Treating tobacco dependence to aid re-employment among job-seekers: A randomized controlled trial.

INTRODUCTION: U.S. reductions in smoking have not been experienced equally. Smoking prevalence is greater among persons of lower education, lower income, and unemployed. We evaluated whether a cessation intervention for job-seekers would result in significantly fewer cigarettes smoked per day and a greater likelihood of tobacco abstinence and re-employment, compared to the control condition at 6-months follow-up. METHODS: Unemployed, job-seekers who smoked daily were recruited from five employment development departments in the San Francisco Bay Area, October 2015 to February 2018. Intention to quit smoking was not required. Participants were randomized to a brief motivationally-tailored, computer-assisted counseling intervention or referred to a toll-free quitline. Midstudy, 8-weeks of combination nicotine replacement was added to the intervention. Expired carbon monoxide and cotinine testing verified abstinence. Data were analyzed fall 2019. RESULTS: Participants (N = 360; 70% men; 43% African American, 27% non-Hispanic Caucasian; 19% unhoused) averaged 12 cigarettes/day (SD = 6), 67% smoked within 30 min of wakening; 27% were in preparation stage to quit. During the 6-month study period, intervention participants were more likely to make a quit attempt (71% vs. 58%, p = .021) and reported significantly greater reduction in cigarettes/day than control participants (median reduction: 6.9 vs. 5.0, p = .038); however, bioconfirmed abstinence (3%) and re-employment (36%) did not differ by treatment group. CONCLUSIONS: In a diverse sample with economic hardships, quit attempts and smoking reduction were greater in the intervention group; however, few achieved abstinence, and neither abstinence nor re-employment differed by condition. A priority group, further research is needed on smoking and re-employment.

Instrucciones de Alta por Video: Effectiveness of Video Discharge Instructions for Spanish-Speaking Caregivers in the Pediatric Emergency Department.

INTRODUCTION: Although evidence supports the addition of video discharge instructions to improve caregiver knowledge among English-speaking caregivers of children in the pediatric emergency department, there is no evidence about the effectiveness of videos for Spanish-speaking caregivers. The purpose of this study was to test whether Spanish video discharge instructions added to standard written and oral discharge instructions would result in improved knowledge and satisfaction among caregivers compared with written and oral instructions alone. METHODS: Spanish videos were created for fever, gastroenteritis, and bronchiolitis. A quasi-experimental, consecutive-sample, pre-post-test design was used with an audio computer-assisted survey platform to provide surveys in Spanish. The intervention group received written and oral instructions + video, whereas the comparison group received written and oral instructions alone. RESULTS: Data were collected from 150 caregivers. Caregivers who were given written and oral instructions + video showed significant knowledge improvement regarding their child's diagnosis and treatment (+19.3% and +23.6%, respectively, among standard participants; P < 0.001). Moreover, videos did not significantly improve caregivers' knowledge regarding illness duration and when to seek further care. Regardless of the discharge instruction format, no significant difference was observed in the helpfulness of the instructions (-1%; pre vs post, 84% vs 80%; χ2 = 0.35; P = 0.58). DISCUSSION: Study results demonstrate that when tailored to reflect diagnosis-specific education, video discharge instructions can improve Spanish-speaking caregiver knowledge about discharge education compared with written and oral instructions alone. Videos can be integrated to standardize the ED discharge process as an adjunct to nurse-provided written and oral instructions with an interpreter for Spanish-speaking families.

Evidence-Based Practice: Video-Discharge Instructions in the Pediatric Emergency Department.

PROBLEM: While a high quality discharge from a Pediatric Emergency Department helps caregivers feel informed and prepared to care for their sick child at home, poor adherence to discharge instructions leads to unnecessary return visits, negative health outcomes, and decreased patient satisfaction. Nurses at the Inova Loudoun Pediatric ED utilized the Johns Hopkins Model of Evidence Based Practice to answer the following question: Among caregivers who have children discharged from the ED, does the addition of video discharge instructions (VDI) to standard written/verbal discharge instructions (SDI) result in improved knowledge about the child's diagnosis, treatment, illness duration, and when to seek further medical care? METHODS: A multidisciplinary team reviewed available evidence and created VDI for three common pediatric diagnoses: gastroenteritis, bronchiolitis, and fever. Knowledge assessments were collected before and after delivery of discharge instructions to caregivers for both the SDI and VDI groups. RESULTS: Analysis found that the VDI group achieved significantly higher scores on the post test survey (P < .001) than the SDI group, particularly regarding treatment and when to seek further medical care. After integrating the best evidence with clinical expertise and an effective VDI intervention, the team incorporated VDI into the discharge process. IMPLICATIONS FOR PRACTICE: VDI offer nurses an efficient, standardized method of providing enhanced discharge instructions in the ED. Future projects will examine whether VDI are effective for additional diagnoses and among caregivers for whom English is not the primary language.

Swimming Behavior of Daphnia magna Is Altered by Pesticides of Concern, as Components of Agricultural Surface Water and in Acute Exposures.

Pesticides with novel modes of action including neonicotinoids and anthranilic diamides are increasingly detected in global surface waters. Little is known about how these pesticides of concern interact in mixtures at environmentally relevant concentrations, a common exposure scenario in waterways impacted by pesticide pollution. We examined effects of chlorantraniliprole (CHL) and imidacloprid (IMI) on the sensitive invertebrate, Daphnia magna. Exposures were first performed using surface waters known to be contaminated by agricultural runoff. To evaluate the seasonal variation in chemical concentration and composition of surface waters, we tested surface water samples taken at two time points: during an extended dry period and after a first flush storm event. In surface waters, the concentrations of CHL, IMI, and other pesticides of concern increased after first flush, resulting in hypoactivity and dose-dependent photomotor responses. We then examined mortality and behavior following single and binary chemical mixtures of CHL and IMI. We detected inverse photomotor responses and some evidence of synergistic effects in binary mixture exposures. Taken together, this research demonstrates that CHL, IMI, and contaminated surface waters all cause abnormal swimming behavior in D. magna. Invertebrate swimming behavior is a sensitive endpoint for measuring the biological effects of environmental pesticides of concern.

Agricultural surface water, imidacloprid, and chlorantraniliprole result in altered gene expression and receptor activation in Pimephales promelas.

The toxicity of single pesticides is likely underestimated when considering complex pesticide mixtures found in agricultural runoff and this is especially true for newer pesticides with little toxicity data on non-target species. The goal of our study was to compare the toxicity of two newer pesticides, imidacloprid (IMI) and chlorantraniliprole (CHL), when an invertebrate and fish were exposed to single compounds, binary mixtures or surface water collected near agricultural fields. A secondary goal was to determine whether changes in select subcellular molecular pathways correspond to the insecticides' mechanisms of activity in aquatic organisms. We conducted acute (96 h) exposures using a dilution series of field water and environmentally relevant concentrations of single and binary mixtures of IMI and CHL. We then evaluated survival, gene expression and the activity of IMI toward the n-acetylcholine receptor (nAChR) and CHL activity toward the ryanodine receptor (RyR). Both IMI and CHL were detected at all sampling locations for May 2019 and September 2019 sampling dates and exposure to field water led to high invertebrate but not fish mortality. Fish exposed to field collected water had significant changes in the relative expression of genes involved with detoxification and neuromuscular function. Exposure of fish to single compounds or binary mixtures of IMI and CHL led to increased relative gene expression of RyR in fish. Furthermore, we found that IMI targets the nAChR in aquatic invertebrates and that CHL can cause overactivation of the RyR in invertebrates and fish. Overall, our finding suggests that IMI and CHL may impact neuromuscular health in fish. Expanding monitoring efforts to include sublethal and molecular assays would allow the detection of subcellular level effects due to complex mixtures present in surface water near agricultural areas.

Discretionary spending priorities of unemployed, job-seeking adults who smoke cigarettes.

OBJECTIVE: Tobacco use is detrimental to physical and financial wellbeing. Smoking is associated with unemployment and a harder time finding re-employment. The current study examined job-seekers' prioritization of smoking over other discretionary items. METHODS: Adult, unemployed job-seekers smoking daily ranked items from 1 (highest) to 13 (lowest) for prioritization of their discretionary spending. The online survey randomly ordered the presentation of items. The Heaviness of Smoking Index (HSI, time to first cigarette and cigarettes per day) assessed severity of nicotine addiction. RESULTS: The sample (N = 290) was 70% men, 42% African American and 30% non-Hispanic Caucasian, with mean age of 43 (SD = 11), smoking an average of 12 cigarettes per day (SD = 6), and 67% smoking within 30 min of waking. Overall, cigarettes (M = 4.7, SD = 3.1) ranked second in importance behind only food (M = 2.5, SD = 2.7); 45% of the sample ranked tobacco in their top 3 spending priorities, and 26% ranked cigarettes as a higher priority than food. Cellular charges, transportation, grooming, and clothing ranked third through sixth, respectively. Higher HSI scores significantly correlated with greater prioritization of cigarettes (r = -0.25), and lower prioritization of food (r = 0.16) and transportation (r = 0.13), p's < 0.05. CONCLUSIONS: Findings indicate cigarettes were highly prioritized, second only to food among job-seekers who smoke. Cigarettes were prioritized over job-seeking resources and health care, particularly among those who were more heavily addicted. Tobacco addiction can preempt basic life needs and reduce resources for finding re-employment.