A Retrospective Study of Federal Employees' Outcomes Following A Smoking Cessation Intervention.

This retrospective study aimed to describe the federal employee population who participated in Federal Occupational Health's (FOH) smoking cessation intervention and to examine relationships and factors that influenced smoking cessation within this population. A large-scale national database of federal employees who participated in the smoking cessation intervention from January 2009 to January 2019 was obtained from FOH's administrators. The sample included 1265 participants who completed the survey 6 months post intervention. Descriptive statistics, chi square (c2), Pearson's correlation, and logistic regression were used to describe and correlate variables. Out of 1243 smokers, 590 (47.5%) successfully quit smoking while 653 (52.5%) did not quit smoking post intervention. Employees smoked, on average, for 23 years and smoked 18 cigarettes (more than ½ pack) per day before quitting. There was a positive correlation between the number of cigarettes smoked and number of years smoked before quitting. As the number of cigarettes and length of time smoking increased, the odds of quitting increased. FOH's cessation intervention helped participants quit smoking. FOH is positioned to integrate cessation strategies with its health promotion and protection programs to help end tobacco-related illnesses and diseases. The investigators' findings provide important evidence and support for FOH's work-site smoking cessation intervention. FOH could collaborate with other federal entities and provide evidence-based smoking cessation interventions with limited or no barriers.

Military suicide coverage: AP news wire & suicide guidelines.

The authors evaluated how well Associated Press News Wire stories adhered to the Recommendations for Reporting on Suicide™ during 2012, a peak year of military suicide. They included individual suicide stories (N = 167) from randomly selected days. They also evaluated differences in the military versus civilian coverage. Military and civilian stories typically had about five negative practices, and less than one positive practice, with military stories significantly more likely to miss valuable opportunities to promote help-seeking. The findings, combined with previous evidence, suggest the need for the development of specific military suicide reporting guidelines.

Readability and Suitability of Spanish Language Hypertension and Diabetes Patient Education Materials.

Hispanics who speak Spanish are at risk for low health literacy. We evaluated Spanish language hypertension (HTN) and diabetes mellitus (DM) patient education materials from U.S. federal agency public sector sources using the Suitability of Assessment (SAM) instrument. Mean readability for HTN materials was grade 7.9 and for DM materials was grade 6.6. Mean SAM score for HTN materials was 43.9 and for DM materials was 63.2. SAM scores were significantly better for DM than for HTN materials in overall score, content, graphics, layout, stimulation/motivation, and cultural appropriateness (p < .05). Clinicians should evaluate suitability of Spanish language HTN and DM materials that they use in patient teaching.

Meaning of Adherence in Hepatitis C-Infected Military Veterans.

Among United States (U.S.) veterans, the prevalence of chronic hepatitis C infection is three times that of the general U.S. population. Treatment success is proportionate to the degree of treatment adherence. There has been little research dedicated to the systematic exploration of issues related to treatment adherence. The purpose of this study was to describe factors that influenced adherence in infected military veterans. Phenomenological research emphasizes a rich description. A convenience sample of 21 veterans was recruited from a clinic in north Texas. One-time in-depth interviews explored reasons for remaining in treatment despite difficult side effects. Analysis included immersion, data transformation, thematic analysis, and summary. Cognitive strategies to stay on medication include making a commitment to treatment, "not ready to leave this world," conserving energy and staying busy, looking forward, and starting over. Veterans utilize previously learned military discipline to stay on medications and follow providers' orders. They are not ready to die and have plans for life after treatment. Patient education should focus on side effect management, rather than on genotypes or viral load. Treatment teams should include substance abuse specialists and gastroenterology providers. Future studies need to develop a measurement tool for adherence during antiviral treatment.

An ethnography of chronic pain in veteran enlisted women.

Enlisted women are an essential subpopulation within the United States (U.S.) Armed Services, yet little is known about their chronic pain experiences. The purpose of this study was to describe veteran enlisted women's chronic pain experiences, both while on active duty and since active duty ended. A total of 15 enlisted women were interviewed. This ethnographic approach produced stories of their beliefs, attitudes, and behaviors regarding their chronic pain and the care they have received both while serving and after discharge or retirement. The findings show that U.S. military culture and training have a major impact on enlisted women's chronic pain experiences. Enlisted women learn to ignore or deny acute pain because it would hamper their ability to complete their military mission. Even when they admit to themselves that they are in pain, they may mask the pain from others for fear of being called weak or fear of discrimination and ostracism. When the pain can no longer be ignored and they seek health care, they are frustrated when their pain reports are not believed by supervisors and health care providers. Chronic pain eventually leads to discharge or retirement when they can no longer do their job. Health care providers must understand both U.S. military culture and enlisted women's strategies concerning pain if they are to accurately diagnose and sufficiently treat enlisted women in pain.

Mexican immigrants' and Mexican Americans' perceptions of hypertension.

Although the rate of hypertension (HTN) is no higher for Mexican-origin clients than for non-Hispanic Whites, their rate of blood pressure (BP) control is lower. To effectively assist clients with their BP, health care providers must first understand barriers and facilitators to BP control from the clients' perspectives. The purpose of this study was to describe the experience of living with HTN for Mexican immigrants and Mexican Americans. A phenomenological method was appropriate to describe their lived experience. We conducted one-time interviews with 26 adults who self-identified as Mexican-origin. Some participants did not know what caused HTN and others believed in causes they could control. Many believed HTN was of short duration. Some participants forgot to take medication or were not able to afford it. Mexican-origin clients need more assistance with BP control, and need it in both English and Spanish.

Voices of Adults Living with Sickle Cell Disease Pain.

The purpose of this qualitative study was to describe the lived experiences of adults with sickle cell disease-related pain. Using a qualitative, phenomenological approach, a purposive sample of 13 African-American adults living with Sickle Cell Disease (SCD) was recruited from a national SCD support group. Participants were asked to describe living with SCD-related pain and their experiences with pain management. Four themes emerged from the data: (1) description of the pain experience, (2) pain scales do not work, (3) managing pain, and (4) managing relationships. Persons living with SCD need comprehensive pain assessment from Health-Care Providers [HCPs], who recognize the impact of pain on their patients' lives. The findings support further research aimed at the assessment and management of SCD-related pain. HCPs are strategically positioned to improve health outcomes for those with SCD pain by listening to patients' unique stories and accurately assessing and effectively intervening to promote pain relief for patients living with SCD-related pain.

Transition to Practice: The Lived Experience of New Graduate Nurses in Early Solo Flight.

This qualitative study is based on individual interviews with 15 new graduate nurses during their first few months of independent practice. Three themes emerged from the data that reflected their lived experience: feeling overwhelmed, navigating work-based relationships, and finding their flow. Nursing professional development specialists who work with these newly independent nurses are uniquely situated to offer ongoing educational support and to conduct evidence-based conversations with them about the transition to practice.

Voices of Mexican American caregivers for family members with cancer: on becoming stronger.

This grounded theory study report describes the experience of 34 Mexican American (MA) female caregivers who provided care to a family member with cancer. Caregivers identified a process of "Becoming Stronger" as a result of their caregiver role. The emerging theoretical model of female MA cancer caregiving offers evidence to change current cancer care approaches from patient-focused to family-focused care for this ethnic group. Findings suggest that changes most responsive to cultural values and likely to provide accessible and quality cancer care for MA families are those that involve active partnering with MA caregivers to prioritize the patient's cancer care.

Self-Determination Theory With Application to Employee Health Settings.

Occupational health nurses motivate employees to engage in healthy behaviors. Both clinicians and researchers need strong theories on which to base decisions for health programs (e.g., healthy diet) and experimental interventions (e.g., workplace walking). The self-determination theory could be useful as it includes concepts of individual autonomy, competence to perform healthy behaviors, and relationships as predictors of health behaviors and outcomes. In this article, the self-determination theory is described and evaluated using Walker and Avant's criteria. The theory is applied to a population of federal employees who smoke. By increasing employees' ability to autonomously choose smoking cessation programs, support their competence to stop smoking, and improve their relationships with both others who smoke and employee health services, smoking cessation should increase.

Community social support for Cuban refugees in Texas.

Social support has been linked to positive health outcomes for many populations across multiple health issues. The interactional approach defines social support as a complex, transactional process between the person and his or her social environment. Being part of a community enhances the likelihood of social bonding, leading to increased perceived support. In this study, the authors describe recently arrived adult Cuban refugees' perceptions of community-level support in Texas. Practical and emotional support needs included jobs and companionship away from everyday problems. The two major sources of practical support were resettlement agencies and other Cubans. The two major sources of emotional support were other Cubans and English-speaking friends. There were no local Cuban clubs or associations where Cubans could meet. Besides receiving support, many Cubans were also supporting other Cubans locally and in Cuba, and some experienced discrimination.

Health risk and promotion behaviors in refugee populations.

Refugees resettling in the U.S. are generally low-income and underserved by health promotion interventions. To begin to address refugee health promotion issues, this study describes health behaviors of newly arrived (less than 90 days) adult refugees in the U.S. The methods used were retrospective description of clients from one refugee health screening program. The sample consisted of adult refugees (n=591), men and women, from Cuba, Bosnia, Vietnam, Kosovo, Iran, Iraq, and other countries. Rates of overweight were highest among Bosnians and lowest among Vietnamese. Cubans reported the most physical activity and Kosovars the least. Rates of smoking were highest among Bosnians and lowest among Cubans. Older refugees were more overweight and reported less physical activity and more smoking than younger adults. In some cases, different refugee groups have similar health promotion needs, while in others needs differ. This baseline descriptive data supports calls for further health promotion research and interventions in refugee populations.

Refugee women's reproductive health in early resettlement.

OBJECTIVE: To describe reproductive health needs and screening rates for breast and cervical cancer for newly arrived (less than 90 days) refugee women in the United States. DESIGN: A retrospective study of existing medical charts from 1996 to 2000. SETTING: Refugee health screening clinic, central Texas. PATIENTS: Refugee women (n = 283) newly arrived in the United States from Cuba (31.1%), Bosnia (26.1%), Vietnam (24.7%), and other countries (18.0%); age range = 18 to 74 years, mean age = 34.4 years. MAIN OUTCOME MEASURES: Frequency of reproductive health problems and breast and cervical cancer screening rates. RESULTS: Twenty-five percent of women in the sample were pregnant or had a reproductive health problem. A significant percentage older than 40 (86%) had never had a mammogram when compared to American women of the same age (33%). Only 24% reported having had a Pap test within the previous 3 years. CONCLUSIONS: The risk of not receiving adequate reproductive health care is higher among newly arrived refugee women compared to nonrefugee women in the United States. For refugee women to enjoy optimum health, their individual needs and health care system issues must be addressed.

Refugees' perceptions of healthy behaviors.

This descriptive study explored refugees' knowledge and perceptions of nutrition, physical activity and smoking behaviors using the Health Promotion and Transtheoretical Models. A one-time interview used both closed- and open-ended questions. The sample included 31 adults from Bosnia, Iran, and Cuba. Refugees had some knowledge of a healthy diet and physical activity, and were aware of both benefits and barriers for health behaviors. They had a realistic perception of their weight (55% overweight), and none thought obesity was a positive characteristic. Changes in diet, physical activity and smoking since arrival in the US have been positive for some and negative for others. For all categories discussed, refugees were in the pre-contemplation stage of change. There is a need to study refugees' health behaviors over time after arrival. Health behavior interventions must be specific to ethnicity in order to accurately document progress and to be culturally appropriate.