Smoking cessation counseling during periodic health examinations.

Periodic health examinations are an excellent opportunity to counsel smokers to quit. The impact of a specialized smoking cessation counselor on the smoking behavior of patients having periodic health examinations was studied in a general internal medicine practice. One hundred fifty-five smokers having periodic health examinations were randomly assigned to a control group who received usual physician advice or an intervention group who received usual physician advice and two counseling sessions with a smoking cessation counselor. The two groups were similar in all demographic variables, smoking-related baseline variables, and baseline levels of motivation and intention to quit smoking. The smoking status of 97% of the subjects was assessed 6 months later. In the intervention group, 46% made quit attempts and 19% quit, compared with 34% and 12%, respectively, in the control group. Intervention-group smokers made more quit attempts (mean +/- SD, 5.0 +/- 2.5 vs 1.8 +/- 0.2) and had a greater reduction in daily cigarette use (8.4 +/- 1.5 vs 3.5 +/- 1.3). Of the 74% of smokers with higher levels of motivation to quit smoking, more intervention-group smokers attempted to quit (70.8% vs 45.5%) and succeeded in quitting at the 6-month follow-up (27.1% vs 10.9%). Periodic health examinations are an excellent opportunity to counsel smokers to quit, especially those smokers with higher levels of motivation to quit smoking.

Acquired immunodeficiency syndrome/human immunodeficiency virus risk behavior among gay men in small cities. Findings of a 16-city national sample.

BACKGROUND: Most research on acquired immunodeficiency syndrome has been conducted in several of the country's largest cities, and little is known about the current level of human immunodeficiency virus risk taking among gay men in other geographical areas. The purpose of this study was to determine the frequency of risk behavior practices among gay men in smaller communities. METHOD: A large sample of men who patronized gay bars in 16 small and moderate-size cities drawn from six states in four different regions of the country was surveyed to determine the frequency of high-risk behavior and factors influencing risk taking. Eighty-five percent of men in all cities' bars completed all survey measures. The community samples were 1991 men; mean age, 31.3 years; mean education, 10.6 years; 90% were white and 10% were of other ethnicities. All participants provided detailed information on their sexual behavior practices over the preceding 2 months and completed measures assessing their perceived peer norms concerning safer sex practices and risk avoidance, intentions to avoid risk, personal risk estimation, acquired immunodeficiency syndrome risk knowledge, perceived threat of acquired immunodeficiency syndrome/human immunodeficiency virus, and serostatus testing history. RESULTS: High-risk patterns were still common among gay men in these smaller cities; nearly one third of all men had engaged in unprotected anal intercourse an average of eight times in the past 2 months, usually outside monogamous relationships. High-risk behavior was most strongly associated with beliefs that safer sex practices would not be well accepted by peers, weak intentions to use condoms, underestimation of personal vulnerability to the acquired immunodeficiency syndrome, younger age, and higher levels of overall sexual activity. Nine percent of men tested said they were seropositive. CONCLUSIONS: Growing human immunodeficiency virus prevalence and continued high rates of risk behavior indicate that a new "front line" for human immunodeficiency virus prevention among homosexually active men has shifted to the country's smaller cities. Community prevention efforts in these areas are urgently needed to avert sharp increases in future human immunodeficiency virus infections in this population.

High risk sexual behavior and alcohol consumption among bar-going gay men.

OBJECTIVES: To determine whether alcohol use prior to sexual behavior influenced the occurrence of unprotected anal intercourse among bar-going gay men. METHODS: Anonymous AIDS behavioral risk surveys were administered to men entering gay bars in 16 cities on three nights in February 1993 in six states in the United States. RESULTS: Of the 1519 men who completed the survey, 85% were current alcohol drinkers. Men who had unprotected anal intercourse after consuming alcohol drank more and reported more incidents of unprotected anal intercourse than men who had unprotected anal intercourse but not after drinking. Overall, unprotected anal intercourse occurred less frequently after alcohol consumption than without prior consumption. CONCLUSIONS: This study found that heavy alcohol use and frequent high-risk sexual behavior occurred among the same individuals. However, we found no evidence for a causal link between alcohol use and unprotected sexual behavior in this sample of bar-going gay men.

Smoking relapse prevention during pregnancy. A trial of coordinated advice from physicians and individual counseling.

INTRODUCTION: Our objective was to examine the efficacy of physicians' advice and referral to individual counseling in preventing relapse to smoking among women who were smokers early in pregnancy, but quit prior to their first prenatal visit. DESIGN: A randomized controlled trial of prompted physician's advice and individual relapse prevention counseling during pregnancy compared to usual physician advice. Smoking status was assessed by self-report, exhaled carbon monoxide, and urinary cotinine during pregnancy and by self-report 1 year postpartum. RESULTS: There were no significant differences in relapse rates between the intervention and usual-care groups during pregnancy, nor at 1 year postpartum. Relapse rates were 23% in both groups at the 36-week visit, and 32% and 22%, respectively, 1 year postpartum. Younger age, higher motivation to resume smoking, and higher levels of exhaled carbon monoxide at the first prenatal visit were predictive of relapse to smoking during pregnancy. With the conservative assumption that all those lost to follow-up relapsed, the combined 1-year postpartum relapse rate, 51%, was 17 percentage points lower than we observed in an earlier relapse prevention trial, and 15 percentage points lower than that observed nationally a decade earlier. CONCLUSION: Prompting physicians to provide supportive advice combined with referral to individual relapse prevention counseling did not reduce smoking relapse rates during pregnancy, or postpartum. However, the level of attention paid to smoking by physicians in both intervention and usual-care groups during pregnancy may have contributed to the relatively low relapse rates seen 1-year postpartum.

Helping women quit smoking: baseline observations for a community health education project.

INTRODUCTION: Our objectives were (1) to examine the relationship between women's intention of stopping smoking in the next month and a broad range of mediating variables and (2) to assess the implications of these relationships for intervention components of a comprehensive community-wide health education program to help women quit smoking. METHODS: In preparation for the community-wide program to help women quit smoking, baseline data were collected through a random digit dialing telephone survey of 6,324 adult women, 18-64 years of age. RESULTS: At baseline, smoking prevalence, defined as smoking an average of one or more cigarettes per day, was 25.8% and showed clear relationships with age and income, but most strikingly with education, indicating the need for programs for women of childbearing age with low incomes and fewer years of schooling. Among female smokers, knowledge of the health effects of smoking; motivations toward quitting; confidence in controlling weight, or handling stress, anger or boredom; number of strategies named to cope when upset of angry; number of community smoking cessation resources named; perceptions of support for quitting; and perceptions of norms concerning women smoking varied significantly with level of intention to quit smoking in the next month. CONCLUSIONS: These relationships provided support for the broad range of health behavior change strategies proposed for this community-based program to help women quit smoking.

Smoking relapse prevention counseling during prenatal and early postnatal care.

Our objective was to examine the efficacy of the added effect of individualized smoking relapse prevention counseling on obstetricians' and nurse midwives' usual advice during prenatal care. One hundred and seventy-five pregnant women who were smoking early in their pregnancy, but had quit by first prenatal visit, were randomly assigned to receive the usual advice from their obstetrician or nurse midwife, or usual advice plus individual relapse prevention counseling. Smoking status was measured by self-report, by urinary cotinine/creatinine ratio at the 36-week visit, and by self-report at long-term postpartum follow-up. We found that a smaller percentage of women in the intervention group (8.8%) reported smoking at the thirty-sixth-week visit than those in the usual care group (16.9%), a nonsignificant difference. No significant difference in relapse rates during pregnancy was observed based on urinary cotinine/creatinine ratios, but these rates, 29.5% and 27.9% respectively, were substantially higher than those based on self-report. The average number of days abstinent reported by women in the intervention group was significantly longer than that in the usual care group, 199 days versus 166 days respectively (P < .01). Logistic regression analysis indicated that longest time abstaining before first visit, level of belief in smoking's harm to the fetus, and motivation to smoke were independently related to the probability of relapsing to smoking by the 36-week visit. Long-term relapse rates were not significantly different: intervention group, 50.9%, usual care group, 50.0%.(ABSTRACT TRUNCATED AT 250 WORDS)

Smoking cessation among self-quitters.

We examined cessation among 630 smokers who quit abruptly on their own. Continuous, complete abstinence rates were 33% at 2 days, 24% at 7 days, 22% at 14 days, 19% at 1 month, 11% at 3 months, 8% at 6 months postcessation, and 3% at 6 months with biochemical verification. Slipping (smoking an average of less than 1 cigarette/day) was common (9% to 15% of subjects) and was a strong predictor of relapse; however, 23% of long-term abstainers slipped at some point. These results challenge beliefs that most smokers can initially stop smoking and that most relapse occurs later on postcessation.

State legislators' intentions to vote and subsequent votes on tobacco control legislation.

The predictive validity of state legislators' behavioral intentions in relation to their votes on tobacco control legislation was assessed by using the theory of planned behavior (I. Ajzen, 1991). Intentions to vote for cigarette tax increases were measured through interviews in the summer of 1994. A bill containing cigarette tax increases was considered about 8 months later. Votes were compared with intentions and were found to be consistent for 78% of these legislators (N = 120). Multiple logistic regression analyses showed a strong independent relationship between intentions and voting and a similar effect of political party; results suggested but did not confirm that votes were predicted by interactions between intentions and perceived control. Legislator surveys that use this conceptual model can provide results relevant to understanding tobacco policy development.

An investigation of self-efficacy, partner support and daily stresses as predictors of relapse to smoking in self-quitters.

Six hundred and thirty smokers who intended to quit smoking themselves completed pre-cessation measures of self-efficacy, partner support, daily stresses and demographics. Subjects were contacted at 2, 7, 14, 30, 90 and 180 days post-cessation to determine smoking status and to re-administer the measures at 7, 14 and 30 days post-cessation. A series of logistic regression examined which prospective factors best predicted relapse between 0-2 days, 3-7 days, 8-14 days, 15-30 days, 31-90 days and 91-180 days. Relapse was predicted by different variables at different times; however, self-efficacy was a consistent predictor of relapse over time.

Factors predicting continued high-risk behavior among gay men in small cities: psychological, behavioral, and demographic characteristics related to unsafe sex.

Nearly 6,000 men entering gay bars in 16 small American cities were anonymously surveyed to assess their sexual behavior and to determine predictors of risky sexual practices. Excluding individuals in long-term exclusive relationships, 27% of the men reported engaging in unprotected anal intercourse in the past 2 months. Factors strongly predictive of risk included having a large number of different male partners, estimating oneself to be at greater risk, having weak intentions to use condoms at next intercourse, believing that safer sex is not an expected norm within one's peer reference group, being of younger age, and having less education. These findings indicate that HIV prevention efforts are urgently needed for gay men in smaller cities, with efforts particularly focused on young and less educated men sexually active with multiple partners. Prevention should focus on strengthening intentions to change behavior and on changing social norms to foster safer sex.

Differences in HIV risk characteristics between bisexual and exclusively gay men.

Research investigating HIV-risk sexual behaviors of men who have sex with men usually combines gay and bisexual men, treating them as a single, homogeneous group. However, gay and bisexual men may differ in their HIV risk behavior and in psychological characteristics indicative of risk. Exclusively gay (N = 1,180) and bisexual men (N = 136) completed anonymous surveys at gay bars. The surveys assessed demographic, psychological, and behavioral data related to sexual behavior and HIV risk. Relative to exclusively gay men, bisexual men had lower intentions to use condoms in their next intercourse occasion, reported a greater frequency of oral sex with men and more oral-sex partners, knew fewer people who were HIV positive, and perceived weaker peer norms favoring safer sex and risk avoidance. One-third of bisexual men reported engaging in unprotected anal intercourse, and 17% of bisexual men had multiple unprotected anal sex partners in the past two months. Interventions tailored to the needs of bisexual men are urgently needed and should focus on increasing intentions to use condoms, increasing HIV-risk sensitization, and fostering norms favoring safer sex and risk avoidance.

Psychosocial differences between recently HIV tested and non-tested gay men who reside in smaller US cities.

While a number of studies have examined behavioural and psychosocial correlates of HIV test seeking, most of this research has relied on samples of urban gay men. Less is known about HIV testing rates and factors associated with testing among gay and bisexual men who live in smaller cities. The present research administered surveys to 3969 non-exclusively partnered gay and bisexual men attending gay bars in small American cities to determine (a) rates of HIV test seeking, and (b) how tested and non-tested men differed on a battery of psychosocial indices. A total of 68% of men had been tested for antibodies to HIV--50% in the past year. Men tested for HIV in the past year, compared to men never tested for HIV, knew more people who were HIV positive or were diagnosed with AIDS, had a closer relationship with someone who had died of AIDS, were more likely to be ethnic minorities, reported more conversations with friends about safer sex, and had stronger intentions to use condoms during their next intercourse occasion. Our results indicate that HIV counselling and testing programmes comprise an important component of HIV prevention efforts assisting gay men residing in smaller USA cities.

Smoking cessation practices in dental offices.

We have surveyed the health promotion efforts of dentists and dental hygienists in general dental practice in Chittenden County, Vermont, in relation to smoking. The response rate was 61 percent. Smoking issues were addressed by 76 percent of dentists and 81 percent of dental hygienists in approximately one quarter of their smoking patients. Although the majority of both dentists and dental hygienists advised their patients to change their smoking behavior, their advice was usually to cut down rather than to quit. Most of the respondents--78 percent of dentists and 93 percent of dental hygienists--considered it appropriate to give advice about smoking during visits for routine dental care and 68 percent and 89 percent, respectively, were willing to learn brief methods of advising their patients about smoking. Experience with giving advice about smoking and agreement that it was appropriate to give such advice were both strongly related to willingness to learn brief methods of giving such advice. In individual dental practices, there were virtually no correlations between the dentist's and the dental hygienist's behaviors as far as the proportion of patients from whom a smoking history was taken, the proportion of smokers advised about smoking, the content of the advice, or the nature of the advice. Only nine percent of dentists and 11 percent of dental hygienists were current smokers.

Barriers to condom use among heterosexual male and female college students.

The authors used a questionnaire to assess gender differences in barriers to condom use among 198 female and 89 male heterosexual undergraduate college students. Participants were divided into three groups--consistent users, inconsistent users, and nonusers--based on their reported condom use. Factor analyses on each gender revealed similar barrier factor structures, but the barriers explained more of the variance in condom use among women than among men. Of the 9 or 10 predictors assessed, the low perceived need barrier was the most powerful predictor of condom use for both genders. Male and female participants who were nonusers, in a current monogamous relationship, and using oral contraceptives were more likely to report a low perceived need to use condoms. Implications for future research are discussed.

PIP: 309 college students were recruited from three undergraduate psychology classes at the University of Vermont in the spring of 1990 to respond to survey questions designed to identify prevailing barriers to condom use. The students reported engaging in only heterosexual relations. Analysis included only the 198 female and 89 male students who reported having had sexual intercourse at least five times in the preceding 2 years; 90.8% of the men and 93.8% of the women. Barriers assessed were concern that condom use reduces the pleasure of sex, concern that condoms reduce emotional intimacy, concern about what a partner will think if you suggest using condoms, concern about what friends will think if they knew that you use condoms, concern about how to talk with your partner about condom use, and the belief that you have no need to use condoms. 24.7% of the men were consistent users, 41.6% were inconsistent users, and 33.7% nonusers. 22.7% of the women were consistent users, 29.8% inconsistent users, and 47.5% nonusers. The men and women had an average of 3.48 and 2.64 sex partners in the preceding 2 years. 11.2% of the men and 12.1% of the women had histories of STD. 55.1% of the men and 73.2% of the women were currently in a relationship, depending largely upon oral contraceptives for protection against unwanted pregnancy. The survey found the low perceived need barrier to be the most powerful predictor of condom use for both sexes. Low perceived need, however, was not based upon participants' actual STD risk and actual STD risk was not related to condom-use category. Male and female participants who were nonusers, in a current monogamous relationship, and using oral contraceptives were more likely to report a low perceived need to use condoms. Implications for future research are discussed.

A statewide survey of dentists' smoking cessation advice.

The general practitioners of the Vermont State Dental Society (251) were surveyed in 1986 to determine their smoking cessation activities. Seventy-eight percent of the dentists completed the survey and 87% reported that they discussed concerns about smoking with their patients who smoke. They estimated spending an average of 2.4 minutes addressing cigarette smoking issues. Among those dentists who discussed smoking issues, the majority (60%) provided some advice on ways to change smoking behavior. The remaining 40% provided no guidance regarding smoking behavior change. The larger the proportion of smokers advised about smoking, the greater the dentists' interest in using incentives to help smokers make an attempt to quit.

Physician interest in breast cancer screening education. A survey of Vermont family physicians.

A mailed survey of 141 Vermont family physicians (74% participating) was conducted to determine their breast cancer screening practices and beliefs and their interest in receiving training in breast cancer screening. Of these, only 12% reported that at least three fourths of their female patients older than 50 years received mammograms at least once a year, compared with 33% who reported providing breast self-examination instruction and 35% who administered clinical breast examination with at least three fourths of these patients at least once a year. Nevertheless, 55% of the physicians rated mammography as a very effective breast-screening procedure; 28% rated breast self-examination and 16% rated clinical breast examination as very effective. Three fourths of the physicians showed great interest in learning more about breast palpation, breast self-examination instruction, and mammography. Individual instruction in the office was preferred over a group workshop format, and a trained nonphysician health professional was considered as acceptable as a physician to provide the instruction. Results suggest that breast cancer screening education for family physicians is a high priority, and that physicians will welcome such training, particularly if it is office-based.

Prevention of the spread of AIDS: An interview with Jeffrey A. Kelly.

Jeff Kelly is the Chief of the Division of Psychology in the Department of Psychiatry Human Behavior at the University of Mississippi Medical Center. Trained as a clinical psychologist, he has performed research and written extensively on the topics of sex roles, social skills training, and prevention of child abuse. Since 1985, Jeff has devoted much of his clinical and research efforts to understanding and helping AIDS victims and to preventing the spread of AIDS. He is the Principal Investigator of a grant from the National Institute of Mental Health to study behavioral training to reduce AIDS at-risk activities, and is a co-author of the forthcoming book entitled,Psychosocial Interventions for AIDS.

The effects of EMG feedback training during problem solving: a case study.

The present case study investigated the effects of competing task demands on biofeedback training to reduce frontalis muscle tension. Baseline levels of frontalis muscle tension were recorded for relaxation and problem solving. The subject was trained to decrease muscle tension with biofeedback for the problem-solving task alone. The results indicated that EMG training during problem-solving was successfully accomplished. Frontalis muscle tension during relaxation baseline did not change as a result of reductions in muscle tension during problem-solving feedback training. This suggests that the decrease of muscle tension cannot be attributed to reductions in overall muscle tension levels. Instead, training was specific to the problem-solving feedback phases. Additionally, it was found that accuracy in problem-solving did not decline as a result of simultaneous feedback training. Thus EMG biofeedback training can be accomplished and exercised without disruption of ongoing mental activity.

Why volunteers helped to promote a community breast self-exam program.

Involving volunteers in community health programs is common practice. However, there is little information about specific methods to motivate volunteers to become involved and stay involved. In a community breast self-exam (BSE) education project, volunteers played a major role in the recruitment of women for BSE training presentations given by nurse instructors. Working in a support group capacity, approximately 20 women volunteers in each of two communities completed recruitment tasks such as hosting presentations in their own homes, arranging for presentations for a club or organization, and endorsing the program in the media. At the end of a three-month period, the activities of these volunteers had increased participation of community women in presentations by 50% in one community and 115% in the second community, and the BSE education program had increased both the frequency and quality of BSE practice throughout both communities. Because of the success of the volunteer support group strategy, an interview was conducted with the eleven "super-star" volunteers to assess the motivational factors influencing their initial and continued involvement. Results include a description of common characteristics of these highly motivated volunteers and several recommendations for volunteer administrators or for anyone attempting to recruit and maintain motivated groups of volunteers.