Social support for smoking cessation and abstinence: the Lung Health Study. Lung Health Study Research Group.

This article evaluates the relationship of social support to smoking cessation and continued abstinence of 3923 men and women with mild to moderate airway obstruction in the Lung Health Study. At both the end of a 12-week group program and after 1 year, men but not women who were supported in quitting were more likely to be successful. Married status facilitated quitting but was less strongly related to long-term abstinence. Participants supported by an ex-smoker who had attended the group program with them were very likely not smoking after 1 year (men, 74.7%; women, 72.4%). Participants supported by a smoker were less than half as likely to have achieved abstinence after 1 year but still had cessation rates greater than 30%. The nature of these relationships has implications for the distinction between women and men in studies of social support and for intervention strategies. Support people should be included in cessation intervention programs. Spouse involvement, however, is more evidently useful for men than for women.

Use of focus group methodology to develop an asthma self-management program useful for community-based medical practices.

Health education programs developed in academic medical centers are not optimally disseminated to community clinical settings. Strategies are needed to translate the findings of research on health education programs into programs useful in a wide range of health care settings. Focus group techniques were used to provide data for revising a successful university-based asthma self-management program to make it more practical for use by community physicians. Physicians representing a variety of specialties attended the sessions and provided feedback on the utility of various components of the original program. The discussions revealed that many physicians felt they did not have the time or resources to conduct the original program and identified elements viewed as impractical. This physician input contributed significantly to the development of a revised program with a briefer, less costly intervention. The revised program was later evaluated by focus group participants. Eighty-eight percent of those who evaluated the revised program agreed they would be able and willing to use the program in their own practices. As a formative evaluation tool, the focus group technique made available useful information that would have been difficult to obtain through evaluation forms alone.

Medication adherence patterns in chronic obstructive pulmonary disease.

While medical treatment of COPD has advanced, the failure to adhere to regimens for medication poses a significant barrier to effective management. Furthermore, no data are available regarding adherence for patients within the United States. Data from this investigation indicate that 78 outpatients from a medical center in the southeastern region of the United States were prescribed an average of 6.26 medications with both various dosing schedules and different modes of administration. Adherence was poor, with 42 patients (54 percent) underutilizing medications, 39 patients (50 percent) overutilizing medications during periods of respiratory distress, and 24 patients (31 percent) employing ineffective inhaler dosing techniques. Prescription patterns and adherence were not associated with demographic variables; however, adherence was related to classes of medication and situational variables.

Peak flow meters: are they monitoring tools or training devices?

Previous studies have been inconclusive as to whether peak flow meter use teaches asthma patients to better perceive their own pulmonary functioning. This investigation utilized a delayed baseline design to determine if pulmonary awareness could be improved among a sample of 24 adult patients who compared daily peak expiratory flow rates (PEFR) with asthma symptom ratings. Results indicated that among this sample of adult patients: (i) perception of pulmonary functioning was poor, (ii) adherence to peak flow meter use was poor, and (iii) among patients who use peak flow meters daily, self-perception of pulmonary functioning did not improve significantly. Summary tables and descriptive statistics for pulmonary functioning are provided, and treatment implications are discussed.

Alcohol intake and blood pressure in young adults: the CARDIA Study.

Associations between self-reported average daily alcohol intake and blood pressure were assessed in 5031 black and white men and women ages 18-30 from the Coronary Artery Risk Development in Young Adults Study (CARDIA). In general, intake was positively but weakly related to both systolic and diastolic blood pressure. Associations with systolic pressure were generally stronger than those with diastolic pressure. With average daily alcohol intake categorized as none, 0.1-9.9 ml, 10.0-19.9 ml, 20.0-29.9 ml, and 30.0+ ml, mean systolic pressure, adjusted for age, body mass index, education, smoking, and physical activity, increased progressively with increasing intake in black and white men and in white women. Mean diastolic pressure increased progressively with increasing intake only in white men and women, but was highest for those averaging 30.0+ ml per day in black women as well as white men and women. Mean pressures were also compared for those averaging 75.0+ ml per day (men) or 50.0+ ml per day (women) vs those reporting no intake. Differences in adjusted mean pressures for white men were 3.2 mmHg (95% confidence limits (CL) -0.3, 6.8) for systolic pressure and 1.7 mmHg (-1.6, 5.0) for diastolic pressure. In black men differences were 4.4 mmHg (1.4, 7.4) and 3.4 mmHg (0.6, 6.3), respectively. Differences in white women were 1.4 mmHg (-2.5, 5.3) for systolic pressure and 0.9 mmHg (-2.7, 4.5) for diastolic pressure and for black women, -0.2 mmHg (-4.3, 3.8) and 1.9 mmHg (-1.9, 5.8). Separate analyses in smokers and nonsmokers of the associations between alcohol intake and blood pressure suggested that associations may differ by smoking status in some sex-race groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The discrepancy between emotional vs. rational estimates of body size, actual size, and ideal body ratings: theoretical and clinical implications.

Thirty-two asymptomatic college females were assessed on multiple aspects of body image. Subjects' estimation of the size of three body sites (waist, hips, thighs) was affected by instructional protocol. Emotional ratings, based on how they "felt" about their body, elicited ratings that were larger than actual and ideal size measures. Size ratings based on rational instructions were no different from actual sizes, but were larger than ideal ratings. There were no differences between actual and ideal sizes. The results are discussed with regard to methodological issues involved in body image research. In addition, a working hypothesis that differentiates affective/emotional from cognitive/rational aspects of body size estimation is offered to complement current theories of body image. Implications of the findings for the understanding of body image and its relationship to eating disorders are discussed.

Patient characteristics relevant to effective self-management: scales for assessing attitudes of adults toward asthma.

The Asthma Opinion Survey, a 33-item Likert-type instrument, was designed to measure attitudes relevant to self-management in adult outpatients. Items fall into eleven clusters; General Vulnerability, Specific Vulnerability, Attitudes Toward Patient Knowledge, Recognition of Airway Obstruction, Accessibility of Health Care, Panic-Fear, Belief in Treatment Efficacy, Staff-Patient Relationships, Sense of Control, Personal Impact, and Social Impact. Factor analysis of the clusters yielded three factors Vulnerability, Perceived Quality of Care, and Recognition and Control. The items, clusters, and factors all had adequate to good score spreads and internal consistencies. Asthma opinions covaried significantly with demographic characteristics, asthma severity, and intensity of health care utilization, and correlated with the Asthma Symptoms Checklist, an instrument developed at the National Jewish Hospital-National Asthma Center, in ways supporting construct validity. These results suggest the Asthma Opinion Survey is achieving its intended purpose.

Evaluation, narcotics and behavioral treatment influences on pain ratings in chronic pain patients.

Changes in self-reported pain ratings were assessed in 95 chronic pain patients from data collected at three times: pretreatment evaluation, initial days of treatment and final days of treatment. These data were collected separately for regular, sporadic and nonusers of narcotic medication. Each patient completed a four-week interdisciplinary behaviorally based noninvasive treatment program. There was an average decrease of 7% in self-reported pain ratings between evaluation and the onset of treatment for the three groups. An additional decrease of 21%, 16% and 10% for the sporadic, nonusers and regular users of narcotics respectively was noted during treatment. Statistical analysis revealed a significant decrease in pain ratings across assessment phases but not between groups. Sporadic users of narcotics showed a pattern more similar to nonusers than to the regular users.

Transcutaneous electrical nerve stimulation in urinary retention.

A 53-year-old woman with chronic back pain manifesting urinary frequency and incomplete voiding, presumably due to epidural scarring, was treated with standard TENS. Magnitude of residual urine and urinary frequency were decreased to acceptable limits and maintained in the absence of TENS treatment, allowing discontinuance of daily catheterization.

Narcotic utilization for back pain patients housed in private and semi-private rooms.

Hospital records from 40 back pain patients in private rooms and 40 back pain patients in semi-private rooms were reviewed to determine: (a) if patients in private rooms used more narcotics than patients in semi-private rooms; and (b) whether room type was a predictive variable for narcotic utilization. Patients in private rooms were found to be more likely to use intramuscular request-contingent narcotics than similar patients in semi-private rooms. No differences in the amount of narcotics were observed for other categories of narcotic analgesics. Room type, relevant medical, and demographic variables failed to account for this difference in medication utilization, suggesting that other factors such as medical staff and patient personality variables may be playing an important role in contributing to the use of narcotic analgesics by back-pain patients.

Toilet training and enuresis.

Toilet training is often taken for granted because it appears to occur so readily in such a large majority of children. It would be easy to hypothesize some internal mechanism which, if triggered at the right point in time, results in the initiation of a preprogrammed process that terminates with the child being trained. Variations across cultures regarding the age at which children are trained, the multitude of training procedures used by parents, and the variety of problems encountered during toilet training suggest that such is not the case. Toilet training has not been the focus of extensive systematic research as incontinence appears to impose no immediate or uncompromising physical threat to the child. Our apparent insensitivity to the emotional and psychological discomfort is perhaps highlighted by our rather cavalier attitude regarding the necessity of treating the younger (6 to 10 year old) child. Enuresis takes on added significance to the extent that it seems to be the symptom of some underlying neurologic or urologic abnormality. Once the enuresis is determined to be functional in nature, we are often satisfied with allowing the child and family to deal with the matter on their own and to return if the problem persists into adolescence. If treatment is begun at an early age, it seems to have a greater chance of success with fewer complications. It need not be particularly time-consuming once an adequate assessment has been carried out. Nurses, paraprofessionals, mental health technicians, and so forth, can be trained and utilized effectively in following the process of the parent and child. A compassionate, understanding, and systematic approach encourages compliance and patients on the part of the child and parents.