Trying to stop smoking: Effects of perceived addiction,attributions for failure,and expectancy of success

This paper reports the results of a postal questionnaire completed by 2343 smokers who had contacted a television company for help with stopping smoking. Of these, 1848 (78.9%) completed a follow-up questionnaire 1 year later. This indicated that 797 had tried to stop, 709 had tried to cut down, and 164 had become abstinent. Analyses show that the intention to try to stop smoking was dependent not only on the perceived health benefit, but also on the subjects' confidence that they would succeed if they tried to stop. As predicted by Weiner's [(1979). J. Educ. Psychol.71: 3–25] model of achievement motivation, those who attributed other smokers' failures at quitting to stable factors had lower expectancies of success, as had those who saw themselves as more addicted. When the follow-up data are considered, reported attempts at quitting were strongly related to previously declared intentions, and reported abstinence was related to previous confidence (expectancy of success) and perceived addiction. There is no support for hypotheses concerning self-other differences in attribution, or defensive attribution, in subjects' attributions for their own failures at cessation. Implications for antismoking interventions are discussed.This research was facilitated to various extents by grants from the British Council, the Department of Health and Social Security, the Medical Research Council, and the Social Science Research Council, London. When the data were collected, all authors were at the Addiction Research Unit, Institute of Psychiatry, University of London.     

The effect of haloperidol,spiperone and pimozide on the flexor reflex of the hind limb of the spinal rat

Summary It was found that spiperone and pimozide in doses which themselves do not influence the flexor reflex of the hind limb of the spinal rat inhibit stimulation of this reflex induced by serotoninomimetic drugs (LSD and fenfluramine). Higher doses of spiperone depress the flexor reflex and inhibit the stimulating effect of clonidine. Pimozide has no such effect. Haloperidol in doses which do not influence the action of LSD and fenfluramine produces a depression of the flexor reflex and antagonizes the action of clonidine. Our findings indicate that, irrespective of their antidopamine action, spiperone has a central antiserotonin effect and an antinoradrenaline one, pimozide—an antiserotonin one and haloperidol—an antinoradrenaline one.The results of this paper were presented at the Polish-Hungarian Symposium on Monoaminergic mechanisms in Tihany, June 21–23, 1977.     

A survey of tobacco dependence treatment guidelines in 31 countries

Aims The Framework Convention on Tobacco Control (FCTC) asks countries to develop and disseminate comprehensive evidence‐based guidelines and promote adequate treatment for tobacco dependence, yet to date no summary of the content of existing guidelines exists. This paper describes the national tobacco dependence treatment guidelines of 31 countries. Design, setting, participants A questionnaire on tobacco dependence treatment guidelines was sent by e‐mail to a convenience sample of contacts working in tobacco control in 31 countries in 2007. Completed questionnaires were received from respondents in all 31 countries. During the course of these enquiries we also made contact with people in 14 countries that did not have treatment guidelines and sent them a short questionnaire asking about their plans to produce guidelines. Measurements The survey instrument was a 17‐item questionnaire asking the following key questions: do the guidelines recommend brief interventions, intensive behavioural support, medications; which medications; do the guidelines apply to the whole health‐care system and all professionals; do they refer explicitly to the Cochrane database; are they based on another country's guidelines; are they national or more local; are they endorsed formally by government; did they undergo peer review; who funded them; where were they published; do they include evidence on cost effectiveness of treatment? Findings According to respondents, all their countries' guidelines recommended brief advice, intensive behavioural support and nicotine replacement therapy (NRT); 84% recommended bupropion; 19% recommended varenicline; and 35% recommended telephone quitlines. Nearly half (48%) included cost‐effectiveness evidence. Seventy‐one per cent were supported formally by their government and 65% were supported financially by the government. Most (84%) used the Cochrane reviews as a source of evidence, 84% underwent a peer review process and 55% were based on the guidelines of other countries, most often the United States and England. Conclusion Overall, the guidelines reviewed followed the evidence base closely, recommending brief interventions, intensive behavioural support and NRT, and most recommended bupropion. Varenicline was not on the market in most of the countries in this survey when their guidelines were written, illustrating the need for guidelines to be updated periodically. None recommended interventions not proven to be effective, and some recommended explicitly against specific interventions (for lack of evidence). Most were peer‐reviewed, many through lengthy and rigorous procedures, and most were endorsed or supported formally by their governments. Some countries that did not have guidelines expressed a need for technical support, emphasizing the need for countries to share experience, something the FCTC process is well placed to support.     

An evil trade

Surveys in the UK show that young people have no difficulty buying cigarettes even though the law forbids their sale under the age of 16. That, essentially, is what Martin Jarvis & Ann McNeill's paper in this issue of the British Journal of Addiction shows. In ‘Children's purchases of single cigarettes: evidence for drug pushing?’ they show how easily 14-to 15-year-old children buy their cigarettes, but with an added twist–many shops break open the packs and sell single cigarettes to children who cannot afford, or do not yet need, a whole packet. This editorial discusses the reasons for this state of affairs and notes the similarities with the situation in the USA, where the Secretary of State for Health has expressed concern. The tobacco industry has expressed concern also but has shown a cynical and typical lack of interest in correcting the situation and, in fact, has failed to respond to suggested solutions. Shops who illegally sell cigarettes to children should be regarded as the drug pushers they are, and treated accordingly.     

Surfactant protein-A and phosphatidylglycerol suppress type IIA phospholipase A2 synthesis via nuclear factor-kappaB

We previously showed that surfactant inhibits the synthesis of type IIA secretory phospholipase A2 (sPLA2-IIA) by alveolar macrophages. These cells have been identified as the main source of this enzyme in an animal model of acute lung injury. The aim of the present study was to identify the surfactant components involved in the inhibition of sPLA2-IIA expression in alveolar macrophages and the signaling pathways that mediate this inhibition. Our results show that various surfactant preparations can inhibit sPLA2-IIA expression in endotoxin-stimulated alveolar macrophages. Both the surfactant protein (SP)-A and the surfactant phospholipid fraction inhibit this expression. The surfactant phospholipid dioleylphosphatidylglycerol (DOPG) abolishes sPLA2-IIA expression, whereas dipalmitoylphosphatidylcholine does not. Chromatographic analysis and confocal microscopy revealed that phosphatidylglycerol was rapidly incorporated and metabolized by alveolar macrophages and that its metabolites accumulate in the cytosol. Nuclear factor-kappaB (NF-kappaB) modulates sPLA2-IIA expression in endotoxin-activated alveolar macrophages, and surfactant preparations, surfactant phospholipid fraction, SP-A, and DOPG indeed suppressed NF-kappaB activation. In summary, our results show that SP-A and DOPG play a role in the surfactant-mediated inhibition of sPLA2-IIA expression in alveolar macrophages and that this inhibition occurs via a downregulation of NF-kappaB activation.     

Anatomical distribution of colorectal cancer over a 10 year period in a district general hospital: is there a true "rightward shift"?

Introduction: Recent studies of patients with colorectal cancer have suggested a shift towards the proximal colon and an increase in the incidence of right sided colon cancer. This study aimed to determine the anatomical distribution of colorectal cancer over a 10 year period in a district general hospital. Methods: Records of patients diagnosed with primary colorectal cancer from 1993 to 2002 were reviewed for demographic data, histology subtype, and anatomical location of the tumour. Tumours located at and proximal to the splenic flexure were defined as right sided cancer and tumours arising distal to the splenic flexure were defined as left sided cancer. Results: A total of 763 patients were included in the study, of whom all had adenocarcinoma and 99% were white. Sixty nine percent of cancers were left sided and 31% were right sided. Although there was a 4% increase in the proportion of right sided cancers, there was no statistically significant increase using logistic regression analysis. Mann-Whitney U test revealed no significant difference in age at diagnosis between the right and left sided cancers. Although a higher proportion of females were diagnosed with right sided cancer compared with left sided cancer, this was not statistically significant. Conclusion: The anatomical distribution of colorectal cancer has been fairly stable at this hospital with no evidence of a shift towards the proximal colon. No differences were identified in the tumour distribution with respect to gender and age at diagnosis. Our findings support the initial application of flexible sigmoidoscopy for investigating patients with suspected colorectal malignancy and follow up colonoscopy for selected patients to exclude right sided pathology.