Randomized controlled trial of an interactive internet smoking cessation program with long-term follow-up.

BACKGROUND: Internet programs for smoking cessation are widely available but few controlled studies demonstrate long-term efficacy. PURPOSE: To determine the 13-month effectiveness of an Internet program presenting a set sequence of interactive steps, and the role of depressed affect. METHODS: In a randomized controlled trial sponsored by the American Cancer Society, a treatment condition (n = 1,106) was compared to a control site (n = 1,047). RESULTS: More treatment condition participants were abstinent (30-day point prevalence) than control site participants (12.9% vs. 10.1%, p < .05) at 13 months. This effect was greater among participants not reporting depressed affect (15.0% vs. 10.1%, p < .01). Among smokers who reported depressed affect, there was no difference in abstinence between the treatment and control conditions. CONCLUSIONS: Data support the long-term efficacy of an Internet intervention for cessation modeled on a structured, in-person treatment approach, especially for participants not experiencing daily depressed affect.

Making a case for the examination of ethnicity of Blacks in United States Health Research.

Important differences between Blacks of different ethnicities in the U.S. in chronic disease morbidity and mortality have been reported. Blacks in the U.S. constitute a heterogeneous group, including immigrants from Africa, Caribbean nations, Central and South America, as well as people now known as African Americans. Ethnicity among Blacks is seldom examined in health research, although in-depth examination of the ethnicity and culture-related pathways through which psychosocial factors may act to influence health have the potential to improve our understanding of health disparities. This improved understanding could in turn lead to the development of new, innovative, culturally based interventions that may reduce health disparities in the U.S. We briefly review the literature that examines Black ethnicity and birthplace, health outcomes, health-related knowledge and behaviors, and health-related psychological and social factors. We present a conceptual framework to aid in understanding the links between these factors and health. Suggestions are offered for conducting research in the future.

Breast feeding, bottle feeding, and maternal autonomic responses to stress.

OBJECTIVE: The aim of this study was to examine the effects of breast feeding on autonomic nervous system (ANS) response to stressors. METHODS: Sympathetic and parasympathetic activities were examined before, during, and after standard laboratory stressors in women who were either exclusively breast feeding (n=14) or nonexclusively breast feeding (n=14), and in non-postpartum controls (n=15). RESULTS: Mothers who breast fed exclusively showed greater levels of parasympathetic cardiac modulation and slower heart rate (HR) throughout the session and less HR increase and preejection period (PEP) shortening to mental arithmetic (MA) than did nonexclusive breast feeders and controls. Nonexclusive breast-feeders showed greater electrodermal reactivity to, and greater differences in skin conductance response (SCR) frequency between baseline and recovery from cold pressor (CP) than did either exclusive breast-feeders or controls. Sympathetic activity was negatively related to the number of breast feedings and positively related to bottle feedings. CONCLUSION: Breast feeding shifts maternal ANS balance toward relatively greater parasympathetic and lesser sympathetic activity; the opposite occurs with bottle feeding. The frequency of feeding also is a critical factor in determining breast feeding effects on maternal ANS function.

Cardiovascular reactivity to mental arithmetic and cold pressorin African Americans, Caribbean Americans, and white Americans.

BACKGROUND: Caribbean Americans and African Americans, two of the largest Black ethnic groups in the United States, differ in cardiovascular-disease-related mortality rates. PURPOSE: Cardiovascular reactivity to psychological stress may be an important marker or mediator of risk for cardiovascular disease development in Blacks in the United States, yet little attention has been paid to ethnicity among Blacks in reactivity research. This study examined cardiovascular reactivity to psychological stress in African American, Caribbean American, and White American participants. METHODS: Forty-five women and 43 men performed mental arithmetic and hand cold pressor (CP) tasks. RESULTS: Caribbean Americans displayed larger decreases in heart period variability during mental arithmetic than White Americans (p =.02). White Americans exhibited a pre-ejection period decrease, whereas African Americans and Caribbean Americans displayed pre-ejection period increases during CP (p =.023). African Americans exhibited greater decreases in interbeat interval during CP than White Americans (p =.013). Caribbean Americans displayed greater decreases in cardiac output than White Americans during CP (p =.009). White Americans exhibited significantly greater increases in systolic blood pressure than Caribbean Americans during CP (p =.014). CONCLUSIONS: These findings suggest that differences in reactivity to psychological stress exist among Black ethnic groups in the United States and underscore the need to consider ethnicity as a factor in reactivity research with Black Americans.

Effects of trial order and differential conditioning on acquisition of differential shock expectancy and skin conductance conditioning to masked stimuli.

Research suggests that when people are fear conditioned to masked spiders and snakes (electric shocks are contingent on only spiders or snakes), they acquire a conditional skin conductance response and can predict the occurrence of shocks even though they are unable to identify the masked spiders and snakes. Because in prior studies trial order was not completely random, it is unclear if findings were due to the contingencies from differential conditioning or a restricted trial order or both. When participants were assigned to four groups to disentangle effects of trial order and differential conditioning to masked pictures in acquisition, effects were obtained only for trial order. These findings demonstrate that trial order can result in conditioning. However, because effects were observed even for participants who reported unawareness of the contingency from trial order, results are consistent with the notion of hunches or gut feelings.

Breast-feeding and maternal health in online mothers.

Self-reports of mothers currently breast-feeding (n = 561) and mothers who had breast-fed in the past (n = 452) were compared for perceived stress, self-reports of upper respiratory infection symptoms, and physician visits for psychological illnesses. Possible demographic confounds were controlled statistically. In analyses examining breast-feeding status as a dichotomous variable (current vs. past), breast-feeding was negatively associated with perceived stress and upper respiratory symptoms (the latter association dissolved when controlling for perceived stress), but not with physician visits for psychological illnesses. However, analyses of the continuous variables of frequency of breast-feeding and cumulative amount of breast-feeding revealed negative associations, and analyses of times since last nursing revealed positive associations with likelihood for physician visits for psychological illnesses. Frequency of bottle-feeding was positively associated with perceived stress. The results support the interrelatedness of breast-feeding and maternal health in online mothers.