Summary of Smoking Workgroup
July 20-21, 2000, Washington DC
The smoking outcomes group focused our discussion on defining issues of
lapse, relapse, and maintenance, difficulties associated with recruitment and retention of
smokers, the new AHRQ Clinical Guidelines, and other important advances in the literature
on risk and treatment. |
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| 1. | Definitions. Lapse and relapse definitions as well as recommendations for definitions of quit attempts, successful change, short-term, and long-term maintenance, relapse and lapse, and recycling were discussed. The reference from Okene et al., 2000 in Health Psychology will be added to the website and provides an excellent place to start. |
| 2. | Recruitment of smokers seems to be running similarly across sites. Approximately 50-60% of people who call and say they will participate actually make it to their first study visit in the Rochester and Minnesota studies. Drop out is high as the participants move through the studies (estimated at 30-40%). This dropout rate is consistent with previous studies. It was suggested that sites might keep track of what recruitment efforts were most successful, and what did they cost per enrollee. |
| 3. | New Guidelines from AHRQ were published in JAMA on June 28th. The important changes in the Guidelines might impact how some of the interventions are structured. These changes include the addition of the 5th "A" (Assess — determine the willingness of all smokers to quit) to the Ask, Advise, Assist and Arrange model. Also, there are 5 FDA approved medications (bupropion, and nicotine gum, patch, nasal spray and inhaler) for first line treatment of nicotine dependence, and two second line medications (clonidine and nortriptyline). Recommendations were included to have interventions provide intra and extra treatment social support as well as problem solving and skills building elements. See the website AHRQ.gov for the full guidelines. |
| 4. | Other important publications on the risks
of smoking, diet and exercise for coronary artery disease and cancer are referenced below. Recent Important Smoking References Dornelas, E. A., Sampson, R. A., Gray, J. F., Waters, D., Thompson, P. D. (2000). A randomized controlled trial of smoking cessation counseling after myocardial infarction. Preventive Medicine, 30, 261-268. Lichetenstein, P., Holm, N.V., Verkasalo, P. K., Iliadou, A., Kaprio, J., Koskenvuo, M., Pukkala, E., Skytthe, A., Hemminki, K. (2000). Environmental and heritable factors in the causation of cancer. New England Journal of Medicine, 343, 78-85. Ockene J. K., Emmons, K. M., Mermelstein,R. J., Perkins, K. A., Bonollo D. S., Voohees C. C., Hollis, J. F. (2000). Relapse and maintenance issues for smoking cessation. Health Psychology, 19(1), 17-31. Stampfer, M. J., Hu, F. B., Manson, J. E., Rimm, E. B., Willett, W. C. (2000). Primary prevention of coronary heart disease in women through diet and lifestyle. New England Journal of Medicine, 343, 16-22. The Tobacco Use and Dependence Clinical Practice Guideline Panel. (2000). A clinical practice guideline fo treating tobacco use and dependence. A US Public Health Service Report. Journal of the American Medical Association, 283, 3244-3254. |