Culturally specific versus standard smoking cessation messages targeting Hispanics: An experiment.

Few smoking cessation trials have focused on U.S. Hispanics. Consequently, little is known about culturally specific considerations for intervention delivery. The purpose of this study was to test the efficacy of a written smoking cessation intervention varying in cultural specificity and language. Participants (N = 222) were English-Spanish bilingual Hispanic smokers recruited from the community. A 2 (cultural specificity-culturally specific or standard) × 2 (receipt of preferred language materials-preferred or less preferred) between-subjects experiment was conducted. Participants were assessed at baseline and at a 2-week post intervention follow-up. Dependent variables measured intervention evaluations (intended utilization and content evaluation), cigarettes smoked per day, and smoking cessation (secondary outcome). We hypothesized independent effects of cultural specificity, receipt of preferred language materials, and an interaction effect. Results demonstrated that intended utilization was greater among participants who received the intervention in their preferred language, F(1, 213) = 9.772, p = .002, η2 = .044. No differences in content evaluations were observed. However, number of cigarettes smoked per day was lower, and self-reported cessation was significantly greater among participants who received a culturally specific intervention, F(1, 152) = 4.939, p = .028, partial η2 = .031, and materials in their preferred language, OR = 5.356, p = .037, 95% CI [1.106, 25.948], respectively. In conclusion, this study contributes to our understanding of dimensions influencing responses to smoking cessation interventions among Hispanics. Both cultural specificity and preferred language delivery appear to be causally related to the intended utilization of interventions and smoking behavior. (PsycINFO Database Record

Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes.

BACKGROUND: Effective depression treatment does not reliably reduce glycosylated hemoglobin (HbA1c) in depressed patients with type 2 diabetes, possibly in part due to deficits in functional capacity, i.e. performance of certain everyday living skills, essential for effective diabetes self-management. We sought to determine: a) the magnitude of deficits in functional capacity among urban, African American (AA) patients with type 2 diabetes, and b) whether these deficits were associated with poorer glycemic control. METHODS: At their initial visit to an inner-city diabetes clinic, 172 AA patients with type 2 diabetes were assessed with a variety of instruments, including the Mini International Neuropsychiatric Interview (MINI) and the UCSD Performance Skills Assessment-Brief (UPSA-B). They then entered a comprehensive diabetes management intervention, whose success was indexed by HbA1c levels at up to four reassessments over a one-year period. A mixed-effects model repeated-measures method was used to predict HbA1c. RESULTS: The prevalence of depression was 19%; the mean UPSA-B score was 81 ± 17. After multivariate adjustment, increased HbA1c levels over time were predicted by the presence of major depression (B = .911, p = .002) and decreasing (worse) scores on the UPSA-B (B = -.016, p = .027), respectively. Further adjustment for increasing the dosage of oral or insulin during the treatment eliminated the association between the UPSA score and HbA1c level (B = -.010, p = .115). CONCLUSIONS: Depression, as well as deficits in functional capacity, predicted reduced effectiveness of a diabetes self-management intervention. Future studies will determine whether interventions targeted at both improve glycemic control.

Racial/Ethnic differences among smokers: revisited and expanded to help seekers.

INTRODUCTION: Most research on racial/ethnic differences among smokers is outdated and does not focus on help seekers. The purpose of this study was to revisit racial/ethnic differences in variables related to cessation in a sample of smokers enrolled in a randomized trial. METHODS: Adult smokers (N = 417; n = 126 White; n = 123 Hispanic; n = 168 Black) completed measures of demographics, smoking history, alcohol use, depressive symptoms, and readiness to quit. RESULTS: We found significant differences in these factors across groups. Blacks were more likely to be older, less educated, single, low income, smoke menthol cigarettes, and report greater nicotine dependence. Hispanics were younger, reported fewer years smoking and cigarettes per day, lower nicotine dependence, preferred mentholated cigarettes, and reported greater alcohol use intensity. After controlling for demographics and smoking history, Blacks reported greater depressive symptoms and lower readiness to quit compared with Whites and Hispanics. CONCLUSIONS: Help-seeking Blacks may exhibit more risk factors for difficulty quitting compared with other groups. Hispanics may have some protective factors, such as lower dependence, but require attention to alcohol use and menthol smoking. Identifying preintervention racial/ethnic differences in characteristics related to cessation is important for developing evidence-based and culturally specific interventions and for reducing tobacco-related health disparities.

Associations between coping, affect, and social support among low-income African American smokers.

OBJECTIVE: Previous research has documented disparities in smoking cessation between African Americans and Caucasians. Many low-income African American smokers face a range of circumstances that may inhibit effective coping during quit attempts, yet previous research has not considered factors that influence coping in this population. This study examined (a) affect (positive and negative) and (b) perceived social support in association with coping strategies. METHODS: The baseline assessment of African American smokers (N = 168) enrolled in a randomized controlled trial included the Positive and Negative Affect Schedule, the Multidimensional Scale of Perceived Social Support, and the Brief COPE. A factor analysis of the Brief COPE resulted in two factors, adaptive and maladaptive strategies. RESULTS: Participants were mostly single (64%), women (61%), with ≥12 years of education (68%), and low-income. They were middle aged (M = 46.1, SD = 8.7), smoked 21.8 (SD = 13.3) cigarettes/day for 24.3 (SD = 11) years, and were moderately nicotine dependent. Results demonstrated that adaptive coping was positively correlated with positive affect and social support. Maladaptive coping was positively correlated with negative affect, and inversely related to positive affect and social support. Multivariate analyses revealed that positive affect and social support were independently associated with adaptive coping strategies. In contrast, maladaptive coping was independently associated with negative affect, but not social support. CONCLUSIONS: Interventions that harness positive resources, such as social support and positive mood, may facilitate adaptive coping. Also, addressing negative affect among low-income African American smokers may be important to reduce maladaptive coping strategies.

The impact of escitalopram on IL-2-induced neuroendocrine, immune, and behavioral changes in patients with malignant melanoma: preliminary findings.

Interleukin (IL)-2, a T-cell cytokine used to treat malignant melanoma, can induce profound depression. To determine whether pretreatment with the antidepressant escitalopram could reduce IL-2-induced neuroendocrine, immune, and neurobehavioral changes, 20 patients with Stage IV melanoma were randomized to either placebo or the serotonin reuptake inhibitor, escitalopram (ESC) 10-20 mg/day, 2 weeks before, and during IL-2 treatment (720 000 units/kg Q8 h × 5 days (1 cycle) every 3 weeks × 4 cycles). Generalized estimation equations were used to examine HPA axis activity (plasma ACTH and cortisol), immune activation (plasma IL-6), and depressive symptoms (Hamilton Depression Rating Scale (HDRS) score). Tolerance of IL-2 treatment (concomitant medications required) and adherence (number of IL-2 doses received) were also assessed. Both the groups (ESC (n=9), placebo (n=11)) exhibited significant IL-2-induced increases in plasma cortisol, IL-6, and depressive symptoms (p<0.05), as well as a temporal trend for increases in plasma ACTH (p=0.054); the effects of age and treatment were not significant. Higher plasma ACTH concentrations were associated with higher depressive symptoms during cycles 1-3 of IL-2 therapy (p<0.01). Although ESC had no significant effects on ACTH, cortisol, IL-6, tolerance of, or adherence to IL-2, ESC treatment was associated with lower depressive symptoms, ie, a maximal difference of ∼3 points on the HDRS, which, though not statistically significant (in part, due to small sample size), represents a clinically significant difference according to the National Institute for Health and Clinical Excellence guidelines. A larger sample size will establish whether antidepressant pretreatment can prevent IL-2-induced neurobehavioral changes.

Neurobehavioral effects of interferon-α in patients with hepatitis-C: symptom dimensions and responsiveness to paroxetine.

In patients at high risk for recurrence of malignant melanoma, interferon-α (IFN-α), a stimulator of innate immunity, appears to induce distinct neurobehavioral symptom dimensions: a mood and anxiety syndrome, and a neurovegetative syndrome, of which the former is responsive to prophylactic administration of paroxetine. We sought to determine whether symptom dimensions (and treatment responsiveness) arise in patients with hepatitis C administered IFN-α and ribavirin. In a randomized, double-blind, 6-month study, 61 patients with hepatitis C eligible for therapy with IFN-α and ribavirin received the antidepressant paroxetine (n=28) or a placebo (n=33). Study medication began 2 weeks before IFN-α/ribavirin therapy. Neuropsychiatric assessments included the 10-item Montgomery-Asberg Depression Rating Scale (MADRS). The items of the MADRS were grouped into depression, anxiety, cognitive dysfunction, and neurovegetative symptom dimensions, and analyzed using a mixed model. By 2 weeks of IFN-α/ribavirin therapy, all four dimensions increased, with the symptom dimensions of anxiety and cognitive dysfunction fluctuating and worsening, respectively, in both groups over time. The depression symptom dimension was significantly lower in the paroxetine treatment group (p=0.04); severity of the neurovegetative symptom dimension was similar in both groups. Similar to patients with malignant melanoma receiving high-dose IFN-α, the depression symptom dimension is more responsive to paroxetine treatment in individuals undergoing concomitant IFN-α/ribavirin therapy. However, the anxiety, cognitive dysfunction, and neurovegetative symptom dimensions appear less responsive to prophylactic paroxetine administration. Different neurobiologic pathways may contribute to the responsiveness of IFN-α-induced symptom dimensions to antidepressant treatment, requiring relevant psychopharmacologic strategies.

Sequential multiple-assignment randomized trial design of neurobehavioral treatment for patients with metastatic malignant melanoma undergoing high-dose interferon-alpha therapy.

BACKGROUND: Interferon-alpha therapy, which is used to treat metastatic malignant melanoma, can cause patients to develop two distinct neurobehavioral symptom complexes: a mood syndrome and a neurovegetative syndrome. Interferon-alpha effects on serotonin metabolism appear to contribute to the mood and anxiety syndrome, while the neurovegetative syndrome appears to be related to interferon-alpha effects on dopamine. PURPOSE: Our goal is to propose a design for utilizing a sequential, multiple assignment, randomized trial design for patients with malignant melanoma to test the relative efficacy of drugs that target serotonin versus dopamine metabolism during 4 weeks of intravenous, then 8 weeks of subcutaneous, interferon-alpha therapy. METHODS: Patients will be offered participation in a double-blinded, randomized, controlled, 14-week trial involving two treatment phases. During the first month of intravenous interferon-alpha therapy, we will test the hypotheses that escitalopram will be more effective in reducing depressed mood, anxiety, and irritability, whereas methylphenidate will be more effective in diminishing interferon-alpha-induced neurovegetative symptoms, such as fatigue and psychomotor slowing. During the next 8 weeks of subcutaneous interferon therapy, participants whose symptoms do not improve significantly will be randomized to the alternate agent alone versus escitalopram and methylphenidate together. RESULTS: We present a prototype for a single-center, sequential, multiple assignment, randomized trial, which seeks to determine the efficacy of sequenced and targeted treatment for the two distinct symptom complexes suffered by patients treated with interferon-alpha. LIMITATIONS: Because we cannot completely control for external factors, a relevant question is whether or not 'short-term' neuropsychiatric interventions can increase the number of interferon-alpha doses tolerated and improve long-term survival. CONCLUSIONS: This sequential, multiple assignment, randomized trial proposes a framework for developing optimal treatment strategies; however, additional studies are needed to determine the best strategy for treating or preventing neurobehavioral symptoms induced by the immunotherapy interferon-alpha.