D. M.Doan, K.Fiore, M. C.Baker, T. B.1999A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessationNew England Journal of Medicine3409685-691Mar 410053177Administration, CutaneousAdultAntidepressive Agents, Second-Generation/adverse effects/*therapeutic useBupropion/adverse effects/*therapeutic useDelayed-Action PreparationsDrug Therapy, CombinationFemaleHumanMaleNicotine/adverse effects/*therapeutic useSmoking Cessation/*methods/psychology/statistics & numerical dataSubstance Withdrawal SyndromeSupport, Non-U.S. Gov'tWeight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10053177Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison, USA.151,154,205-207) shows that a typical decline in abstinence rates from 6 to 12 months is about 4%. A similar adjustment was applied to our expected six-month abstinence rates to yield projected 12-month abstinence rates (See Table 2). Comparisons with actual reported 12 month rates ADDIN EN.CITE Tonnesen1999287002870100656621321999FebHigher dosage nicotine patches increase one-year smoking cessation rates: results from the European CEASE trial. Collaborative European Anti-Smoking Evaluation. European Respiratory Society238-46Dept of Pulmonary Medicine, Gentofte Hospital, Hellerup, Denmark.Tonnesen, P.Paoletti, P.Gustavsson, G.Russell, M. A.Saracci, R.Gulsvik, A.Rijcken, B.Sawe, U.Eur Respir JAdministration, CutaneousAdultAgedBody WeightDouble-Blind MethodFemaleHumanMaleMiddle AgedNicotine/*administration & dosage/adverse effectsPatient ComplianceSmoking Cessation/*methodsSupport, Non-U.S. Gov'tTreatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10065662Daughton19982871028719755734751998Sep-OctTransdermal nicotine therapy and primary care. Importance of counseling, demographic, and participant selection factors on 1-year quit rates. The Nebraska Primary Practice Smoking Cessation Trial Group425-30Department of Internal Medicine, University of Nebraska Medical Center, Omaha, USA. ddaughto@unmc.eduDaughton, D.Susman, J.Sitorius, M.Belenky, S.Millatmal, T.Nowak, R.Patil, K.Rennard, S. I.Arch Fam MedAdministration, CutaneousAdultDouble-Blind MethodFemaleHumanMaleMiddle AgedNebraskaNicotine/*administration & dosageNicotinic Agonists/*administration & dosagePatient SelectionPrimary Health Care/*methodsRisk FactorsSmoking Cessation/*methods/*statistics & numerical dataSupport, Non-U.S. Gov'tTime FactorsTreatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9755734Killen199728720287292565686541997AugNicotine patch and self-help video for cigarette smoking cessation663-72Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, California 94304-1885, USA. Killen@SCRDP.Stanford.EDUKillen, J. D.Fortmann, S. P.Davis, L.Varady, A.J Consult Clin PsycholAdministration, CutaneousAdultChi-Square DistributionFemaleHumanLogistic ModelsMale*ManualsMiddle AgedNicotine/*therapeutic useNicotinic Agonists/*therapeutic useProportional Hazards ModelsProspective StudiesSelf Care/*methodsSmoking Cessation/*methodsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Survival AnalysisTreatment Outcome*Video Recordinghttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9256568Jorenby1999208602086Jorenby, D. E.Leischow, S. J.Nides, M. A.Rennard, S. I.Johnston, J. A.Hughes, A. R.Smith, S. S.Muramoto, M. L.Daughton, D. M.Doan, K.Fiore, M. C.Baker, T. B.1999A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessationNew England Journal of Medicine3409685-691Mar 410053177Administration, CutaneousAdultAntidepressive Agents, Second-Generation/adverse effects/*therapeutic useBupropion/adverse effects/*therapeutic useDelayed-Action PreparationsDrug Therapy, CombinationFemaleHumanMaleNicotine/adverse effects/*therapeutic useSmoking Cessation/*methods/psychology/statistics & numerical dataSubstance Withdrawal SyndromeSupport, Non-U.S. Gov'tWeight Gainhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10053177Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison, USA.Richmond2003247402474128509072222003JunReview of bupropion for smoking cessation203-20School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia. r.richmond@unsw.edu.auRichmond, R.Zwar, N.Drug Alcohol RevAntidepressive Agents, Second-Generation/adverseeffects/pharmacology/*therapeutic useBupropion/adverse effects/pharmacology/*therapeutic useCardiovascular Diseases/complicationsDelayed-Action PreparationsDepression/complicationsDopamine/metabolismHumanImpulsive Behavior/psychologyNorepinephrine/metabolismPulmonary Disease, Chronic Obstructive/complicationsRecurrence*SmokingSmoking Cessation/*methodsTobacco Use Disorder/complications/*drug therapy/prevention & controlhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12850907Blondal1999286902869992405231871791999Jan 30Nicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow up285-8Reykjavik Health Care Centre, Baronstigur 47, 101 Reykjavik and National University Hospital, Iceland. blondal@hr.isBlondal, T.Gudmundsson, L. J.Olafsdottir, I.Gustavsson, G.Westin, A.BmjAdministration, CutaneousAdministration, IntranasalAdultAgedDouble-Blind MethodFemaleFollow-Up StudiesHumanMaleMiddle AgedNicotine/*administration & dosageNicotinic Agonists/*administration & dosageSmoking Cessation/*methodsSupport, Non-U.S. Gov'tTreatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9924052Fiore(in press)192701927Fiore, M.CMcCarthy, D.EJackson, T.CZehner, M.E.Jorenby, D.EMielke, M.M.Smith, SSGuiliani, T.ABaker, T.B(in press)Integrating smoking cessation treatment into primary care: An effectiveness studyPreventive Medicine151,153,207-211 shows precedence for these estimates.
Attrition. Attrition in Project 2 will be influenced by attrition that occurs during Project 1 (the first year after the quit attempt; see Project 1 for more details). Our attrition expectation for Project 1 suggests one-year attrition rates of 10-20%, based on prior research. For instance, in our most recent clinical trial, ADDIN EN.CITE Piper(in press)193701937Piper, M.EPiasecki, T. M.Federman, E.BBolt, D.MSmith, S.S.Fiore, M.CBaker, T.B(in press)A multiple motives approach to tobacco dependence: The Wisconsin Inventory of Smoking Dependence Motives (WISDM-68)Journal of Consulting & Clinical Psychology138 10% of the sample stopped study participation over the 12-month follow-up period. This study is highly relevant to the current attrition estimate since it involved similar assessment and ethnic representation as is proposed for Project 1. That study, however, did not include additional aggressive steps that we will follow to minimize attrition in the current research (see Steps to reduce attrition below). In two of our other recent clinical trials having extensive assessment burdens and visit schedules, attrition was about 18% at one year. The attrition projection of 15% over the course of Project 1 therefore, seems reasonable given the retention steps to be employed in the proposed study. Thus, we envision that 15% of 1,520 participants enrolled Project 1 will attrit by month 12, leaving approximately 1,292 available for enrollment in Project 2 (many more than the target enrollment for Project 2 of 900).
Among the 900 subjects enrolled in Project 2, some will attrit over the two-year course of this study. Table 3 summarizes the expected sample size by year for Project 2 based on an initial enrollment of 900 and factoring in expected rates of attrition, additional quitting and relapse that are project to take place over the two year course of the study. Based upon other long-term cohort studies that involve aggressive efforts to maintain subject involvement across multiple years of follow-up, we expect the bulk of attrition (15%) to occur in Year 1. ADDIN EN.CITE Badawi1999204002040101898153421999FebPsychopathology and attrition in the Baltimore ECA 15-year follow-up 1981-199691-8Westat, RA, Rockville, Maryland 20850-3129, USA.Badawi, M. A.Eaton, W. W.Myllyluoma, J.Weimer, L. G.Gallo, J.Soc Psychiatry Psychiatr EpidemiolAdolescentAdultAgedBaltimore/epidemiologyComparative Study*Data CollectionFemaleFollow-Up StudiesHumanMaleMental Disorders/*epidemiologyMiddle AgedRetrospective StudiesSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10189815Deeg2002204302043119271985542002AprAttrition in the Longitudinal Aging Study Amsterdam. The effect of differential inclusion in side studies319-28Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands. djh.deeg.emgo@med.vu.nlDeeg, D. J.van Tilburg, T.Smit, J. H.de Leeuw, E. D.J Clin EpidemiolAgedAged, 80 and over*AgingFemaleHuman*Longitudinal StudiesMaleMiddle AgedNetherlandsReproducibility of Results*Research DesignSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11927198212,213 Moreover, we expect to limit attrition over the next two years (Project 2) to 5% per year (see Table 3). These projections are consistent with prior longitudinal follow-up studies involving both smokers ADDIN EN.CITE Bjornson199519900199078567828521995FebGender differences in smoking cessation after 3 years in the Lung Health Study223-30Department of Physiology, Oregon Health Sciences University, Portland 97201.Bjornson, W.Rand, C.Connett, J. E.Lindgren, P.Nides, M.Pope, F.Buist, A. S.Hoppe-Ryan, C.O'Hara, P.Am J Public HealthAdultAlcohol DrinkingAnalysis of VarianceComparative StudyEducational StatusEvaluation StudiesFemaleHealth StatusHealth SurveysHumanLung Diseases, Obstructive/epidemiology/*prevention & controlMaleMarriageMiddle AgedSex FactorsSmoking/*adverse effectsSmoking Cessation/*methodsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7856782214 and other subjects. ADDIN EN.CITE Badawi1999204002040101898153421999FebPsychopathology and attrition in the Baltimore ECA 15-year follow-up 1981-199691-8Westat, RA, Rockville, Maryland 20850-3129, USA.Badawi, M. A.Eaton, W. W.Myllyluoma, J.Weimer, L. G.Gallo, J.Soc Psychiatry Psychiatr EpidemiolAdolescentAdultAgedBaltimore/epidemiologyComparative Study*Data CollectionFemaleFollow-Up StudiesHumanMaleMental Disorders/*epidemiologyMiddle AgedRetrospective StudiesSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10189815BootsMiller1998204102041981899333131998NovMethods of ensuring high follow-up rates: lessons from a longitudinal study of dual diagnosed participants2665-85University of Michigan Substance Abuse Research Center, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs Medical Center, 48133-1070, USA.BootsMiller, B. J.Ribisl, K. M.Mowbray, C. T.Davidson, W. S.Walton, M. A.Herman, S. E.Subst Use Misuse*Diagnosis, Dual (Psychiatry)Follow-Up StudiesHumanMental Disorders/*complicationsProfessional-Patient RelationsResearch/standardsSubstance-Related Disorders/*complicationsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9818993Cotter2002206702067Cotter, R.B., Burke, J.D., Loeber, R., & Navratil, J.L.2002Innovative retention methods in longitudinal research: a case of the developmental trends studyJournal of Child and Family Studies11485-498McKenzie1999204502045105818851041999NovTracking and follow-up of marginalized populations: a review409-29Department of Medicine/Immunology, Miriam Hospital, Providence, RI 02906, USA.McKenzie, M.Tulsky, J. P.Long, H. L.Chesney, M.Moss, A.J Health Care Poor UnderservedAdolescentAdultCommunicationFemaleHomeless Persons/*statistics & numerical dataHumanMalePopulation Surveillance/*methods*Poverty*Residential MobilitySan Francisco/epidemiologySubstance-Related Disorders/epidemiologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10581885204,212,215,216 These estimates suggest that 812 subjects (approximately 90% of the original 900) will be available for analysis at the end of Project 2.
Steps to reduce attrition. Attrition will occur not only in the first year (Project 1: Efficacy), but will continue throughout the course of Project 2. Since attrition can have extreme negative impacts on the external and internal validity of a study (producing bias, reducing power), we will take a series of steps to minimize attrition. These steps are supported by considerable research on determinants of attrition in longitudinal studies and will include the following:
We will obtain an extensive list of family, social network, and employment information that we can use to locate subjects lost to follow-up. ADDIN EN.CITE Cotter2002206702067Cotter, R.B., Burke, J.D., Loeber, R., & Navratil, J.L.2002Innovative retention methods in longitudinal research: a case of the developmental trends studyJournal of Child and Family Studies11485-498Claus2002204202042120031153412002Jan-MarPredictors of attrition in a longitudinal study of substance abusers69-74Missouri Institute of Mental Health, St. Louis 63139, USA. clausr@mimh.eduClaus, R. E.Kindleberger, L. R.Dugan, M. C.J Psychoactive DrugsAdultAnalysis of VarianceEducationEmploymentFemaleFollow-Up StudiesHumanInterviewsLogistic ModelsLongitudinal StudiesMaleMental Disorders/complications/psychologyMissouriPatient Dropouts/*psychologyPredictive Value of TestsPrognosisQuestionnairesSocioeconomic FactorsSubstance-Related Disorders/complications/psychology/*rehabilitationSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12003115Deeg2002204302043119271985542002AprAttrition in the Longitudinal Aging Study Amsterdam. The effect of differential inclusion in side studies319-28Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands. djh.deeg.emgo@med.vu.nlDeeg, D. J.van Tilburg, T.Smit, J. H.de Leeuw, E. D.J Clin EpidemiolAgedAged, 80 and over*AgingFemaleHuman*Longitudinal StudiesMaleMiddle AgedNetherlandsReproducibility of Results*Research DesignSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11927198213,216,217
At least 10 efforts to contact individuals, using both telephone and mail, will be made to ensure that subjects fully participate in the key follow-up points: telephone (at months 18 and 30) and in-person (at 12, 24 and 36 months). Successful contact strategies will be maintained and used in subsequent efforts to establish contact.
Each participant will be assigned a UW TTURC staff person who will be the liaison for the participant throughout the entire study period. Previous research shows that a personal relationship with a study liaison is highly important in study retention. ADDIN EN.CITE BootsMiller1998204102041981899333131998NovMethods of ensuring high follow-up rates: lessons from a longitudinal study of dual diagnosed participants2665-85University of Michigan Substance Abuse Research Center, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs Medical Center, 48133-1070, USA.BootsMiller, B. J.Ribisl, K. M.Mowbray, C. T.Davidson, W. S.Walton, M. A.Herman, S. E.Subst Use Misuse*Diagnosis, Dual (Psychiatry)Follow-Up StudiesHumanMental Disorders/*complicationsProfessional-Patient RelationsResearch/standardsSubstance-Related Disorders/*complicationsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9818993Cotter2002206702067Cotter, R.B., Burke, J.D., Loeber, R., & Navratil, J.L.2002Innovative retention methods in longitudinal research: a case of the developmental trends studyJournal of Child and Family Studies11485-498McKenzie1999204502045105818851041999NovTracking and follow-up of marginalized populations: a review409-29Department of Medicine/Immunology, Miriam Hospital, Providence, RI 02906, USA.McKenzie, M.Tulsky, J. P.Long, H. L.Chesney, M.Moss, A.J Health Care Poor UnderservedAdolescentAdultCommunicationFemaleHomeless Persons/*statistics & numerical dataHumanMalePopulation Surveillance/*methods*Poverty*Residential MobilitySan Francisco/epidemiologySubstance-Related Disorders/epidemiologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10581885204,215,216 The contact person will conduct principal assessments in this study with the exception of the smoking outcome questionnaires.
Research suggests that belief in the importance of the research and the importance of personal participation both affect attrition. ADDIN EN.CITE Janson200120440204411728627226 Suppl2001DecAttrition and retention of ethnically diverse subjects in a multicenter randomized controlled research trial236S-43SDepartment of Community Health Systems, University of California, San Francisco, San Francisco, CA 94143-0608, USA.Janson, S. L.Alioto, M. E.Boushey, H. A.Control Clin TrialsAdultAsthma/drug therapyFemaleHumanMaleMinority GroupsMulticenter Studies/*statistics & numerical dataPatient Dropouts/*psychology/statistics & numerical dataRandomized Controlled Trials/*statistics & numerical datahttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11728627218 In light of this, we will inform subjects of study progress through a participant newsletter that will be sent to them twice/year, we will send them birthday cards each year acknowledging and thanking them for their participation, and we will send them small gifts labeled with study logos and phone/email information (e.g., pens, refrigerator magnets, notebooks).
Previous research shows that incentives can promote adherence and continued participation ADDIN EN.CITE McKenzie1999204502045105818851041999NovTracking and follow-up of marginalized populations: a review409-29Department of Medicine/Immunology, Miriam Hospital, Providence, RI 02906, USA.McKenzie, M.Tulsky, J. P.Long, H. L.Chesney, M.Moss, A.J Health Care Poor UnderservedAdolescentAdultCommunicationFemaleHomeless Persons/*statistics & numerical dataHumanMalePopulation Surveillance/*methods*Poverty*Residential MobilitySan Francisco/epidemiologySubstance-Related Disorders/epidemiologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10581885204. Therefore, we will use inducements and monetary compensation to recognize subjects efforts.
Allowing considerable personal control over assessment completion has been linked to greater study adherence. Research suggests that nonadherence or reluctance is often a temporary state and that 70% of subjects are willing to participate at some point in time after a refusal. ADDIN EN.CITE Cotter2002206702067Cotter, R.B., Burke, J.D., Loeber, R., & Navratil, J.L.2002Innovative retention methods in longitudinal research: a case of the developmental trends studyJournal of Child and Family Studies11485-498Navaratil1994207302073Navaratil, J. LO., Green, S. M., Loeber, R., & Lahey, B. B.1994Minimizing subject loss in a longitudinal study of deviant behaviorJournal of Child and Family Studies389-106Stouthamer-Loeber1992274302743Stouthamer-Loeber, M., Van Kammen, W., Loeber, R.1992The nuts and bolts of implementing large-scale longitudinal studiesViolence and Victims7163-78216,219,220 In the proposed research we will allow subjects flexibility regarding assessments including rain checks and make-up scheduling.
A significant proportion of our sample will be African-American and some data suggest that they are more likely to attrit than other participants. ADDIN EN.CITE Badawi1999204002040101898153421999FebPsychopathology and attrition in the Baltimore ECA 15-year follow-up 1981-199691-8Westat, RA, Rockville, Maryland 20850-3129, USA.Badawi, M. A.Eaton, W. W.Myllyluoma, J.Weimer, L. G.Gallo, J.Soc Psychiatry Psychiatr EpidemiolAdolescentAdultAgedBaltimore/epidemiologyComparative Study*Data CollectionFemaleFollow-Up StudiesHumanMaleMental Disorders/*epidemiologyMiddle AgedRetrospective StudiesSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10189815Siddiqui199620460204688883232551996Sep-OctFactors affecting attrition in a longitudinal smoking prevention study554-60Prevention Research Center, University of Illinois at Chicago 60607, USA.Siddiqui, O.Flay, B. R.Hu, F. B.Prev MedAdolescentCaliforniaChildCohort StudiesEthnic GroupsFemaleHumanLongitudinal StudiesMalePatient Dropouts/*statistics & numerical dataRegression AnalysisSmoking/*prevention & controlSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8888323212,221 In order to retain high percentages of African-American participants we will ensure that research staff are culturally sensitive, that assessments are scheduled around work and childcare obligations, and that appointments can be easily rescheduled. ADDIN EN.CITE Janson200120440204411728627226 Suppl2001DecAttrition and retention of ethnically diverse subjects in a multicenter randomized controlled research trial236S-43SDepartment of Community Health Systems, University of California, San Francisco, San Francisco, CA 94143-0608, USA.Janson, S. L.Alioto, M. E.Boushey, H. A.Control Clin TrialsAdultAsthma/drug therapyFemaleHumanMaleMinority GroupsMulticenter Studies/*statistics & numerical dataPatient Dropouts/*psychology/statistics & numerical dataRandomized Controlled Trials/*statistics & numerical datahttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11728627218
Some of these steps designed to promote adherence might affect some outcomes such as abstinence. We view this possibility as being preferable to high levels of missing data and the bias that would result from a less aggressive retention strategy. Also, we note that some of these steps (e.g., sending a newsletter) will be started in Project 2, so they should not bias abstinence rates in Project 1. Contact persons will be extensively trained to avoid giving any counseling/advice during contacts, as well as to be nonjudgmental, active listeners, and persistent. ADDIN EN.CITE Prinz200122370223711146258201 Suppl2001JanRecruitment and retention of participants in prevention trials involving family-based interventions31-7Department of Psychology, University of South Carolina (Prinz, Smith, Laughlin, White, Barron), Columbia, South Carolina 29208, USA. prinz@sc.eduPrinz, R. J.Smith, E. P.Dumas, J. E.Laughlin, J. E.White, D. W.Barron, R.Am J Prev MedChild Behavior Disorders/*prevention & control*FamilyHumanIntervention StudiesLongitudinal StudiesPersonnel Selection/*methodsSubstance-Related Disorders/prevention & controlSupport, Non-U.S. Gov'tSupport, U.S. Gov't, Non-P.H.S.Support, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11146258222 Research shows that when steps such as the above are used, 80 to 97% of participants can be followed effectively over multiple years. This is true even for individuals low in SES, drug users, and those with psychiatric comorbidities. ADDIN EN.CITE Badawi1999204002040101898153421999FebPsychopathology and attrition in the Baltimore ECA 15-year follow-up 1981-199691-8Westat, RA, Rockville, Maryland 20850-3129, USA.Badawi, M. A.Eaton, W. W.Myllyluoma, J.Weimer, L. G.Gallo, J.Soc Psychiatry Psychiatr EpidemiolAdolescentAdultAgedBaltimore/epidemiologyComparative Study*Data CollectionFemaleFollow-Up StudiesHumanMaleMental Disorders/*epidemiologyMiddle AgedRetrospective StudiesSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10189815Bjornson199519900199078567828521995FebGender differences in smoking cessation after 3 years in the Lung Health Study223-30Department of Physiology, Oregon Health Sciences University, Portland 97201.Bjornson, W.Rand, C.Connett, J. E.Lindgren, P.Nides, M.Pope, F.Buist, A. S.Hoppe-Ryan, C.O'Hara, P.Am J Public HealthAdultAlcohol DrinkingAnalysis of VarianceComparative StudyEducational StatusEvaluation StudiesFemaleHealth StatusHealth SurveysHumanLung Diseases, Obstructive/epidemiology/*prevention & controlMaleMarriageMiddle AgedSex FactorsSmoking/*adverse effectsSmoking Cessation/*methodsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7856782BootsMiller1998204102041981899333131998NovMethods of ensuring high follow-up rates: lessons from a longitudinal study of dual diagnosed participants2665-85University of Michigan Substance Abuse Research Center, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs Medical Center, 48133-1070, USA.BootsMiller, B. J.Ribisl, K. M.Mowbray, C. T.Davidson, W. S.Walton, M. A.Herman, S. E.Subst Use Misuse*Diagnosis, Dual (Psychiatry)Follow-Up StudiesHumanMental Disorders/*complicationsProfessional-Patient RelationsResearch/standardsSubstance-Related Disorders/*complicationsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9818993Cotter2002206702067Cotter, R.B., Burke, J.D., Loeber, R., & Navratil, J.L.2002Innovative retention methods in longitudinal research: a case of the developmental trends studyJournal of Child and Family Studies11485-498McKenzie1999204502045105818851041999NovTracking and follow-up of marginalized populations: a review409-29Department of Medicine/Immunology, Miriam Hospital, Providence, RI 02906, USA.McKenzie, M.Tulsky, J. P.Long, H. L.Chesney, M.Moss, A.J Health Care Poor UnderservedAdolescentAdultCommunicationFemaleHomeless Persons/*statistics & numerical dataHumanMalePopulation Surveillance/*methods*Poverty*Residential MobilitySan Francisco/epidemiologySubstance-Related Disorders/epidemiologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10581885204,212,214-216
Smoking outcomes. Smoking status will be somewhat fluid over the two years of follow-up for subjects in Project 2 as some participants will transition between smoking and abstinence during this time. Research suggests that between 3 5% of abstainers at the end of Year one (end of Project 1) will resume smoking each year over the course of follow-up Years 2 & 3 of Project 2. ADDIN EN.CITE Gilpin199745045Gilpin,E.APierce,J.P1997Duration of smoking abstinence and success in quittingJournal of the National Cancer Institute898572-577Aprabstinencesmokingrelapseinterventionssmoking cessationsurveyadultssmoking statuscigarettes13 Based upon this, we estimate an annual relapse rate of 4% among those confirmed to be successful quitters one year post-quit (See Table 3).
Conversely, data suggest that a significant percentage of those relapsing by Year 1 or later will re-establish abstinence. The large COMMIT longitudinal study suggests a natural quit rate of about 4%/year over several years ADDIN EN.CITE Li2003206932069Li, Q., Hyland, A., Bauer, J., Giovino, G., & Cummings, M.2003Long-term predictors of indicators of smoking cessation and relapseSociety for Research on Nicotine and TobaccoNew OrleansFebruary, 2003223. These figures agree with those from the Working Well Trial, the Normative Aging Study, and others showing approximate long term 3% to 5% spontaneous quit rate/year. ADDIN EN.CITE McClure2002163001630McClure, J. B.Wetter, D. W.de Moor, C.Cinciripini, P. M.Gritz, E. R.2002The relation between alcohol consumption and smoking abstinence: Results from the Working Well TrialAddictive Behaviors273367-79May-Jun12125663AdultAlcohol Drinking/*epidemiologyCommunity Mental Health ServicesFemaleFollow-Up StudiesHealth BehaviorHumanMaleSmoking/epidemiologySmoking Cessation/*statistics & numerical dataSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12125663Group Health Cooperative, Center for Health Studies, Seattle, WA 98101, USA. mcclure.j@ghc.orgNordstrom2000175601756Nordstrom, B. L.Kinnunen, T.Utman, C. H.Krall, E. A.Vokonas, P. S.Garvey, A. J.2000Predictors of continued smoking over 25 years of follow-up in the normative aging studyAmerican Journal of Public Health903404-6Mar10705859AdultAge FactorsAgedAged, 80 and overEducational StatusFemaleHumanMaleMiddle AgePredictive Value of TestsRisk FactorsSmoking/*epidemiology/psychologySupport, U.S. Gov't, Non-P.H.S.Support, U.S. Gov't, P.H.S.Survival AnalysisUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10705859Harvard School of Dental Medicine, Boston, MA 02108, USA. beth_nordstrom@hms.harvard.eduKrall20027760776Krall,E.AGarvey,A.JGarcia,R.I2002Smoking relapse after 2 years of abstinence: Findings from the VA Normative Aging StudyNicotine & Tobacco Research495-100abstinencealcoholcessationmodelrelapserisksmoking12,101,224 Some studies such as the Health and Retirement Study ADDIN EN.CITE Franks200242042Franks, M. M.Pienta, A. M.Wray, L. A.2002It takes two: Marriage and smoking cessation in the middle yearsJournal of Aging and Health143336-54Aug12146510FemaleHealth BehaviorHumanMale*Marital StatusMarriageMiddle Age*Smoking Cessation/methods/psychology*Social Support*Spouses/psychologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12146510Wayne State University, Detroit, MI, USA. m.m.franks@wayne.edu113 report higher spontaneous quit rates but the older age range of those participants makes the data less relevant. It is possible that quit rates over Follow-up Years 2 & 3 will be somewhat higher than 4% in this study due to follow-up contacts and the fact that participants entered the study because of an interest in quitting smoking. However, we will use a 4% quit rate as a conservative estimate for both Follow-up Years 2 & 3 (Table 3). We recognize that newly abstinent subjects cannot be treated as continuously abstinent. However, our data will permit continuous measures of smoking over the three-year follow-up period.
Some analyses will use subjects who have been continuously abstinent for the entire 3-year follow-up. Given the abstinence and attrition estimates in Table 3, we expect 300 subjects to fulfill criteria for continuous abstinence at the end of Year 3.
Table 4. Assessment schedules (Orientation visits part of Project 1)
EvaluationOrientation
(3 Visits)One Year In-Person Visit18-month Phone Follow-UpTwo Year In-Person Visit30-month Phone Follow-UpThree Year In-Person VisitSign Informed Consent and HIPAAXDemographicsXSmoking History XWisconsin Inventory of Smoking Dependence Motives (WISDM-68)XXXXWisconsin Predicting Relapse in Smoking Measure (WI-PRISM)XFagerstrm Test of Nicotine Dependence (FTND)XWisconsin Smoking Withdrawal Scale (WSWS)XXXXXXMultidimensional Personality Questionnaire-Short Form (MPQ-S)XPositive and Negative Affect Scale (PANAS)XXXXXXDepression Proneness Inventory (DPI)XHolmes-Rahe Social Readjustment Rating ScaleXXXXInternational Physical Activity Questionnaire (IPAQ)XXXPrimeScreen (dietary questionnaire)XXXXXXFood Frequency Questionnaire (FFQ)XXXXVital SignsaXXXXXXSuicidality AssessmentXXXXComplete Physical ExamXWaist CircumferenceXXXXNational Comorbidity Survey Revised (NCS-R-CIDI)bXXXXShort Inventory of Problems (SIP-2R) Alcohol related problemsXXXXXXSocial Network InterviewXXXXKansas Marital Satisfaction Scale cXXXQuality of Life Inventory (QOLI)XXXXPregnancy Test for womenXUltrasound Carotid IntimaMedia Thickness (CIMT)XXUltrasound Brachial Artery Response Test (UBART)XExercise Stress TestXXPedometer Training and AssessmentXXXXBlood DrawdXXXSmoking StatuseXXXXXXTime Required For Each Visit (in hours)8424a Vital signs includes carbon monoxide, blood pressure, weight, temperature, pulse, and height at Visit 2. b NCS-R-CIDI, which should last on average 90 minutes, includes a Screener and the following modules: Depression, Irritable Depression, Panic Disorder, Specific Phobia, Social Phobia, Agoraphobia, Generalized Anxiety Disorder, Suicidality, Use of Services, Alcohol Use, Tobacco Use, Chronic Conditions, Neurasthenia, 30-Day Functioning, 30-Day Symptoms, Obsessive-Compulsive Disorder, Worries and Unhappiness. c This will be administered to participants who are married or who have a domestic partner. d Blood will be drawn for the following tests: NMR lipid profile, creatinine, simultaneous fasting blood glucose and insulin, possibly carotenoids, hemoglobin A1C, and high-sensitivity c-reactive protein. e Smoking status includes a review of the abstinence calendar, nature of relapse contexts, use of cessation aids and new quit attempts.
Measurement and Data Collection Plan
For Project 1, baseline questionnaire/interview data as well as physiological assessments will be collected during visits occurring prior to the quit day. This pre-quit data will also provide baseline data for Project 2. In addition to this baseline data, many of these same assessments will be collected at 12, 24, and 36 month (in-person) and 18, 30, and 42 month (telephone) follow-up contacts for Project 2. The timetable for data collected over the three years that comprise Projects 1 and 2 is depicted in Table 4.
Annual In-Person Clinic Visits (Months 12, 24, and 36). Participants enrolled in Project 2: Longterm Outcomes will attend an in-person clinic visit at one, two, and three years (12, 24, and 36 months) post-quit attempt. During these visits, participants will repeat many of the baseline assessments (see Table 4) including information to determine continuous and point-prevalence abstinence, the nature of any relapse event (environmental and social context, stressors, alcohol use, and so on), use of any new cessation aids, new quit attempts, and withdrawal and affective status (WSWS, PANAS, etc.). Suicidality will be assessed and appropriate referrals made in the event that suicide risk is determined.
Table 4 also lists other assessments that will take place at each annual in-person visit. Virtually all of the baseline paper-pencil questionnaires will be re-administered as well as the NCS-R-CIDI. In addition, some physiologic measures will be assessed including weight, body mass index, vital signs, waist circumference, and carbon monoxide (provided via a breath sample). Selected physical measures will be collected at some of these visits. For instance, the Carotid IMT, Exercise Stress Test, and NMR LipoProfile tests will be performed at the Baseline and Year 3 Visit. Brachial artery endothelial function will be tested at the Baseline and Year 1. Blood tests will completed at Baseline, Year 1 and Year 3 (but not Year 2) including NMR Lipoprofile, fasting glucose and insulin, hemoglobin A1C, creatinine, high sensitivity C-Reactive Protein, and possibly carotenoids.
The annual in-person clinic visits will occur over two days. The first day will involve assessment administration (questionnaires, simple physiologic measures). The second day will involve more complex physiologic measures including, when indicated, carotid IMT, brachial artery endothelial function, exercise treadmill stress test, and blood tests. Each of the two in-person Follow-up Visits days require about 2 hours (except for Year 2 when only a single day 2 hour visit is required). To ease the assessment burden we will take the following steps: (1) participants may interrupt the assessment session to take breaks, (2) there will be snacks to provide energy and a break from responding, (3) questionnaires may be completed at home if requested, and (4) participants may complete the assessments in multiple visits.
Pedometers will be distributed at the Annual Visits (months 12, 24, 36) along with a weekly recording log and a stamped, padded envelope addressed to the research center. Participants will be instructed to record the pedometer reading each night for a week and then return the pedometer by mail. Participants will receive a reminder phone call the day after they receive the pedometer to encourage daily recordings.
Assessments will be completed using the same procedures as at baseline. For instance, the NCS-R-CIDI will be administered in a computer-assisted format. If the participant is tested outside the research site, study personnel will administer it via laptop computer. Only the medical tests mandate an in-person visit. Finally, an additional visit will occur at 60 months after the quit day, but not within the funding period of this award. As in our previous research, responses on all forms will either be entered via computer (with catch criteria) at the time of collection or recorded on scannable forms to minimize the need for manual data entry. When scannable forms are used the researcher will inspect each form as it is completed to reduce scanning errors.
Telephone Clinic Visits (Months 18 and 30). A follow-up telephone assessment will take place at 18 and 30 months post quit-attempt. At this phone contact, the following factors will be assessed: continuous and seven day point-prevalence tobacco abstinence, the nature of the relapse contexts (environmental context, stress occurrence, use of alcohol, social context and so on), use of any cessation aids, new quit attempts, alcohol use in the last 7 days, tobacco withdrawal symptoms (WSWS), the PrimeScreen qualitative dietary survey, and affective status (PANAS) including suicidality. In total, this telephone assessment is estimated to take between 20 and 30 minutes.
Measurement and Data Collection Plan - Assessments
Physiologic
This research will target cardiovascular disease risk as the primary physiologic outcome of interest. This research will utilize state of the art, well-validated technologies and measures to prospectively assess atherosclerosis progression as well overall cardiovascular risk. Three of these measures (ultrasound measurement carotid IMT, brachial artery endothelial function, and advanced lipoprotein testing using NMR spectroscopy) are described below.
Carotid intima-media thickness (Carotid IMT). Carotid IMT quantifies sub-clinical atherosclerosis. This measure will be assessed at baseline and at the three year follow-up visit. Carotid IMT has been shown to provide specific predictive value for risk of heart attack and stroke and will be measured using the standardized protocol from the Atherosclerosis Risk in Communities (ARIC) study that optimizes images of the common, bifurcation, and internal segments of each carotid artery. ADDIN EN.CITE Touboul199225210252114032321051992JulUse of monitoring software to improve the measurement of carotid wall thickness by B-mode imagingS37-41Centre for Neurovascular Diagnosis and Prevention, Paris, France.Touboul, P. J.Prati, P.Scarabin, P. Y.Adrai, V.Thibout, E.Ducimetiere, P.J Hypertens SupplAgedCarotid Arteries/anatomy & histology/*ultrasonographyFemaleHumanImage Interpretation, Computer-Assisted/*methodsMaleObserver VariationReproducibility of ResultsSoftwareUltrasonography/methodshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1403232225 The carotid arteries will be imaged with an 8.0 MHz linear array ultrasound transducer (8L5, Acuson Sequoia, Siemens Ultrasound). Images will be recorded and stored digitally using a Camtronics Vericis System (Camtronics Medical Systems, Hartland, WI) (Figure 2). The combined thicknesses of the intimal and medial layers of the far walls of each 10 mm carotid artery segment are measured in triplicate. Far wall mean and maximum wall thicknesses of each carotid segment are averaged to define a segmental mean or maximum Carotid IMT score. Composite Carotid IMTmax is calculated as the mean of the segmental maximum scores from all measurable segments (maximum of six). Composite Carotid IMTmean is calculated as the mean of the segmental mean scores from all measurable segments (maximum of six). ADDIN EN.CITE Riley1991251002510Riley, W., Barnes, R., Bond, M., Evans G., Chambless, L., Heiss, G.1991High-resolution B-mode ultrasound reading methods in the Atherosclerosis Risk in Communities (ARIC) cohort. The ARIC Study GroupJ Neuroimaging14168-72Nov10149810Carotid Arteries/anatomy & histology/*ultrasonographyCarotid Artery, Internal/anatomy & histology/ultrasonographyHumanMiddle AgedObserver VariationReproducibility of ResultsSupport, U.S. Gov't, P.H.S.Ultrasonography/methodshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10149810Wendelhag1997252402524936856428111997NovA new automated computerized analyzing system simplifies readings and reduces the variability in ultrasound measurement of intima-media thickness2195-200Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Goteborg University, Gothenburg, Sweden. inger.wendelhag@wlab.wall.gu.seWendelhag, I.Liang, Q.Gustavsson, T.Wikstrand, J.StrokeAutomationCarotid Arteries/ultrasonographyComparative StudyEvaluation StudiesFemoral Artery/ultrasonographyHuman*Image Processing, Computer-AssistedObserver VariationSupport, Non-U.S. Gov'tTime FactorsTunica Intima/*ultrasonographyTunica Media/*ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9368564226,227 In our laboratory, the coefficient of variation for Carotid IMTmax is 4.9% and Carotid IMTmean is 3.2%. These values imply a high degree of reproducibility, as good as or better than reported in major epidemiologic trials. ADDIN EN.CITE Chambless1997221002210Chambless, L. E.Heiss, G.Folsom, A. R.Rosamond, W.Szklo, M.Sharrett, A. R.Clegg, L. X.1997Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: The Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993American Journal of Epidemiology1466483-494Sep 159290509Age DistributionArteriosclerosis/complications/*pathologyCarotid Arteries/*pathologyCoronary Disease/*epidemiology/ethnology/*etiology/pathologyFemaleHumanIncidenceMaleMiddle AgedMinnesota/epidemiologyProportional Hazards ModelsRisk FactorsSex DistributionSupport, U.S. Gov't, P.H.S.Tunica Intima/pathologyTunica Media/pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9290509Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill 27514, USA.Chambless2000214902149Chambless, L. E.Folsom, A. R.Clegg, L. X.Sharrett, A. R.Shahar, E.Nieto, F. J.Rosamond, W. D.Evans, G.2000Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) studyAmerican Journal of Epidemiology1515478-87Mar 110707916Carotid Arteries/*pathology/ultrasonographyCarotid Artery Diseases/*complications/ultrasonographyCerebrovascular Accident/*epidemiology/etiologyComparative StudyCoronary Arteriosclerosis/*complications/ultrasonographyFemaleHumanIncidenceMaleMiddle AgedPredictive Value of TestsProportional Hazards ModelsProspective StudiesRisk FactorsSupport, U.S. Gov't, P.H.S.Tunica Intima/*pathology/ultrasonographyUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10707916Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill 27514, USA.Selzer1994251302513784080511111994NovEvaluation of computerized edge tracking for quantifying intima-media thickness of the common carotid artery from B-mode ultrasound images1-11M/S 168-514, Jet Propulsion Laboratory, California Institute of Technology, Pasadena 91109.Selzer, R. H.Hodis, H. N.Kwong-Fu, H.Mack, W. J.Lee, P. L.Liu, C. R.Liu, C. H.AtherosclerosisAdultAgedCarotid Artery, Common/*ultrasonographyFemaleHumanImage Processing, Computer-AssistedMaleMiddle AgedModels, StructuralSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Tunica Intima/*ultrasonographyTunica Media/*ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7840805Touboul199225210252114032321051992JulUse of monitoring software to improve the measurement of carotid wall thickness by B-mode imagingS37-41Centre for Neurovascular Diagnosis and Prevention, Paris, France.Touboul, P. J.Prati, P.Scarabin, P. Y.Adrai, V.Thibout, E.Ducimetiere, P.J Hypertens SupplAgedCarotid Arteries/anatomy & histology/*ultrasonographyFemaleHumanImage Interpretation, Computer-Assisted/*methodsMaleObserver VariationReproducibility of ResultsSoftwareUltrasonography/methodshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=140323220,23,225,228
Brachial artery reactivity testing (BART): Endothelial function will be assessed using ultrasound measurement of the brachial artery in response to flow mediated vasodilation (FMD). This dynamic measure of arterial function is impacted immediately by cigarette smoking and is extremely sensitive to rapid changes in risk factors for cardiovascular disease. This will be measured at baseline and at the one-year post-quit attempt visit. Impaired endothelial function is associated with cardiovascular risk factors and prevalent as well as incident cardiovascular disease including among smokers. ADDIN EN.CITE Celermajer1992216802168135920934088281992Nov 7Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis1111-5Cardiothoracic Unit, Hospital for Sick Children, London, UK.Celermajer, D. S.Sorensen, K. E.Gooch, V. M.Spiegelhalter, D. J.Miller, O. I.Sullivan, I. D.Lloyd, J. K.Deanfield, J. E.LancetAdolescentAdultAgedArteriosclerosis/etiology/*physiopathology/ultrasonographyBlood Flow Velocity/physiologyBrachial Artery/ultrasonographyChildCoronary Disease/physiopathologyEndothelium, Vascular/*physiopathology/ultrasonographyFemaleFemoral Artery/ultrasonographyHumanHypercholesterolemia, Familial/physiopathologyMaleMiddle AgedReproducibility of ResultsRisk FactorsSmoking/physiopathologySupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1359209Corretti199521690216977333392684 Pt 21995AprTechnical aspects of evaluating brachial artery vasodilatation using high-frequency ultrasoundH1397-404Department of Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.Corretti, M. C.Plotnick, G. D.Vogel, R. A.Am J PhysiolAdultArmBrachial Artery/*physiology/*ultrasonographyConstrictionCoronary Disease/physiopathology/ultrasonographyFemaleHumanMaleMiddle AgedReference Values*Vasodilationhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7733339Celermajer19932166021668222109885 Pt 11993NovCigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults2149-55Cardiothoracic Unit, Hospital for Sick Children, London.Celermajer, D. S.Sorensen, K. E.Georgakopoulos, D.Bull, C.Thomas, O.Robinson, J.Deanfield, J. E.CirculationAdolescentAdultAnalysis of VarianceComparative StudyEndothelium, Vascular/*physiologyFemaleHumanMaleMiddle AgedMultivariate AnalysisNitroglycerin/pharmacologyReference ValuesRegional Blood Flow/physiologySmoking/*adverse effectsSupport, Non-U.S. Gov't*Vasodilation/physiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8222109Heitzer199621670216786410239371996Apr 1Cigarette smoking potentiates endothelial dysfunction of forearm resistance vessels in patients with hypercholesterolemia. Role of oxidized LDL1346-53Medizinische Klinik III, Universitat Freiburg, Germany.Heitzer, T.Yla-Herttuala, S.Luoma, J.Kurz, S.Munzel, T.Just, H.Olschewski, M.Drexler, H.CirculationAcetylcholine/pharmacologyAdrenergic alpha-Antagonists/pharmacologyArginine/analogs & derivatives/pharmacologyArteriosclerosis/epidemiologyAutoantibodies/*bloodCardiovascular Diseases/epidemiologyComparative StudyEndothelium, Vascular/*physiopathologyFemaleForearm/blood supplyHumanHypercholesterolemia/complications/*physiopathology*Lipid PeroxidationLipoproteins, LDL/blood/immunology/*physiologyMaleMiddle AgedMuscle, Smooth, Vascular/drug effectsNitric Oxide/metabolismNitroprusside/pharmacologyOxidation-ReductionPhentolamine/pharmacologyRisk FactorsSmoking/*adverse effectsVascular ResistanceVasodilation/*drug effectsVasodilator Agents/pharmacologyVasomotor System/drug effectsomega-N-Methylargininehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8641023Corretti2002217002170117882173922002Jan 16Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force257-65Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland 21205-1595, USA. mcorrett@umaryland.eduCorretti, M. C.Anderson, T. J.Benjamin, E. J.Celermajer, D.Charbonneau, F.Creager, M. A.Deanfield, J.Drexler, H.Gerhard-Herman, M.Herrington, D.Vallance, P.Vita, J.Vogel, R.J Am Coll CardiolBrachial Artery/*physiology/*ultrasonographyEndothelium, Vascular/*physiologyHumanImage Processing, Computer-AssistedNitric Oxide/physiologySupport, Non-U.S. Gov't*Vasodilationhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11788217229-233 This association is dose-dependent, both with increasing pack-years of exposure and varying levels of environmental tobacco smoke. It also seems to be potentially reversible as evidenced by the weaker association seen in former smokers. ADDIN EN.CITE Celermajer1996217102171Celermajer, D. S.Adams, M. R.Clarkson, P.Robinson, J.McCredie, R.Donald, A.Deanfield, J. E.1996Passive smoking and impaired endothelium-dependent arterial dilatation in healthy young adultsNew England Journal of Medicine3343150-4Jan 188531969AdolescentAdultCase-Control StudiesDose-Response Relationship, DrugEndothelium, Vascular/*drug effectsFemaleHumanMaleSmoking/*adverse effectsSupport, Non-U.S. Gov'tTobacco Smoke Pollution/*adverse effectsVasodilation/*drug effectshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8531969Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.234 Further studies suggest a synergism between smoking and hypercholesterolemia, ADDIN EN.CITE Heitzer199621670216786410239371996Apr 1Cigarette smoking potentiates endothelial dysfunction of forearm resistance vessels in patients with hypercholesterolemia. Role of oxidized LDL1346-53Medizinische Klinik III, Universitat Freiburg, Germany.Heitzer, T.Yla-Herttuala, S.Luoma, J.Kurz, S.Munzel, T.Just, H.Olschewski, M.Drexler, H.CirculationAcetylcholine/pharmacologyAdrenergic alpha-Antagonists/pharmacologyArginine/analogs & derivatives/pharmacologyArteriosclerosis/epidemiologyAutoantibodies/*bloodCardiovascular Diseases/epidemiologyComparative StudyEndothelium, Vascular/*physiopathologyFemaleForearm/blood supplyHumanHypercholesterolemia/complications/*physiopathology*Lipid PeroxidationLipoproteins, LDL/blood/immunology/*physiologyMaleMiddle AgedMuscle, Smooth, Vascular/drug effectsNitric Oxide/metabolismNitroprusside/pharmacologyOxidation-ReductionPhentolamine/pharmacologyRisk FactorsSmoking/*adverse effectsVascular ResistanceVasodilation/*drug effectsVasodilator Agents/pharmacologyVasomotor System/drug effectsomega-N-Methylargininehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8641023232 raising the possibility that smoking potentiates endothelial dysfunction by enhancing LDL oxidation. ADDIN EN.CITE Celermajer199724930249392475013021997AugEndothelial dysfunction: does it matter? Is it reversible?325-33Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia. davidc@card.rpa.cs.nsw.gov.auCelermajer, D. S.J Am Coll CardiolBlood Coagulation/physiologyCoronary Arteriosclerosis/physiopathologyEndothelium, Vascular/*physiologyHumanMuscle, Smooth, Vascular/physiologyNitric Oxide/physiologySupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9247501Mano1996250402504857901313121996FebEndothelial dysfunction in the early stage of atherosclerosis precedes appearance of intimal lesions assessable with intravascular ultrasound231-8First Department of Medicine, Osaka University School of Medicine, Japan.Mano, T.Masuyama, T.Yamamoto, K.Naito, J.Kondo, H.Nagano, R.Tanouchi, J.Hori, M.Inoue, M.Kamada, T.Am Heart JAcetylcholine/diagnostic useAnimalsAorta, Abdominal/ultrasonographyAortic Diseases/etiology/*physiopathology/*ultrasonographyArteriosclerosis/etiology/*physiopathology/*ultrasonographyEndothelium, Vascular/drug effects/*physiopathologyHypercholesterolemia/etiology/physiopathology/ultrasonographyMaleNitroglycerin/diagnostic useRabbitsTunica Intima/ultrasonographyUltrasonography, InterventionalVasodilation/drug effects/*physiologyVasodilator Agents/diagnostic usehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8579013235,236
Brachial artery endothelial function will be measured noninvasively in the morning in the fasting state by a well-validated technique using high-resolution B-mode ultrasound of the brachial artery. ADDIN EN.CITE Suwaidi20002517025171070415910192000Mar 7Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction948-54Center for Coronary Physiology and Imaging, Division of Cardiovascular Diseases, and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.Suwaidi, J. A.Hamasaki, S.Higano, S. T.Nishimura, R. A.Holmes, D. R., Jr.Lerman, A.CirculationAcetylcholine/diagnostic useAdultAgedCerebrovascular CirculationCoronary Disease/complications/*physiopathology/ultrasonographyCoronary Vessels/physiopathologyEndothelium, Vascular/*physiopathologyFemaleFollow-Up StudiesHeart Diseases/mortalityHumanLongitudinal StudiesMaleMiddle AgedMyocardial Infarction/etiologyMyocardial RevascularizationSupport, Non-U.S. Gov'tUltrasonography, Interventionalhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10704159Neunteufl2000250602506109134838622000Jul 15Late prognostic value of flow-mediated dilation in the brachial artery of patients with chest pain207-10Department ofCardiology, University of Vienna, Vienna, Austria. tneunteufl@pop3.kard.akh-wien.ac.atNeunteufl, T.Heher, S.Katzenschlager, R.Wolfl, G.Kostner, K.Maurer, G.Weidinger, F.Am J CardiolAdultBrachial Artery/*physiopathology/ultrasonographyChest Pain/physiopathologyCoronary AngiographyCoronary Disease/*physiopathologyEndothelium, Vascular/*physiopathologyFemaleHumanMaleMiddle AgedPrognosisRegional Blood FlowRegression AnalysisVasodilation/*physiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10913483Celermajer199724930249392475013021997AugEndothelial dysfunction: does it matter? Is it reversible?325-33Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia. davidc@card.rpa.cs.nsw.gov.auCelermajer, D. S.J Am Coll CardiolBlood Coagulation/physiologyCoronary Arteriosclerosis/physiopathologyEndothelium, Vascular/*physiologyHumanMuscle, Smooth, Vascular/physiologyNitric Oxide/physiologySupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9247501Vogel200125220252211473743882A2001Jul 19Measurement of endothelial function by brachial artery flow-mediated vasodilation31E-34EDivision of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA. rvogel@heart.umaryland.eduVogel, R. A.Am J CardiolAdultBrachial Artery/*ultrasonographyCoronary Arteriosclerosis/*etiologyCoronary CirculationCytokines/pharmacologyEndothelium, Vascular/*physiologyFemaleHumanMaleMiddle AgedNitric Oxide/pharmacologyPlasminogen Activator Inhibitor 1/pharmacologyRisk FactorsTunica Intima/ultrasonographyVasodilation/physiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11473743Mano1996250402504857901313121996FebEndothelial dysfunction in the early stage of atherosclerosis precedes appearance of intimal lesions assessable with intravascular ultrasound231-8First Department of Medicine, Osaka University School of Medicine, Japan.Mano, T.Masuyama, T.Yamamoto, K.Naito, J.Kondo, H.Nagano, R.Tanouchi, J.Hori, M.Inoue, M.Kamada, T.Am Heart JAcetylcholine/diagnostic useAnimalsAorta, Abdominal/ultrasonographyAortic Diseases/etiology/*physiopathology/*ultrasonographyArteriosclerosis/etiology/*physiopathology/*ultrasonographyEndothelium, Vascular/drug effects/*physiopathologyHypercholesterolemia/etiology/physiopathology/ultrasonographyMaleNitroglycerin/diagnostic useRabbitsTunica Intima/ultrasonographyUltrasonography, InterventionalVasodilation/drug effects/*physiologyVasodilator Agents/diagnostic usehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8579013235-239 Subjects who regularly use tobacco-containing products must refrain for 12 hours. After a 10-minute rest in a temperature-controlled room (68-70 F), the diameter of the right brachial artery blood flow are measured at baseline and in response to increased blood flow with a high-resolution ((7.5 MHz) linear array vascular ultrasound transducer. Increased forearm blood flow, an endothelium-dependent vasodilator, is induced by inflating a pneumatic blood pressure tourniquet placed around the widest part of the forearm to a systolic blood pressure of 250 mm Hg., the release of which after 4.5 minutes leads to hyperemia. The change in brachial artery diameter in response to hyperemia relative to the baseline diameter defines FMD, which is described as a percentage change from baseline. A single-lead electrocardiogram is monitored throughout the study. Coronary and brachial artery flow-mediated vasodilation are correlated strongly (r=0.79, p<0.001). ADDIN EN.CITE Mannion199825030250310102666341998Non-invasive assessment of brachial artery endothelial vasomotor function: the effect of cuff position on level of discomfort and vasomotor responses263-7Evans Memorial Department of Medicine, Boston University School of Medicine, MA, USA.Mannion, T. C.Vita, J. A.Keaney, J. F., Jr.Benjamin, E. J.Hunter, L.Polak, J. F.Vasc MedAdultArm/blood supplyBlood Flow Velocity/physiologyBrachial Artery/*physiology/physiopathology/*ultrasonographyComparative StudyCoronary Disease/diagnosis/physiopathology/ultrasonographyEndothelium, Vascular/physiology/physiopathology/*ultrasonographyFemaleHumanMaleMiddle AgedPain/physiopathologyPain MeasurementPhlebotomyReference ValuesSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Ultrasonography/*adverse effects/instrumentation/*methodsVasodilation/physiologyVasomotor System/*physiology/physiopathology/*ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10102666240 Endothelial function of the brachial artery also predicts future adverse cardiovascular events. ADDIN EN.CITE Celermajer199724930249392475013021997AugEndothelial dysfunction: does it matter? Is it reversible?325-33Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia. davidc@card.rpa.cs.nsw.gov.auCelermajer, D. S.J Am Coll CardiolBlood Coagulation/physiologyCoronary Arteriosclerosis/physiopathologyEndothelium, Vascular/*physiologyHumanMuscle, Smooth, Vascular/physiologyNitric Oxide/physiologySupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9247501Mano1996250402504857901313121996FebEndothelial dysfunction in the early stage of atherosclerosis precedes appearance of intimal lesions assessable with intravascular ultrasound231-8First Department of Medicine, Osaka University School of Medicine, Japan.Mano, T.Masuyama, T.Yamamoto, K.Naito, J.Kondo, H.Nagano, R.Tanouchi, J.Hori, M.Inoue, M.Kamada, T.Am Heart JAcetylcholine/diagnostic useAnimalsAorta, Abdominal/ultrasonographyAortic Diseases/etiology/*physiopathology/*ultrasonographyArteriosclerosis/etiology/*physiopathology/*ultrasonographyEndothelium, Vascular/drug effects/*physiopathologyHypercholesterolemia/etiology/physiopathology/ultrasonographyMaleNitroglycerin/diagnostic useRabbitsTunica Intima/ultrasonographyUltrasonography, InterventionalVasodilation/drug effects/*physiologyVasodilator Agents/diagnostic usehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8579013235,236 In our laboratory, the coefficient of variation for FMD is 2.9% which compares favorably to that reported in the literature. ADDIN EN.CITE Herrington1999220202202Herrington, D. M.Werbel, B. L.Riley, W. A.Pusser, B. E.Morgan, T. M.1999Individual and combined effects of estrogen/progestin therapy and lovastatin on lipids and flow-mediated vasodilation in postmenopausal women with coronary artery diseaseJournal of the American College of Cardiology3372030-2037Jun10362210AgedAged, 80 and overAnticholesteremic Agents/*therapeutic useBlood Flow VelocityBrachial Artery/drug effects/physiologyComparative StudyCoronary Disease/blood/*drug therapy/physiopathologyCross-Over StudiesDouble-Blind MethodDrug Therapy, CombinationEstrogens, Conjugated (USP)/*therapeutic useFemaleHumanLipoproteins, LDL Cholesterol/blood/drug effectsLovastatin/*therapeutic useMedroxyprogesterone 17-Acetate/*therapeutic useMiddle Aged*PostmenopauseProgesterone Congeners/*therapeutic useRetrospective StudiesSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Treatment OutcomeVasodilation/drug effectshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10362210Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA. dherring@wfubmc.eduUehata1997220302203Uehata, A.Lieberman, E. H.Gerhard, M. D.Anderson, T. J.Ganz, P.Polak, J. F.Creager, M. A.Yeung, A. C.1997Noninvasive assessment of endothelium-dependent flow-mediated dilation of the brachial arteryVascular Medicine2287-929546961AdultAnalysis of VarianceBlood PressureBrachial Artery/*physiology/ultrasonographyCholesterol/bloodEndothelium, Vascular/*physiology/ultrasonographyFemaleForearm/*blood supplyHumanHyperemiaMaleObserver VariationReference ValuesRegional Blood FlowReproducibility of ResultsSex CharacteristicsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Vasodilation/*physiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9546961Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.Sorensen1995220402204Sorensen, K. E.Celermajer, D. S.Spiegelhalter, D. J.Georgakopoulos, D.Robinson, J.Thomas, O.Deanfield, J. E.1995Non-invasive measurement of human endothelium dependent arterial responses: Accuracy and reproducibilityBritish Heart Journal743247-253Sep7547018AdultAnalysis of VarianceArteries/*physiology/ultrasonographyArteriosclerosis/diagnosisComparative StudyEndothelium, Vascular/*physiology/ultrasonographyFemaleHumanMaleMiddle AgedModels, StructuralRegional Blood FlowReproducibility of ResultsSensitivity and Specificityhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7547018Cardiothoracic Unit, Hospital for Sick Children, London.241-243
Advanced lipoprotein testing. We intend to assess atherosclerotic risk and gain insight into observed changes in carotid IMT and endothelial function by assessing lipoprotein status using nuclear magnetic resonance (NMR) spectroscopy at baseline and during the three-year follow-up period of this grant. The NMR Lipoprofile (LipoScience, Inc. Raleigh, NC) provides a comprehensive assessment, including a large array of lipid sub-fractions that have been associated with atherosclerotic progression and cardiovascular events. Lipoproteins are also influenced by other factors associated with cessation such as weight gain and change in exercise rate.
Although total cholesterol levels are correlated with risk of cardiovascular disease, total cholesterol is not a good predictor of cardiovascular disease because cholesterol is a constituent of all major lipoproteins found in fasting plasma, including very-low density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). Patients can have widely varying concentrations of these lipoproteins and have the same total cholesterol concentration. ADDIN EN.CITE Otvos222772227Otvos, J.DMeasurement of lipoprotein subclass profiles by nuclear magnetic resonance spectroscopyRifai, NWarnick, GWDominiczak, M.HHandbook of lipoprotein testing, 2nd editionWashington, D.CAACC Press609-623Otvos2002222802228Otvos, J.D2002Why cholesterol measurements may be misleading about lipoprotein levels and cardiovascular disease risk - clinical implication of lipoprotein quantification using NMR spectroscopyJournal of Laboratory Medicine26544-550244,245 VLDL and LDL concentrations are associated positively with atherosclerotic vascular disease, whereas HDL concentrations are associated negatively with vascular disease. Lipoprotein metabolism is complex, however, and VLDL, LDL, and HDL each represent heterogeneous groups of particle subclasses that differ in size, lipid composition, and observed associations with cardiovascular disease. ADDIN EN.CITE Rosenson2002223102231Rosenson, R. S.Otvos, J. D.Freedman, D. S.2002Relations of lipoprotein subclass levels and low-density lipoprotein size to progression of coronary artery disease in the Pravastatin Limitation of Atherosclerosis in the Coronary Arteries (PLAC-I) trialAmerican Journal of Cardiology90289-94Jul 1512106834Anticholesteremic Agents/*pharmacologyCholesterol/bloodCoronary AngiographyCoronary Arteriosclerosis/blood/*drug therapy/radiographyCoronary Vessels/drug effectsDisease ProgressionFemaleHumanLipoproteins/blood/classification/*drug effectsLipoproteins, LDL/blood/drug effectsMaleMiddle AgedParticle SizePravastatin/*pharmacologySupport, U.S. Gov't, P.H.S.Treatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12106834Preventive Cardiology Center, Division of Cardiology, Department of Medicine, Northwestern University Medical School, Chicago, Illinois, USA.Otvos2002222902229Otvos, J. D.Jeyarajah, E. J.Cromwell, W. C.2002Measurement issues related to lipoprotein heterogeneityAmerican Journal of Cardiology908A22i-29iOct 1712419478Coronary Arteriosclerosis/diagnosis/epidemiology/genetics*Genetic HeterogeneityGenetic Markers/geneticsHumanLaboratory Techniques and ProceduresLipoproteins/blood/*geneticsMagnetic Resonance SpectroscopyPredictive Value of TestsRisk Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12419478LipoScience, Inc., Raleigh, North Carolina 27616, USA. jotvos@liposcience.comOtvos222772227Otvos, J.DMeasurement of lipoprotein subclass profiles by nuclear magnetic resonance spectroscopyRifai, NWarnick, GWDominiczak, M.HHandbook of lipoprotein testing, 2nd editionWashington, D.CAACC Press609-623Otvos2002222802228Otvos, J.D2002Why cholesterol measurements may be misleading about lipoprotein levels and cardiovascular disease risk - clinical implication of lipoprotein quantification using NMR spectroscopyJournal of Laboratory Medicine26544-550Kuller2002223302233121177342272002Jul 1Nuclear magnetic resonance spectroscopy of lipoproteins and risk of coronary heart disease in the cardiovascular health study1175-80Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa 15261, USA. kuller@ pitt.eduKuller, L.Arnold, A.Tracy, R.Otvos, J.Burke, G.Psaty, B.Siscovick, D.Freedman, D. S.Kronmal, R.Arterioscler Thromb Vasc BiolAgedAging/blood*Cardiovascular SystemCase-Control StudiesCohort StudiesCoronary Disease/blood/*epidemiologyFemale*Health StatusHumanLipoproteins, HDL/bloodLipoproteins, LDL/*bloodLipoproteins, VLDL/bloodMagnetic Resonance Spectroscopy/*methodsMaleNuclear Magnetic Resonance, Biomolecular/methodsRisk FactorsSex FactorsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12117734Blake200222320223212370215106152002Oct 8Low-density lipoprotein particle concentration and size as determined by nuclear magnetic resonance spectroscopy as predictors of cardiovascular disease in women1930-7Center for Cardiovascular Disease Prevention, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02215, USA.Blake, G. J.Otvos, J. D.Rifai, N.Ridker, P. M.CirculationC-Reactive Protein/analysisCardiovascular Diseases/*epidemiologyCase-Control StudiesCerebrovascular Accident/epidemiologyComparative StudyCoronary Disease/mortalityFemaleFollow-Up StudiesHumanLipids/bloodLipoproteins, LDL/*blood/*chemistryMiddle AgedMyocardial Infarction/epidemiologyNuclear Magnetic Resonance, Biomolecular/*methodsParticle SizeProspective StudiesRisk FactorsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12370215Mackey2002223002230Mackey, R. H.Kuller, L. H.Sutton-Tyrrell, K.Evans, R. W.Holubkov, R.Matthews, K. A.2002Lipoprotein subclasses and coronary artery calcium in postmenopausal women from the healthy women studyAmerican Journal of Cardiology908A71i-76iOct 1712419483AdultAgedBiological Markers/bloodCalcinosis/diagnosis/epidemiology/*metabolismComparative StudyCoronary Arteriosclerosis/diagnosis/epidemiology/*metabolismFemaleFollow-Up StudiesHumanLipoproteins/*metabolismLipoproteins, HDL/metabolismLipoproteins, LDL/metabolismLipoproteins, VLDL/metabolismLogistic ModelsLongitudinal StudiesMagnetic Resonance SpectroscopyMiddle AgedPostmenopause/*metabolismReference ValuesRisk FactorsStatisticsSupport, U.S. Gov't, P.H.S.United States/epidemiologyWomen's Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12419483Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA. mackey@edc.gsph.pitt.edu244-250
Advanced lipoprotein testing using NMR spectroscopy provides direct measurements of chylomicrons, VLDL, intermediate-density lipoproteins (IDL), LDL, and HDL and quantitative information about particle sizes (Figure 3). ADDIN EN.CITE Otvos2002222902229Otvos, J. D.Jeyarajah, E. J.Cromwell, W. C.2002Measurement issues related to lipoprotein heterogeneityAmerican Journal of Cardiology908A22i-29iOct 1712419478Coronary Arteriosclerosis/diagnosis/epidemiology/genetics*Genetic HeterogeneityGenetic Markers/geneticsHumanLaboratory Techniques and ProceduresLipoproteins/blood/*geneticsMagnetic Resonance SpectroscopyPredictive Value of TestsRisk Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12419478LipoScience, Inc., Raleigh, North Carolina 27616, USA. jotvos@liposcience.comOtvos222772227Otvos, J.DMeasurement of lipoprotein subclass profiles by nuclear magnetic resonance spectroscopyRifai, NWarnick, GWDominiczak, M.HHandbook of lipoprotein testing, 2nd editionWashington, D.CAACC Press609-623Otvos2002222802228Otvos, J.D2002Why cholesterol measurements may be misleading about lipoprotein levels and cardiovascular disease risk - clinical implication of lipoprotein quantification using NMR spectroscopyJournal of Laboratory Medicine26544-550244,245,247 The NMR lipoprotein profile is necessary to interpret the physiological impact of metabolic changes and any changes in atherosclerosis progression and endothelial function that may be observed in this study. Recent data demonstrate that information about LDL particle concentration and LDL and HDL particle sizes improves cardiovascular disease risk prediction, even after controlling for standard lipid values. ADDIN EN.CITE Rosenson2002223102231Rosenson, R. S.Otvos, J. D.Freedman, D. S.2002Relations of lipoprotein subclass levels and low-density lipoprotein size to progression of coronary artery disease in the Pravastatin Limitation of Atherosclerosis in the Coronary Arteries (PLAC-I) trialAmerican Journal of Cardiology90289-94Jul 1512106834Anticholesteremic Agents/*pharmacologyCholesterol/bloodCoronary AngiographyCoronary Arteriosclerosis/blood/*drug therapy/radiographyCoronary Vessels/drug effectsDisease ProgressionFemaleHumanLipoproteins/blood/classification/*drug effectsLipoproteins, LDL/blood/drug effectsMaleMiddle AgedParticle SizePravastatin/*pharmacologySupport, U.S. Gov't, P.H.S.Treatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12106834Preventive Cardiology Center, Division of Cardiology, Department of Medicine, Northwestern University Medical School, Chicago, Illinois, USA.Otvos2002222902229Otvos, J. D.Jeyarajah, E. J.Cromwell, W. C.2002Measurement issues related to lipoprotein heterogeneityAmerican Journal of Cardiology908A22i-29iOct 1712419478Coronary Arteriosclerosis/diagnosis/epidemiology/genetics*Genetic HeterogeneityGenetic Markers/geneticsHumanLaboratory Techniques and ProceduresLipoproteins/blood/*geneticsMagnetic Resonance SpectroscopyPredictive Value of TestsRisk Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12419478LipoScience, Inc., Raleigh, North Carolina 27616, USA. jotvos@liposcience.comOtvos222772227Otvos, J.DMeasurement of lipoprotein subclass profiles by nuclear magnetic resonance spectroscopyRifai, NWarnick, GWDominiczak, M.HHandbook of lipoprotein testing, 2nd editionWashington, D.CAACC Press609-623Otvos2002222802228Otvos, J.D2002Why cholesterol measurements may be misleading about lipoprotein levels and cardiovascular disease risk - clinical implication of lipoprotein quantification using NMR spectroscopyJournal of Laboratory Medicine26544-550Kuller2002223302233121177342272002Jul 1Nuclear magnetic resonance spectroscopy of lipoproteins and risk of coronary heart disease in the cardiovascular health study1175-80Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa 15261, USA. kuller@ pitt.eduKuller, L.Arnold, A.Tracy, R.Otvos, J.Burke, G.Psaty, B.Siscovick, D.Freedman, D. S.Kronmal, R.Arterioscler Thromb Vasc BiolAgedAging/blood*Cardiovascular SystemCase-Control StudiesCohort StudiesCoronary Disease/blood/*epidemiologyFemale*Health StatusHumanLipoproteins, HDL/bloodLipoproteins, LDL/*bloodLipoproteins, VLDL/bloodMagnetic Resonance Spectroscopy/*methodsMaleNuclear Magnetic Resonance, Biomolecular/methodsRisk FactorsSex FactorsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12117734Blake200222320223212370215106152002Oct 8Low-density lipoprotein particle concentration and size as determined by nuclear magnetic resonance spectroscopy as predictors of cardiovascular disease in women1930-7Center for Cardiovascular Disease Prevention, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02215, USA.Blake, G. J.Otvos, J. D.Rifai, N.Ridker, P. M.CirculationC-Reactive Protein/analysisCardiovascular Diseases/*epidemiologyCase-Control StudiesCerebrovascular Accident/epidemiologyComparative StudyCoronary Disease/mortalityFemaleFollow-Up StudiesHumanLipids/bloodLipoproteins, LDL/*blood/*chemistryMiddle AgedMyocardial Infarction/epidemiologyNuclear Magnetic Resonance, Biomolecular/*methodsParticle SizeProspective StudiesRisk FactorsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12370215Mackey2002223002230Mackey, R. H.Kuller, L. H.Sutton-Tyrrell, K.Evans, R. W.Holubkov, R.Matthews, K. A.2002Lipoprotein subclasses and coronary artery calcium in postmenopausal women from the healthy women studyAmerican Journal of Cardiology908A71i-76iOct 1712419483AdultAgedBiological Markers/bloodCalcinosis/diagnosis/epidemiology/*metabolismComparative StudyCoronary Arteriosclerosis/diagnosis/epidemiology/*metabolismFemaleFollow-Up StudiesHumanLipoproteins/*metabolismLipoproteins, HDL/metabolismLipoproteins, LDL/metabolismLipoproteins, VLDL/metabolismLogistic ModelsLongitudinal StudiesMagnetic Resonance SpectroscopyMiddle AgedPostmenopause/*metabolismReference ValuesRisk FactorsStatisticsSupport, U.S. Gov't, P.H.S.United States/epidemiologyWomen's Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12419483Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA. mackey@edc.gsph.pitt.edu244-250 The limitations of standard enzymatic determinations of lipid levels are well known. ADDIN EN.CITE Otvos222772227Otvos, J.DMeasurement of lipoprotein subclass profiles by nuclear magnetic resonance spectroscopyRifai, NWarnick, GWDominiczak, M.HHandbook of lipoprotein testing, 2nd editionWashington, D.CAACC Press609-623Otvos2002222802228Otvos, J.D2002Why cholesterol measurements may be misleading about lipoprotein levels and cardiovascular disease risk - clinical implication of lipoprotein quantification using NMR spectroscopyJournal of Laboratory Medicine26544-550244,245
The following methods will be used to determine NMR Lipoprofiles. After a 12 hour fast, approximately 2 cc of blood will be collected into a purple top EDTA specimen tube. This sample will be centrifuged immediately at 3000 rpm for 15 minutes. Plasma will be stored at -70(C and shipped to LipoScience, Inc.. The technique LipoScience, Inc. uses to acquire and process the NMR data has been described in detail ADDIN EN.CITE Otvos2002222902229Otvos, J. D.Jeyarajah, E. J.Cromwell, W. C.2002Measurement issues related to lipoprotein heterogeneityAmerican Journal of Cardiology908A22i-29iOct 1712419478Coronary Arteriosclerosis/diagnosis/epidemiology/genetics*Genetic HeterogeneityGenetic Markers/geneticsHumanLaboratory Techniques and ProceduresLipoproteins/blood/*geneticsMagnetic Resonance SpectroscopyPredictive Value of TestsRisk Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12419478LipoScience, Inc., Raleigh, North Carolina 27616, USA. jotvos@liposcience.comOtvos222772227Otvos, J.DMeasurement of lipoprotein subclass profiles by nuclear magnetic resonance spectroscopyRifai, NWarnick, GWDominiczak, M.HHandbook of lipoprotein testing, 2nd editionWashington, D.CAACC Press609-623Otvos2002222802228Otvos, J.D2002Why cholesterol measurements may be misleading about lipoprotein levels and cardiovascular disease risk - clinical implication of lipoprotein quantification using NMR spectroscopyJournal of Laboratory Medicine26544-550244,245,247 and consists of three steps: 1) acquisition, in duplicate, of the 400 MHz proton NMR spectra from the plasma specimen at 47(C, 2) deconvolution of the lipid methyl group signal envelope appearing in the spectra at approximately 0.8 ppm, which yield the derived NMR signal amplitudes broadcasted by 16 modeled lipoprotein subclasses (Figure 4), and 3) conversion of the signal amplitudes into subclass concentrations using experimentally determined factors that relate the signal amplitudes of isolated subfraction standards to their chemically measured cholesterol and triglyceride concentrations. In general, large VLDL particles (V6, V5), IDL, small LDL (L1), and small HDL (H3, H2, H1) are considered atherogenic and associated with Metabolic Syndrome, as is an increased number of LDL particles. ADDIN EN.CITE Otvos2002222902229Otvos, J. D.Jeyarajah, E. J.Cromwell, W. C.2002Measurement issues related to lipoprotein heterogeneityAmerican Journal of Cardiology908A22i-29iOct 1712419478Coronary Arteriosclerosis/diagnosis/epidemiology/genetics*Genetic HeterogeneityGenetic Markers/geneticsHumanLaboratory Techniques and ProceduresLipoproteins/blood/*geneticsMagnetic Resonance SpectroscopyPredictive Value of TestsRisk Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12419478LipoScience, Inc., Raleigh, North Carolina 27616, USA. jotvos@liposcience.comOtvos222772227Otvos, J.DMeasurement of lipoprotein subclass profiles by nuclear magnetic resonance spectroscopyRifai, NWarnick, GWDominiczak, M.HHandbook of lipoprotein testing, 2nd editionWashington, D.CAACC Press609-623Otvos2002222802228Otvos, J.D2002Why cholesterol measurements may be misleading about lipoprotein levels and cardiovascular disease risk - clinical implication of lipoprotein quantification using NMR spectroscopyJournal of Laboratory Medicine26544-550244,245,247
Carotid IMT, brachial artery enthothelial function testing and NMR lipoprofile testing will occur during Baseline of Project 1 (pre-quit). Because of the rapid changes in response expected for brachial artery endothelial function, it will be assessed again at one year post quit attempt. In contrast, carotid IMT will be assessed three years post quit when beneficial effects of cessation and detrimental effects of continued smoking are most likely to be seen. Finally, NMR Lipoprofile will be assessed at baseline, Year 1 and Year 3 post quit.
Other measures correlated with atherosclerotic risk will be assessed including blood pressure, weight, body mass index, heart and respiratory rate, creatinine, high-sensitivity C Reactive Protein, fasting plasma glucose and insulin, and hemoglobin A1C.
Physical Activity and Physical Fitness
Physical activity. This will be quantified using two methods: a physical activity questionnaire and pedometer measurements at baseline prequit, and at the ends of Years 1 & 3. The first is the International Physical Activity Questionnaire that covers all realms of physical activity (occupational, housework, etc.). This instrument has recently been shown to have acceptable reliability (Spearmans rho = 0.80) and criterion-related validity (rho = 0.30), similar to other physical activity questionnaires. ADDIN EN.CITE Craig2003190401904Craig, C. L.Marshall, A. L.Sjostrom, M.Bauman, A. E.Booth, M. L.Ainsworth, B. E.Pratt, M.Ekelund, U.Yngve, A.Sallis, J. F.Oja, P.2003International physical activity questionnaire: 12-country reliability and validityMedicine and Science in Sports and Exercise3581381-1395Aug12900694AdolescentAdultAgedDeveloped Countries/statistics & numerical dataDeveloping Countries/statistics & numerical dataExerciseFemaleHealth BehaviorHumanInterviewsMaleMiddle Aged*Motor ActivityPopulation Surveillance/*methodsQualitative Research*QuestionnairesReproducibility of ResultsSocioeconomic Factors*World Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12900694Canadian Fitness and Lifestyle Research Institute, Ottawa, Canada.251 Questionnaires, however, tend not to be valid measures of moderate activity such as walking. ADDIN EN.CITE Bassett Jr.2002206672066Bassett Jr., D. R., Strath, SJ.2002Use of pedometers to assess physical activityWelk, GJPhysical activity assessments for health-related researchChampaign, ILHuman Kinetics Publishers, Inc.252 Since walking is the most prevalent leisure-time activity in the U.S., is intrinsic to many daily routines, and is specifically mentioned in current nationwide physical activity recommendations ADDIN EN.CITE Pate1995205802058Pate, R. R.Pratt, M.Blair, S. N.Haskell, W. L.Macera, C. A.Bouchard, C.Buchner, D.Ettinger, W.Heath, G. W.King, A. C.et al.,1995Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports MedicineJAMA2735402-407Feb 17823386AdultCenters for Disease Control and Prevention (U.S.)Female*Health Promotion/standardsHumanMaleMiddle Aged*Physical Fitness*Public Health/standardsSocieties, MedicalSports MedicineUnited Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7823386Department of Exercise Science, University of South Carolina School of Public Health, Columbia 29208.253 it is particularly important to measure this specific activity. Pedometry has proven to be a very reliable and valid measure of steps walked when specific pedometer models are used. ADDIN EN.CITE Schneider2003189801898Schneider, P. L.Crouter, S. E.Lukajic, O.Bassett, D. R., Jr.2003Accuracy and reliability of 10 pedometers for measuring steps over a 400-m walkMedicine and Science in Sports and Exercise35101779-1784Oct14523320http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14523320Department of Health and Exercise Science, University of Tennessee, 1914 Andy Holt Avenue, Knoxville, TN 37996, USA. pschnei1@utk.edu254
We propose to measure 7 days of walking annually with a Yamax Digiwalker SW-701. Subjects can be easily and quickly trained in the appropriate use of the pedometer and asked to fill out a simple log to record daily steps over the 7-day period. ADDIN EN.CITE Tudor-Locke2001276402764112533147212001MarMethodological considerations for researchers and practitioners using pedometers to measure physical (ambulatory) activity1-12Prevention Research Center, Norman J. Arnold School of Public Health, University of South Carolina, USA.Tudor-Locke, C. E.Myers, A. M.Res Q Exerc SportAdolescentAdultAgedChildChild, PreschoolData Collection/*methods*Electronics*Equipment and SuppliesExercise/*physiologyFemaleHumanMaleMiddle AgedReference ValuesWalking/*physiology/statistics & numerical datahttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11253314255 Through the use of both a simple questionnaire and a pedometer, we should be able to capture regular physical activity at targeted timepoints throughout the study.
Physical fitness. Each subject will have a symptom-limited treadmill test administered at baseline and at the 3-year follow-up. Peak oxygen consumption will be calculated from the final workload achieved on the test, and oxygen saturation (via pulse oximetry) will be measured at rest and continually during the test. The calculated oxygen consumption provides a measure of fitness, not physical activity, and is therefore a more objective measure than physical activity questionnaires and pedometry monitoring. This provides the opportunity to assess important changes in cardiorespiratory fitness associated with smoking cessation and physical activity.
While directly measuring oxygen consumption would provide a slightly more accurate assessment, the cost would be much greater. A modified Balke protocol will be used. ADDIN EN.CITE Balke1959219602196Balke, B.Ware, R. W.1959An experimental study of physical fitness of Air Force personnelU S Armed Forces Medical Journal106875-888Jun13659732http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=13659732256 Briefly, each subject will maintain a brisk walking pace and treadmill grade will be increased 2.5% every two minutes until volitional exhaustion. Oxygen saturation and 12-lead electrocardiogram (ECG) will be monitored continuously. ECG, heart rate, and blood pressure will be recorded at the end of each stage, maximum exercise, and every two minutes during recovery. The Borg scale rating of perceived exertion (RPE) ranging from 6 to 20 will be obtained near the end of each stage and maximum exercise. Differences will be compared between subjects baseline prequit and three year follow-up tests for changes as they relate to smoking status. Changes in fitness based on these treadmill tests will be compared to other changes in the subjects health status, including body weight, metabolic changes, and health outcomes.
Diet
Dietary factors will be assessed by a combination of a well documented food frequency questionnaire (FFQ), a qualitative screening food frequency questionnaire to track short-term changes, and objective biochemical indicators of diet (NMR Lipoproteins and, possibly, carotenoids).
The semi-quantitative FFQ to be used is that developed by Willett and colleagues, ADDIN EN.CITE Rimm19922285022851632423135101992May 15Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals1114-26; discussion 1127-36Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115.Rimm, E. B.Giovannucci, E. L.Stampfer, M. J.Colditz, G. A.Litin, L. B.Willett, W. C.Am J EpidemiolAge FactorsBostonComparative StudyDiet Records*Diet Surveys*Food Habits*Health Personnel/statistics & numerical dataHumanMaleNutrition SurveysProspective StudiesQuestionnairesReproducibility of ResultsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1632423Willett199825780257897625122011998Approaches for conducting large cohort studies91-9Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.Willett, W. C.Colditz, G. A.Epidemiol RevBiological Markers*Cohort StudiesData CollectionEnvironmental ExposureFollow-Up StudiesHumanResearch DesignRisk FactorsSupport, U.S. Gov't, P.H.S.United Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9762512257,258 which has been continually updated and refined over time to account for secular changes. The questionnaire consists of approximately 130 food items with specified serving sizes, and for each item the participant is asked to report how often, on average over the past year, they have consumed that item. A multiple-choice response (nine categories) is provided. Nutrients are calculated using an extensive companion food composition database maintained at the Department of Nutrition, Harvard School of Public Health. The FFQ will be administered at baseline prequit and at annual in-person follow-up visits (12, 24, 36 months post quit attempt). The validity of this 130-item questionnaire has been demonstrated consistently on the bases of strong relations with multiple diet records (rs > .60), ADDIN EN.CITE Rimm19922285022851632423135101992May 15Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals1114-26; discussion 1127-36Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115.Rimm, E. B.Giovannucci, E. L.Stampfer, M. J.Colditz, G. A.Litin, L. B.Willett, W. C.Am J EpidemiolAge FactorsBostonComparative StudyDiet Records*Diet Surveys*Food Habits*Health Personnel/statistics & numerical dataHumanMaleNutrition SurveysProspective StudiesQuestionnairesReproducibility of ResultsSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1632423Willett1998269512695Willett, W.C.1998Nutritional epidemiology, 2nd editionNew YorkOxford University Press257,259 and with biochemical markers of dietary intake (plasma beta-carotene, red cell folate, adipose linoleic acid, and others. ADDIN EN.CITE Stryker1988257902579325735012721988FebThe relation of diet, cigarette smoking, and alcohol consumption to plasma beta-carotene and alpha-tocopherol levels283-96Department of Epidemiology, Harvard School of Public Health, Boston, MA.Stryker, W. S.Kaplan, L. A.Stein, E. A.Stampfer, M. J.Sober, A.Willett, W. C.Am J EpidemiolAdolescentAdultAged*Alcohol DrinkingCarotenoids/administration & dosage/*bloodCross-Sectional Studies*DietFemaleHumanMaleMiddle AgedSmoking/*bloodVitamin E/administration & dosage/*bloodbeta Carotenehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3257350Ascherio1992258002580151262812291992SepCorrelations of vitamin A and E intakes with the plasma concentrations of carotenoids and tocopherols among American men and women1792-801Department of Epidemiology, Harvard School of Public Health, Boston, MA.Ascherio, A.Stampfer, M. J.Colditz, G. A.Rimm, E. B.Litin, L.Willett, W. C.J NutrCarotenoids/analogs & derivatives/*bloodComparative Study*DietFemaleHumanLutein/bloodMaleMiddle AgedProspective StudiesReference ValuesSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Vitamin A/*administration & dosageVitamin E/*administration & dosage/*bloodbeta Carotenehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1512628Giovannucci1993259002590849231685111993Jun 2Folate, methionine, and alcohol intake and risk of colorectal adenoma875-84Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, Mass. 02115.Giovannucci, E.Stampfer, M. J.Colditz, G. A.Rimm, E. B.Trichopoulos, D.Rosner, B. A.Speizer, F. E.Willett, W. C.J Natl Cancer InstAdenoma/*epidemiology/etiology/metabolism/prevention & controlAdultAgedAlcohol Drinking/*adverse effectsColorectal Neoplasms/*epidemiology/etiology/metabolism/prevention &controlFemaleFolic Acid/*administration & dosageFood HabitsHumanMaleMethionine/*administration & dosageMethylationMiddle AgedPrevalenceProspective StudiesQuestionnairesRiskSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8492316Hunter1992269602696155009313541992Feb 15Comparison of measures of fatty acid intake by subcutaneous fat aspirate, food frequency questionnaire, and diet records in a free-living population of US men418-27Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115.Hunter, D. J.Rimm, E. B.Sacks, F. M.Stampfer, M. J.Colditz, G. A.Litin, L. B.Willett, W. C.Am J EpidemiolAdipose Tissue/*chemistryAdultAgedBody Mass IndexBody WeightComparative Study*Diet Records*Diet Surveys*Dietary FatsEnergy Intake*Fatty Acids/analysisHumanMaleMiddle AgedQuestionnairesSupport, U.S. Gov't, P.H.S.United Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1550093London199125910259118586985421991AugFatty acid composition of subcutaneous adipose tissue and diet in postmenopausal US women340-5Department of Preventive Medicine, University of Southern California Medical School, Los Angeles 90033.London, S. J.Sacks, F. M.Caesar, J.Stampfer, M. J.Siguel, E.Willett, W. C.Am J Clin NutrAdipose Tissue/*metabolismAdultAgedAged, 80 and overBody Weight*DietDiet RecordsDietary Fats/*administration & dosageDietary Fats, Unsaturated/administration & dosageEnergy IntakeFatty Acids/administration & dosage/*metabolismFatty Acids, Monounsaturated/administration & dosage/metabolismFatty Acids, Unsaturated/administration & dosage/metabolismFemaleHumanMenopauseMiddle AgedQuestionnairesSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.United Stateshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1858698260-264 Recently, a validation analysis using N-3 fatty acids from adipose aspirates and plasma carotenoids has demonstrated validity for the questionnaire in an African-American population in Detroit (MD Holmes, submitted manuscript).
For tracking short-term changes in diet we will use a brief screening questionnaire (PrimeScreen), also developed at Harvard School of Public Health. This questionnaire takes about 5 min to complete and has been validated with correlations with the full FFQ and via associations with selected biomarkers. ADDIN EN.CITE Rifas-Shiman200122870228711299098422001AprPrimeScreen, a brief dietary screening tool: reproducibility and comparability with both a longer food frequency questionnaire and biomarkers249-541Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 126 Brookline Avenue, Boston, MA 02215, USA.Rifas-Shiman, S. L.Willett, W. C.Lobb, R.Kotch, J.Dart, C.Gillman, M. W.Public Health NutrAdultAgedBiological Markers/*bloodComparative Study*DietFemaleHumanMaleMass Screening/*methodsMiddle Aged*Nutrition AssessmentQuestionnairesReproducibility of Resultshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11299098265 For foods and food groups, the mean correlation coefficient (r) was 0.70 for reproducibility and 0.61 for comparability with the FFQ. For nutrients, the mean r was 0.74 for reproducibility and 0.60 for comparability with the FFQ. No substantial differences were evident by sex, race, body mass index, occupation or education. The PrimeScreen will be administered at follow-up phone contacts at 18 and 30 months post quit attempt.
Psychosocial
Structured interview. Mental health will be assessed in this study using the new computer-assisted National Comorbidity Survey-Replication Composite International Diagnostic Interview (the NCS-R-CIDI), which arose out of a joint project of the World Health Organization and the former US ADAMHA. The reliability and validity of the original paper-pencil CIDI was demonstrated in both large epidemiological studies as well as in smaller validity studies. ADDIN EN.CITE Robins1991195711957Robins, L.NRegier, D.A1991Psychiatric disorders in AmericaNew YorkMacMillanKessler1994195801958Kessler, R. C.McGonagle, K. A.Zhao, S.Nelson, C. B.Hughes, M.Eshleman, S.Wittchen, H. U.Kendler, K. S.1994Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity SurveyArchives of General Psychiatry5118-19Jan8279933AdolescentAdultAge FactorsAntisocial Personality Disorder/epidemiologyAnxiety Disorders/epidemiologyComorbidityContinental Population GroupsDepressive Disorder/epidemiologyFemaleHealth Services/utilizationHealth SurveysHumanMaleMarital StatusMental Disorders/*epidemiologyMiddle AgedPrevalenceProbabilityPsychiatric Status Rating Scales/statistics & numerical dataResidence CharacteristicsRisk FactorsSex FactorsSocial ClassSubstance-Related Disorders/epidemiologyUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8279933Institute for Social Research, University of Michigan, Ann Arbor.Wittchen199119600196017563401591991NovCross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials645-53, 658Max-Planck-Institut fur Psychiatrie, Munchen, Germany.Wittchen, H. U.Robins, L. N.Cottler, L. B.Sartorius, N.Burke, J. D.Regier, D.Br J PsychiatryComparative Study*Cross-Cultural ComparisonHumanMental Disorders/*classification/*diagnosis/psychologyObserver VariationPsychiatric Status Rating Scales/*statistics & numerical dataPsychometricsReproducibility of ResultsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.World Health Organizationhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1756340Wittchen199419610196180646412811994Jan-FebReliability and validity studies of the WHO--Composite International Diagnostic Interview (CIDI): a critical review57-84Max-Planck-Institute of Psychiatry, Clinical Institute, Munchen, Germany.Wittchen, H. U.J Psychiatr ResComparative StudyCross-Cultural ComparisonHumanMental Disorders/classification/diagnosis/psychologyPersonality Assessment/*statistics & numerical dataPsychometricsReproducibility of Resultshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8064641266-269 The NCS-R-CIDI is now being used by three International Consortia as part of the World Mental Health 2000 Initiative, ADDIN EN.CITE Holden20001962019621076663328854632000Apr 7Mental health. Global survey examines impact of depression39-40Holden, C.Science*Cost of IllnessDepression/economics/*epidemiologyDepressive Disorder/economics/*epidemiology/psychologyHealth SurveysHumanInterviewsWorld Health*World Health Organizationhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10766633Kessler2000196301963Kessler, R.CUstun, T.B2000The World Health Organization World Mental Health 2000 InitiativeHospital Management International195-196270,271 which seeks to characterize mental health in 27 countries (see Girolamo & Bassi ADDIN EN.CITE Girolamo2003196401964Girolamo, GBassi, M2003Community surveys of mental disorders: Recent achievements and works in progressCurrent Opinion in Psychiatry16403-411272). The newer CIDI has been adapted for computer-assisted administration (versus the CIDI-Auto which is self-administered). It generates mental health diagnoses using DSM-IV criteria. The reliability and validity of the CIDI is supported by the extensive field testing of the instrument, ADDIN EN.CITE Girolamo2003196401964Girolamo, GBassi, M2003Community surveys of mental disorders: Recent achievements and works in progressCurrent Opinion in Psychiatry16403-411272 the prior validation of the paper-pencil CIDI, its reliance on ICD-10 and DSM-IV criteria and earlier validation studies. ADDIN EN.CITE Kessler200319650196512813115289232003Jun 18The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R)3095-105Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. NCS@hcp.med.harvard.eduKessler, R. C.Berglund, P.Demler, O.Jin, R.Koretz, D.Merikangas, K. R.Rush, A. J.Walters, E. E.Wang, P. S.JamaAdultComorbidityDepression, Involutional/diagnosis/*epidemiologyDiagnostic and Statistical Manual of Mental DisordersFemaleHumanInterview, PsychologicalMaleMiddle Aged*Population SurveillancePrevalenceRegression AnalysisSelf Assessment (Psychology)Socioeconomic FactorsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.United States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12813115273
The NCS-R-CIDI has notable strengths that make it appropriate for the present research. First, it permits assessment and diagnosis over three timeframes (lifetime, past year, and past month). In the present work we will administer the lifetime NCS-R-CIDI in Project 1: (Efficacy) and the past-year versions in the current project (Year 1, 2 & 3 follow-ups). In addition, it also assesses such relevant constructs as quality of life (daily functioning, social and family relationships), impact of mental health symptoms, and constructs relevant to physical illness (major diseases, use of clinicians). Also, it permits skip patterns so that individuals may be briefly screened for a disorder/condition, and it is suitable for administration by trained lay interviewers. NCS-trained staff will train lay interviews in all structured interview measures. Interviewers will be subject to repeated reliability assessments throughout the study.
We plan to administer the following NCS-R-CIDI components: mental health (Depression, Irritable Depression, Panic Disorder, Specific Phobia, Social Phobia, Agoraphobia, Generalized Anxiety Disorder, Suicidality, Alcohol Use, Tobacco Use, Neurasthenia, Obsessive-Compulsive Disorder, Worries and Unhappiness, and 30-Day Symptoms), physical health and health quality of life (Use of Services, 30-Day Functioning, Chronic Conditions). Importantly, we are deleting a number of CIDI scales in the interest of reducing burden (e.g., all childhood disorder scales, eating disorders, gambling, demographics).
These scales will provide critical information on diagnosis and dimensional information on mental health, physical health, their impact on quality of life, and health & mental health care utilization. These NCS-R-CIDI measures will be supplemented with other measures to achieve a greater sense of status in critical domains.
Psychometric status of additional instruments. The instruments used in this study (see Table 4) all have psychometric properties that support the inferences for which they are being used. For instance, the MPQ brief form (MPQ-BF) has excellent psychometric properties as a personality measure. ADDIN EN.CITE Patrick2002194301943120560771422002JunDevelopment and validation of a brief form of the Multidimensional Personality Questionnaire150-63Department of Psychology, University of Minnesota, Twin Cities Campus, Elliott Hall, 75 East River Road, Minneapolis, Minnesota 55455, USA. cpatrick@tc.umn.eduPatrick, C. J.Curtin, J. J.Tellegen, A.Psychol AssessAdolescentAdultAgedFemaleHumanMaleMiddle AgedPersonality Disorders/*diagnosis*Personality InventoryReproducibility of ResultsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12056077147 The Wisconsin Dependence Measure (WISDM-68) the Wisconsin-Probability of Relapse and Smoking Measure (WI-PRISM), and the Fagerstrm Test of Nicotine Dependence (FTND) have been shown to predict dependence outcomes such as relapse and withdrawal severity. ADDIN EN.CITE Piper(in press)193701937Piper, M.EPiasecki, T. M.Federman, E.BBolt, D.MSmith, S.S.Fiore, M.CBaker, T.B(in press)A multiple motives approach to tobacco dependence: The Wisconsin Inventory of Smoking Dependence Motives (WISDM-68)Journal of Consulting & Clinical PsychologyPiper(in preparation)228102281Piper, M.EMa, G.XBolt, D.MMcCarthy, D. E.Baker, T.B(in preparation)The Wisconsin Predicting Relapse in Smoking Measure (WI-PRISM) - A new measure of relapse pronenessPoster presented at the 10th Annual Meeting of the Society for Research on Nicotine and Tobacco. Scottsdale, Az138,156 In fact, there is a substantial literature attesting to the positive psychometric properties of all of the measures that will be used: e.g., the PANAS, ADDIN EN.CITE Watson198819440194433978655461988JunDevelopment and validation of brief measures of positive and negative affect: the PANAS scales1063-70Department of Psychology, Southern Methodist University, Dallas, Texas 75275.Watson, D.Clark, L. A.Tellegen, A.J Pers Soc PsycholArousalHumanMood Disorders/*psychology*Psychological TestsPsychometricshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3397865274 the Quality of Life Inventory, ADDIN EN.CITE Frisch1992190501905Frisch, M.BCornell, JVillanueva, MRetzlaff, P.J1992Clinical validation of the Quality of Life Inventory: A measure of life satisfaction for use in treatment planning and outcome assessmentsPsychological Assessment492-101275 the Depression Proneness Inventory (DPI), ADDIN EN.CITE Alloy1990194201942Alloy, LAbramson, LMetalsky, GHarlages, S1990The Depression Proneness Inventory: A stress-responsive measure of vulnerability to depression(unpublished manuscript)Smith20016440644Smith,S.S.Jorenby,D.EFiore,M.C.Anderson,J.E.Mielke,M.M.Beach,K.E.Piasecki,T.M.Baker,T.B.2001Strike while the iron is hot: Can stepped-care treatments resurrect relapsing smokers?Journal of Consulting & Clinical Psychology693429-439abstinencecessationcounselingefficacyintervention practicesrelapserelapse preventionrisksmokingsupport154,276 and so on. The psychometric properties of other, chief measures were discussed earlier.
Genotyping
DNA sequencing will take place at the University of Utah Huntsman Cancer Institute. It has four ABI 3700s and one ABI3730 which can run a total of 28,000 sequence ladders per week. SNP typing will be performed by the ABI SNPlex system. This system can detect 4500 SNPs in parallel in as little as 15 minutes. Extensive capabilities also exist in this center for bioinformatics that enable investigators to collect and analyze DNA sequence, haplotype and SNP data. DNA extraction is described in Project 1.
Compensation
Participants will be compensated for completion of vital study milestones. Specifically, we will compensate participants $100 for completing each of the three annual in-person study visits to take place at Months 12, 24, and 36 (total compensation $300). In addition, we will send participants birthday cards each year thanking them for their participation, and small gifts labeled with study identifiers and phone/email information (e.g., pens, refrigerator magnets, notebooks) (see Steps to reduce attrition above).
Analytic Plan
Representing Constructs: Selection and Synthesis of Measures. One virtue of this research is that many of the important constructs are assessed with multiple measures. The measures are not only psychometrically strong individually, but their conjoint use permits us to determine convergent validity. Moreover, some of these measures are collected in very different ways and this has the advantage of reducing method variance. While use of multiple measures confers advantages, it also requires decisions regarding which measures are to be used for which purposes.
The general approach we will adopt with dependent variables is as follows: when there are multiple measures of a type of dependent variable, we will examine the interrelations among the measures, determine the stability of findings across the class, and perhaps analyze a composite measure. For instance, with respect to mental health the NCS-R-CIDI yields categorical diagnoses and symptom counts. In addition it comprises measures of mental health quality of life, impact of mental health symptoms on daily functioning, and use of psychiatric services. We will explore how these different indicators are interrelated, and whether predictors bear similar relation to the different indicators. The latter will help us determine whether a finding is robust and stable. This strategy requires that we report findings across the different measures of common constructs. Finally, we may examine composite measures. For instance, in some analyses we plan to collapse across all major anxiety, affective, and substance use diagnoses (taking into account comorbidity). We plan to employ a similar strategy across the different major types of dependent variables that have multiple indicators: e.g., atherosclerosis, quality of life, nicotine dependence, alcohol use/abuse. For instance, alcohol variables will arise from time-line follow-back data, the Short Inventory of Problems, CIDI Diagnosis, and electronic diary data gathered in Project 1. Smoking relapse and calendar measures of smoking over each year will be produced using data generated by the time-line follow-back procedures used in follow-up interviews. This will produce measures of continuous abstinence, point-prevalence, and percent days smoking each year. Amount of smoking will be determined in each 7-day point prevalence period. Any of these could be used in analyses, but for modeling over time, percent days smoking over each year combined with heaviness measures should yield the most useful measures of tobacco exposure over time. Use of other tobacco or nicotine containing products will also be examined.
With respect to independent variables, we will use model-building procedures (described below) to systematically select best measures from a class, and also report prediction stability across measures.
Data Acquisition and Preparation. Data will be inspected on a continuous basis over the course of the study to ensure that data acquisition is satisfactory. Virtually all of the data will be captured via computer entry, scannable forms and palm-top computers. One further data source will be data obtained from medical tests. These typically do not generate computer data files and when they do not, they will be double-entered.
Data Comparisons. This study will permit us to address numerous important questions about how quitting smoking and relapse are related to health and psychosocial outcomes, and for whom particular outcomes are especially likely. We cannot outline all of the analyses permitted by this data set. However, we will present analytic plans for several important outcomes. These will reveal the strategies that we will use and the relations to be tested.
We will identify a critical question, use regression methods to identify significant predictors of ultimate endpoints, and then use structural models to explore more complex relations among significant predictors across time. We will assess genetic correlates of critical phenotypes (e.g., nicotine dependence, quitting success, mental health status, and atherosclerosis status and progression) in a parallel research track. We will eventually combine genetic and nongenetic variables in integrated prediction models to determine potential mediators of genetic relations (e.g., via personality) and whether candidate genes predict particular endophenotypes (e.g., smokers reporting escalating or prolonged withdrawal ADDIN EN.CITE Piasecki2003111801118Piasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.2003Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relationsJournal of Abnormal Psychology112114-27Feb12653410AdultBupropion/therapeutic useDopamine Uptake Inhibitors/therapeutic useDouble-Blind MethodFemaleFollow-Up StudiesHumanMaleNicotine/*adverse effectsRecurrenceSeverity of Illness IndexSmoking/drug therapy/*prevention & controlSmoking Cessation/*methods*Substance Withdrawal Syndrome/diagnosis/etiology/prevention & controlSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12653410Department of Psychological Sciences, University of Missouri-Columbia 65211, USA. PiaseckiT@missouri.eduPiasecki2003111901119Piasecki, T. M.Jorenby, D. E.Smith, S. S.Fiore, M. C.Baker, T. B.2003Smoking withdrawal dynamics: I. Abstinence distress in lapsers and abstainersJournal of Abnormal Psychology11213-13Feb12653409Administration, CutaneousDouble-Blind MethodHumanNicotine/administration & dosage/*adverse effectsRecurrenceSmoking/*prevention & controlSmoking Cessation/*methodsSubstance Withdrawal Syndrome/diagnosis/*etiologySupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12653409Department of Psychological Sciences, University of Missouri-Columbia 65211, USA. PiaseckiT@missouri.edu124,125). Construction of genetic models will follow the principles outlined below.
Predicting Discrete Endpoints. Many clinicians and others interested in public health will primarily be interested in best-fitting models that predict outcomes (e.g., psychiatric diagnostic outcomes such as depression, or diagnoses such as diabetes, quality of life) at some future point in time. To address the prediction of outcomes at discrete points in time, we will use logistic and multiple regression models (for categorical & continuous dependent variables, respectively) in which ultimate status at Year 2 or 3 is predicted by both prequit and postquit variables.
In testing predictive relations we will follow a general strategy consistent with the model building recommendations made by Hosmer & Lemeshow. ADDIN EN.CITE Hosmer2000197411974Hosmer, D.W.Lemeshow, S2000Applied Logistic Regression, Second EditionNew YorkJohn Wiley & Sons, Inc.2nd277
We will identify on an a priori, substantive basis, the major predictors to be tested, control variables, and critical interactions. Predictors will include both static and dynamic variables gathered both before and after the quit attempt.
We will then examine distributions and use transformations where appropriate.
Missingness will be addressed through direct Maximum Likelihood estimation ADDIN EN.CITE Allison20032706027061467486811242003NovMissing data techniques for structural equation modeling545-57Sociology Department, University of Pennsylvania, Philadelphia, PA 19104-6299, USA. allison@ssc.upenn.eduAllison, P. D.J Abnorm Psycholhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14674868278 assuming that ignorability assumptions are appropriate and standard error and test statistics are robust. ADDIN EN.CITE Yuan20002734027341089552153 ( Pt 1)2000MayRobust transformation with applications to structural equation modelling31-50Department of Psychology, University of North Texas, Denton 76203-1280, USA. kyuan@unt.eduYuan, K. H.Chan, W.Bentler, P. M.Br J Math Stat PsycholHuman*Models, StatisticalMultivariate AnalysisSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10895521279
We will test univariate relations for all substantive variables so that their nonresidualized relations may be reported. Univariate variables will be modeled in various ways discussed in the section Representing Constructs) in order to determine the generalizability of obtained relations.
We will use model-building procedures described below to identify best-fitting models using all promising candidate measures identified in univariate analyses.
We will engage in secondary analyses to explore the relations of other variables with important targeted outcomes. These analyses will explore models that are less clinically or theoretically important than those tested in primary analyses, but ones that may provide the basis for future hypotheses and research. If reported, secondary analyses will clearly be labeled as exploratory.
All logistic regression models will be developed and tested using procedures and recommendations of Hosmer & Lemeshow. ADDIN EN.CITE Hosmer2000197411974Hosmer, D.W.Lemeshow, S2000Applied Logistic Regression, Second EditionNew YorkJohn Wiley & Sons, Inc.2nd277 For instance, variable selection will start with a careful univariate analysis of each variable, and computation of smoothed scatterplots for continuous variables. After univariate analyses, all independent variables with P-values <0.25 will be candidates for multivariate analyses. Subsequent variable selection will occur in the context of forward selection with a test for backwards elimination. Subsequent to the identification of a multivariate logistic model, the performance of each variable will be evaluated via inspection of the Wald statistic, and the comparison of the multivariate and univariate errors and regression coefficients. If a new model is generated this will be compared with the larger former model via the likelihood ratio test. Eliminated variables will be re-entered to ensure that they have not become valid predictors through the exclusion of other variables. The performance of all continuous variables will be tested for linearity of the logit and any hypothesized (a priori) interactions tested. Model fit will be assessed via the Hosmer-Lemeshow test and via area under the ROC curve. Standard model diagnostics will be used (e.g., inspection of leverage values, variance of residuals for covariate patterns). Construction of multiple regression models will be similarly standardized and subjected to appropriate diagnostics. ADDIN EN.CITE Cohen2003280112801Cohen, JCohen, P.West, S.GAiken, L.S2003Applied multiple regression/correlation analysis in the behavioral sciences (3rd ed.)Malwah, NJLawrence Erlbaum Associates280
Model building will follow strategies frequently used in longitudinal research. ADDIN EN.CITE Howard1998225802258Howard, G.Wagenknecht, L. E.Burke, G. L.Diez-Roux, A.Evans, G. W.McGovern, P.Nieto, F. J.Tell, G. S.1998Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) StudyJAMA2792119-124Jan 149440661Arteriosclerosis/epidemiology/pathology/*physiopathology/ultrasonographyCarotid Arteries/*pathology/ultrasonographyCohort StudiesDisease ProgressionFemaleHumanLife StyleLinear ModelsLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9440661Department of Public Health Sciences of Wake Forest University, Winston-Salem, NC 27157-1063, USA. ghoward@rc.phs.bgsm.edu1 Thus, control variables will be routinely entered (e.g., gender, age, site, ethnicity, Project 1 treatment, SES). Change will be modeled via entry of pretreatment (baseline) measures of the dependent variable and via change scores (which protect against interpretive biases of partialled scores. ADDIN EN.CITE Rogosa1988287572875Rogosa, D.1988Myths about longitudinal researchK.W., Schaie, R.T. Campbell, W. Meredith & S.C. RawlingsMethodological issues in aging researchSan DiegoSpringer171-210Maris1998287402874Maris, E1998Covariance adjustment versus gain scores-revisitedPsychological Methods3309-327281,282 Next, relevant individual differences will be entered: e.g., nicotine dependence, personality, and genotypes, depending upon the analysis. Then other modifiable risk factors will be entered: i.e., measures of diet, alcohol use/abuse, weight/BMI/waist circumference, stressors/distress, exercise, blood pressure, serum lipids, and exposure to second hand smoke. Principal relations will be presented both in univariate and multivariate models. Two-way interactions to be tested will be based upon a priori hypotheses for each tested model.
Principal Hypotheses
Hypothesis 1: Smoking cessation (amount of abstinence over the follow-up period coded either dichotomously or continuously) will be associated with reversal or arrest of atherosclerosis as assessed via CIMT. Baseline CIMT scores will be used to determine change. Individual differences and control variables: Progression will be greater among males ADDIN EN.CITE Gariepy20002808028081105870815312000NovGender difference in the influence of smoking on arterial wall thickness139-45Centre de Medecine Preventive Cardiovasculaire, Hopital Broussais, 96 Rue Didot, 75674 cedex 14, Paris, France.Gariepy, J.Denarie, N.Chironi, G.Salomon, J.Levenson, J.Simon, A.AtherosclerosisAdolescentAdultAgedAging/physiologyArteries/*ultrasonographyCarotid Arteries/ultrasonographyFemaleFemoral Artery/ultrasonographyHumanMaleMiddle Aged*Sex CharacteristicsSmoking/*adverse effectsSupport, Non-U.S. Gov'tTime FactorsTunica Intima/ultrasonographyTunica Media/ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11058708Mowbray1997271502715986566745-61997Oct-DecCardiovascular risk factors for early carotid atherosclerosis in the general population: the Edinburgh Artery Study357-62Department of Public Health Sciences, Medical School, Edinburgh, UK.Mowbray, P. I.Lee, A. J.Fowkes, G. R.Allan, P. L.J Cardiovasc RiskAgedAged, 80 and overAnalysis of VarianceArteriosclerosis/*etiology/pathology/*ultrasonographyCarotid Stenosis/*etiology/pathology/*ultrasonographyFemaleHumanLinear ModelsMaleMiddle AgedProspective StudiesQuestionnairesRisk FactorsScotlandSmoking/adverse effectsSupport, Non-U.S. Gov'tTunica Intima/*pathology/*ultrasonographyUrban Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9865667283,284 and among those high in trait (MPQ) Negative Emotionality. ADDIN EN.CITE Barefoot1996275102751864097193111996Jun 1Symptoms of depression, acute myocardial infarction, and total mortality in a community sample1976-80Behavioral Medicine Research Center, Duke University Medical Center, Durham, NC 27710, USA. foot@acpub.duke.eduBarefoot, J. C.Schroll, M.CirculationAgedAged, 80 and overCause of DeathCohort StudiesCross-Sectional StudiesDenmark/epidemiologyDepression/complications/*epidemiologyFemaleForced Expiratory VolumeHumanMmpiMale*MortalityMyocardial Infarction/*epidemiology/etiology/prevention & controlMyocardial Ischemia/epidemiologyProportional Hazards ModelsRiskRisk FactorsSupport, U.S. Gov't, P.H.S.Survival Analysishttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8640971Goodman199627600276086918927181996AugHostility predicts restenosis after percutaneous transluminal coronary angioplasty729-34Department of Psychiatry and Behavioral Medicine, Union Memorial Hospital, Baltimore, Maryland, USA.Goodman, M.Quigley, J.Moran, G.Meilman, H.Sherman, M.Mayo Clin ProcAged*Angioplasty, Transluminal, Percutaneous CoronaryCoronary Disease/*psychology/therapyFemale*HostilityHumanLogistic ModelsMaleMiddle AgedPredictive Value of TestsPrognosisProspective StudiesRecurrenceRetrospective StudiesRisk FactorsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8691892Smith2002271002710120903697032002JunPsychosocial influences on the development and course of coronary heart disease: current status and implications for research and practice548-68Department of Psychology, University of Utah, Salt Lake City 84112, USA. tim.smith@psych.utah.eduSmith, T. W.Ruiz, J. M.J Consult Clin PsycholCoronary Disease/*etiology/prevention & controlHumanRisk FactorsSocial DominanceSocial EnvironmentStress, Psychological/psychologySupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=120903692,4,8 The following modifiable risk factors will predict greater atherosclerotic progression: weight gain, fat intake, ADDIN EN.CITE Howard1998225802258Howard, G.Wagenknecht, L. E.Burke, G. L.Diez-Roux, A.Evans, G. W.McGovern, P.Nieto, F. J.Tell, G. S.1998Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) StudyJAMA2792119-124Jan 149440661Arteriosclerosis/epidemiology/pathology/*physiopathology/ultrasonographyCarotid Arteries/*pathology/ultrasonographyCohort StudiesDisease ProgressionFemaleHumanLife StyleLinear ModelsLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9440661Department of Public Health Sciences of Wake Forest University, Winston-Salem, NC 27157-1063, USA. ghoward@rc.phs.bgsm.edu1 BMI, second-hand smoke, sedentariness, and high levels of stress (e.g., ADDIN EN.CITE Lacy199527540275478639987571995Mar 1Coronary vasoconstriction induced by mental stress (simulated public speaking)503-5Department of Medicine, UMDNJ-Robert Wood Johnson Medical School.Lacy, C. R.Contrada, R. J.Robbins, M. L.Tannenbaum, A. K.Moreyra, A. E.Chelton, S.Kostis, J. B.Am J CardiolAgedBlood PressureCoronary Disease/physiopathologyCoronary Vessels/*physiopathologyFemaleHeart RateHumanMaleMiddle AgedStress, Psychological/*physiopathology*Vasoconstrictionhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7863998von Kanel20012755027551139736587122001Jun 15Effect of acute psychological stress on the hypercoagulable state in subjects (spousal caregivers of patients with Alzheimer's disease) with coronary or cerebrovascular disease and/or systemic hypertension1405-8Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA.von Kanel, R.Dimsdale, J. E.Ziegler, M. G.Mills, P. J.Patterson, T. L.Lee, S. K.Grant, I.Am J CardiolAgedAged, 80 and overAlzheimer Disease/blood/*psychologyAntithrombin III/metabolismCaregivers/*psychologyCatecholamines/bloodCoronary Thrombosis/blood/*psychologyFemaleFibrin Fibrinogen Degradation Products/metabolismHemodynamic Processes/physiologyHumanHypertension/blood/*psychologyIntracranial Embolism/blood/*psychologyMaleMiddle AgedPeptide Hydrolases/metabolismRisk FactorsStress, Psychological/blood/*complicationsSupport, Non-U.S. Gov'tThrombophilia/blood/*psychologyvon Willebrand Factor/metabolismhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11397365Whiteman2000275902759110201016252000Sep-OctPersonality and social predictors of atherosclerotic progression: Edinburgh Artery Study703-14Wolfson Unit for Prevention of Peripheral Vascular Diseases, Public Health Sciences, University of Edinburgh, Scotland.Whiteman, M. C.Deary, I. J.Fowkes, F. G.Psychosom MedAgedAnkle/blood supplyAnxiety Disorders/diagnosisArteriosclerosis/*diagnosis/epidemiology/*etiologyBrachial Artery/physiologyCross-Sectional StudiesDisease ProgressionFemaleFollow-Up StudiesHostilityHumanMaleMiddle AgedPeripheral Vascular Diseases/*diagnosis/*etiologyPersonality Disorders/*diagnosis/*psychologyPredictive Value of TestsPressurePrevalenceProspective StudiesReference ValuesSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=110201015-7). Exercise/activity, however, will predict greater regression. Two critical interactions with smoking will involve second-hand smoke and gender since research suggests different impacts of smoking depending upon these variables. ADDIN EN.CITE Gariepy20002808028081105870815312000NovGender difference in the influence of smoking on arterial wall thickness139-45Centre de Medecine Preventive Cardiovasculaire, Hopital Broussais, 96 Rue Didot, 75674 cedex 14, Paris, France.Gariepy, J.Denarie, N.Chironi, G.Salomon, J.Levenson, J.Simon, A.AtherosclerosisAdolescentAdultAgedAging/physiologyArteries/*ultrasonographyCarotid Arteries/ultrasonographyFemaleFemoral Artery/ultrasonographyHumanMaleMiddle Aged*Sex CharacteristicsSmoking/*adverse effectsSupport, Non-U.S. Gov'tTime FactorsTunica Intima/ultrasonographyTunica Media/ultrasonographyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11058708Howard1998225802258Howard, G.Wagenknecht, L. E.Burke, G. L.Diez-Roux, A.Evans, G. W.McGovern, P.Nieto, F. J.Tell, G. S.1998Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) StudyJAMA2792119-124Jan 149440661Arteriosclerosis/epidemiology/pathology/*physiopathology/ultrasonographyCarotid Arteries/*pathology/ultrasonographyCohort StudiesDisease ProgressionFemaleHumanLife StyleLinear ModelsLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9440661Department of Public Health Sciences of Wake Forest University, Winston-Salem, NC 27157-1063, USA. ghoward@rc.phs.bgsm.edu1,283
Hypothesis 2. Smoking cessation/reduction will be associated with positive changes in mental health functioning (from baseline status). Change will be measured from either baseline (lifetime) history of diagnosis, or baseline symptom levels, depending upon the analysis. While cessation may initially increase depression/depressive symptoms, long-term cessation will be associated with improved mental health status as reflected by lower rates of psychiatric diagnoses and reduced symptoms (thus, some analyses will focus on Year 2 and 3 symptoms/diagnoses). Individual differences and control variables: post-cessation symptoms will be positively related to trait (MPQ) Negative Emotionality and female gender (especially if diagnoses are restricted to internalizing disorders) and severity of prequit nicotine dependence. Modifiable risk factors: mental health symptoms/diagnoses will be inversely related to post-quit social support and physical health, and positively related to post-quit stressor occurrence and frequency of postquit heavy drinking days (relevant to dependent variables that do not themselves comprise alcohol diagnoses). No interactions are predicted for this family of analyses.
Hypothesis 3. Smoking cessation/reduction will lead to improved quality of life. We expect continuing smokers to report diminishing QOL levels over the follow-up period (relative to baseline), and we expect exsmokers to report improving QOL. Change will be measured from baseline levels of tested measures (e.g., Quality of Life Questionnaire or other QOL indicator: e.g., 30 day functioning). Individual differences and control variables: Improvement in QOL will be inversely related to age. Modifiable risk factors: QOL improvements will be inversely related to postquit heavy drinking days, postquit increase in BMI, post-quit measures of physical health symptoms (CIDI Chronic Conditions & 30 Day Symptoms) and positively related to postquit social support available in the social network. We make a further prediction that much of the improvement in QOL will be mediated by postquit psychiatric symptoms/disorders. We predict that the influence of smoking on QOL will be moderated by postquit weight gain/BMI as those gaining more weight will show a reduced relation between cessation and QOL improvements. ADDIN EN.CITE Department of Health and Human Services2001269412694Department of Health and Human Services,2001Women and smoking: A report of the Surgeon GeneralRockville, MDU.S. Department of Health and Human Services11
Hypothesis 4. Smoking relapse late in the follow-up period (>1 yr postquit) will be related to presence of alcohol use in the persons social network/dyad and to presence of smokers in the social network/dyad and alcohol use. Late relapse will be modeled both as 3-year point-prevalence or latency from 1-year post-quit. Individual differences and control variables: Importantly, baseline nicotine dependence will not predict late relapse, nor will female gender (although this may be because these factors may have already exerted their influence in the first year of follow-up which we will examine). Modifiable risk factors: We expect late relapse likelihood will be positively related to both number of drinking days and heavy drinking days (both postquit), to number of smokers in the social network and contact with such smokers (postquit), and to spousal smoking among partnered participants.
Hypothesis 5. Abstinence from smoking will be associated with reductions in the frequency of drinking-days in the post-quit period. Change will be determined from prequit frequency of drinking. Individual differences and control variables: Postquit drinking frequency will be positively related to male gender, and inversely related to MPQ Constraint and SES. Modifiable risk factors: Postquit drinking frequency will be inversely related to presence of drinking and smoking in the social network, and inversely related to exercise level. Finally, we expect an interaction between prequit diagnosis of alcohol abuse or alcohol problems (SIP) and smoking status. We believe these variables will reduce the impact of smoking cessation on drinking. Thus, smoking cessation will affect drinking frequency principally among those with fewer drinkers in their social network and who show no prequit drinking problems. These analyses will not reveal the temporal ordering of drinking and smoking influences, or their reciprocal effects over time. These issues will be addressed in structural models described below.
Secondary analyses. These will examine the predictors of the following postquit outcomes: (1) physiological outcomes other than CIMT: BART endothelial function, lipid measures, blood pressure, diabetes indicators, (2) diet/nutrition/weight: BMI, waist circumference, diet measures, (3) physical fitness/activity: pedometry, treadmill, IPAQ (4) health-related quality of life: NCS-R-CIDI physical symptoms & functioning, (5) quality/nature of the social network: size, smoking and alcohol use in network, supportiveness of network. It is important to note that the above models will be carefully refined with on-going consultation with our expert Co-Investigators in relevant fields.
Structural Models. We will use structural modeling to take advantage of the truly prospective, multiple measurement properties of the design. In particular we will use latent trajectory models (LTMs) to examine direct, indirect, and reciprocal relations among critical variables (including latent variables) over time. In these models intercepts and trajectories of repeated measures (e.g., smoking over time) will be modeled as random variables. In constructing trajectory models linear and quadratic trajectories will be modeled, as well as completely latent change functions since different inter-measure intervals may increase the value of shrinking or stretching time to capture trajectories. ADDIN EN.CITE Aber1991273572735Aber, M.SMcArdle, J.J1991Latent growth curve approaches to modeling the development of competenceChandler, MChapman, MCriteria for competenceNewbury Park, CASage231-258Curran20032708027081467486711242003NovThe use of latent trajectory models in psychopathology research526-44Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3270, USA. curran@unc.eduCurran, P. J.Hussong, A. M.J Abnorm Psycholhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14674867285,286 Analyses will be developed programmatically such that more complex structures will be tested only after characterization of simpler (nested) models. For instance, in modeling change in smoking or alcohol intake over time, we will first determine functional forms of these dynamic variables, then determine how they are influenced by key individual-difference exogenous variables (e.g., baseline nicotine dependence, history of psychiatric disorder), and then determine whether obtained relations are affected by inclusion of control variables (gender, site, ethnicity). Fit will be determined via conventional fit statistics. ADDIN EN.CITE Tomarken20032741027411467486611242003NovIntroduction to the special section on structural equation modeling523-5Department of Psychology, Vanderbilt University, Nashville, TN 37203, USA. andrew.j.tomarken@vanderbilt.eduTomarken, A. J.Baker, T. B.J Abnorm Psycholhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14674866287
LTM methods allow for modeling of both mediational and moderating effects. In the former one can determine factors that mediate the effects of variables on the intercepts or trajectories of targeted variables (e.g., mental health outcomes). In the latter, one can determine under what conditions a relation exists between a predictor and a targeted construct. Moreover, we will use an autoregressive LTM to characterize the performance of two different variables measured repeatedly and their interdependencies over time. ADDIN EN.CITE Curran20032708027081467486711242003NovThe use of latent trajectory models in psychopathology research526-44Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3270, USA. curran@unc.eduCurran, P. J.Hussong, A. M.J Abnorm Psycholhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14674867286 This will reveal, for example, whether time-specific values in drinking, relative to average drinking values, predict subsequent values in smoking (relative to average levels of smoking), and vice versa. There will be six repeated measures for follow-up phone variables and four measures for those gathered at in-person visits. (LTM will not be used for variables gathered only twice: e.g., Carotid IMT). Latent variables may be used for some central constructs (e.g., mental health status).
Figure 5 depicts an example of a multivariate unconditional latent trajectory model (LTM) for exploring alcohol use and smoking (modeled with only 4 repeated measures). Such models might also be used to explore relations between smoking and psychiatric symptoms, and between smoking and weight gain. Control variables such as those described in the Predicting Discrete Endpoints will be used as exogenous variables (MPQ Constraint, Gender, and Smoking in the Social Network). One exemplar set of predictions (Figure 5) would be that Gender will influence both initial drinking and smoking indices (Intercepts) with males showing higher levels. Low levels of trait Constraint would predict high initial smoking and drinking, and predict high levels of smoking over time. Post-quit smoking in the Social Network would also predict a reduced decline in smoking over time. Smoking and drinking might be inter-related in that higher smoking intercepts predict reduced declines in drinking over time.
Power
After accounting for relapse and attrition (initial N=900), we expect that data for at least 300 continuously abstinent and 450 smoking participants to be available for analysis. These estimates are based on the expectation that approximately 9% of the participants enrolled in Project 2 will either relapse (approximately 4% per year) or drop out of the study (approximately 5% per year) in years 2 and 3. The large number of primary and secondary hypotheses precludes presentation of power estimates for all possible comparisons. Two power analyses are presented below of central, discrete endpoint hypotheses.
Long-term smoking status and atherosclerotic progression: The best relevant estimates of CIMT effect sizes were reported by Howard et al. ADDIN EN.CITE Howard1998225802258Howard, G.Wagenknecht, L. E.Burke, G. L.Diez-Roux, A.Evans, G. W.McGovern, P.Nieto, F. J.Tell, G. S.1998Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) StudyJAMA2792119-124Jan 149440661Arteriosclerosis/epidemiology/pathology/*physiopathology/ultrasonographyCarotid Arteries/*pathology/ultrasonographyCohort StudiesDisease ProgressionFemaleHumanLife StyleLinear ModelsLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9440661Department of Public Health Sciences of Wake Forest University, Winston-Salem, NC 27157-1063, USA. ghoward@rc.phs.bgsm.edu1 These authors analyzed CIMT change over a 3-year period in terms of smoking status (current, past, never) and ETS exposure. Howard et al. ADDIN EN.CITE Howard1998225802258Howard, G.Wagenknecht, L. E.Burke, G. L.Diez-Roux, A.Evans, G. W.McGovern, P.Nieto, F. J.Tell, G. S.1998Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) StudyJAMA2792119-124Jan 149440661Arteriosclerosis/epidemiology/pathology/*physiopathology/ultrasonographyCarotid Arteries/*pathology/ultrasonographyCohort StudiesDisease ProgressionFemaleHumanLife StyleLinear ModelsLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9440661Department of Public Health Sciences of Wake Forest University, Winston-Salem, NC 27157-1063, USA. ghoward@rc.phs.bgsm.edu1 used mean common CIMT as the measure of progression (CIMTmean ). The authors computed linear regression models that controlled for demographic, life-style, and other risk factors and found a significant difference between current and past smokers of 7.3 (m, equivalent to a 20% difference in progression.
In the current study, we will use a more sensitive measure of carotid IMT (CIMTmax ) that averages segmental maximum carotid wall thicknesses from all measurable carotid artery segments (up to a maximum of six segments). Bots et al. ADDIN EN.CITE Bots20032802028021461561934122003DecCarotid intima-media thickness measurements in intervention studies: design options, progression rates, and sample size considerations: a point of view2985-94Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands. m.l.bots@jc.azu.nlBots, M. L.Evans, G. W.Riley, W. A.Grobbee, D. E.StrokeCarotid Arteries/*ultrasonographyCarotid Artery Diseases/*diagnosis/physiopathologyDisease ProgressionHumanRandomized Controlled Trials/methodsReproducibility of Results*Research DesignSample SizeSensitivity and SpecificitySupport, Non-U.S. Gov'tTunica Intima/*ultrasonographyTunica Media/*ultrasonographyUltrasonography/instrumentation/standardshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14615619288 recommended CIMTmax for intervention trials and also computed pooled estimates of the annual rate of CIMT change across multiple atherosclerosis trials. These pooled estimates were then used to compute sample size estimates for intervention trials. We use these same pooled estimates of CIMTmax change in power calculations for the current study. Other assumptions include: (=.05, a 20% difference in CIMT progression between abstinent participants (N = 300) and continuing smokers (N = 450), and use of the CIMTmax measure with an estimated change in CIMT for continuing smokers of 5.28 (m (SD= 5.0 (m). ADDIN EN.CITE Bots20032802028021461561934122003DecCarotid intima-media thickness measurements in intervention studies: design options, progression rates, and sample size considerations: a point of view2985-94Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands. m.l.bots@jc.azu.nlBots, M. L.Evans, G. W.Riley, W. A.Grobbee, D. E.StrokeCarotid Arteries/*ultrasonographyCarotid Artery Diseases/*diagnosis/physiopathologyDisease ProgressionHumanRandomized Controlled Trials/methodsReproducibility of Results*Research DesignSample SizeSensitivity and SpecificitySupport, Non-U.S. Gov'tTunica Intima/*ultrasonographyTunica Media/*ultrasonographyUltrasonography/instrumentation/standardshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14615619288 Based on these assumptions, we will have power of .81 to detect a 20% difference in progression between abstinent and smoking participants. This is a conservative power estimate as control variables should reduce error and our N is likely to exceed 750, and the projected effect size is smaller than that reported by Howard et al. ADDIN EN.CITE Howard1998225802258Howard, G.Wagenknecht, L. E.Burke, G. L.Diez-Roux, A.Evans, G. W.McGovern, P.Nieto, F. J.Tell, G. S.1998Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) StudyJAMA2792119-124Jan 149440661Arteriosclerosis/epidemiology/pathology/*physiopathology/ultrasonographyCarotid Arteries/*pathology/ultrasonographyCohort StudiesDisease ProgressionFemaleHumanLife StyleLinear ModelsLongitudinal StudiesMaleMiddle AgedRisk FactorsSmoking/*adverse effectsSupport, U.S. Gov't, P.H.S.Tobacco Smoke Pollution/*adverse effectsTunica Intima/*pathologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9440661Department of Public Health Sciences of Wake Forest University, Winston-Salem, NC 27157-1063, USA. ghoward@rc.phs.bgsm.edu1 Thus, we believe that the current study is adequately powered to detect predicted differences in CIMT progression over three years for the comparison of smokers versus continuously abstinent ex-smokers. Analyses of continuous measures of post-quit smoking also may yield greater power.
Long-term smoking status and psychiatric morbidity. We predict that, compared to continuing smokers, abstinent ex-smokers will experience lower rates of occurrence of new psychiatric disorders during the 3-year follow-up. In one test of this hypothesis, we will use a composite measure of total incidence ADDIN EN.CITE Eaton2002280472804Eaton, W.W2002Studying the natural history of psychopathologyTsuang, M.TTohen, ATextbook in psychiatric epidemiology (2nd ed.)New YorkWiley-Liss215-238289 that combines mood, anxiety, and substance use disorders. Total incidence refers to disorder onsets (counting both new and recurrent cases) within a defined time period (e.g., 2 or 3 years). Power computation is difficult because to our knowledge, no population-based total incidence data for psychiatric disorders are available for smokers, ex-smokers, or never smokers. General population incidence rate data are available for certain psychiatric disorders (e.g., major depressive disorder, panic disorder) but these rates often exclude individuals with a past history of a given disorder (these are initial incidence rates) and the time frame is typically one year.
Although there are almost no data on total annual incidence of psychiatric disorders among quitting vs. continuing smokers (and hence, one reason for doing the proposed research), there are data that show incidence rates in the general population. An analysis of five Epidemiologic Catchment Area sites revealed a 1-year total incidence rate of about 12% for any diagnosis of affective, anxiety, or substance use disorders. ADDIN EN.CITE Regier199328650286584275585021993FebThe de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services85-94Division of Epidemiology and Services Research, National Institute of Mental Health, National Institutes of Health, Rockville, Md.Regier, D. A.Narrow, W. E.Rae, D. S.Manderscheid, R. W.Locke, B. Z.Goodwin, F. K.Arch Gen PsychiatryAdolescentAdultAge FactorsAgedAmbulatory CareCatchment Area (Health)Delivery of Health Care/statistics & numerical dataFemaleHealth PolicyHospitalizationHumanIncidenceMaleMental Disorders/*epidemiology/therapyMental Health Services/*utilizationMiddle AgedNational Health ProgramsPatient Acceptance of Health CarePrevalenceProspective StudiesRecurrenceSelf-Help Groups/utilizationSocial SupportSubstance-Related Disorders/*epidemiology/therapyUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=842755893 However, we will be studying incidence over three years and the ECA data do not model the impact of recurrences. Perhaps the best data on 3-year incidence comes from De Graaf et al. ADDIN EN.CITE De Graaf20042800028001467495910912004JanRapid onset of comorbidity of common mental disorders: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)55-63Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands WODC, Research and Documentation Center of the Ministry of Justice, The Hague, The Netherlands.De Graaf, R.Bijl, R. V.Ten Have, M.Beekman, A. T.Vollebergh, W. A.Acta Psychiatr Scandhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14674959290 These authors reported a 3-year incidence of 10% for initial diagnoses in those with no prior psychiatric diagnosis. We expect a higher incidence among nicotine dependent, continuing smokers given their higher rates of prevalence than nonsmokers (and hence higher rates than in the general population) and the majority of diagnoses tend to be recurrences. ADDIN EN.CITE Kessler2002287312873Kessler, R.C.2002Epidemiology of depression. Handbook of depressionNew YorkGuilford23-42Regier199328650286584275585021993FebThe de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services85-94Division of Epidemiology and Services Research, National Institute of Mental Health, National Institutes of Health, Rockville, Md.Regier, D. A.Narrow, W. E.Rae, D. S.Manderscheid, R. W.Locke, B. Z.Goodwin, F. K.Arch Gen PsychiatryAdolescentAdultAge FactorsAgedAmbulatory CareCatchment Area (Health)Delivery of Health Care/statistics & numerical dataFemaleHealth PolicyHospitalizationHumanIncidenceMaleMental Disorders/*epidemiology/therapyMental Health Services/*utilizationMiddle AgedNational Health ProgramsPatient Acceptance of Health CarePrevalenceProspective StudiesRecurrenceSelf-Help Groups/utilizationSocial SupportSubstance-Related Disorders/*epidemiology/therapyUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=842755893,291 Regular smokers often have rates of psychiatric disorder that are 2-4 times the rates of nonsmokers (e.g., ADDIN EN.CITE Breslau19912130213Breslau,NKilbey,MAndreski,P1991Nicotine dependence, major depression, and anxiety in young adultsArchives of General Psychiatry481069-107412/1991adultsanxietydepressionnicotinemental healthsmokingpsychiatric disordersalcoholcocaineratesBreslau20002190219Breslau,NJohnson,E.O2000Predicting smoking cessation and major depression in nicotine-dependent smokersAmerican Journal of Public Health9071122-1128Julycessationdepressionsmokingsmoking cessation292,293, and we expect their three-year total incidence rate to reflect that). We propose that continuing smokers will compile a 3-year incidence of 30% for affective, anxiety and alcohol diagnoses combined. ADDIN EN.CITE Regier199328650286584275585021993FebThe de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services85-94Division of Epidemiology and Services Research, National Institute of Mental Health, National Institutes of Health, Rockville, Md.Regier, D. A.Narrow, W. E.Rae, D. S.Manderscheid, R. W.Locke, B. Z.Goodwin, F. K.Arch Gen PsychiatryAdolescentAdultAge FactorsAgedAmbulatory CareCatchment Area (Health)Delivery of Health Care/statistics & numerical dataFemaleHealth PolicyHospitalizationHumanIncidenceMaleMental Disorders/*epidemiology/therapyMental Health Services/*utilizationMiddle AgedNational Health ProgramsPatient Acceptance of Health CarePrevalenceProspective StudiesRecurrenceSelf-Help Groups/utilizationSocial SupportSubstance-Related Disorders/*epidemiology/therapyUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=842755893 We expect quitting to reduce 3-year incidence by about a third (a smaller effect size than was reported for a cessation-induced reduction of panic attacks. ADDIN EN.CITE Breslau19991992019921059129256121999DecSmoking and panic attacks: an epidemiologic investigation1141-7Department of Psychiatry, Henry Ford Health System, Detroit, Mich 48202-3450, USA. nbresla1@hfhs.orgBreslau, N.Klein, D. F.Arch Gen PsychiatryAdultAlcohol Drinking/epidemiologyComorbidityComparative StudyEpidemiologic StudiesFemaleHealth SurveysHumanLung Diseases/epidemiologyMaleMichigan/epidemiologyPanic Disorder/diagnosis/*epidemiology/etiologyPrevalenceProportional Hazards ModelsPsychiatric Status Rating Scales/statistics & numerical dataRandom AllocationRisk FactorsSmoking/*epidemiologySmoking Cessation/statistics & numerical dataSupport, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1059129284 We believe such a decrease would be significant from a public health and clinical perspective.
Given the above assumptions, we predict that approximately 20% of abstinent participants and 30% of continuing smokers will develop a psychiatric disorder over the three-year post-quit period. Setting (=.05, the current study has power of > .80 to detect a difference of this magnitude. Table 5 provides power estimates for various rates in the abstinent ex-smokers and 30% for the continuing smokers. As shown in Table 5, our group sample sizes provide sufficient power to detect a difference in rates as small as 9% (i.e., 30% versus 21%) with power of .79.
It is important to observe that the above power estimate does not take into account the impact of a prior diagnosis history covariate which should be significantly related to post-quit incidence. Also, we expect to have even greater power to detect change in continuous symptom measures since the one relevant study ADDIN EN.CITE Mino2000201102011108038115422000AprDoes smoking cessation improve mental health?169-72Department of Hygiene and Preventive Medicine, Okayama University Medical School, Japan. yoshmino@med.okayama-u.ac.jpMino, Y.Shigemi, J.Otsu, T.Tsuda, T.Babazono, A.Psychiatry Clin NeurosciAdultCohort StudiesHumanJapanMale*Mental HealthMiddle AgedPersonality Inventory/statistics & numerical dataPsychometricsSmoking/adverse effects/psychologySmoking Cessation/*psychologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1080381197 suggests a moderate effect size.
Limitations
One limitation is that the smokers who volunteer, may not be representative of smokers in general. However, we will compare smokers in our study to smokers in general on the basis of SES, educational attainment, smoking rates, ethnicity, and so forth. Recent BRFSS data and Wisconsin Tobacco Survey data (2003) will provide opportunities to assess sample representativeness. Also, we will compare treatment adherers vs. dropouts in order to gauge attrition bias. In addition, those quitting in response to Project 1 treatments may not show the same outcomes as those making unaided quit attempts. As with any longitudinal study, this study does not permit absolute certainty with respect to causal inferences. Also, it is possible that the assessment activities involved in this research may produce reactivity: e.g., questions about smoking might elicit smoking urges and prompt relapse - - or medical assessments might make participants more health conscious and adopt healthier lifestyles.
Another important concern is that the assessment burden might cause many participants to refuse to enroll or to drop out. The research has many features designed to reduce or manage the burden: skip patterns, individualization of assessments, and compensation. We will regularly monitor participants reports of overload and strive to achieve maximal amounts of information while placing greater emphasis on maintaining participants in the study. Modern missingness techniques permit meaningful analysis despite incomplete data sets. Some outcomes (e.g., some diagnostic classes) will be infrequent and so cannot be analyzed as discrete outcomes with adequate power. However, many of these variables can be meaningfully analyzed as composites (e.g., collapsing across internalizing diagnoses). In addition, it is important to collect information on some infrequent outcomes since they provide a more comprehensive picture of the sample and its performance over time and can help establish the validity of some of the other measures.
Connections with TTURC Theme and Companion Research Proposals
Each of the proposals in this TTURC application will advance our understanding of tobacco dependence treatments and treatment outcomes. The present study will track the health and psychosocial outcomes associated with quitting or continuing smoking over three years, targeting a broad array of important physical and mental domains. In this way, this project focuses on diverse ultimate outcomes associated with tobacco cessation. This study will complement other studies in this TTURC proposal that address other dimensions of treatment outcomes. For example, Project 1 will address short-term outcomes such as withdrawal symptoms and early abstinence. Project 4, Healthcare Costs and Utilization of Smoking and Quitting, also focuses on the longterm outcomes of a quit attempt, but in a different domain and context. Whereas the current project will track individual and dyad outcomes along health and psychosocial dimensions, Project 4 will track the systems-level health care cost and utilization outcomes associated with successful or unsuccessful quit attempts. Projects 2 and 4 also differ in terms of study population and research context. Whereas Project 2 involves intensive assessment of research volunteers seeking treatment, Project 4 involves unobtrusive assessment of primary care patients who accepted treatment offered as part of their normal healthcare. Conducting these projects jointly as part of the UW TTURC will advance our understanding of the immediate and delayed, and specific and global effects associated with tobacco dependence treatment in a way that no single project could accomplish-- by tackling core research questions on multiple levels of analysis, across distinct populations, and in diverse contexts.
E. HUMAN SUBJECTS
Risks to the Subjects
Human Subjects Involvement and Characteristics: While 1520 participants will be enrolled at the baseline of this study (Project 1: Efficacy), only 900 will participate in the proposed follow-up study (Project 2). All individuals who report 7-day point-prevalence abstinence at Week 52 of Project 1 (approximate n = 360) will be invited to participate in the proposed study. The remainder of Project 2 participants (approximate n = 540) will be randomly selected from all relapsed participants from Project 1. All participants will be 18 years of age or older. Inclusion criteria at baseline for Project 1 will be: (1) smoking at least 10 cigarettes/day (on average) for the previous 6 months, (2) a breath sample with a CO level > 9 ppm, (3) being motivated to quit, (4) able to read and write English, (5) agree to respond to EMA prompts throughout the day, (6) plan to remain in the treatment catchment area for at least 12 months after the initiation of treatment, (7) no medical contraindications for use of bupropion (e.g., no uncontrolled hypertension, history of bipolar illness, recent myocardial infarction, recent heavy alcohol use, seizure history, or use of MAO inhibitors or other contraindicated medications), (8) no imminent risk of suicide, (9) no other member of the household is participating, and (10) women are not pregnant and agree to prevent pregnancy during the course of study pharmacotherapy. There will be no restrictions on participation based on sex or race.
Sources of Materials: Participants in this program will provide data for the express purpose of research. Data will consist of answers to questionnaires and interviews assessing smoking history, demographics, nicotine dependence, personality, affect and affective vulnerability, psychopathology, stress, social networks, physical activity and food intake. Other assessments will include vital signs (blood pressure, heart and respiratory rate), body weight, waist circumference, height, breath samples to permit determination of carbon monoxide, blood samples for cotinine, DNA, lipid profiles, creatinine, simultaneous fasting blood glucose and insulin, hemoglobin A1C, c-reactive protein, and possibly blood carotenoids. Carbon monoxide and cotinine assays reflect smoking status. Data regarding lung and cardiovascular function will be collected using specific medical procedures, including ultrasound Carotid Intima-Media Thickness test (CIMT), Ultrasound Brachial Artery Reactivity Test (UBART) of endothelial functioning, and an exercise stress test.
Potential Risks: Although participants will have received cessation treatment as part of Project 1, they will not be receiving any treatment as a part of this proposed study, therefore, the risks associated with this research are judged to be minimal. The only significant risks are those posed by the exercise stress test. The most substantial risk associated with the exercise stress test is the risk of a coronary event. However, the risk of a coronary event in medically supervised exercise treadmill tests is less than 1 per 5000 - 10,000 tests, and events are usually minor in nature due to the test being supervised (for angina, dizziness, etc). Serious coronary or other events are rare due to the monitoring and the cessation of the test in the presence of ECG changes, any arrhythmias, abnormal symptoms, etc. Medical supervision will be available for all tests. One final potential risk includes the fact that participants will be informed about any urgent medical condition that they may have previously been unaware of (e.g., advanced atherosclerosis that might lead to stroke). The other medical assessments pose little or no risk. Brachial and carotid artery ultrasound studies are safe, noninvasive, and without discomfort. There are no known adverse physiologic effects related to diagnostic medical ultrasound. Subjects who elect not to participate in this research program, or are eliminated due to screening failure, will be given a list of alternative smoking cessation programs. Finally, we will not give subjects feedback regarding our assessments until the end of the entire follow-up study. However, if we discover evidence of a significant new disease (e.g., advanced carotid atherosclerosis suggesting a high risk of an acute stroke) we will inform the subject of the finding, and urge him or her to address it immediately. With the permission of the participant, we will send a letter to a health care provider.
Adequacy of Protection Against Risks
Recruitment and Informed Consent: As in our previous research, participants will be recruited at baseline via advertisements in newspapers, radio, television, billboards, and other media. In addition, free media (e.g., press conferences) will be utilized. Participants will be recruited in both Madison and Milwaukee. Advertisements and publicity will contain a phone number for interested individuals to call to contact study personnel. After calling this number, participants will undergo initial phone screening to rule out those with clear exclusions. The study will be briefly described, questions answered, and potentially qualifying individuals will be invited to attend an Orientation Session. At the Orientation Session, the general requirements for participation will be reviewed (e.g., session attendance, need for follow-up, participation in assessments, participation for at least 3 years). In addition, participants will be informed of the nature of the treatments involved. After answering additional questions about research participation and treatment, participants will be asked to read and sign a consent form as well as an appropriate HIPAA form. Subjects will also be given copies of the consent form and HIPAA form to take home. After signing a consent agreement, potential subjects will be scheduled for an individual screening session, where previously assessed inclusion/exclusion criteria will be confirmed and other inclusion/exclusion criteria will be assessed. Individuals will be encouraged to ask any further questions about the study protocol throughout the study.
Protection Against Risk: With respect to the treadmill stress electrocardiogram tests, participants will participate only if they do not have contraindications and are clinically stable. Participants will be screened prior to the test by trained physiologists for absolute and relative contraindications to stress testing, using physician reviewed protocols. Participants will have documented clearance by physicians for testing prior to the test, and informed consent will be obtained. Twelve-lead ECGs will be reviewed by a physician prior to the test to ensure that the participant does not have ECG or clinical contraindications to the test. Test termination criteria are also standard for stress testing, including the development of chest pain, more than 1 mm. of horizontal or downsloping ST segment depression in standard leads and other usual ECG criteria in addition to clinical criteria including abnormal hemodynamics, serious arrhythmias, abnormal symptoms, significant dyspnea, or abnormal oxygen saturation measurements. Subjects will be given a telephone number to contact the study physician if they experience serious adverse effects. Adverse events (AEs) and serious adverse events (SAEs) will be assessed at each study visit and study staff will verify that all adverse effects are being addressed either by the subject, his/her regular physician, or offer to have the study physician address the concern. In addition, suicidality will be assessed at every visit and follow-up contact. Individuals who report any suicidal ideation will be contacted by a licensed psychologist who will assess the level of risk and provide referrals as needed. Confidentiality of subject data and information will be accomplished by using subject numbers as unique identifiers, allowing us to keep subject data separate from identifying information. No publications or presentations resulting from this research program will contain any identifying information about individual participants.
Potential Benefits of the Proposed Research to the Subjects and Others
The potential benefits for smokers participating in this study include the chance to be informed of any urgent health risks of which they many not have been previously aware that become apparent as part of the study assessment procedures. The risks of this research are chiefly associated with the exercise stress test discussed above. In addition, this research has the potential to provide important information about quitting patterns and longterm health and psychosocial outcomes of quitting or not quitting smoking.
Importance of the Knowledge to be Gained
This is the first research study to provide longterm assessment of the physical health, mental health, lifestyle factors, and overall quality of life using state-of-the-art measures. The data from this study may allow researchers and clinicians to better understand the important health outcomes that result from quitting or not quitting smoking. The data will also allow researchers to understand the interactions among the different longterm outcomes. Given the minimal risks of the exercise stress test and the rigorous pre-treatment screening and the availability of both physicians and psychologists to address any adverse effects, we believe that the potential risks involved in participating in the study are outweighed by the benefits to both society and the individual.
Participation of Women
Based on previous research conducted in Madison and Milwaukee (see Preliminary Studies), we project that approximately 56% of participants will be women. Because women are well represented in the two communities, there is no need for a specific recruitment strategy. The research plan does include analyses that will evaluate data by gender. Differential response to treatment based on gender is one of the central hypotheses of the research. See targeted enrollment table.
Participation of Minorities
Previous work in Madison and Milwaukee (see Preliminary Studies) indicates that the proposed recruitment strategies will result in a diverse mix of participants. We anticipate approximately 17% African-American participants, with another 2% split between Native American/Alaska Native and Asian participants. Approximately 2% of participants will have Hispanic heritage. The research plan also includes some analyses that will evaluate data by minority status. Given the demographics of the communities where recruitment is occurring and the size of the study, it is anticipated that the study will recruit sufficient African American participants to allow these data to be separately evaluated. See targeted enrollment table.
Participation of Children
Children under the age of 18 will not be included in the proposed clinical research because none of the medications being used in the proposed baseline study (Project 1: Efficacy) have been approved by the FDA for use by children under that age. Therefore, no children under the age of 18 will be in the eligible pool of participants from which participants for this proposed study will be drawn. Individuals between 18 and 21 will be eligible to participate. In the state of Wisconsin, persons of this age are allowed to consent to their own participation in clinical research.
Data and Safety Monitoring Plan
The following Data Safety and Monitoring Plan (DSMP) pertains to all research that is supported under the National Cancer Institute/National Institute on Drug Abuse/National Institute on Alcohol Abuse and Alcoholism Transdisciplinary Tobacco Use Research Center (TTURC) Award. This plan comprises not only the research conducted directly by the University of Wisconsin Center for Tobacco Research and Intervention (CTRI) researchers, but also research conducted by other investigators who are supported by TTURC funds. All investigators must agree to comply with the procedures outlined in this DSMP. This DSMP does not reduce any investigators obligation to comply with the requirements of the Institutional Review Board (IRB) at his/her home institution or the IRB of any collaborating organizations.
Monitoring the progress of trials and the safety of participants. Each Project Principal Investigator is responsible for routine monitoring of the trials progress. This includes scheduled biweekly meetings with study staff and review of written documentation. Data that are reviewed at these meetings include the number and type of participants enrolled, the number and reasons for exclusions from enrollment, the number treated and the stage of treatment, summary of adverse events, individual review of serious adverse events and study participation and outcome data.
Additionally, each Project Principal Investigator is responsible for briefing the TTURC Principal Investigator on the trials progress on a regularly scheduled basis (typically biweekly). As data become available, the Data Manager, Project Principal Investigator, and TTURC Principal Investigator will review the data on a regularly scheduled basis (typically biweekly) to determine progress.
To facilitate participant safety, study participants must meet study inclusion criteria. Once enrolled in the trial, follow-up protocols will assess for the presence of adverse events. Should either excessive risk to study participants and/or lack of measurable benefit to study participants be determined, the study will be stopped and all participants notified in a manner appropriate to the nature of the risk and/or lack of benefit.
Plans for assuring compliance with requirements regarding the reporting of adverse events. This DSMP requires that investigators notify the National Cancer Institute (NCI) and the University of Wisconsin IRB of the occurrence of any serious adverse event (SAE), or any adverse event (AE) which is severe, unexpected, and possibly related to study medication or protocol. Such notification must occur within five days of investigators becoming aware of the event.
If the study in question involves a pharmaceutical agent, and the serious adverse event might be related to drug use, both the Food and Drug Administration and the manufacturer will also be notified with five days of investigators becoming aware of the event. Examples of serious adverse events would be untoward medical or treatment occurrences that result in death, are life-threatening, require hospitalization or prolonging of existing hospitalization, create persistent or significant disability/incapacity, or involve congenital abnormality/birth defects. Unanticipated adverse events would include less serious problems that merit reporting because they are severe, unexpected, and possibly related to study participation. Any serious adverse event (SAE) will be queried and reported even if it appears that the serious adverse event is unrelated to treatment participation.
Not only will investigators report any serious adverse events (whether or not they are unanticipated), but the Principal Investigator of each project will also be responsible for the accurate documentation, investigation and follow-up of all study-related adverse events.
Adverse event assessment, recording, reporting and investigation will be accomplished through staff training, structured or standardized assessments of untoward occurrences/events, and regular monitoring by study investigators. The Project Principal Investigator and the TTURC Principal Investigators have ultimate responsibility for ensuring that serious adverse events are detected and reported in a timely manner. Additionally, the IRB will receive an annual report of all serious adverse events and adverse events meeting the criteria listed above.
Plans for assuring that any action resulting in a temporary or permanent suspension of an NCI-funded clinical trial is reported to the NCI grant program director responsible for the grant. The NCI grant program director will be notified within five days if the TTURC Principal Investigator deems it necessary to suspend a clinical trial. In the case of a temporary suspension, the TTURC Principal Investigator and Project Principal Investigator will develop a plan for continuation of the study and discuss this plan with the NCI grant program director in a reasonable time frame.
Plans for assuring data accuracy and confidentiality and protocol compliance. The Data Manager and Project Principal Investigators will develop plans for assuring data accuracy and protocol compliance, which will be reviewed and approved by the TTURC Principal Investigator. Such plans will include data verification and protocol compliance checks. The Data Manager and Project Principal Investigator shall also be responsible for ensuring that the data for the project are securely stored, that storage is in compliance with University and federal regulations and that no unauthorized persons have access (electronic or physical) to any participant-identifiable data. In addition, all HIPAA regulations and guidelines will be followed.
F. Vertebrate Animals N/A
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H. Consortium/Contractual Arrangements N/A
I. Consultants
University of Wisconsin budgetary procedures do not permit co-investigators who are not UW employees to be listed in the personnel section of the budget. Hence, co-investigators who are not UW employees are listed as consultants.
J. Letters of Support/Commitment
See attached letters.
Principal Investigator/Program Director (Last, first, middle): Fiore, Michael C
PHS 398/2590 (Rev. 05/01) Page _______ Continuation Format Page
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Figure 3. Lipoprotein Subclasses Identified by NMR
Figure 4. Relationship Between Plasma Lipid NMR Signal and Lipoprotein Subclasses
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