Comparative efficacy of 24-hour and 16-hour transdermal nicotine patches for relief of morning craving.

AIMS: To compare a transdermal nicotine patch designed for 24-hour wear with one designed for 16-hour wear for relief of craving and withdrawal, particularly in the morning hours. DESIGN: Smokers were randomly assigned to use one of two common patch regimens: NicoDerm/NiQuitin (24-hour wear, 21 mg nicotine) or Nicotrol/Nicorette (16-hour wear, 15 mg). In a double-dummy design, participants wore two patches during the day, one active, one placebo and one patch while sleeping. SETTING: A smoking cessation research clinic. PARTICIPANTS: Two hundred and forty-four smokers who suffered morning cravings. INTERVENTION: Two patch formulations approved and marketed for over-the-counter use in the US--NicoDerm CQ (labeled as 21 mg over 24 hours) and Nicotrol (labeled as 15 mg over 16 hours)--were each used according to its instructions. Smokers also received behavioral counseling. MEASUREMENTS: For a week of baseline and 2 weeks after quitting, smokers used palm-top computers to assess craving and withdrawal symptoms several times each day. FINDINGS: The 21 mg/24-hour patch yielded consistently better control of craving, not only during the morning hours, but throughout the day, and over the 2-week period of abstinence. Additionally, the 21 mg/24-hour patch yielded greater reductions in anxiety, irritability and restlessness. Smokers using the 21 mg/24-hour dosing regimen also experienced longer abstinence than those using the 15 mg/16-hour patch. CONCLUSIONS: These findings demonstrate that 24-hour dosing with a 21 mg patch affords superior relief of craving and withdrawal during the first 2 weeks of abstinence, when symptoms are at their peak, and when relapse is most likely. They confirm the importance of dosing parameters in nicotine replacement products.

Dynamic effects of self-efficacy on smoking lapse and relapse.

Self-efficacy (SE) is thought to be critical to success in smoking cessation both as an individual difference and as a dynamic process after a quit attempt. In this study, 214 smokers used palm-top computers to record day-to-day variations in SE during 4 weeks after quitting. SE remained at high and stable levels prior to a 1st lapse but decreased and became more variable thereafter. The authors used event history models with time-varying covariates to assess the effect of daily SE on lapse and relapse risk. Daily SE measures predicted an initial lapse on the subsequent day. However, this relationship was accounted for by stable baseline differences in SE (assessed by questionnaire), rather than by day-to-day dynamics in SE. Progression from 1st lapse to relapse was also examined. In this instance, daily SE predicted subsequent relapse risk, even when baseline SE and concurrent smoking were accounted for, suggesting the importance of SE dynamics for this stage of the relapse process.

Individual differences in smoking: gender and nicotine addiction.

Understanding individual differences in smoking behavior and nicotine dependence can increase knowledge of smoking dynamics and aid in the development of treatment regimens. Nicotine dependence among smokers is variable, and in some cases, fails to develop even after years of smoking. This variation can influence treatment outcome and presents a challenge to treatment developers. Gender differences are evident sometimes in smoking prevalence, in smoking cessation, and smoking rate. Gender, however, may be a superficial indicator; reasons for smoking, individual reactions to nicotine, and cultural sanctions and role definitions may be more influential. Analyses of individual differences should focus on identifying the underlying processes that control smoking behavior.

Assessing disruptive behaviors of nursing home residents: use of microcomputer technology to promote objectivity in planning nursing interventions.

1. Simultaneous recording of multiple behaviors, as well as their antecedents and consequences, is made possible with the use of microcomputers. 2. Objective identification of key environmental events provides significant assessment data to plan care for the person with dementia. 3. With a more precise assessment base through naturalistic observation of disruptive behaviors, management of these behaviors can affect, more positively, the quality of life of the nursing home resident.

Psychological factors and adolescent illicit drug use: ethnicity and sex differences.

Of four psychological factors examined in a representative sample of New York State secondary school students, only two, depressive mood and normlessness, show a positive relationship with the use of illicit drugs, especially drugs other than marihuana. The association of depressive mood and normlessness with illegal multiple drug use varies by ethnicity and sex, being consistently stronger among girls and among whites. In addition, depressive mood is negatively related to multiple drug use for black and Puerto Rican boys. These findings suggest that psychological factors play a different role in adolescent drug involvement within various social and cultural groups.

Reconciling unidimensional and multidimensional models of patterns of drug use.

Guttman-scale analyses and factor analyses seem to produce contradictory results in analyzing patterns of multiple drug use. Guttman-scale analyses usually show that drug use fits a unidimensional and cumulative model of involvement; factor analyses reject the unidimensional model. The two methods, however, can be reconciled. Guttman scaling is appropriate for discerning patterns of drug involvement, factor analysis for operationalizing degree of involvement within a specific pattern of use.