Cigarette and waterpipe smoking associated knowledge and behaviour among medical students in Lebanon.

As future physicians capable of controlling tobacco dependence in the population, medical students are considered a main target for tobacco control interventions. This cross-sectional study reported on the prevalence of tobacco use (cigarettes and waterpipes) and associated knowledge and behaviour among 6th-year medical students in 2009-2010 from 6 medical schools in Lebanon. The self-administered questionnaire based on the Global Health Professional Survey (GHPSS) core questions also enquired about training in tobacco cessation approaches. All enrolled students were asked to participate; the response rate was 191/354 (54.3%). The prevalence of tobacco use was 26.3% for cigarettes and 29.5% for waterpipes. Smoking waterpipes was the only significant predictor for cigarette smoking and there was no difference by sex and socioeconomic status. A minority reported ever receiving any formal training in treatment approaches for tobacco dependence. Medical schools should include tobacco dependence treatment training programmes in their curriculum and discourage tobacco use.

Women's perceived and partners' reported support for smoking cessation during pregnancy.

Studies of the influence of social support on successful smoking cessation have been based on the smoker's perceptions only. In this pilot study of 58 couples, pregnant women who had smoked in the 30 days before pregnancy and their partners reported the positive and negative support for cessation they had received (women) or provided (partners). Mean levels of the women's and partners' perceptions of support were compared, and correlations of the two reports were analyzed while controlling for the effect of the couple's smoking status. Women's and partners' reports were similar except partners reported wanting the women to stop smoking more than women perceived. Women's and partners' perceived negative support were moderately correlated (r approximately equal to .48, p approximately equal to .001). Partner-reported positive support also was associated with women's perceived negative support (r approximately equal to .30, p approximately equal to .03). These relationships remained signif cant after controllingfor partners' and women's smoking status. Generally, partners reported giving more positive and less negative support than women perceived. Results suggest the need for further examination of couples' perceptions of support and the impact on smoking cessation during pregnancy.

Promoting smoking abstinence in pregnant and postpartum patients: a comparison of 2 approaches.

OBJECTIVE: To compare the implementation, delivery, and implications for dissemination of 2 different maternal smoking-cessation/relapse-prevention interventions in managed care environments. STUDY DESIGN: Healthy Options for Pregnancy and Parenting (HOPP) was a randomized, controlled efficacy trial of an intervention that bypassed the clinical setting. Stop Tobacco for OuR Kids (STORK) was a quasi-experimental effectiveness study of a point-of-service intervention. Both incorporated prenatal and postnatal components. PATIENTS AND METHODS: Subjects in both studies were pregnant women who either smoked currently or had quit recently. The major intervention in HOPP was telephone counseling delivered by trained counselors, whereas the STORK intervention was delivered by providers and staff during prepartum, inpatient postpartum, and well-baby visits. RESULTS: In HOPP, 97% of telephone intervention participants reported receiving 1 or more counselor calls. The intervention delayed but did not prevent postpartum relapse to smoking. Problems with intervention delivery related primarily to identification of the target population and acceptance of repeated calls. STORK delivered 1 or more cessation contacts to 91% of prenatal smokers in year 1, but the rate of intervention delivery declined in years 2 and 3. Modest differences were obtained in sustained abstinence between 6 and 12 months postpartum, but not in point prevalence abstinence at 12 months. CONCLUSIONS: The projects were compared using 4 of the 5 dimensions of the RE-AIM model including reach, adoption, implementation, and maintenance. It was difficult to apply the fifth dimension, efficacy, because of the differences in study design and purpose of the interventions. The strengths and limitations of each project were identified, and it was concluded that a combined intervention that incorporates elements of both HOPP and STORK would be optimal if it could be implemented at reasonable cost.

Motivation for smoking cessation among pregnant women.

The authors evaluated an expanded measure of intrinsic and extrinsic motivation for smoking cessation in a population-based sample of 897 pregnant smokers (500 current smokers and 397 recent quitters). The measure assessed motivation related to pregnancy and parenthood in addition to general intrinsic and extrinsic dimensions. Current smokers at baseline who quit smoking by 28 weeks of pregnancy (n = 102) had significantly higher baseline levels of pregnancy-related motivation than continuing smokers. Extrinsic and pregnancy motivation dropped between baseline and 28 weeks of pregnancy among continuing smokers. Higher levels of intrinsic relative to extrinsic motivation at baseline were associated with sustained abstinence during the first 2 months postpartum. Results suggest that both general and pregnancy-specific motivation are important for smoking cessation and relapse prevention during pregnancy. Interventions to enhance the salience of health benefits over and above those related to pregnancy and other intrinsic benefits of a greater sense of self-control could protect against postpartum relapse.

Infection control among professional tattooists in Minneapolis and St. Paul, MN.

OBJECTIVE: This study investigated infection control knowledge, beliefs, and practices of professional tattooists. METHODS: In a cross-sectional study of professional tattooists (N = 61), a self-administered questionnaire measured knowledge and beliefs related to blood-borne pathogen transmission and control and self-reported infection control procedures. The study also involved direct observation of the infection control practices of 25 tattoo artists. RESULTS: All respondents believed that bloodborne pathogens could be transmitted via tattooing, and most denied that trouble or expense were barriers to infection control. Knowledge about infection transmission and control was high and was positively associated with learning about infection control from a health official. Subjects were observed implementing an average of 44 of 62 recommended procedures. The percentage of recommended procedures used was negatively associated with years of tattooing experience. CONCLUSIONS: Tattooists have an understanding of the risks associated with exposure to blood, but this knowledge is not fully operationalized in the workplace. Interventions should focus on needle disposal, handwashing, cross-contamination, and cleaning prior to sterilization. Tattooists with > or = 10 years of experience are most in need of intervention. National guidelines for tattooing infection control and strategies for collaboration between public health officials and tattooists are needed.

Doing Our Part So Kids Don't Start. An evaluation of a statewide public awareness campaign.

This article describes outcomes related to the product and process involved in an evaluation of one component of a statewide public awareness campaign, the Doing Our Part So Kids Don't Start toolkit. The campaign was designed to garner support for and to increase compliance with a recent Minnesota law intended to reduce youth access to tobacco. More than 35,000 toolkits were distributed statewide. The results of the evaluation suggest that the toolkit was successful in reaching and engaging its target audience and should be considered a good strategy for disseminating information to a wide variety of individuals, particularly those new to tobacco control, and for encouraging them to participate in preventing tobacco use among youth. Future American Cancer Society endeavors would benefit from considering the needs of both the program planner and program evaluator before implementing new projects or programs.

Tobacco, alcohol, and caffeine use and cessation in early pregnancy.

OBJECTIVES: Little is known about what happens when individuals attempt to make multiple behavior changes simultaneously. Pregnant women in particular are often in the position of needing to change several behaviors at once, including giving up more than one pleasurable substance. We investigated the success of pregnant women in spontaneously quitting tobacco, alcohol, or caffeine, alone or in combination. METHODS: Pregnant women (n = 7489) were identified in the practices of large health maintenance organizations in Seattle and Minneapolis and were interviewed by telephone. Analyses examined the patterns of using and quitting more than one substance, and the extent to which using more than one substance predicts ability to quit other substances. RESULTS: Use of the three substances tended to cluster within individuals. Users of multiple substances were less likely to quit each substance than users of single substances. However, in the subgroup of multiple substance users who had quit one substance, having quit a second substance was more, rather than less, common. In multivariate analyses predicting quitting, demographic variables, and not having been pregnant previously were significant predictors of quitting each substance; being a nonsmoker predicted quitting alcohol, and being a nonsmoker and nondrinker predicted quitting caffeine. CONCLUSIONS: The reasons for difficulty in quitting more than one substance are unknown but may include the difficulty of formulating appropriate behavioral strategies or less concern about healthy behavior in pregnancy. Many women in the study successfully quit using two substances, however, and counseling should focus on achieving that outcome.

Stress, depressive symptoms, and smoking cessation among pregnant women.

Perceived stress and depressive symptoms were examined as correlates and predictors of smoking cessation during pregnancy in a sample of 819 pregnant smokers (454 baseline smokers and 365 baseline quitters). Women who quit early in pregnancy had lower levels of stress and depressive symptoms than baseline smokers. Adjusting for level of addiction and other demographic factors related to stress and depressive symptoms eliminated the significant association between depressive symptoms and smoking cessation. Lower levels of stress and depressive symptoms were not predictive of cessation in later pregnancy. Prenatal healthcare providers should continue to assess level of addiction and provide targeted intensive cessation interventions. Interventions that reduce stress and depression may also be of benefit to women who are continuing smokers in early pregnancy.

Prevention of relapse in women who quit smoking during pregnancy.

OBJECTIVES: This study is an evaluation of relapse prevention interventions for smokers who quit during pregnancy. METHODS: Pregnant smokers at 2 managed care organizations were randomized to receive a self-help booklet only, prepartum relapse prevention, or prepartum and postpartum relapse prevention. Follow-up surveys were conducted at 28 weeks of pregnancy and at 8 weeks, 6 months, and 12 months postpartum. RESULTS: The pre/post intervention delayed but did not prevent postpartum relapse to smoking. Prevalent abstinence was significantly greater for the pre/post intervention group than for the other groups at 8 weeks (booklet group, 30%; prepartum group, 35%; pre/post group, 39%; P = .02 [different superscripts denote differences at P < .05]) and at 6 months (booklet group, 26%, prepartum group, 24%; pre/post group, 33%; P = .04) postpartum. A nonsignificant reduction in relapse among the pre/post group contributed to differences in prevalent abstinence. There was no difference between the groups in prevalent abstinence at 12 months postpartum. CONCLUSIONS: Relapse prevention interventions may need to be increased in duration and potency to prevent post-partum relapse.

Relationships between physician advice and tobacco and alcohol use during pregnancy.

INTRODUCTION: We sought to examine relationships between physician advice and use of tobacco and alcohol during pregnancy among 683 women in the upper Midwest. METHODS: Data on risk of substance use during pregnancy were analyzed using logistic regression analysis. RESULTS: A higher proportion of women used tobacco (34%) than alcohol (25%) during their most recent pregnancy. Women who received advice from a physician to abstain from alcohol reported a lower risk of smoking and drinking during pregnancy than women who did not receive such advice. Risk of smoking and drinking during pregnancy was also common among women who reported early onset of alcohol use. CONCLUSIONS: Results suggest that physician advice regarding alcohol use during pregnancy is protective against maternal smoking and drinking during pregnancy.

Evaluation of a community-based program to improve infant immunization rates in rural Minnesota.

OBJECTIVE: The purpose of this study was to evaluate the effects of enrollment in a community-based public health nursing program, Communities Caring for Children (CCC), on infant immunization rates in rural Minnesota. The program involved health education, a registry, and a reminder system. DESIGN: The evaluation was a collaborative effort of university, public health agency, and private managed-care personnel. Two data sources were used to assess the association of program enrollment and immunization compliance; public birth certificates and a telephone survey of 421 CCC enrollees and non-enrollees. RESULTS: Birth certificate and survey data showed that CCC enrollees were significantly younger, less educated, more likely to be white, and of lower parity than non-enrollees. The average age of subjects' infants was eight months. The survey data showed that, overall, CCC enrollees perceived less danger in infant immunizations than did non-enrollees and were more likely than non-enrollees to have access to infant immunization reminder cards. CCC enrollees reported significantly higher immunization compliance for their infants than did non-enrollees. CONCLUSIONS: The area served by this program is relatively low-income and rural. Infant immunization status was among the lowest in Minnesota prior to the implementation of CCC. The evaluation suggested that enrollment in CCC was one of the most powerful predictors of infant immunization compliance.

Soliciting defined populations to recruit samples of high-risk older adults.

BACKGROUND: Generalizable research on high-risk older persons requires samples that are both large enough for adequate statistical power and similar enough to community populations that its results can be generalized to them. We tested the effectiveness and efficiency of mixed-mode (mail-telephone) solicitation of a defined population as a method for recruiting a large, representative sample for a randomized trial of outpatient geriatric evaluation and management (GEM). METHODS: Fee-for-service, community-dwelling older Medicare beneficiaries were mailed a short self-administered screening questionnaire. Eligible respondents were called to assess eligibility and willingness to give consent; consenters were called again for baseline data. Information about nonrespondents, ineligibles, and refusers was obtained from the Health Care Financing Administration. RESULTS: The response rate to the screening questionnaire was 61.1%. Of the respondents, 13.2% were eligible for the study and, of those, 34.4% agreed to participate. Response rates appeared to be influenced by small financial incentives and by subjects' age, race, sex, location of residence, and use of hospitals in the previous year. Consent rates were influenced by age and sex. The final sample (N = 522) was representative of community high-risk respondents in racial composition, previous use of hospitals, and probability of repeated admission (Pre) in the future, but it was slightly younger and contained a higher percentage of men. Recruitment costs averaged $286.92 per consenting person. CONCLUSIONS: Mixed-mode solicitation of defined populations can produce, at reasonable cost, large samples whose representativeness of community high-risk populations can be determined. Procedures that may enhance the success of this approach include: advance communication with members of the target population and their families and physicians; provision of medical and small financial incentives; continuous monitoring of recruitment results; and attention to subjects' needs for convenience, time, transportation, and reassurance.

Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies.

OBJECTIVES: This study examined whether pregnancy intention was associated with cigarette smoking, alcohol drinking, use of vitamins, and consumption of caffeinated drinks prior to pregnancy and in early pregnancy. METHODS: Data from a telephone survey of 7174 pregnant women were analyzed. RESULTS: In comparison with women whose pregnancies were intended, women with unintended pregnancies were more likely to report cigarette smoking and less likely to report daily vitamin use. Women with unintended pregnancies were also less likely to decrease consumption of caffeinated beverages or increase daily vitamin use. CONCLUSIONS: Pregnancy intention was associated with health behaviors, prior to pregnancy and in early pregnancy, that may influence pregnancy course and birth outcomes.

Attitudes and perceptions related to smoking among pregnant and postpartum women in a low-income, multiethnic setting.

PURPOSE: The purpose of this study was to gain insight into attitudes and perceptions about smoking during pregnancy, passive smoke exposure, barriers to quitting, and program preferences among women in a low-income, ethnically diverse setting. DESIGN: Nine focus group discussions were conducted with African-American, Native American, and white women. Discussions were moderated by local residents who shared the same ethnic background as group participants. SETTING: Discussions were held in neighborhood centers and clinics in an urban area. SUBJECTS: A total of 57 women participated. Moderators recruited participants from within their social networks and from neighborhood programs. The informal process of recruitment did not allow calculation of response rates. MEASURES: A series of open-ended questions with selected probes was used to guide the conversation. RESULTS: Participants were aware that smoking during pregnancy is harmful and were concerned to varying degrees about their smoking behavior. Most women who smoked took active steps to reduce the risks. Actions were frequently accompanied by beliefs that rationalized moderate levels of smoking. While concerned, women were uncertain about what constituted harmful, passive smoke exposure. Personal barriers to quitting included being around others who smoked, feelings of stress and boredom, addiction, and not believing smoking is dangerous enough. Participants tended to value pregnancy-related advice from female friends and relatives over advice from professionals. CONCLUSIONS: Results suggest that many women respond to warnings about smoking during pregnancy, but actions are not necessarily measured in quit rates. Misconceptions about the risks may help to rationalize continued smoking. Subjects lacked knowledge about how best to reduce the risks of passive smoke. Educational efforts may be effective when directed at networks of women who share information. The nature of qualitative data collection prevents extrapolation of these results to a larger population.

Partner smoking status and pregnant smoker's perceptions of support for and likelihood of smoking cessation.

Perceptions of support for cessation of smoking during pregnancy, likelihood of quitting, and partner smoking status were explored in a sample of 688 pregnant smokers (372 baseline smokers and 316 baseline quitters). Women with nonsmoking partners were significantly more likely to be baseline quitters than women with partners who smoked. Baseline quitters reported significantly more positive support from their partners than did continuing smokers (p = .02). Neither partner smoking status nor partner support at baseline was associated with cessation or relapse later in pregnancy. Women reported greater support, both positive and negative, from nonsmoking partners than from partners who smoked (p = .001). Among partner smokers, those who were trying to quit were perceived to be particularly supportive. Cessation interventions for expectant fathers may increase pregnant women's success at quitting.

Parent and physician response to children's cholesterol values of 200 mg/dL or greater: the Child and Adolescent Trial for Cardiovascular Health Experiment.

OBJECTIVE: To determine parental actions and concerns and physician responses to parental notification that a child's cholesterol value was 200 mg/dL or greater, a value recommended by the National Cholesterol Education Program to warrant physician follow-up and evaluation. METHODOLOGY: A telephone survey of parents (n = 784) and physicians (n = 117) was carried out after parental notification of a total blood cholesterol value obtained as part of measurement done while participating in the Child and Adolescent Trial for Cardiovascular Health in 96 schools located in California, Louisiana, Minnesota, and Texas. RESULTS: Only 20% of parents contacted physicians. Factors associated with this action included whether the parent was notified once or twice, the level of the cholesterol, previous cholesterol testing in the parent, and medical insurance that covered the visit. Family history of cardiovascular disease, when other factors were considered, did not increase the likelihood that a physician contact would be made. After contact with the physician, 59% of physicians reported evaluating children for cholesterol; about half reported repeating the cholesterol determination. CONCLUSION: Parental knowledge of a child's cholesterol value of 200 mg/dL or greater did not result in substantially further seeking of health care.

Long-term responses of higher and lower risk youths to smoking prevention interventions.

BACKGROUND: Adolescents at risk for cigarette smoking are difficult to reach with conventional interventions but have substantial exposure to the mass media. This study is the first to show that smoking prevention messages presented through the mass media can have large and durable effects on higher risk adolescents. METHODS: Students in two communities received media and school interventions beginning in grades 5-7; those in matched comparison communities received school interventions. Media interventions were targeted to higher risk youths. School surveys were conducted before and after the interventions, in grades 4-6 and grades 8-10. Two years after interventions ended, when participants were in grades 10-12, school and telephone surveys were conducted to assess smoking status. Survey participants (n = 2,860) were classified at baseline as having higher or lower risk for becoming a smoker. RESULTS: Smoking prevalence within the higher risk sample was significantly lower for those receiving media-school interventions than for those receiving school interventions only (odds ratio = 0.71). Effects on the lower risk sample were similar in magnitude but marginally significant. CONCLUSIONS: Mass media and school interventions achieved lower smoking rates among higher risk youngsters 2 years following completion of the interventions. This strategy represents a uniquely effective method for communicating with a high-priority group.

Prevention of pediatric drowning and near-drowning: a survey of members of the American Academy of Pediatrics.

OBJECTIVE: To assess pediatricians' knowledge about the epidemiology of childhood drowning, their opinions and current practices regarding its prevention, and their interest in taking on more responsibility for its prevention. DESIGN: A self-administered questionnaire was mailed to 800 pediatricians in the United States, randomly selected from the American Academy of Pediatrics' approximately 18,000 full fellows. RESULTS: A total of 560 completed surveys were returned, a response rate of 70.1%. Although 85% of respondents believe it is the responsibility of pediatricians to become involved in community and/or legislative efforts to prevent childhood drowning, only 4.1% were involved in such efforts. Only a minority of respondents provided written materials and anticipatory guidance on drowning prevention to their patients. Women were more likely than men to discuss drowning prevention with their patients. Younger physicians were more likely than older physicians to discuss drowning prevention with their patients. Physicians who received formal education on drowning prevention during their pediatric residency training were more likely to provide written materials and anticipatory guidance on drowning prevention to their patients. However, only 17.9% of respondents received formal education on drowning prevention during their pediatric residency training. Seventy-four percent of all respondents felt that further education on the prevention of childhood drowning and near-drowning would be useful to them. CONCLUSION: Although drowning is the second leading cause of death by unintentional injury in the pediatric population (aged 0 to 19 years), most pediatricians do not routinely provide information to their patients, or to their patients' parents, on drowning prevention. IMPLICATION: Pediatricians have been effective child advocates in many areas of injury prevention. If the prevention of drowning is made a priority in pediatric practice, many more children's lives will be saved.

Incorporating social support into a community-wide smoking-cessation contest.

Social support for smoking cessation has been identified as a key factor differentiating which individuals are most likely to quit smoking. Attempts to enhance social support in clinic-based programs have generally been unsuccessful. This study investigated a strategy for increasing the involvement of supportive others among participants in a community-based smoking-cessation contest. These smokers were undertaking quit attempts without the supportive environment offered in clinic-based group programs. Subjects included 734 adult smokers who had participated in a smoking-cessation contest in their local community. Contest participants had the option of designating a "support person" who would assist them in quitting smoking and be eligible for prizes if the participant was a contest winner. Follow-up was by telephone survey 3 months after the end of the contest. No differences were observed in demographic or smoking history variables between those who did and did not elect to name a support person. A relatively high proportion (60%) of contest participants elected to identify a support person and self-reported smoking-cessation rates were significantly better among those who named a support person than among those who did not. Identifying a support person was a particularly effective strategy for those with smoking or nonsupportive spouses.

Promoting abstinence among relapsed chronic smokers: the effect of telephone support.

OBJECTIVES: The present study used telephone support both to sustain abstinence and to encourage renewed quit attempts in smokers who had completed an intensive smoking cessation clinic. METHODS: Subjects were hard-core smokers (n = 1083) who had attended a multisession cessation clinic. They were then assigned randomly to receive telephone support (intervention calls 3, 9, and 21 months after the targeted cessation clinic quit date) or no further intervention. RESULTS: In the intervention condition, subjects who relapsed were significantly more likely to resume abstinence (that is, to recycle) than those in the comparison condition at follow-up (6 months: 17.8% vs 11.3%; 24 months: 25.7% vs 18.2%). Telephone support was not effective in preventing relapse, and overall differences in abstinence outcome were not significant. CONCLUSIONS: The major hypothesis of the current study--that telephone support would enhance the resumption of abstinence--received partial support. However, there was no evidence either of an overall treatment effect or of an effect in preventing relapse. Telephone outreach may be more effective in the context of self-help or other less intensive interventions.