Assessing the reach of nicotine replacement therapy as a preventive public health measure.

INTRODUCTION: Access to Nicotine Replacement Therapy (NRT) is a key public health intervention to reduce smoking. We assessed prevalence and correlates of use of NRT in Ontario, where NRT is available without prescription. METHODS: Participants were a representative sample of 2262 adult smokers in the Ontario Tobacco Survey cohort. Prospectively measured use of NRT over a 6-month period was reported in relation to smoking behaviour and history, attempts to quit, receipt of other supports for cessation supports and attitudes toward NRT. RESULTS: Overall, 11% of smokers used NRT over the six-month follow-up period. Prevalence was 25% among the 27% of smokers matching clinical guidelines that recommend NRT as a therapeutic option, and low among smokers not trying to quit. CONCLUSION: With increasing accessibility of NRT, further surveillance and research are warranted to determine the impact of the reach and benefits of NRT, considering both the general and targeted smoking populations.

Predictive validity and measurement issues in documenting quit intentions in population surveillance studies.

INTRODUCTION: Discrete classification of smokers by intention to quit is desirable in many public health and clinical settings. METHODS: Two methodological studies examine measurement properties of measures of discrete-time intention to quit smoking used in population-based tobacco surveillance surveys: an ecological comparison of rates of positive intention in relation to the form of measure used and a prospective analysis examining predictive validity of self-reported quit intentions using multiple possible points of dichotomization of an ordinal measure of intention to quit. The prospective analysis used a repeated measures design and follow-up to 1 year for 2,047 smokers in the Ontario Tobacco Survey cohort. RESULTS: The estimated percent of smokers intending to quit was significantly higher using the Stages of Change intention measure, relative to another single question measure. Significant dose-response effects were found. The sooner one intended to quit the more likely one was to make an attempt or achieve at least 30 days abstinence in the next 6 months. Intending to quit in a month or later was not associated with cessation during follow-up among respondents without prior attempts. Examination of cutpoints revealed no value, which maximized both positive and negative prediction. Regardless of quit attempt history, greatest predictive validity was found where respondents stated that they had no intention at all. DISCUSSION: Measures of intentions quit smoking in specific time periods and expressed as dichotomies have limited psychometric properties but utility in applied research. Our findings suggest a possible measurement effect warranting caution in comparisons across studies.

Do smokers know how to quit? Knowledge and perceived effectiveness of cessation assistance as predictors of cessation behaviour.

AIMS: Despite the existence of effective cessation methods, the vast majority of smokers attempt to quit on their own. To date, there is little evidence to explain the low adoption rates for effective forms of cessation assistance, including pharmaceutical aids. This study sought to assess smokers' awareness and perceived effectiveness of cessation methods and to examine the relationship of this knowledge to cessation behaviour. DESIGN: A random-digit-dial telephone survey (response rate = 76%) with 3-month follow-up was conducted with 616 adult daily smokers in South-Western Ontario, Canada. MEASUREMENTS: A baseline survey assessed smoking behaviour, as well as smokers' awareness and perceived effectiveness of cessation assistance. A follow-up survey measured changes in smoking behaviour and adoption of cessation assistance at 3 months. FINDINGS: Participants demonstrated a poor recall of cessation methods: 45% of participants did not recall nicotine gum, 33% did not recall the nicotine patch and 57% did not recall bupropion. Also, many participants did not believe that the following cessation methods would increase their likelihood of quitting: nicotine replacement therapies (36%), bupropion (35%), counselling from a health professional (66%) and group counselling/quit programmes (50%). In addition, 78% of smokers indicated that they were just as likely to quit on their own as they were with assistance. Most important, participants who perceived cessation methods to be effective at baseline, were more likely to intend to quit (OR = 1.80, 95% CI: 1.12-2.90), make a quit attempt at follow-up (OR = 1.80, 95% CI: 1.03-3.16) and to adopt cessation assistance when doing so (OR = 3.62, 95% CI: 1.04-12.58). CONCLUSIONS: This research suggests that many smokers may be unaware of effective cessation methods and most underestimate their benefit. Further, this lack of knowledge may represent a significant barrier to treatment adoption.

Impact of the graphic Canadian warning labels on adult smoking behaviour.

OBJECTIVE: To assess the impact of graphic Canadian cigarette warning labels on current adult smokers. DESIGN: A random-digit-dial telephone survey was conducted with 616 adult smokers in south western Ontario, Canada in October/November 2001, with three month follow up. MAIN OUTCOME MEASURES: Smoking behaviour (quitting, quit attempts, and reduced smoking), intentions to quit, and salience of the warning labels. RESULTS: Virtually all smokers (91%) reported having read the warning labels and smokers demonstrated a thorough knowledge of their content. A strong positive relation was observed between a measure of cognitive processing-the extent to which smokers reported reading, thinking about, and discussing the new labels-and smokers' intentions to quit (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.16; p < 0.001). Most important, cognitive processing predicted cessation behaviour at follow up. Smokers who had read, thought about, and discussed the new labels at baseline were more likely to have quit, made a quit attempt, or reduced their smoking three months later, after adjusting for intentions to quit and smoking status at baseline (OR 1.07, 95% CI 1.03 to 1.12; p < 0.001). CONCLUSIONS: Graphic cigarette warning labels serve as an effective population based smoking cessation intervention. The findings add to the growing literature on health warnings and provide strong support for the effectiveness of Canada's tobacco labelling policy.

Population-based recruitment for quit-smoking programs: an analytic review of communication variables.

BACKGROUND: Attempts to reduce the prevalence of smoking through quit-smoking programs have been unsuccessful because they have not attracted large numbers of smokers to participate in them. METHOD: An analytic review of the literature was conducted to identify potential communication variables that might enhance recruitment for community-based quit-smoking programs. Recruitment was defined as the number of smokers who enroll in a quit-smoking program divided by the estimated number of smokers in the target population. RESULTS: Thirty-three publications reporting the results of 40 recruitment campaigns were located. The median recruitment rate was 2.0%. Logistic regression was used to examine the effect of six variables on recruitment rate: the type of program sponsor, the type of program, program costs, use of participation incentives, whether messages were segmented by stage of change, and the type of channel used to send messages. The only significant predictor of recruitment rate was channel type (i.e., the method used to deliver a message). Studies that used interactive recruitment channels (telephone, interpersonal communication) were 66.5 times more effective than those using passive recruitment strategies (mass media, direct mail). Results examining the segmentation of messages by stage of change on recruitment were inconclusive. CONCLUSIONS: Results suggest that researchers and practitioners interested in population-based smoking cessation programs should pay more attention to recruitment methods. The use of interpersonal channels has been underused and appears to be particularly promising for improving the population impact of quit-smoking programs.

The expression and perception of facial emotion in alexithymia: a pilot study.

The term alexithymia denotes a cluster of traits including a marked difficulty in finding words to describe emotions. Despite a rapidly growing literature, the construct has not been validated adequately. The present study addressed the validity of the construct. Twenty males assessed as alexithymic or not, on the basis of the Schalling-Sifneos Personality Scale, were videotaped during tasks designed to elicit spontaneous and posed facial expressions of emotion. They also rated the emotional impact of the tasks and prototypic displays of emotion. Results showed that alexithymics were comparable to controls in judgments of the impact of provocative slides and in their ability to label posed expressions. With the exception of expressions of anger and happiness, they were also comparable in the ability to pose emotions. Alexithymics showed a deficit in spontaneous displays of negative affect. Results support the validity of the concept and suggest that deficits in nonverbal expression are central to the phenomenon. Implications for conceptualizations of alexithymia and emotion are discussed.

Amino Acid Sequence Around the Catalytic Site in Glyceraldehyde-3-Phosphate Dehydrogenase from Bacillus stearothermophilus.

The tryptic peptide containing the active-site cysteine in glyceraldehyde-3-phosphate dehydrogenase from Bacillus stearothermophilus 1503 was isolated after inhibition of the enzyme with (14)C-iodoacetate. The amino acid sequence of the 20-residue peptide was determined by 19 successive cycles of dansyl-Edman degradation. The sequence shows considerable homology with its counterparts from mesophilic sources but differs by the addition of Ala-His-His at the N-terminus and by the substitution of phenylalanine for leucine in the prototype sequence.