Preventing relapse among former smokers: a comparison of minimal interventions through telephone and mail.

This study compared 2 minimal interventions for reducing relapse in ex-smokers. One intervention involved 12-month access to a telephone hot line. In the other intervention, 8 relapse-prevention booklets were mailed to participants over 1 year. The 2 interventions were crossed in a 2 x 2 factorial design, yielding control, hot-line-only, mailings-only, and combined conditions. The criterion of at least 1 week of abstinence at baseline was met by 584 participants, 446 of whom also completed a 12-month assessment. Repeated mailings, but not the hot line, reduced relapse for those participants who had been abstinent for less than 3 months at baseline. At follow-up, 12% of those in the mailings conditions were smoking again compared with 35% in the nonmailing conditions. As predicted, both interventions were effective at attenuating the association between depressive symptoms and poor outcome found in the control condition.

Classical conditions of environmental cues to cigarette smoking.

Smoking-related cues tend to produce urges and cardiac responses in smokers. This reactivity has been assumed to reflect prior classical conditioning. However, little direct evidence exists supporting the notion that environmental cues can be classically conditioned to cigarette smoking. In this study, 8 smokers received 22 daily trials during which 2 cue complexes (comprising visual, olfactory, and auditory stimuli) were paired with smoking (CS+ trials) and not smoking (CS- trials). Reactivity to the environmental cues, as measured by self-report of urge and pulse rate, increased across CS+ trials, diverging from responses in the CS- trials. Reactivity was stronger among light smokers and those who verbalized awareness of smoking contingencies. Findings indicate that environmental cues can be classically conditioned to smoking.

Very delayed smoking relapse warrants research attention.

Recent findings suggest that former smokers remain at risk for relapse well beyond the traditional treatment follow-up period of one year. Although progress has been made in understanding factors involved in smoking cessation and short-term maintenance, very little attention has been paid to research on the process, predictors, and treatment implications of very delayed relapse. Possible research questions are offered to stimulate further investigation in this area.

Gender differences in depression in primary care.

OBJECTIVES: To determine gender differences in the frequency and manifestation of depression in primary care. STUDY DESIGN: PRIME-MD, a new assessment tool, was tested in 1000 patients as an aid to diagnose depression in primary care patients. Answers to a self-assessment questionnaire completed by patients determined whether physicians administered the mood module in the Clinician Evaluation Guide to diagnose depression. Functional status was assessed with the Medical Outcomes Study Short Form (SF-20). RESULTS: More women than men were diagnosed as having a mood disorder (31% vs 19%; p < 0.01), and an antidepressant was newly prescribed only for women (p < 0.001). There were no gender differences in physician ratings of patients' health, but women rated their health significantly more poorly than did men. Similarly, functional impairment scores were significantly lower in women than in men. CONCLUSIONS: Women are much more likely than men to have depressive disorders, and when these disorders are diagnosed, to receive a prescription for antidepressant medication. Further research is needed to determine why women seem to suffer disproportionately from symptoms of depression and signs of functional impairment.