Health Effects Reported by Adolescent Water Pipe and/or Cigarette Smokers Compared to Nonsmokers.

PURPOSE: The purpose of this study was to determine the prevalence of respiratory and/or physical fitness health problems in adolescent (ages 18-21) water pipe (WP) smokers (with or without cigarette smoking), cigarette-only smokers, and nonsmokers. METHODS: A comparative four-group study design was used to recruit a non-probability sample of 153 WP smokers only, 103 cigarette smokers only, and 102 cigarette+WP smokers along with 296 nonsmokers. Our hypothesis was that youth who smoked WPs and/or cigarettes would report more respiratory problems and/or poorer physical fitness than those who did not smoke. RESULTS: The results showed that coughs were significantly associated with smoking in all three of the smoking groups (p < .05). Cigarette-only smokers reported the most adverse outcomes with more wheezing, difficulty breathing, and less ability to exercise without shortness of breath. A dose-response analysis showed similar patterns of adverse health effects for both WP and cigarette smokers. The combined use of both products was not appreciably worse than smoking one product alone. This could be due to cigarette+WP smokers' reporting using less of the respective products when only one product was smoked. CONCLUSIONS: Even during the adolescent years, WP and/or cigarette smoking youth experienced reportable negative health effects.

A National Study Links Nurses' Physical and Mental Health to Medical Errors and Perceived Worksite Wellness.

OBJECTIVE: The aim of this study was to describe (1) nurses' physical and mental health; (2) the relationship between health and medical errors; and (3) the association between nurses' perceptions of wellness support and their health. METHODS: A cross-sectional descriptive survey was conducted with 1790 nurses across the U.S. RESULTS: Over half of the nurses reported suboptimal physical and mental health. Approximately half of the nurses reported having medical errors in the past 5 years. Compared with nurses with better health, those with worse health were associated with 26% to 71% higher likelihood of having medical errors. There also was a significant relationship between greater perceived worksite wellness and better health. CONCLUSION: Wellness must be a high priority for health care systems to optimize health in clinicians to enhance high-quality care and decrease the odds of costly preventable medical errors.

Nursing interventions for smoking cessation.

BACKGROUND: Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing-delivered smoking cessation interventions in adults. To establish whether nursing-delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow-ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialized Register and CINAHL in January 2017. SELECTION CRITERIA: Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed-effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI). MAIN RESULTS: Fifty-eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I2 = 50%) and not explained by subgroup analysis. Because of this, we judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, we did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. Subgroup analyses found no evidence that high-intensity interventions, interventions with additional follow-up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow-up or aids. There was no evidence that the effect of support differed by patient group or across healthcare settings. AUTHORS' CONCLUSIONS: There is moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence. There is insufficient evidence to assess whether more intensive interventions, those incorporating additional follow-up, or those incorporating pathophysiological feedback are more effective than one-off support. There was no evidence that the effect of support differed by patient group or across healthcare settings.

Nursing interventions for smoking cessation.

BACKGROUND: Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing-delivered smoking cessation interventions. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group specialized Register and CINAHL in June 2013. SELECTION CRITERIA: Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed-effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI). MAIN RESULTS: Forty-nine studies met the inclusion criteria. Pooling 35 studies (over 17,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention to increase the likelihood of quitting (RR 1.29; 95% CI 1.20 to 1.39). In a subgroup analysis the estimated effect size was similar for the group of seven studies using a particularly low intensity intervention but the confidence interval was wider. There was limited indirect evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized adults also showed evidence of benefit. Eleven studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Six studies of nurse counselling on smoking cessation during a screening health check or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found nursing intervention to have less effect under these conditions. AUTHORS' CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses, with reasonable evidence that intervention is effective. The evidence for an effect is weaker when interventions are brief and are provided by nurses whose main role is not health promotion or smoking cessation. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow-up.

Water pipe smoking among the young: the rebirth of an old tradition.

This article provides information on the growing threat of water pipe smoking (hookah) around the world and in the United States. Historically an activity of Middle Eastern older adults, the most recent growth in water pipe smoking (WPS) has been among adolescents and young adults. Associated with its use is a growing list of health problems. To date no interventions have been specifically designed for this form of tobacco use and they are sorely needed. Nurses must continue to teach No Tobacco Use in any form and that means no water pipe smoking must be part of every health message.

Monitoring the tobacco epidemic with national, regional, and international databases and systematic reviews: evidence for nursing research and clinical decision making.

Tobacco use (primarily cigarette smoking) continues to be the most preventable health risk in the United States and the second greatest health threat around the world. In 2020 the global burden is expected to exceed nine million deaths annually. Nursing, with the largest numbers of health care professionals has an opportunity to make a significant reduction in tobacco use through its research and client-focused care. This chapter addresses why and how monitoring the tobacco epidemic with population-based databases and meta-analyses is important for nurse researchers and for evidence-based nursing practice. Population-based surveys permit an examination of trends in tobacco use and the progress in tobacco control with some confidence across time, places (i.e., states, nations, communities, etc.), and large numbers of participants. Included in this review are a description of the numerous national and international databases and other resources that nurse researchers can use to build the science of tobacco use. Additionally, research reviews and meta-analyses are described as other vehicles for providing a basis for making evidence-based decisions about nursing intervention. Nurse scientists have an obligation to use and evaluate these diverse resources to determine the gaps in knowledge, provide a foundation for clinical practice, and identify the needs and directions for future research in the field.

Comparison of cigarette and water-pipe smoking by Arab and non-Arab-American youth.

BACKGROUND: Water-pipe smoking is a rapidly growing form of tobacco use worldwide. Building on an earlier report of experimentation with cigarette and water-pipe smoking in a U.S. community sample of Arab-American youth aged 14-18 years, this article examines water-pipe smoking in more detail (e.g., smoking history, belief in harmfulness compared to cigarettes, family members in home who smoke water pipes) and compares the water-pipe-smoking behaviors of Arab-American youth with non-Arab-American youth in the same community. METHODS: A convenience sample of 1872 Arab-American and non-Arab-American high school students from the Midwest completed a 24-item tobacco survey. Data were collected in 2004-2005 and analyzed in 2007-2008. RESULTS: Arab-American youth reported lower percentages of ever cigarette smoking (20% vs 39%); current cigarette smoking (7% vs 22%); and regular cigarette smoking (3% vs 15%) than non-Arab-American youth. In contrast, Arab-American youth reported significantly higher percentages of ever water-pipe smoking (38% vs 21%) and current water-pipe smoking (17% vs 11%) than non-Arab-American youth. Seventy-seven percent perceived water-pipe smoking to be as harmful as or more harmful than cigarette smoking. Logistic regression showed that youth were 11.0 times more likely to be currently smoking cigarettes if they currently smoked water pipes. Youth were also 11.0 times more likely to be current water-pipe smokers if they currently smoked cigarettes. If one or more family members smoked water pipes in the home, youth were 6.3 times more likely to be current water-pipe smokers. The effects of ethnicity were reduced as a result of the explanatory value of family smoking. CONCLUSIONS: Further research is needed to determine the percentages, patterns, and health risks of water-pipe smoking and its relationship to cigarette smoking among all youth. Additionally, youth tobacco prevention/cessation programs need to focus attention on water-pipe smoking in order to further dispel the myth that water-pipe smoking is a safe alternative to cigarette smoking.

Health issues in the Arab American community. Tobacco use patterns among high school students: do Arab American youth differ?

OBJECTIVE: To determine tobacco use rates (cigarette, water pipe smoking [WPS] or narghile) in Arab American compared to non-Arab youth. DESIGN/SETTING: A convenience sample of 2,782 14- to 18-year-old high school students from a midwest community completed a 21-item tobacco use history survey. RESULTS: Seventy-one percent of the participants were ArA. Grades 9 through 12 were equally represented. Results included 'ever tried cigarettes [narghile]' (20%, 39%); 'smoked cigarettes [narghile] in the past 30 days' (7%, 22%); and 'regular smoking [narghile]' (3%, 15%) for ArA and non-Arab youths, respectively. Each was significantly related to grade and ethnicity. WPS for ArA and non-Arab youths was (38%, 21%); (17%, 11%); and (7%, 5%) for 'ever used,' 'used in the past 30 days,' and 'regular use,' respectively. Grade, ethnicity, and sex were significantly related to WPS. CONCLUSIONS: Cigarette smoking rates for non-Arab youth were lower than current national youth smoking rates but significantly higher than ArA youth. Rates for ArA youth were much lower than current national reported data. Rates of WPS for US youth, regardless of race or ethnicity, are not known. Findings from this study indicate that both ArA and non-Arab youth are experimenting and using WPS regularly. These results underscore the importance of assessing novel forms of tobacco use, particularly WPS, a growing phenomenon among US youth.

Predictors of Arab American Adolescent Tobacco Use.

This study examined personal, psychosocial, sociocultural, and environmental predictors in tobacco use for 1671 Arab American adolescents. Cigarette smoking in past 30 days was 6.9%. This increased from 1% at age 14 to 14% at age 18. Twenty-nine percent of the youths reported 'ever cigarette smoking.' Experimentation with narghile was 27%; it increased from 23% at 14 years to 40% at 18 years. All trends were significant (p < .001). Logistic regression analyses found ten predictors for 'smoked a cigarette in past 30 days' and nine and seven, respectively, for 'ever smoked a cigarette or narghile'. Friends and family members smoking were the strongest predictors of cigarette smoking and 'ever narghile use.' 'Ever narghile use' supported cigarette smoking.

Nursing research and treatment of tobacco dependence: state of the science.

Tobacco use is considered to be the single most preventable cause of premature morbidity and mortality among men and women. It is well documented that tobacco cessation reduces the burden of disease significantly and is cost effective. Efficacious therapy for tobacco dependence exists, and nurses have been shown to be effective tobacco cessation interventionists. Given the large number of nurses in the United States, nurses can influence national health objectives of reduced tobacco use significantly and help to decrease the number of adults at risk for tobacco-attributable disease and death. The objectives of this presentation are to (a) describe the scientific evidence for tobacco cessation interventions, based on the U.S. clinical practice guideline Treating Tobacco Use and Dependence; (b) present the meta-analytic findings of the efficacy of nursing interventions for smoking cessation; (c) discuss barriers to nursing research and tobacco interventions; and (d) provide future directions for nursing intervention research.

Nursing intervention and smoking cessation: meta-analysis update.

OBJECTIVE: The study objective was to determine through meta-analysis the effects of nursing-delivered smoking-cessation interventions. RESULTS: Thirty-four studies met inclusion criteria in this updated meta-analysis. Twenty-six studies compared a nursing intervention with a control or usual care group of adults and found interventions of high and low intensity to modestly increase the odds of quitting (1.36, 95% confidence interval 1.22-1.51). The study results demonstrated heterogeneity; using a random effects model did not make a difference. There was evidence that interventions were most effective for hospital inpatients with cardiovascular disease than for patients with other conditions (odds ratio 2.14, confidence interval 1.39-3.31). Interventions in nonhospitalized adults were beneficial as well; no effect was found for additive intervention components. Counseling during health-screening programs or as part of multifactorial secondary preventions programs was found to be the least effective. The challenge will be to incorporate smoking-cessation interventions into evidence-based nursing practice.

Arab-American adolescent tobacco use: four pilot studies.

OBJECTIVES: Four pilot studies were conducted to determine the (1) current tobacco use patterns and predictors among 14- to 18-year-old Arab-American youths; (2) psychometric properties of study measures (English and Arabic); (3) cultural appropriateness of Project Toward No Tobacco (TNT) for intervention; (4) accessible population for a longitudinal study. METHODS: Three studies were descriptive and one used a pretest-posttest design. From four Pilot Focus groups (N = 28 smokers) key tobacco use themes emerged along with information on study measures and the Project TNT intervention; Pilot Intervention tested the tailored Project TNT intervention with 9 Arab-American teens; Pilot Clinic (N = 44) determined the characteristics of the accessible teen health clinic population; and Pilot School (N = 119) obtained tobacco use data only. RESULTS: From Pilot Focus seven themes (being cool, "nshar ma'a al shabab" [hanging out with the guys], present [time] orientation, smoking feels and tastes good, keeps your mind off trouble, easy to get, and (many) "barriers to quitting") emerged from the data. In the Pilot Intervention a 37.5% cessation rate was found. In the Pilot Clinic study, 24% males and 17% females smoked. The current smoking rate in the Pilot School (N = 119) sample was 17%; 34% admitted to having ever smoked (even a puff). Significant predictors for current tobacco use included poor grades, stress, having many family members and peers who smoke, being exposed to many hours of smoking each day, receiving offers of tobacco products, advertising and mail, and believing that tobacco can help one to make friends. CONCLUSIONS: The four pilots contributed unique and essential knowledge for designing a longitudinal clinical trial on tobacco use by Arab-American adolescents.