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Publications:
Riley, W.T., Jerome, A., Behar, A., & Weil,
J. (2002). Computer and manual self-help behavioral strategies for
smoking reduction: Initial feasibility and one year follow-up. Nicotine
and Tobacco Research, 4 (supp 2), S183-S188.
This study sought
to test the feasibility of two self-help behavioral interventions
to reduce and maintain a 50% reduction in those unable or unwilling
to quit, and to evaluate the impact of smoking reduction on subsequent
quit attempts. Ninety-three smokers who desired to reduce rather
than quit smoking were entered in the study and randomly assigned
to either computerized scheduled gradual reduction (CSGR) or to
a manual-based selective elimination reduction (SER). Both groups
produced significant reductions in smoking, approximately 10 cigarettes
per day, during the seven week treatment phase which were maintained
over one year. Except for significantly greater mean percent reductions
in smoking from pre- to post-treatment (37% for CSGR, 20% for
SER) and a greater percentage of subjects meeting the 50% reduction
goal (30% for CSGR, 16% for SER) which approached significance,
the CSGR intervention produced reductions in smoking comparable
to the SER intervention, particularly at the 6 and 12 month follow-up.
Although subjects with a current desire for smoking cessation
were excluded from this study, one third of subjects reported
a 24 hr. quit attempt for the year following study initiation,
and 8.6% of subjects met seven-day point-prevalence criteria for
abstinence (CO validated) at the 12 month follow-up. The results
of this study lend support to the feasibility of self-help behavioral
interventions to produce sustained reductions in smoking rates
without apparent negative impact on subsequent quit attempts.
Riley, W., Jerome,
A., Behar, A., & Zack, S. (2002). Feasibility of computerized
scheduled gradual reduction for adolescent smoking cessation. Substance
Use & Misuse, 37, 277-285.
The purpose of
this project was to modify a smoking cessation program that uses
computerized scheduled gradual reduction for use with adolescent
smokers and to test the feasibility of this cessation approach
in group support and minimal contact modalities. Utilizing a lesson
plan approach with high school marketing students in five high
schools and student survey feedback, the LifeSign program was
modified to be an acceptable smoking cessation program for adolescent
smokers. In the first study, 17 adolescent smokers used the modified
program with seven associated weekly group support sessions. At
the end of treatment, 29% had quit smoking, and over half of those
who continued to smoke reduced their smoking rate by 50%. In the
second study, the LifeSign for Teens program was evaluated with
18 adolescent smokers in a minimal contact format. At the end
of treatment, 17% had quit smoking, and mean smoking rate reductions
of 43% were found among those who continued smoking. At 1-year
follow-up, all subjects who had quit at posttreatment reported
continuous abstinence. The results of these two small trials suggest
that a computerized scheduled gradual reduction approach may be
an accepted and potentially efficacious approach for smoking cessation
among adolescent smokers.
Severson, H. H., Akers, L., Andrews, J. A., Lichtenstein, E.,
& Jerome, A. (2000). Evaluating two self-help interventions
for smokeless tobacco cessation. Addictive Behaviors, 25, 465-470.
The need for effective, low-cost self-help treatment methods for
smokeless tobacco (ST) addiction becomes more evident as rates
of product use and associated morbidities increase. This study
evaluated two self-help methods for ST cessation. One hundred
ninety-eight ST users were randomly assigned into two conditions:
half received LifeSign, a credit-card sized computer designed
for gradual ST cessation, and half received the Enough Snuff self-help
manual and a video. Subjects in both conditions received telephone
support for their quit effort. The study was conducted entirely
through phone and mail, allowing the delivery of the intervention
to both rural and urban users. Self-reported rates of sustained
abstinence (no tobacco use at two months and six months) were
24.5% for the manual/video condition, and 18.4% for the LifeSign
condition.
Jerome, A., Fiero,
P. L., & Behar, A. (2000). Computerized scheduled gradual reduction
for smokeless tobacco cessation: Development and preliminary evaluation
of a self-help program. Computers in Human Behavior, 16, 493-505.
The paper chronicles
the development and feasibility testing of a computerized scheduled
gradual reduction program for smokeless tobacco cessation. During
Study 1, the LifeSign smoking cessation computer was adapted for
use with smokeless tobacco by pairing it with an electronic timer.
The computer recorded frequency of dips during a baseline phase
and prompted for tobacco use during a gradual reduction phase.
The timer was used to track the length of dips during baseline
and to hold them to a fixed length during the reduction phase.
Abstinence rates among 60 male daily smokeless tobacco users who
received the program were 29% at 3-month follow-up (biochemically
validated) and 19% at 12-month follow-up. Self-reported changes
in topography of tobacco use were consistent with the scheduled
reduction protocol. Study 2 evaluated a prototype computer that
tracked both frequency and duration of dips during baseline and
gradually reduced both parameters during the reduction phase.
Among 19 subjects who received the program, self-reported abstinence
was 56% at end of treatment and 11% at 12-month follow-up. Results
of these two studies demonstrate the feasibility of computerized
scheduled gradual reduction for smokeless tobacco cessation and
provide a basis for further product development.
Jerome, A., Perrone, R., & Kalfus, G. (1992). Computer-assisted
smoking treatment: A controlled evaluation and long-term follow-up.
Journal of Advancement in Medicine, 5, 29-41.
The present study
provided a controlled outcome evaluation and long-term follow-up
assessment of a computer-assisted smoking treatment (CAST), implemented
by a credit card-sized, fully dedicated microcomputer. Seventy-one
smokers were randomly assigned to one of three groups: 1) CAST,
2) CAST plus therapist assistance, or 3) waitlist control. Results
indicated that subjects complied with the computer treatment protocol
and that daily cigarette consumption and carbon monoxide levels
decreased across treatment weeks in both CAST groups. At 18-month
follow-up, 24% of subjects in the CAST group and 36% of subjects
in the CAST plus therapist assistance group were abstinent. These
findings are comparable to outcomes reported for many clinic-based
interventions and thereby suggest that this CAST program can be
utilized effectively in either a self-help or therapist-assisted
format.
Prue, D. M., Riley,
A., W., Orlandi, M. A., & Jerome, A. (1990). Development of
a computer-assisted smoking cessation program: A preliminary report.
Journal of Advancement in Medicine, 3, 131-139.
The effectiveness
of a self-help smoking cessation program implemented by a hand-held
micro computer was evaluated with 77 smokers. The computer implements
a gradual rate reduction protocol that targets both physiological
dependence on nicotine and conditioned stimuli that may elicit
smoking. One-year post treatment abstinence rates for two samples
of smokers were 18.5% and 22%. The results of this study suggest
that a computer-based self-help program may meet the needs of
health care providers for an easily administered, effective tool
for assisting patients with smoking cessation.
Top
Reviews and Citations
Institute of Medicine
(2001). Clearing the Smoke: Assessing the Science Base for Tobacco
Harm Reduction. Washington, DC. National Academy Press.
"More recent
exploration of reduced smoking has used computerized devices to
gradually wean smokers from cigarettes as a means to achieve cessation.
One computerized program, LifeSign Computer Assisted Smoking Program,
involves a scheduled reduction by increasing the interval between
cigarettes and informing individuals when to smoke. The scheduled
time-interval approach seems the most promising of the behavioral
treatment methods based on studies by Ciniciripini and colleagues
(Ciniciripini et al., 1995 and 1997) compared to abrupt discontinuation
or nonscheduled reduction of cigarettes. This behavioral method
systematically reduces the level of nicotine exposure, disrupts
habitual smoking patterns, and gives smokers the opportunity to
develop new behaviors or skills in response to cues associated
with smoking."
Compliance in Health
Care and Research (2001). Edited by Lora Burke and Ira Ockene, American
Heart Association Monograph Series, Futura Publishing, Armonk, NY
"The LifeSign
(PICS, Inc., Reston, VA) is a compact electronic recording device
approximately the size of a credit card and one-half inch thick.
The individual records each time a tobacco product is used by
pushing one button."
"The primary advantage of using electronic recording devices
is that data are collected in real time, at the time of the symptoms
or behavioral performance."
Lora Burke, PhD,
MPH, RN
Chapter 8, Electronic
Measurement
SRNT Newsletter
(Vol 6, No. 1, April, 2000)
"Robin Corelli
and Karen Hudmon, in collaboration with the Pharmacy Partnership
of the California Medical Association Foundation, have orchestrated
a project whereby pharmacy faculty members and tobacco researchers
have designed a six-hour, comprehensive, tobacco curriculum program
for pharmacy students."
"The three
hour workshop component includes role playing with case studies
and hands-on experience with pharmaceutical aids for smoking cessation
and the LifeSign hand-held computer for scheduled, gradual reduction
of smoking."
The Behavior
Therapist (Vol. 13, No. 3, March, 1990)
"I was very
impressed with the program. It clearly incorporates sound behavioral
principles both the computerized cessation program itself, and
in the supporting materials provided in the manual."
"Existing data, most from small N studies, suggest that the
program may be at least as effective as other self-help smoking
reduction programs, and perhaps more so.""The bland
paragraphs above don’t communicate my intense excitement
about the program. Whatever the data ultimately suggest regarding
the effectiveness of the program in its current state, this is
an important development in behavioral self-help programming because
of the potential that this technology portends.""I think
LifeSign opens tremendously important doors to research and applications
in self-help behavioral programs."
Robert K. Klepac,
Ph.D.
Wilford Hall Medical Center
Top
Recent
Presentations at Scientific Meetings
William T. Riley,
PH.D., Bradford W. Applegate, PH.D., Allison Sowell , M.S.; PICS,
Inc. (2004) A Comparison Of Computer-Assisted Scheduled Gradual
Reduction VS. Self Help in Unmotivated Smokers.
Abstract:
Despite recent
advances in treatment, many tobacco users are unwilling or unable
to quit. Harm reduction strategies have recently been proposed
as an alternative to current treatment approaches. The present
data examines the efficacy of a computerized scheduled reduction
program (SGR) as compared to a self-help manual (SH).
Participants who smoked > 15 cpd and had no intentions of quitting
in the next 30 days (N = 268) were randomly assigned to SGR or
SH conditions. The SGR condition monitored use for 7 days, followed
by SGR to achieve a 50% reduction. SH participants received information
on reducing use. Smoking rates and associated variables were measured
at baseline, 9 weeks, and 6 months.
Participants smoked 27 cpd and were 46 years old, on average.
The sample was 50% male and 59% Caucasian. There were no significant
differences between conditions at baseline. Treatment completion
was 74% at 9 weeks and 61% at 6 months.
Repeated measures MANOVA indicated both main and interaction effects
between SGR and SH conditions, (both p’s < .05). SGR
participants reduced intake from 27 to 18.5 cpd at 9 weeks, compared
to a reduction of 27 to 22 CPD in the SH condition. Effects diminished
at 6 months as SGR participants maintained their rates and SH
participants reduced smoking to comparable rates. Secondary analyses
revealed that a greater proportion of SGR participants achieved
> 50% reduction in smoking than SH participants. Changes in
health status and motivation to quit were associated with reducing
intake, but not sufficiently to justify reduction as a harm reduction
approach.
William T. Riley,
PH.D., Melissa Pici, B.A., Valerie L. Forman, Ph.D., Albert Behar,
M.S.; PICS, Inc. (2003) Computerized Dosing of Nicotine Inhalers:
Effects on Use and Quit Rates. Paper presented at the 9th Annual
Meeting of the Society For Research on Nicotine and Tobacco. New
Orleans, LA.
Abstract:
The purpose of
this study was to develop and evaluate a computerized program
to encourage adequate dosing of nicotine inhalers. Two handheld
computerized dosing/prompting programs were developed. Both utilized
a one week smoking baseline to determmine the intitial inhaler
prompting schedule but differed in the length of the stable dosing
period prior to tapering use (3 weeks vs. 12 weeks). These computer
prompting programs were compared to an inhaler only condition
in a radomized trial of 462 smokers evaluated at 9 and 18 weeks
(1 yr. follow-ups pending). At 9 weeks, 32% of the computerized
dosing groups has been quit for 7 days or longer (biochemically
validated) compared to 20% for the inhaler only condition (chi-square
= 4.69, p < .05). Continuous quit rates at 9 weeks were 21%
for the computerized dosing groups and 11% for the inhaler only
group (chi-square = 5.76, p < .02). At 18 weeks, 26% of the
computerized dosing groups and 18% of the inhaler only group met
point prevalence criteria. Continuous quit rates at 18 weeks were
not significantly different (14% vs. 9%). Those in the computerized
dosing conditions also reported higher doses per day in the first
week of use than those in the inhaler only condition (9 vs. 7;
t= 3.34, p < .001). No signficant differences were found between
the two computerized programs. The results of this study indicate
that computerized prompting increases initial nicotine inhaler
dosing and produces higher initial quit rates than typical inhaler
administration.
Valerie L. Forman,
Ph.D., Melissa Pici, B.A., William T. Riley, Ph.D., PICS, Inc. (2003)
Impact of September 11th Tradegy on Smoking and Relapse Rates. Paper
presented at the 9th Annual Meeting of the Society For Research
on Nicotine and Tobacco. New Orleans, LA.
Abstract:
The September
11, 2001 terrorist attacks on the United States had widespread
behavioral and emotional impacts. Although one study found an
increase in smoking rates amoung Manhattan, New York residents
following the tradegy (Vlahov et al., 2002), no studies have examined
the effect on individuals trying to quit smoking at the time of
the attacks. Local media in the Washington, D.C. area was used
to recruit 462 smokers into a study comparing the effect of computerized-scheduled
reduction to ad-lib dosing of nicotine inhalers on quit rates.
The terrorist attack was temporarily associated with various stages
of the study protocol. Mean smoking rates the week before September
11th were slightly lower than mean smoking rates the week after
September 11th (11.8 cigarettes per day versus 12.6 cigarettes
per day respectively). Higher ratings on the Impact of Events
(IES) scale, completed retrospectively after all subjects had
completed the 18-week evaluation, were associated with increased
cigarette use following the terrorist attacks (Pearson's r=0.25
p<0.01). Among the 303 participants who completed smoking diaries,
43.9% did not change smoking rates, 23.1% decreased smoking, and
34.3% increased smoking the week following the tradegy. Thirteen
of the 82 subjects who had quit prior to September 11th relapsed
in the week following the attacks (15.9%); IES scores among those
who relapsed were moderately higher than subjects who remained
quit (36.9 versus 29.8, respectively). Although the terrorist
attacks were associated with increases in smoking and relapse
rates, the effect was relatively small and not significant. Greater
perceived impact of the events of September 11th, however, predicted
moderate increases in smoking and relapse rates.
Obermayer, J., Riley,
B., Asif, O., Jean-Mary, J. (2003). College smoking cessation using
wireless devices. Poster presented at the 2004 Society of Behavioral
Medicine 25th Anniversary Annual Meeting & Scientific Sessions
on March 24-27, Baltimore Marriott Waterfront Hotel, Baltimore,
Maryland.
Objective:
The purpose of this project was to develop and test the feasibility
of a smoking cessation program delivered in the form of text messages
via mobile phones.
Methodology:
The usability of this prototype was assessed in a sample of college
students from local colleges and universities. Forty-six subjects
(54% female, 46% male; 72% White, 15% Asian, 7% African American,
and 6% Other) participated in and completed the 6-week assessment
trial. Subjects registered on the study website to personalize
and initialize their smoking cessation program. This allowed subjects
to create a quitting plan, indicate situations and times when
they were at high risk for smoking, and input and track their
progress towards quitting. Pre-test and post-test measures included
cigarette logs, nicotine dependence scale, smoking and quitting
documentation questionnaire, and a program use questionnaire.
Results: During this study period, 20 subjects (43%) successfully
completed a 24-hour quit attempt. At the end of the six-week study
period, there were 10 subjects (22%) who met the 7-day point prevalence
criterion for quitting. Among subjects who had not quit, cigarette
logs and nicotine dependence scale scores indicated that these
subjects substantially reduced their mean cigarette counts of
77 cigarettes/week to 32 cigarettes/week (t = 5.34, p < .001).
These subjects also experienced lowered (-0.37 to –1, t
= 5.4, p < .001) nicotine dependence as measured by the Nicotine
Dependence Syndrome Scale (NDSS). All of the subjects rated the
program positively on usability, comparison to other methods tried,
and overall satisfaction.Significance: The results of this initial
study trial indicates that the WICS program produces high quit
rates in comparison to the overall 10% quit rate for self-help
smoking cessation programs, as well as resulting in positive outcomes
for non-abstinent subjects. Smoking on college campuses has increased
substantially in the last decade, yet programs have not targeted
these smokers who have unique patterns and causes of smoking.
College students are early adopters of communications technologies
and may, therefore, readily adopt a smoking cessation program
delivered via these technologies.
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