Press Releases 

• Firearms Proved Most Lethal Form of Suicide, Finds New Study

• Depressive Symptoms Impact Alcoholic Smokers' Readiness to Quit Smoking

• Computerized Phone Chats Motivate Physical Activity 

In a large population based study, firearms proved to be the most lethal form of suicide, over two and one half times more fatal than the next lethal method - suffocation. Since a high percentage of suicidal individuals are identified by mental health professionals only after an attempt, surviving a suicide attempt may offer the best hope for these individuals to receive appropriate care. Limiting access to firearms is a potentially effective public health strategy for decreasing suicide mortality and ensuring proper treatment for suicidal individuals, say the authors.

These findings appear in the February issue of the Journal of Epidemiology and Community Health, and come from a group of researchers led by Edmond Shenassa, Sc.D., Assistant Professor, Centers for Behavioral and Preventive Medicine, Brown Medical School/The Miriam Hospital. The researchers reviewed hospital discharge data and death certificate data from the Chicago Department of Health from 1990 - 1997, as

well as hospitalization records for admissions following suicide attempts from hospitals in Illinois during the same time period.

There were 37,352 hospitalizations for attempted suicide and 10,287 deaths due to suicide among individuals 10 years of age and older. Firearms proved to be the most lethal method of suicide for all age groups. If the firearm had not been available and another suicide method had been chosen, suicide mortality rates most likely would have been reduced up to 32% among minors, and 6% - 7% among adults.

Given the difficulties in identifying suicidal individuals, suicide preventive efforts aimed at the community level deserve continued emphasis. Shenassa explains, "our findings suggest that suicide attempts by firearms result in a disproportionate number of deaths. Limiting access to firearms, especially handguns, can be a potentially effective community based approach to decreasing suicide mortality, especially for youth."

This study was funded by the Harvard Injury Control Research Center, Boston MA.

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Depressive Symptoms Impact Alcoholic Smokers' Readiness to Quit Smoking
David B. Abrams, PhD & Brian Hitsman, PhD

New research shows that alcoholic smokers with longer periods since last alcohol use are more ready to quit smoking when they have low levels of depressive symptoms, compared to those with higher levels of depressive symptoms, as published in the September issue of Psychology of Addictive Behaviors.

David B. Abrams, Ph.D., Professor of Psychiatry and Human Behavior and Director, Centers for Behavioral and Preventive Medicine, Brown Medical School and the Miriam Hospital, leads the randomized trial that has enrolled 298 alcoholic patients undergoing outpatient alcohol treatment - one of the largest ever samples of outpatient alcoholic smokers.

More alcohol dependent smokers die prematurely from smoking than from their alcohol use. Abrams further explains the importance of improving smoking cessation rates among those in alcohol treatment. "Previous research has shown that successfully quitting smoking supports alcohol abstinence rates and that continued smoking after alcohol abstinence increases the risk of relapse to drinking."

The study compares a behavioral treatment, with a novel application of a motivational enhancement designed to increase readiness to quit smoking, plus nicotine patch to a standard treatment, plus nicotine patch.

Brian Hitsman, Ph.D., examined readiness to quit levels with a sub-group of 253 participants of the overall study. He found that two factors influence the alcoholic smoker's readiness to quit smoking - length of time since last alcohol use and degree of depressive symptoms. Since the study is on going, smoking cessation outcomes have not been analyzed at this point.

Hitsman explains, "since high levels of depressive symptoms seem to interfere with an alcoholic's readiness to quit smoking, these findings suggest that treatment providers offering smoking cessation treatment to alcoholics should repeatedly assess the smoker's depression level during treatment and treat the depression when warranted."

To learn more about ways to increase readiness to quit smoking and, in turn, successful smoking cessation, among smokers in outpatient alcohol treatment, the authors suggest future studies look more closely at the role of depression - assessing levels of depression throughout the full course of alcohol treatment and thoroughly assessing personal and family history of depression.

This research was funded in part by the National Institute on Alcohol Abuse and Alcoholism and by the National Institute on Drug Abuse.

Automated telephone calls may be able to promote behavior change among adults who are not meeting the recommended level of 30 minutes of moderate-intensity exercise on most days, according to a new study.

Researchers at the Centers for Behavioral and Preventive Medicine, Brown Medical School/The Miriam Hospital, found that participants who received an automated, computer-based telephone intervention were more likely than a comparison group to increase their level of physical activity after three months.

Lead author Bernardine M. Pinto, Ph.D., Associate Professor, explained that the study, headed by Robert Friedman, MD from Boston Medical Center/Boston University and published in the July issue of the American Journal of Preventive Medicine, "is the first to use telephone delivery of a computerized 'simulation' of physical activity counseling."

The study examined 298 randomly selected participants who were sedentary and had unhealthy diets (e.g., high in fat and processed foods). Half of the group received an automated telephone intervention focused on enhancing motivation to engage in moderate-intensity physical activity, such as walking. The other half, a comparison group, received an intervention designed to boost motivation for healthy eating.

"We hoped the system would overcome problems with scheduling and attending face-to-face meetings," says Pinto. "In addition, unlike human counselors, the system would be accessible at any time and less likely to be perceived as judgmental."

Participants called a telephone number and reached a computerized program, which used synthesized speech to ask questions about current activity levels and readiness to change behavior. Subjects provided answers using their telephone keypads.

The computer program assessed the participants' motivation, counseled them on their physical activity or eating behaviors, and offered a task or goal designed to promote or sustain positive behavior changes. Participants and their primary care physicians received computer-generated monthly reports about their level of physical activity.

After three months, 26 percent of the participants receiving the physical activity intervention had achieved the recommended levels of exercise, compared to 19.6 percent of the comparison group. The groups did not differ significantly at six-month follow up.

Despite the drop-off at the six-month mark, Pinto emphasizes that the intervention's short-term effects are promising and suggests continued refinement of automated telephone interventions. "We relied on the users to actively initiate all contacts to access the intervention," explained Pinto. "Placing this responsibility on them may have compromised our ability to deliver the intervention." She notes that the current version of the intervention automatically reminds participants to call the system. The study was funded in part by the National Heart, Lung and Blood Institute and the Harvard Pilgrim Health Care Foundation.

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