Are health care providers still smoking? Data from the 2003 and 2006/2007 Tobacco Use Supplement-Current Population Surveys.

INTRODUCTION: Smoking by health care professionals poses a barrier to interventions with patients. This study reports smoking status changes among health care professionals using the Tobacco Use Supplement-Current Population Surveys (TUS-CPS). METHODS: TUS-CPS self-reported smoking status (current, former, and never) identified by occupation (physicians, physician assistants, registered nurses [RNs], licensed practical nurses [LPNs], respiratory therapists, dentists, and dental hygienists), were analyzed for the 2003 (N = 4,095) and 2006/2007 (N = 3,976) cohorts. Quit ratios among U.S. health care professionals were calculated by dividing the number of former smokers by the number of ever-smokers using weighted estimates. RESULTS: In 2006/2007, LPNs (20.55%) and respiratory therapists (19.28%) had the highest smoking prevalence. Physicians (2.31%), dentists (3.01%), pharmacists (3.25%), and RNs (10.73%) had the lowest prevalence. Data from 2006/2007 indicate that physicians, pharmacists, dentists, and physician assistants had the highest quit ratios; all groups had quit ratios higher than the general public, except LPNs (.52 vs. .46, respectively). Current smoking varied by group but did not significantly decline from 2003 to 2006/2007. The majority of health care professionals were never-smokers. CONCLUSIONS: These data indicate that only 4 health care professional groups met the Healthy People 2010 goal of 12% smoking prevalence. LPNs were the only group with quit ratios lower than the general population. The lack of significant decline in smoking rates among health professionals was similar to the "flat" rate seen among adults in the United States. This is of concern as smoking among health care professionals limits their interventions with smokers and their involvement in tobacco control.

Hypothalamic--pituitary-- adrenal axis dysregulation in women with irritable bowel syndrome in response to acute physical stress.

Irritable bowel syndrome (IBS) supports the concept of a dysregulated hypothalamic-pituitary-adrenal (HPA) axis. This study investigates the neuroendocrine and psychological responses to the acute physical stress of a lumbar puncture (LP) in women with diarrhea-predominant IBS by assessing central and peripheral HPA activity and affective measures. Blood samples have been collected at baseline and immediately post- and 1 hr following LP from 13 women with IBS and 13 controls. Plasma adrenocorticotropic hormone (ACTH), cortisol, epinephrine, and norepinephrine levels are analyzed. A single measure of cerebrospinal fluid (CSF) concentrations of corticotropin-releasing factor (CRF(CSF)) and norepinephrine(CSF) is noted. Affective assessments are used to rate anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) and acute mood state is rated using the Stress Symptom Rating questionnaire (stress, anxiety, anger, arousal). The women with IBS display blunted ACTH and cortisol responses to the LP along with a profile of affective responsiveness suggestive of chronic psychosocial stress, although no CRF(CSF) differences between groups are observed.

Correlates of heavy smoking among alcohol-using methadone maintenance clients.

This cross-sectional study examines predictors of heavy smoking among 256 male and female methadone maintenance therapy (MMT) clients from five MMT clinics in the Los Angeles area. The authors find that women report lower rates of heavy smoking than men (47% vs. 54%, respectively), in concordance with current literature pointing to gender differences in smoking behaviors. In particular, men who report heavy drinking, fair or poor health, and recent heroin use are more likely to report heavy smoking compared with men not reporting these factors. Women who report recent heroin use, a lifetime history of sex trade, and who have been ill enough to require a blood transfusion also have greater odds of reporting heavy cigarette smoking. Findings from this study may aid not only in designing gender-based smoking cessation programs for MMT clients but also in addressing the gender-based issues related to smoking in such a population.

Social networks, caregiver strain, and utilization of mental health services among elementary school students at high risk for ADHD.

OBJECTIVE: This study explores whether parental support networks vary by sociodemographic factors among children at high risk for attention-deficit/hyperactivity disorder (ADHD) and whether network characteristics influence the receipt of mental health treatment for the child. METHOD: A school district-wide, two-phase screening study design was used to identify 266 children at high risk for ADHD. Parents completed standardized instruments assessing network structure and function, DSM-IV diagnoses of disruptive disorders, caregiver strain, and treatment receipt, and children self-reported internalizing symptoms. Relationships were examined with analysis of variance and multivariate prediction, adjusting for sociodemographic characteristics, psychopathology, and parental strain. RESULTS: Network characteristics varied by race and socioeconomic status (SES), but not by child gender. African-American and disadvantaged parents reported smaller network sizes, but more frequent contact and higher levels of support than their white and high-SES counterparts. High levels of instrumental support lowered the odds of ADHD treatment during the 12 months before (OR =.7, p <.001) and after (OR =.7, p <.001) the network assessment interview. In contrast, parental strain increased the likelihood of ADHD treatment during both periods. CONCLUSIONS: Clinicians should anticipate high levels of caregiver strain and low levels of instrumental support among their patients' parents and address the potential high need for respite care in treatment plans.