Tobacco quitline outcomes for priority populations.

BACKGROUND: Despite declining rates of tobacco use, certain subgroups still experience a disproportionate risk for tobacco-related health issues. The South Dakota QuitLine identifies five priority population subgroups as the following: American Indians, tobacco users receiving Medicaid, youth, pregnant women, and spit tobacco users. The purpose of this study was to describe South Dakota QuitLine use among priority population subgroups and to measure associated cessation rates and service satisfaction. METHODS: Priority population subgroups comprised 22.6 percent (9,558 out of 42,237) of South Dakota QuitLine participants during a six-year period (2008-2013). Of the 34,866 total participants eligible for seven-months follow-up, 15,983 completed a telephone survey that measured tobacco quit status and service satisfaction (45.8 percent overall response). Eligible priority population subgroups had a 41.9 percent response (3,094 out of 7,388). RESULTS: The seven-month tobacco quit rate for the non-priority population group (46.9 percent) was higher than the quit rate for pregnant women (42.3 percent), youth (37.5 percent), American Indians (38.1 percent), Medicaid participants (35.7 percent) and participants with more than one priority subgroup designation (35.1 percent). The quit rate for spit tobacco users was highest overall (57.3 percent). All subgroups were satisfied with South Dakota Quitline services (≥ 3.5/4.0 scale; 4 = very satisfied). CONCLUSIONS: Tobacco users in high risk and underserved population subgroups of the South Dakota QuitLine seek cessation services. Quit rates were overall favorable and varied between population subgroups (35.1-57.3 percent). Health care providers play a vital role in early identification of tobacco use and referral to cessation services for priority populations. Providers should assess tobacco use, advise users to quit, and refer to the South Dakota QuitLine.

A statewide assessment of smoke-free policy in multiunit housing settings.

INTRODUCTION: The prevalence of smoke-free policies in multiunit housing (MUH) in South Dakota was examined. Owner beliefs about smoke-free policies were identified. METHODS: Stratified random sampling included 27 South Dakota counties classified as frontier, large rural, or urban. Data collection with MUH owners in selected counties employed a telephone survey with mailed backup. RESULTS: The owner response rate was 41.5% (324/780). A written smoke-free policy was reported by 175 (54.0%) owners, and 31 (10%) reported a verbal smoke-free policy. Owners in large rural counties (57.4%) had more written smoke-free policies than owners in urban (52.2%) and frontier (53.5%) counties. Only 8.5% of properties had policies covering both buildings and grounds. Owners without policies were more than twice as likely to manage U.S. Department of Housing and Urban Development subsidized units and were three times as likely to be current smokers. Owners without a smoke-free policy anticipated that a policy would decrease maintenance costs but increase turnover and vacancy rates. Nearly one-half (47.9%) of owners with no smoke-free policy had previously considered implementing a policy. Owners self-reported beliefs about smoke-free policies identified perceived benefits such as decreased maintenance and costs, improved tenant safety and health, and conscientious tenants. Perceived drawbacks included increased outdoor maintenance, enforcement problems, concerns about long-term tenants who smoke, and freedom/rights of smokers. CONCLUSIONS: This study provides a baseline assessment of smoke-free polices in MUH settings. Perceptions of owners without smoke-free policies focused on economic concerns that were inconsistent with reports from those owners with smoke-free policies.

Palliative and end-of-life care in South Dakota.

BACKGROUND: Geographical disparities play a significant role in palliative and end-of-life care access. This study assessed availability of palliative and end of life (hospice) care in South Dakota. METHODS: Grounded in a conceptual model of advance care planning, this assessment explored whether South Dakota health care facilities had contact persons for palliative care, hospice services, and advance directives; health care providers with specialized training in palliative and hospice care; and a process for advance directives and advance care planning. Trained research assistants conducted a brief telephone survey. RESULTS: Of 668 health care eligible facilities, 455 completed the survey for a response rate of 68 percent (455 out of 668). Over one-half of facilities had no specific contact person for palliative care, hospice services and advance directives. Nursing homes reported the highest percentage of contacts for palliative care, hospice services and advance directives. Despite a lack of a specific contact person, nearly 75 percent of facilities reported having a process in place for addressing advance directives with patients; slightly over one-half (53 percent) reported having a process in place for advance care planning. Of participating facilities, 80 percent had no staff members with palliative care training, and 73 percent identified lack of staff members with end-of-life care training. Palliative care training was most commonly reported among hospice/home health facilities (45 percent). CONCLUSIONS: The results of this study demonstrate a clear need for a health care and allied health care workforce with specialized training in palliative and end-of-life care.

Feasibility and acceptability of alternate methods of postnatal data collection.

This study was done in preparation for the launch of the National Children's Study (NCS) main study. The goal of this study was to examine the feasibility (completion rates and completeness of data), acceptability, staff time and cost-effectiveness of three methods of data collection for the postnatal 3- and 9-month questionnaires completed as part of NCS protocol. Eligible NCS participants who were scheduled to complete a postnatal questionnaire at three and nine months were randomly assigned to receive either: (a) telephone data collection (b) web-based data collection, or (c) self-administered (mailed) questionnaires. Event completion rates and satisfaction across the three data collection methods were compared and the influence of socio-demographic factors on completion rates and satisfaction rates was examined. Cost data were compared to data for completion and satisfaction for each of the delivery methods. Completion rates and satisfaction did not differ significantly by method, but completeness of data did, with odds of data completeness higher among web than phone (p < 0.001) or mail (p < 0.001). Costs were highest for the phone, followed by mail and web methods (p < 0.001). No significant differences in participant time (i.e. burden) across the three data collection methods were seen. Mail and phone data collection were the least complete of the three methods and were the most expensive. Mailed data collection was neither complete nor exceptionally economical. Web-based data collection was the least costly and provided the most complete data. Participants without web access could complete the questionnaire over the phone.

Evaluation of school tobacco-free policies in a rural Northern Plains state.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) has called for tobacco-free school (TFS) policies. In South Dakota (SD), a rural state with a large American Indian population, collaboration between state agencies focused on development and dissemination of a model TFS policy in 2008. This study explored the current status of TFS policies in statewide SD school districts. METHODS: Tobacco policies were requested from all SD school district administrators. A 26-point checklist based on CDC TFS policy guidelines was used to evaluate policies. Follow-up interviews were conducted with selected superintendents. RESULTS: Policies were received from 144 of 217 districts (66% response). Participation was higher for public districts than tribal/Bureau of Indian Education (BIE) districts and nonpublic districts. The overall mean policy score was 11.6 (SD 5.1). Public school districts had the highest mean (12.3) followed by nonpublic (8.9) and tribal/BIE (7.5). In a subset of districts with a large American Indian population (>30%), policy scores were lower for those located on reservation or tribal lands compared with other locations. Barriers to policy development were identified as time and staff expertise. CONCLUSIONS: There is a need to improve statewide TFS policies. A district report card with recommendations for improvement and a resource guide were developed and disseminated.

Knowledge, beliefs, and behaviors regarding organ and tissue donation in selected tribal college communities.

American Indians and Alaska Natives (AI/ANs) suffer a disproportionate burden of diabetes and kidney failure. For those with chronic kidney disease, transplantation may be the most effective treatment option. However, low rates of organ donation and transplantation are reported for AI/ANs, who face significant barriers in accessing the transplant waiting list. They are also less likely than Whites to consent to become organ donors. We partnered with five tribal colleges and universities to conduct focus groups to assess knowledge, cultural beliefs, and behaviors related to organ donation and transplantation among AI/AN college students. Focus group data were used to develop a culturally targeted media campaign and outreach strategy aimed at increasing rates of consent to donate organs. Community knowledge typically drew from direct family experience with chronic illness. Study findings confirmed that attitudes about organ donation were influenced by cultural beliefs. Nevertheless, many participants supported organ donation even when it conflicted with cultural and spiritual beliefs about keeping the body intact for burial. Participants also expressed mistrust of the local health care system, suggesting that trust issues might interfere with health messaging on this topic. This is the first study to examine sociocultural beliefs about organ donation among AI/AN college students. Through focus group findings, study staff were better positioned to develop culturally relevant outreach materials. Rising rates of chronic illness among AI/ANs ensure that organ donation and transplantation will be a long-term feature of the health landscape in AI/AN communities. Targeted health messaging must be part of the strategy to reduce donor shortages.

Secrets of successful short grant applications.

The National Institutes of Health has implemented new grant application guidelines that include a substantial reduction in the number of pages allowed for project descriptions. Shorter proposals will potentially decrease reviewer burden, but investigators may find the new page limits challenging. Writing more concisely while still presenting a persuasive argument requires honing certain skills with regard to preparation, construction, and editing of proposals. This article provides strategies from the Western Journal of Nursing Research editorial board for preparing competitive shorter research proposals. Two key strategies for success are fully conceptualizing the study prior to writing and obtaining assistance from experienced colleagues during the editing process.

Treatment-related needs of statewide cancer survivors.

INTRODUCTION: Research on surviving cancer treatment is a national priority and there is a need to understand the experiences of survivors from predominantly rural areas. The purpose of this study was to identify the perceptions of treatment and post-treatment issues for cancer survivors living in South Dakota. Multidimensional aspects of cancer-related needs were explored, including: psychosocial, physical, spiritual, health promotion and access to care issues. METHODS: The design was a cross-sectional survey of cancer survivors who completed their course of treatment at five accredited cancer treatment centers in South Dakota two years prior to the study. The survey was derived from a synthesis of other published instruments, with added items that focused on issues of interest to rural dwellers. There were 524 of 1933 mailed surveys returned (27 percent response). RESULTS: Respondents identified needs for help coping with various emotions more frequently than needs related to finding support and taking care of practical issues post-treatment. Specifically, coping with uncertainty and finding hope were priority needs (33 percent and 36 percent, respectively), while accessing counseling services and financial planning were low priority (9 percent and 14 percent, respectively). There were limited numbers of participants who reported that access to care (time, expense, travel) interrupted their cancer treatment. CONCLUSIONS: Perceptions of treatment-related needs of cancer survivors living in South Dakota include broad health promotion, practical and, most commonly, emotional concerns. Health care providers who assess for and identify these needs require a keen awareness of community resources to support South Dakota cancer survivors.

Academic freedom: protecting "liberal science" in nursing in the 21st century.

Generating new knowledge through science is one of the most valued contributions of American universities, and is wholly dependent on the tenets of academic freedom. This article provides an overview of academic freedom in the United States, lack of attentiveness to academic freedom in the discipline of nursing, and its relevance for advancing nursing science. Three issues are critically evaluated as they relate to "the free search for truth" that is imperative for scientific progress to occur, including (a) its importance in a liberal science system, (b) recent trends to politically manipulate science, and (c) movements to restrict speech on campus.

Academic freedom and academic duty to teach social justice: a perspective and pedagogy for public health nursing faculty.

Public health nursing practice is rooted in the core value of social justice. Nursing faculty whose expertise is in public health are often the content experts responsible for teaching this essential, yet potentially controversial, value. Contemporary threats to academic freedom remind us that the disciplinary autonomy and academic duty to teach social justice may be construed as politically ideological. These threats are of particular concern when faculty members guide students through a scientific exploration of sociopolitical factors that lead to health-related social injustices and encourage students to improve and transform injustices in their professional careers. This article (a) reviews recent challenges to academic freedom that influence social justice education, (b) explores academic freedom and duty to teach social justice within the discipline of nursing, and (c) proposes a praxis-based approach to social justice education, which is grounded in transformative pedagogy.

Physical activity behavior of American Indian mothers.

BACKGROUND: Mothers of young children who live in low-income households are a population at-risk for sedentary living that could experience important health benefits from improved physical activity behavior. Previous research among Caucasian mothers attending the Women, Infants and Children (WIC) program showed that the Transtheoretical Model of behavior change was an appropriate model for designing interventions for activity promotion. PURPOSE: This study examined the Transtheoretical Model of behavior change in relationship to the physical activity behavior of low-income American Indian mothers. DESIGN: A descriptive-correlational study employed a purposive sample (N = 30) of six American Indian mothers at each of five stages of behavior change. Participants were recruited from a Women, Infants and Children program located on the Pine Ridge Indian Reservation in South Dakota. Instruments included the 7-day Activity Recall, Stages of Exercise Adoption tool, Pros and Cons to Exercise tool, Self-efficacy for Exercise scale, and the Processes of Exercise Adoption tool. FINDINGS: Significant relationships were found between stage of change and energy expenditure indices (r = 0.69-0.74, p < .01), pros (r = 0.62, p < .01), cons (r = -0.58, p < .05), decisional balance (r = 0.59, p < .01), and self-efficacy (r = 0.60, p < .01). Pros and cons were different from a prior study of mothers attending the Women, Infants and Children program. CONCLUSIONS: The Transtheoretical Model is relevant to American Indian mothers and should be tested in future physical activity interventions.

Sociocultural perspective on organ and tissue donation among reservation-dwelling American Indian adults.

OBJECTIVE: To discover the sociocultural patterns that influence decisions about organ and tissue donation among American Indian (AI) adults. DESIGN: This qualitative ethnographic study used a social-ecological framework. A snowball sampling technique was used to recruit 21 Oglala Lakota Sioux participants (age >or= 19 years) living on the Pine Ridge Indian Reservation in South Dakota, USA. Face-to-face interviews were conducted using open-ended questions derived from the social-ecological perspective of Stokols (1992). Interviews were audiotaped and transcribed. Data were categorized into construct codes to identify concepts and to discover emerging themes. RESULTS: Personal and environmental themes regarding organ and tissue donation emerged. There were two personal themes: uncertain knowledge and the diabetes crisis. Participants knew very little about organ and tissue donation but there was a basic understanding of donor/recipient compatibility. The prevalence of diabetes in the community is contributing to a dire need for kidney donors. The diabetes crisis was acknowledged by every participant. There were three environmental themes: cultural transitions, healthcare system competence and outreach efforts. Traditional cultural beliefs such as entering the spirit world with an intact body were acknowledged. However, conversations reflected re-examination of traditional beliefs because of the need for kidney donors. The healthcare environmental context of organ and tissue donation emerged as a theme. Participants were not confident that the local health system was prepared to either address traditional beliefs about organ and tissue donation or implement a donation protocol. The final theme was the environmental context of outreach efforts. Participants desired relevant outreach targeted to the community and disseminated through local communication networks including the family, the media and tribal leaders. CONCLUSIONS: Sociocultural factors relevant to the personal and environmental context of the social ecological model influenced beliefs about organ and tissue donation among the Lakota people in this study. Outreach programs aimed at increasing donation need to respect traditional beliefs yet present the choice about organ and tissue donation within the cultural context. Telling the stories of community members affected by both diabetes and donation is important. Promoting family conversation is critical. Healthcare systems must approach potential donor families with an understanding of traditional beliefs and respect for the process of family communication about organ and tissue donation.

Teaching core nursing values.

Nursing is a caring profession. Caring encompasses empathy for and connection with people. Teaching and role-modeling caring is a nursing curriculum challenge. Caring is best demonstrated by a nurse's ability to embody the five core values of professional nursing. Core nursing values essential to baccalaureate education include human dignity, integrity, autonomy, altruism, and social justice. The caring professional nurse integrates these values in clinical practice. Strategies for integrating and teaching core values are outlined and outcomes of value-based nursing education are described. Carefully integrated values education ensures that the legacy of caring behavior embodied by nurses is strengthened for the future nursing workforce.

Teaching social justice.

Social justice is a core nursing value and the foundation of public health nursing. Social justice ideology requires nursing students to uphold moral, legal, and humanistic principles related to health. As such, teaching social justice requires a basis in moral developmental theory. In addition, teaching social justice demands action beyond classroom pedagogy. The author describes how social justice is taught within a baccalaureate program. A social justice project is described and examples are provided.

Application of the Transtheoretical Model of behavior change to the physical activity behavior of WIC mothers.

This descriptive-correlational study examined the Transtheoretical Model (TTM) of behavior change in relationship to the physical activity behavior of mothers receiving assistance from the Women, Infants, and Children program. A purposive sample (N = 30) of six women at each of the five stages of readiness for behavior change was used. Relationships between stage of behavior change (measured using the Stage of Exercise Adoption tool) and other TTM constructs were examined. The constructs and corresponding instruments included physical activity behavior (Seven-Day Physical Activity Recall), pros, cons, decisional balance (Exercise Benefits/Barriers Scale and two open-ended questions), self-efficacy (Self-efficacy for Exercise scale), and processes of behavior change (Processes of Exercise Adoption tool and the Social Support for Exercise scale). Significant relationships were found between stage of behavior change and two physical activity energy expenditure indices (rs = 0.71-0.73, p < 0.01), daily minutes of moderate to very hard physical activity (rs = 0.81, p < 0.01), pros (rs = 0.56, p < 0.01), cons (rs = -0.52, p < 0.05), decisional balance (rs = 0.56, p < 0.01), and self-efficacy (rs = 0.56, p < 0.01). Use of the 10 processes of change differed by stage of change. Pros to physical activity included a sense of accomplishment, increased strength, stress relief, and getting in shape after pregnancy. Cons included fatigue, childcare, and cold weather. Results support the TTM as relevant to WIC mothers and suggest strategies to increase physical activity in this population.