Christopher Jepson - Academia.edu (original) (raw)

Papers by Christopher Jepson

Issues in Mental Health Nursing, 1996

The United States has one of the highest per capita fire death rates in the world. Death rates al... more The United States has one of the highest per capita fire death rates in the world. Death rates alone, however, fail to reflect the breadth of loss experienced by residential fire survivors. Despite the frequency of home fires and the potential for loss, little is known about this vulnerable population. Interviews were conducted with 440 fire survivors 14 weeks after fires. Demographic characteristics of residential fire survivors, survivors' fire experiences, psychological distress after fires and the interrelationships among these variables were examined. This sample of urban fire survivors largely comprised poor, middle-aged African American women. Psychological distress was measured by the General Severity Index of the Brief Symptom Inventory, and the results showed that survivors were highly distressed, even in the absence of fire-related death or physical injury.

Cancer Epidemiology Biomarkers & Prevention

The increase in levels of blood nicotine that occurs from smoking a single cigarette, sometimes r... more The increase in levels of blood nicotine that occurs from smoking a single cigarette, sometimes referred to as a "nicotine boost," is an individualized measure of how much nicotine has been extracted from smoking a cigarette. This study investigated the demographic, smoking status, and psychological predictors of nicotine boost in a sample of 190 treatment-seeking smokers. Boost was assessed by comparing plasma nicotine levels before and after participants smoked one of their own brand cigarettes ad libitum. Positive affect (mood) was a significant positive predictor of nicotine boost, controlling for baseline cotinine levels and cigarette brand (Federal Trade Commission) nicotine delivery. However the proportion of variability accounted for in the model was relatively small (5%). Future research on individual differences in nicotine boost is warranted to clarify the role of psychological, physiological, and cigarette-related determinants.

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2003

Heuristics and biases, 1982

Psychopharmacology, 2005

Rationale: Human behavioral pharmacology studies can examine how medications that target differen... more Rationale: Human behavioral pharmacology studies can examine how medications that target different neurotransmitter systems influence different aspects of smoking. Naltrexone and bupropion have been shown to alter ad lib smoking behavior; however, medication effects on nicotine reward in a cigarette choice paradigm have yet to be investigated. Objective: This study explored the effects of an acute dose of naltrexone, bupropion, or placebo on the relative reinforcing value of nicotine from cigarette smoking using new nicotine and de-nicotinized (Quest, 0.6 and 0.05 mg = "denicotinized") cigarettes. Methods: In a double-blind, within-subjects design, 26 dependent smokers participated in three experimental cigarette smoking sessions following pretreatment with either naltrexone (50 mg), bupropion (300 mg), or placebo. After medication administration and 2 h of monitored deprivation from cigarettes and food, participants rated their responses to the initial exposure to the cigarettes and then participated in four choice sessions over a 2-h period during which they could take four puffs from either cigarette. Results: The relative reinforcing value of nicotine, as measured by the number of nicotine puffs chosen out of 16, was significantly lower following naltrexone compared to placebo. There were no effects of an acute dose of bupropion on nicotine choices. Conclusions: These results suggest that naltrex-one may reduce the relative reinforcing effects of nicotine via cigarette smoking and support ongoing investigation of opioid antagonists as potential smoking cessation pharmacotherapies.

The Psychology of Intuitive Judgment, 2002

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, Jan 28, 2014

Prevention and early detection measures for melanoma, such as sun avoidance and skin examinations... more Prevention and early detection measures for melanoma, such as sun avoidance and skin examinations, are important, but are practiced inconsistently. In this replication of the Project SCAPE trial, we sought to determine whether tailored print materials were more effective at improving adherence than generic print materials for patients at increased risk of skin cancer. Participants were randomized to receive personalized mailed communications about their skin cancer risk and recommended sun protection, or generic mailings. Participants were Caucasian adults, at moderate or high risk for skin cancer, recruited in outpatient primary care. The main outcomes were overall sun protection behaviors and specific protective behaviors including use of sunscreen, shirt, hat, sunglasses, shade, and sun avoidance; recent sunburns; and skin self-examination and provider skin examination. One hundred ninety-two (93.2%) subjects completed the study. Six outcome variables showed significant intervent...

PsycEXTRA Dataset, 2000

Healthy people generally underestimate the self-reported well-being of people with disabilities a... more Healthy people generally underestimate the self-reported well-being of people with disabilities and serious illnesses. The cause of this discrepancy is in dispute, and the present study provides evidence for 2 causes. First, healthy people fail to anticipate hedonic adaptation to poor health. Using an ecological momentary assessment measure of mood, the authors failed to find evidence that hemodialysis patients are less happy than healthy nonpatients are, suggesting that they have largely, if not completely, adapted to their condition. In a forecasting task, healthy people failed to anticipate this adaptation. Second, although controls understated their own mood in both an estimation task and a recall task, patients were quite accurate in both tasks. This relative negativity in controls' estimates of their own moods could also contribute to their underestimation of the moods and overall well-being of patients.

Psychological Review, 1983

In reasoning about everyday problems, people use statistical heuristics, that is, judgmental tool... more In reasoning about everyday problems, people use statistical heuristics, that is, judgmental tools that are rough intuitive equivalents of statistical principles. Sta-tistical heuristics have improved historically and they improve ontogenetically. Use of statistical heuristics is more likely ...

Social Science & Medicine, 1994

This paper presents preliminary findings from an ongoing study of survivors of residential fires.... more This paper presents preliminary findings from an ongoing study of survivors of residential fires. The purpose of this study was to examine psychological distress and extent of loss in order to provide a psychological profile of survivors over time. The sample (N = 69) was drawn consecutively from the database of residential fires available through the Philadelphia Fire Department. Levels of psychological distress were measured as well as reports of symptoms consistent with the diagnostic criteria for Post-traumatic Stress Disorder. The major findings indicate that residential fires caused significant and sustained distress. An agenda for further research and for services to survivors of these fires is presented.

Social Science & Medicine, 2003

Physicians are increasingly faced with choices in which one screening strategy is both more effec... more Physicians are increasingly faced with choices in which one screening strategy is both more effective and more expensive than another. One way to make such choices is to examine the cost-effectiveness of the more costly strategy over the less costly one. However, little is known about how cost-effectiveness information influences physicians' screening decisions. We surveyed 900 primary care US physicians, and presented each with a hypothetical cancerscreening scenario. We created three familiar screening scenarios, involving cervical, colon, and breast cancer. We also created three unfamiliar screening scenarios. Physicians were randomized to receive one of nine questionnaires, each containing one screening scenario. Three questionnaires posed one of the familiar screening scenarios without costeffectiveness information, three posed one of the familiar scenarios with cost-effectiveness information, and three posed one of the unfamiliar scenarios with cost-effectiveness information. The cost-effectiveness information for familiar scenarios was drawn from the medical literature. The cost-effectiveness information for unfamiliar scenarios was fabricated to match that of a corresponding familiar scenario. In all questionnaires, physicians were asked what screening alternative they would recommend. A total of 560 physicians responded (65%). For familiar scenarios, providing cost-effectiveness information had at most a small influence on physicians' screening recommendations; it reduced the proportion of physicians recommending annual Pap smears ðp ¼ 0:003Þ; but did not significantly alter the aggressiveness of colon cancer and breast cancer screening (both p 0 so0.1). For all three unfamiliar scenarios, physicians were significantly less likely to recommend expensive screening strategies than in corresponding familiar scenarios (all p 0 so0.001). Physicians' written explanations revealed a number of factors that moderated the influence of costeffectiveness information on their screening recommendations. Providing physicians with cost-effectiveness information had only a moderate influence on their screening recommendations for cervical, colon, and breast cancer. Significantly, fewer physicians recommended aggressive screening for unfamiliar cancers than for familiar ones, despite similar costeffectiveness. Physicians are relatively reluctant to abandon common screening strategies, even when they learn that they are expensive, and are hesitant to adopt unfamiliar screening strategies, even when they learn that they are inexpensive. Published by Elsevier Science Ltd. (P.A. Ubel). 0277-9536/03/$ -see front matter Published by Elsevier Science Ltd. PII: S 0 2 7 7 -9 5 3 6 ( 0 2 ) 0 0 1 6 7 -3

Risk Analysis, 2003

Physicians are increasingly asked to use cost-effectiveness information when evaluating alternati... more Physicians are increasingly asked to use cost-effectiveness information when evaluating alternative health care interventions. Little is known about how the way such information is presented can influence medical decision making. We presented physicians with hypothetical screening scenarios with multiple options, varying the type of cost-effectiveness ratios provided as well as whether the scenarios described cancer screening settings that were familiar or unfamiliar. Half the scenarios used average cost-effectiveness ratios, as commonly reported, calculating benefits and costs relative to a no-screening option. The other half used the preferred incremental cost-effectiveness ratios, with each option's benefits and costs calculated relative to the next best alternative. Relative to average cost-effectiveness ratios, incremental cost-effectiveness information significantly reduced preference for the most expensive screening strategies in two of three unfamiliar scenarios. No such difference was found for familiar scenarios, for which physicians likely have established practice patterns. These results suggest that, in unfamiliar settings, average cost-effectiveness ratios as reported in many analyses reported in the literature can hide the often high price for achieving incremental health care goals, potentially causing physicians to choose interventions with poor cost effectiveness.

Research in Nursing & Health, 1994

Psychopharmacology, 2004

Rationale: Nicotine nasal spray (NS) is recommended as one of five first-line smoking cessation p... more Rationale: Nicotine nasal spray (NS) is recommended as one of five first-line smoking cessation products. A clinically convenient tool to identify smokers most likely to benefit from NS could assist healthcare practitioners in selecting the optimal treatment for individual patients. Objectives: To evaluate whether the subjective effects of an initial pre-treatment dose of NS predict 6 month abstinence rates following NS treatment for tobacco dependence. Methods: One hundred and seventy-five smokers received an initial 1 mg pretreatment dose of NS and completed a new measure of NS subjective effects (initial spray experience, ISE). This measure, together with demographic and smoking history variables, was examined as a predictor of 6-month pointprevalence (biochemically verified) abstinence rates. Results: Factor analysis revealed positive and negative effects subscales of the ISE. Smokers with higher ratings of positive effects from the pre-treatment NS dose were significantly more likely to be abstinent at 6-month follow-up. These effects were partially mediated by reduction in urge to smoke. Conclusions: Pending additional validation in human laboratory and clinical studies, assessment of the acute positive subjective effects of initial NS delivery may be an efficient way to predict who will be successful with NS treatment for tobacco dependence.

Psychopharmacology, 2006

Rationale The endogenous opioid system has been implicated in substance abuse and response to pha... more Rationale The endogenous opioid system has been implicated in substance abuse and response to pharmacotherapies for nicotine and alcohol addiction. We examined (1) the association of the functional OPRM1 A118G variant with the relative reinforcing value of nicotine and (2) the main and interacting effects of the mu-opioid receptor antagonist naltrexone on nicotine reinforcement. Methods In a within-subject, double-blind human laboratory study, 30 smokers of each OPRM1 genotype (A/A vs. A/G or G/G) participated in two experimental sessions following 4 days of orally administered naltrexone 50 mg or placebo. Participants completed a validated assessment of the relative reinforcing value of nicotine. This cigarette choice paradigm assesses self-administration of 0.6 mg nicotine vs. 0.05 mg (denicotinized) cigarettes after a brief period of nicotine abstinence. Results The relative reinforcing value of nicotine (number of nicotine cigarette puffs) was predicted by a significant OPRM1 by gender interaction. Among women, the lowactivity G allele (A/G and G/G) was associated with a reduced reinforcing value of nicotine; among male smokers, there was no association with genotype. Smokers carrying a G allele were also significantly less likely to differentiate the nicotine vs. denicotinized cigarettes by subjective ratings of satisfaction and strength. No evidence for an effect of naltrexone on nicotine reinforcement was found in the overall sample or in the genotype or gender subgroups. Conclusions This study provides initial evidence for an association of the OPRM1 A118G variant with nicotine reinforcement in women.

Psycho-Oncology, 1993

Cancer affects not only ill persons but also family members and close friends. An original study ... more Cancer affects not only ill persons but also family members and close friends. An original study from which this report is derived used a longitudinal design to follow patients discharged from one of seven hospitals with one or more complex care problems requiring home care. A total of 233 patients with multiple solid tumors diagnoses and 103 care-givers were included in the original study. Interviews were conducted at discharge and at three and six months post-discharge. This report examined the responses of a subset of 34 subjects (17 patients and their care-givers) for whom patient and care-giver variables were complete on all three occasions. Findings indicate that these patients were being discharged from the hospital with acute care needs. By three and six months posthospitalization, patients' conditions stabilized or improved but their care-givers continued to report similar levels of burden. Patient psychosocial responses were strongly correlated with care-givers' financial impact, impact on schedule, and physical care-giving responsibility at three and six months. Results highlight the importance of developing interventions that reduce family care-givers' burden in providing post-hospital nursing care for patients with complex care requirements.

The Pharmacogenomics Journal, 2006

We have previously demonstrated that a functional dopamine D2 receptor promoter variant (DRD2 À14... more We have previously demonstrated that a functional dopamine D2 receptor promoter variant (DRD2 À141 Ins/Del) predicts response to nicotine replacement therapy (NRT). The present study extends this finding in the same population of 363 NRT-treated subjects, by examining variation in the gene encoding the neuronal calcium sensor-1 protein (FREQ), which functions to regulate D2 receptor desensitization. The results indicate a statistically significant interaction effect of DRD2À141 and FREQ genotypes on abstinence at the end of the NRT treatment phase; 62% of the smokers with at least one copy of the DRD2 À141 Del allele and two copies of the FREQ rs1054879 A allele were abstinent from smoking, compared to 29-38% abstinence rates for other smokers in the trial. This result suggests that the interaction between variation in the DRD2 and FREQ genes, which both encode components of the D2 dopamine receptor signal transduction pathway, impacts the efficacy of NRT.

Pharmacogenetics and Genomics, 2005

Objectives and methods-The Val108/158Met polymorphism in the gene that encodes COMT, a dopamine m... more Objectives and methods-The Val108/158Met polymorphism in the gene that encodes COMT, a dopamine metabolizing enzyme, results in a three-to four-fold reduction in COMT activity. To determine if the lower activity Met allele of COMT was associated with smoking cessation in women, we used two independent studies: a population-based case-control study and a nicotine replacement clinical trial.

Nicotine & Tobacco Research, 2007

Extending a previous finding of an association between functional genetic variation in the mu-opi... more Extending a previous finding of an association between functional genetic variation in the mu-opioid receptor gene and response to nicotine replacement therapy, we explored the role of genetic variants in two genes encoding mu-opioid-receptor-interacting proteins, namely ARRB2 and HINT1. Participants were 374 smokers treated for nicotine dependence with either transdermal nicotine or nicotine nasal spray for 8 weeks in an open-label randomized trial. In a logistic regression model controlling for OPRM1 genotype, treatment type, and other covariates, we found no significant main effect of ARRB2 genotype on abstinence at either end of treatment or 6-month follow-up. Participants with the HINT1 TT genotype had significantly higher abstinence rates at 6-month follow-up, but this may not be a pharmacogenetic effect, given that the participants were drug free during this time. Haplotype analysis did not reveal any significant associations for either gene. We found an interaction of ARRB2 and OPRM1 genotype on abstinence at 6 months that approached significance; however, interpretation of this finding is limited by the small number of participants with the minor alleles for both genes. Although these data do not provide support for the role of genetic variation in these mu-opioid-receptor-interacting proteins and smoking cessation, further exploration of opioid pathway genes in larger prospective pharmacogenetic trials may be warranted.

Nicotine & Tobacco Research, 2011

Introduction: Genome-wide association studies have linked single-nucleotide polymorphisms (SNPs) ... more Introduction: Genome-wide association studies have linked single-nucleotide polymorphisms (SNPs) in the CHRNA5/A3/ B4 gene cluster with heaviness of smoking. The nicotine metabolite ratio (NMR), a measure of the rate of nicotine metabolism, is associated with the number of cigarettes per day (CPD) and likelihood of cessation. We tested the potential interacting effects of these two risk factors on CPD.