Use and effectiveness of buddy support in a self-help smoking cessation program.

Purpose. This study assesses buddy support in a community-based, minimal-contact smoking cessation program. Design. Telephone interviews with participants (n=641, response=74%) before and after (end-of-program, n=1,023, response=83%; three months n=757, response=74%; six months, n=859, response=84%; and 12 months, n=713, response=70%) intervention provided the data to be analyzed. Setting. The Chicago metropolitan area was the setting. Subjects. Subjects were a random sample of registrants for the intervention program. Intervention. A self-help smoking cessation program was used, which included a manual and complementary televised segments. Engaging a buddy was optional. Measures. Background and psychosocial characteristics of participants, characteristics of buddies, program compliance, and smoking behavior were the measures used. Results. Almost one third (30.3%) engaged a buddy. Those most likely to engage a buddy were female (33.4%), younger than 30 (37.2%), educated beyond high school (33.4%), highly determined to quit (41.8%), and more likely to need help from others (39.8%). More than half of the buddies were from outside the participant's household (55.1%), and more than half were nonsmokers (60.9%). Having a buddy was associated positively with manual use (gamma=.38), viewing televised segments (gamma=.23), recalling manual segments (gamma=.33), and recalling televised segments (gamma=.26). Among those who read the manual least, having a buddy was associated with viewing televised segments (gamma=.26, p less than .05) and with end-of-program quitting (16.8% vs. 9.8%, p less than .05). Having a buddy also was associated with higher abstinence through 12 months (5.8% vs. 2.7%, p=.013). Among those with lower determination, the end-of-program quit rate was more than three times greater (p=.013) for those with a buddy (16.1%) than without a buddy (5.2%). Participants whose buddy was their spouse or partner were more likely to quit at end-of-program (29.1% vs. 18.4%, p=.031). Conclusions. Buddy support should be promoted as an adjunct to minimal-contact smoking cessation programs. Impact of buddy support might be improved by guiding participants in choosing a buddy.

Age and stage of readiness for smoking cessation.

Using the 1992 National Health Interview Survey Cancer Control Supplement, relationships were analyzed between stage of readiness for smoking cessation and background characteristics, smoking behaviors, and smoking-related attitudes among smokers aged 18-29, 30-49, and > or = 50 years. For each age group, an ordinal logistic regression model was computed to identify correlates of readiness to quit. The youngest smokers had attitudes most favorable to being ready to try to quit smoking. For smokers aged 30-49, the influence of a medical provider and perceived health effects of smoking were important correlates of readiness. Among smokers 50 and older, those with realistic health consequences of smoking and those who perceived smoking as addictive were more likely to be ready to quit. The effectiveness of smoking cessation programs might be improved by matching interventions to a smoker's age and stage in the smoking cessation process.

Factors associated with nonparticipation among registrants for a self-help, community-based smoking cessation intervention.

Smokers (n = 96) who registered for but did not participate in a televised smoking cessation intervention based on the American Lung Association's self-help manual, Freedom From Smoking in 20 Days, were compared with participants (n = 1,035). Nonparticipants were more likely to be male, employed, and have a higher annual household income. At preintervention, nonparticipants expressed weaker desire to quit smoking, less confidence in their ability to quit, and less determination to quit. At post-program, 92% of nonparticipants smoked, but 93% planned to quit someday, with 82% planning to quit within the next 12 months. Additionally, nonparticipants were asked about their impressions of the manual, reasons for not reading the manual, and reasons for not watching the televised segments. Nonparticipants expressed positive initial impressions of the manual and mentioned time demands and conflicts with other commitments most often as reasons for not reading the manual and not watching the televised segments. Besides motivating smokers to try to quit, smoking cessation programs should help smokers to prepare to act. Also, nonparticipants are good candidates for recycling into subsequent programs.

Evaluating multiple outcomes and gender differences in alcoholism treatment.

This study followed 592 alcoholics (180 women and 412 men) after discharge from inpatient treatment. Multiple measures of treatment outcome were used to broaden our understanding of the process of recovery from alcohol abuse, and how that process differs for men and women. Patients were interviewed by telephone between 3 and 15 months after discharge to gather information about post-treatment experiences including: relationship with family, role performance, psychological impairment, and effort toward recovery. Additionally, if any alcohol use took place after treatment, information was collected about the pattern of alcohol consumption. Results indicated being married is consistently related to less drinking for men, while for women, being married contributes to relapse in the short term. The determinants of each measure of outcome were different for women and men, indicating that the process of recovery is not the same for both genders. The study confirms that drinking is related to other adverse outcomes for men, but not necessarily for women. It is evidence that women and men have different post-treatment functioning, and that different characteristics are predictive of these outcomes.

Age and the role of symptomatology in readiness to quit smoking.

To develop effective age-appropriate strategies for smoking cessation, it is important to understand factors associated with readiness to quit smoking. This article presents results from an analysis of the role of symptomatology in the decisions to quit smoking among three age groups (18-34, 35-54, and > or = 55 years) from a larger sample of smokers in a managed-care setting. Two measures of readiness to quit smoking were used: stages of change and intention to stop. Using ordinal logistic regression, we found that smokers in the middle and oldest age groups who had experienced at least three of five symptoms in the previous 2 weeks were more likely to be in higher stages of readiness. Regardless of age, smokers who attributed symptoms to smoking were more motivated to try to quit, whereas those who attributed symptoms to aging were less likely to intend to stop smoking. Findings from this study indicate a symptom-based approach to smoking cessation may be a useful strategy, especially in provider-based interventions.

Readiness of older adults to stop smoking in a televised intervention.

Smokers aged 60 and older who enrolled in a televised smoking cessation program were compared with older smokers in the target population, using data from telephone interviews. Multiple logistic regressions identified factors that differentiated older smokers at various stages of readiness to quit. Within the target population, smokers planning to quit someday (N = 238) were more likely to have had greater concern about health effects of smoking and perceived a stronger desire by others for them to quit than smokers with no such plan (N = 127). Compared with older smokers in the target population who were planning to quit someday, program registrants (N = 95) perceived greater severity of lung cancer, had greater concern about the health effects of smoking, perceived greater reduction of lung cancer risk from quitting, and had more determination to quit. These findings indicate important factors according to the stage in the smoking cessation process that must be considered when intervening with older smokers.

Providers' smoking cessation attitudes and practices for older patients.

A mail survey of 136 providers in a health maintenance organization in the Chicago metropolitan area examined smoking cessation attitudes and performance of the 4As protocol (asking, advising, assisting, arranging) for patients aged 50 years or older. Asking about smoking was most frequent, followed by arranging, advising, and assisting. Physicians and nurse practitioners performed each of the 4As more often than did registered and licensed practical nurses. In multiple logistic regression analyses, provider type was the only significant predictor of asking about smoking. Advising, assisting, and arranging follow-ups were more likely to be performed by providers who perceived a sense of professional responsibility about older patients' smoking; advising was more likely for providers who perceived that they had enough time to advise older patients about smoking; and assisting and arranging were more likely for providers with a stronger sense of self-efficacy for helping older patients stop smoking.

Attitudes toward physician advertising among rural consumers.

The issue of whether physicians should advertise their services has been the subject of much debate among health policymakers. This study reports data from a survey of rural residents in Illinois regarding attitudes toward physician advertising and reasons for opposition or support of the practice. The results indicate neither strong opposition nor strong support for physician advertising. While those who are opposed are largely nonspecific regarding their reasons, those in favor primarily expect that it will aid in the selection of a physician. However, few respondents indicate a predisposition to shop for a physician. Although the major concern about physician advertising is a danger of false advertising by some physicians, it appears that the respondents are not trusting of advertising in general rather than of advertising by physicians in particular. These findings suggest that regardless of its potential advantages, physician advertising may be relatively ineffective because consumers may be inattentive, unresponsive, or distrusting .

Nonmetropolitan consumers attitudes toward physician advertising.

The debate over whether physicians should be allowed to advertise their services has not yet included a consideration of consumer attitudes based upon empirical data. The results of a telephone survey of residents of a nonmetropolitan area reveal that the respondents are almost evenly divided between opposition to and support of physician advertising. Most respondents do not specify a reason for their position. Attitudes do not differ when several background variables, including residence, age, education, sex, usual source of care, and preferred source of care, are controlled. However, a significant negative association is observed between attitude toward physician advertising and length of residence. This finding suggests that if physician advertising is permitted it may have its greatest impact in areas with high rates of residential turnover.

An evaluation of the index of medical underservice. Results from a rural consumer survey.

The validity of the Index of Medical Underservice (IMU) was evaluated by examining the ability of the IMU to discriminate among levels of need for health services reported by rural consumers in response to a mail survey questionnaire. It was hypothesized that if the IMU is a valid indicator of medical underservice, then where the IMU value for an area was relatively low, respondents would report relatively less access and availability of health services, less utilization of health services, a lower health status level, and less satisfaction with available health services. The IMU was not found to be an effective discriminator among levels of need for health services as reported by the survey respondents. Further, the dichotomous designation of areas as medically underserved or not medically underserved according to IMU values was found to display even less discriminatory ability. A comparison of areas at opposite extremes of the range of IMU values accounted for only a small proportion of the variance in six criterion measures. The findings raise serious questions about the utility of the IMU for determining funding priorities for health services programs. It is recommended that use and interpretation of the IMU be made with caution and supplemented by additional data as much as possible.

A strategy for surveying nursing practice in institutional settings.

Two major obstacles encountered when surveying nursing practice in institutional settings are obtaining a representative sample and collecting an adequate number of observations at a reasonable cost. Past efforts to deal with these problems are reviewed briefly, and results are reported from a two-stage mail survey of a national sample of critical-care nurses. The first stage involved attempts to procure a list of staff nurses from head nurses of critical-care units at 240 randomly selected institutions. An 86% response rate was obtained. The second stage involved mailing questionnaires to a random sample of 600 critical-care nurses listed. Completed, mailed questionnaires were obtained from 87%. Little evidence of bias due to administrative selection and/or volunteerism was found in the lists of staff nurses. An analysis of membership in professional nursing organizations indicates that more than one half of the nurses who responded to this survey would not have been included had the sample been selected from organizational membership lists.

Resources rural consumers indicate they would use for mental health problems.

This study identified the health resources that rural consumers in DHHS Region V indicated they would use for mental health problems. Data were collected by survey research methods from a probability sample of 3057 rural residents. The study found that rural residents prefer to use primary care givers for mental health problems except in the case of serious mental illness.

Rural attitudes toward and knowledge of mental illness and treatment resources.

The stigma associated with mental illness is purported to be a major factor in the resistance of rural residents to mental health services. Through mail questionnaires and personal interviews, the authors gathered data from 3,057 rural residents in six Midwestern states on their attitudes toward and knowledge of mental illness and mental health services. They also examined the relationships between the demographic characteristics of the respondents and their knowledge and attitudes. In contrast to the findings of several other studies, the rural respondents in this study reported positive attitudes about treatment of mental illness. They expressed a high level of awareness of a variety of mental health services and appeared satisfied with those services. The authors discuss possible reasons for the discrepancies between the findings of this study and the studies reporting negative attitudes.

Mothers' health beliefs and use of well-baby services among a high-risk population.

The relationship between mothers' health beliefs and use of well-baby services among a poor, minority, high-risk population is reported. Data were collected from 61 black mothers attending a maternal-child clinic by interviews at the first and sixth months after the birth of their infants. The analysis focused on four health beliefs (susceptibility, severity, benefits, and efficacy) and two health behaviors (clinic visits and immunizations during the first 6 months). Although mothers' health beliefs were not predictive of clinic visits, health beliefs at the sixth month accounted for 30% of the variance in the number of immunizations. This relationship was dominated by perceived efficacy of immunizations and perceived benefits of well-baby services. The findings indicate a need to consider the nature and extent of possible changes in relationships between health beliefs and health behaviors over time.

Accuracy of immunization histories provided by adults accompanying preschool children to a pediatric emergency department.

OBJECTIVE: Because some have advocated the use of emergency departments to administer delayed childhood immunizations, we evaluated the accuracy of immunization histories obtained in this setting by comparison with medical records of inner-city health care facilities. DESIGN: Questionnaires were orally administered to adults accompanying children to the emergency department. Individual medical records were reviewed. SETTING: Pediatric emergency department at Wyler Children's Hospital, University of Chicago and 68 inner-city primary care clinics. PATIENTS: Children aged 3 to 65 months registering for medical care. Of the sample, 98% were African American; 75% were Medicaid recipients. MAIN OUTCOME MEASURES: Adults' knowledge of immunization histories, immunization cards, and medical records compared with American Academy of Pediatrics/Immunization Practices Advisory Committee recommendations. RESULTS: Of the accompanying adults, 64% stated that their child's general immunization status was "up-to-date"; 65% of these had clinic records confirming that status. Only 8% of specific regimens stated by these adults accurately matched those found in clinic records. Moreover, 45% of adults accompanying children at least 16 months and older provided inaccurate information regarding previous receipt of measles immunization. CONCLUSION: Information provided by accompanying adults (from recall or from immunization cards) is inadequate to determine accurately which preschoolers in the pediatric emergency department are delayed in immunizations.

Rural health care consumers' perceptions of the nurse practitioner role.

In a large-scale survey of rural consumers (n = 3,056), respondents were asked whether they would allow a nurse practitioner to perform each of 12 functions. The results indicate general acceptance of a broadly defined role for the nurse practitioner. Only two functions were not acceptable to a majority of the respondents. A factor analysis revealed two relatively weak factors, which were labeled nontraditional and traditional. Scores on a nurse practitioner acceptance scale, constructed from the 12 functions, were analyzed using analysis of variance and multiple regression. Acceptance of a nurse practitioner was greatest among respondents who are relatively young, male, whose income is relatively low, who are dissatisfied with the explanation of diagnosis and treatment they receive at their usual source of health care, and who are generally dissatisfied with their usual source of health care. None of these relationships, however, is strong.

Patients' perceptions of their physician's role in smoking cessation by age and readiness to stop smoking.

BACKGROUND: Patients' perceptions of their physician's role in smoking cessation, using the 4As protocol (asking, advising, assisting, and arranging), were assessed with a focus on associations with age (18-29, 30-49, and > or = 50) and stage of readiness to stop smoking (precontemplation, contemplation, and preparation). METHODS: Self-administered questionnaires were completed by 524 smokers presenting for regularly scheduled appointments at six clinics of an HMO in the Chicago metropolitan area. RESULTS: Almost all patients said their physician should ask about their smoking status and advise them to quit. About half said their physician should assist them with quitting, and about two-thirds said their physician should follow up (arrange) on their smoking behavior. Bivariate associations were found for endorsement of the 4As with both age and stage. Multiple logistic regressions found age was the most consistent and strongest correlate of 4As endorsement, with younger smokers more likely than those age 50 or older to endorse the 4As protocol. CONCLUSIONS: A proactive health promotion orientation should be encouraged among physicians. Patients should be screened for stage of readiness to stop smoking so that health-care providers can emphasize aspects of the 4As protocol that are most appropriate for each patient. Age-tailored smoking cessation strategies should be employed within stages of readiness to stop smoking.

Psychosocial factors and enrollment in a televised smoking cessation program.

Registrants for a smoking cessation program on the evening television news in the Chicago metropolitan area were compared with other smokers in the population to identify psychosocial factors that distinguished registrants. Telephone interviews were conducted before the intervention with random samples of 641 registrants and 2,398 smokers who regularly viewed the evening news. A nested series of three contrasts compared registrants with (1) smokers who regularly viewed the evening television news on any channel, (2) smokers who were regular viewers of the evening news on the intervention channel, and (3) smokers who were regular viewers of the evening news on the intervention channel and were planning to quit smoking. Registration was associated with a smoker's cognitive appraisal of the quitting process, with registrants distinguished by (1) recognition of a need to act (perceived severity of and susceptibility to lung cancer), (2) high outcome expectancies for quitting as an effective means for health promotion, (3) realistic expectations about the effort required to quit, (4) concern about the burden of lung cancer on significant others and related social influence factors, and (5) motivation to quit smoking. The findings suggest that the effectiveness of minimal-contact intervention programs may be enhanced by targeting smokers according to their psychosocial characteristics and by cognitively preparing smokers to attempt to quit.

Psychosocial factors and smoking cessation behaviors among smokers who have and have not ever tried to quit.

Relationships between smoking cessation behaviors and demographic characteristics and attitudes were analyzed among two groups of smokers, those who had and had not ever tried to quit. Telephone interviews were completed with 1501 smokers at baseline and at a 3 month follow-up. Multiple logistic regression analyses were used to identify factors that were associated with planning to quit, attempting to quit and quitting smoking within the two groups of smokers. Different patterns of correlates were found across groups and within the three outcome measures, indicating the potential importance of targeting interventions according to whether or not smokers have made a prior quit attempt. These findings also support the value of using multiple outcome measures in the smoking cessation process.

Age and readiness to quit smoking.

The relationship between planning to quit smoking within the next 3 months and demographic characteristics, smoking history, attitudes and beliefs about smoking cessation, and motivation was analyzed among smokers in three age groups: 18 to 29, 30 to 49, and 50 years or older. Using random-digit dialing, telephone interviews were completed with 2,353 smokers before initiating a self-help, minimal-contact intervention in the Chicago metropolitan area. Multiple logistic regression was used to identify factors that predicted planning to quit within the next 3 months. The two youngest age groups were most likely to have attitudes favorable to being ready to try to quit smoking (they were more concerned about health effects of smoking, perceived a greater reduction in the likelihood of getting lung cancer, were more determined to quit, and were more confident in their ability to quit). Among all three age groups, one-fourth or less planned to quit within the next 3 months, and desire to quit was the strongest predictor in each group. Among smokers who planned to quit someday, the oldest were most likely to plan to quit within the next 3 months. The findings show that there are important age-related differences in readiness to quit smoking that should be considered when planning and evaluating smoking cessation interventions.