SelfhelpMagazine

by Marlene M. Maheu, Ph.D.

The two previous articles in this series discussed teen smokers and smoking cessation counseling. This article will focus on research possibilities for the future.

Research Suggestions

Much basic research underlying most treatment interventions are based only upon outcomes with men. Examination of adequate numbers of both men and women is needed to assess gender interactions. General categories requiring attention include those factors facilitating and mediating smoking initiation, cessation and relapse. These all need to be made a high priority to address the crisis in women's health care caused by nicotine dependency.

Specific areas requiring focused attention include:

• The development of more effective legislation and anti-tobacco programming to combat harmful messages promoted by the tobacco industry targeting America's youth;
• Stimuli promoting relapse and coping responses used to maintain abstinence may differ with gender; including gender and individual differences in physiological activity under resting and stressful conditions;
• Gender and individual differences in physiological and psychological responses to short-, intermediate-, and long-term smoking abstinence;
• Physiological and subjective responses to nicotine and nicotine withdrawal, precessation habitual nicotine intake, smoking history, and self-report indexes of personality, smoking motivation, and tolerance;
• Gender differences in affective response to nicotine abstinence, including emergence of depressive and anxiety disorders;
• Menstrual-cycle-phase-related and menopause-related effects upon the entire cessation process;
• Menopause-related effects of smoking and nicotine response; culture as a determinant of gender differences in smoking prevalence;
• Detection of pharmacological response differences as related to gender-specific treatment-matching in public education campaigns and formal cessation clinics;
• Long term effectiveness of medication with appetite-suppressing effects for women concerned with weight gain

Perhaps 3 million people in the US over the age of 60 are alcoholics or drink too much, the AMA said 9/18/95. Elderly men are five times more likely than women to be alcoholics, the report said, and the problem is so widespread that alcohol-related problems send as many people in the age group to the hospital as do heart attacks.

Family members and doctors often miss the warning signs, said Dr. James Todd, executive vice president of the AMA. Doctors diagnose alcohol problems in the elderly only 22 percent to 37 percent of the time, according to AMA figures.

"When an elderly grandparent shows up with vague complaints of balance problems and memory loss, alcoholism is not the first thing we think of," Todd said. The AMA made the comments in issuing a set of guidelines for doctors to recognize and treat the problem. The over-60 age group in the US is expected to reach 35 million by the year 2000, the AMA said.

If a patient drinks alcohol, doctors can do a quick, four question assessment to look for alcohol Problems according to the AMA: (CAGE) (1) Have you ever felt you could cut down on your drinking? (2) Have people annoyed you by criticizing your drinking? (3) Have you ever felt bad or guilty about your drinking? (4) Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

If the answer to two or more of these questions is yes, it's likely the person has an alcohol problem, said Todd.

American attitudes toward alcohol are changing. Though per capita consumption in this country has been declining since 1981, the percentage of drinkers seeking treatment for alcohol problems (at Alcoholics Anonymous or for-profit centers) has almost doubled in the past 15 years, according to a study of the American Journal of Public Health. Increased public awareness of alcohol addiction and a tendency to report problems at lower levels of consumption may account for the increase. Treatment is now more likely to be covered by insurance.

Back to Part I

About the Author:

Dr. Maheu is an author, speaker, and researcher. She is the lead author of "E-Health, Telehealth & Telemedicine: A Guide to Program Startup and Success" co-written with Pamela Whitten and Ace Allen, published by Jossey-Bass: San Francisco.

She has also been the lead author on these two books: "Infidelity on the Internet" and "The Mental Health Professional and the New Technologies."