College students' preferences for tobacco treatment: a discrete choice experiment.

The purpose of this study was to elicit preferences for the 'format' and 'content' of tobacco treatment among college student smokers, using an online discrete choice experiment (DCE) survey. A DCE survey, supplemented with a think-aloud method, was conducted among 54 college students who smoked combustible cigarettes and/or e-cigarettes. Conditional logistic regression models were constructed to determine optimal profiles of treatment. Cutting down nicotine rather than quitting 'cold turkey' (P < 0.001) and two-way communication (P < 0.001) were viewed as the most critical attributes for the intervention 'format'; changing behaviors rather than social groups/peers (P < 0.001) and autonomy (P < 0.001) were viewed as the most critical attributes for the intervention 'content'. Some preferences varied based on smoking subgroups. Combustible cigarette users preferred interventions with a longer time commitment (P < 0.05) and without nicotine replacement therapies (NRTs) (P < 0.001). Think-aloud data supported the DCE findings and further revealed a strong desire for cutting down nicotine and keeping social groups/peers and misconceptions regarding NRTs. Our study findings can guide tobacco treatment tailored to college students. These treatments should be tailored to specific smoker subgroups.

Prenatal cocaine exposure and child behavior.

OBJECTIVE: The aim of this study was to evaluate previous teacher reports that children exposed to cocaine prenatally have more problem behaviors. METHODS: A historical, prospective design was used. Maternal subjects (n = 116) of 6-year-old singleton, term (>/=36 weeks) children, and the children's first-grade teachers (n = 102) agreed to participate. The child's first-grade teacher, blinded to study design and exposure status, rated the child's behavior with the Conners' Teacher Rating Scales (CTRS) and an investigator-developed scale, the Problem Behavior Scale (PROBS 14), measuring behaviors reported by educators to be specific to cocaine exposure. Mothers were interviewed by telephone regarding demographic and socioeconomic factors. RESULTS: Although the cocaine-exposed group had higher (more problem behaviors) for each of the CTRS subscales, the overall multivariate analysis of variance for the CTRS was not significant. Children exposed to cocaine prenatally had higher scores (more problem behaviors) for 11 of the 14 PROBS items and the overall multivariate analysis of variance relating prenatal cocaine exposure to the PROBS was significant (Wilkes' lambda =.775), even after controlling for gender and prenatal exposure to alcohol and cigarettes. CONCLUSIONS: This pilot study supports that teachers blinded to exposure status of early elementary students did rate the cocaine-exposed group as demonstrating significantly more problem behaviors than control children. Although an important first step, postnatal factors that also may influence behavior were not evaluated; hence, causation is not addressed.

Prenatal coke: what's behind the smoke? Prenatal cocaine/alcohol exposure and school-age outcomes: the SCHOO-BE experience.

Despite media reports and educators' concerns, little substantive data have been published to document or refute the emerging reports that children prenatally exposed to cocaine have serious behavioral problems in school. Recent pilot data from this institution have indeed demonstrated teacher-reported problem behaviors following prenatal cocaine exposure after controlling for the effects of prenatal alcohol use and cigarette exposure. Imperative in the study of prenatal exposure and child outcome is an acknowledgement of the influence of other control factors such as postnatal environment, secondary exposures, and parenting issues. We report preliminary evaluation from a large ongoing historical prospective study of prenatal cocaine exposure on school-age outcomes. The primary aim of this NIDA-funded study is to determine if a relationship exists between prenatal cocaine/alcohol exposures and school behavior and, if so, to determine if the relationship is characterized by a dose-response relationship. A secondary aim evaluates the relationship between prenatal cocaine/alcohol exposures and school achievement. Both relationships will be assessed in a black, urban sample of first grade students using multivariate statistical techniques for confounding as well as mediating and moderating prenatal and postnatal variables. A third aim is to evaluate the relationship between a general standardized classroom behavioral measure and a tool designed to tap the effects thought to be specific to prenatal cocaine exposure. This interdisciplinary research team can address these aims because of the existence of a unique, prospectively collected perinatal Database, funded in part by NIAAA and NICHD. The database includes repeated measures of cocaine, alcohol, and other substances for over 3,500 births since 1986. Information from this database is combined with information from the database of one of the largest public school systems in the nation. The final sample will be composed of over 600 first grade students for whom the independent variables, prenatal cocaine/alcohol exposures, were prospectively assessed and quantified at the university maternity center. After informed consent, the primary dependent variable, school behavior, is assessed, using the PROBS-14 (a teacher consensus developed instrument), the Child Behavior Check List, and the Conners' Teacher Rating Scale. The secondary dependent measure, school achievement, is measured by the Metropolitan Achievement Text and the Test of Early Reading Ability. Control variables, such as the environment and parenting, are measured by several instruments aimed at capturing the child and family ecology since birth. All analyses will be adjusted as appropriate for prospectively gathered control variables such as perinatal risk, neonatal risk, and other prenatal drug and cigarette exposures. Further adjustment will be made for postnatal social risk factors which may influence outcome. Of particular concern are characteristics of the home (adaptation of HOME), parent (depression, stress), and neighborhood (violence exposure). Finally, postnatal exposure to lead and other drugs is being considered.

Couples' patterns of adjustment to colon cancer.

The objectives for this longitudinal study were to: (a) compare colon cancer patients' and their spouses' appraisal of illness, resources, concurrent stress, and adjustment during the first year following surgery; (b) examine the influence of gender (male vs female) and role (patient vs spouse caregiver) on study variables; (c) assess the degree of correlation between patients' and spouses' adjustments; and (d) identify factors that affect adjustment to the illness. Fifty-six couples were interviewed at one week post diagnosis, and at 60 days and one year post surgery. Based on a cognitive-appraisal model of stress, the Smilkstein Stress Scale was used to measure concurrent stress; the Family APGAR, Social Support Questionnaire, and Dyadic Adjustment Scale were used to measure social resources; the Beck Hopelessness Scale and Mishel Uncertainty in Illness Scales were used to measure appraisal of illness; and the Brief Symptom Inventory and Psychosocial Adjustment to Illness Scale were used to measure psychosocial adjustment. Repeated Measures Analysis of Variance indicated that spouses reported significantly more emotional distress and less social support than patients. Gender differences were found, with women reporting more distress, more role problems, and less marital satisfaction, regardless of whether they were patient or spouse. Both patients and spouses reported decreases in their family functioning and social support, but also decreases in emotional distress over time. Moderately high autocorrelations and modest intercorrelations were found among and between patients' and spouses' adjustment scores over time. The strongest predictors of patients' role adjustment problems were hopelessness and spouses' role problems. The strongest predictors of spouses' role problems were spouses' own baseline role problems and level of marital satisfaction. Interventions need to start early in the course of illness, be family-focused, and identify the couples at risk of poorer adjustment to colon cancer.

Effects of long-term moderate exercise on iron status in young women.

The impact of long-term (6-month) moderate exercise on the iron status of previously sedentary women was determined by randomly assigning 62 college-age women into one of the following four groups: 1) 50 mg.d-1 iron supplement, low iron diet (N = 16); 2) Placebo, free choice diet (N = 13); 3) Meat supplement to achieve 15 mg.d-1 iron intake (N = 13); and 4) Control, free choice diet (N = 20). All groups except the Control group exercised 3 d.wk-1 at 60%-75% of their heart rate reserve. VO2max was measured at baseline and week 24. Blood was sampled at baseline and every 4 wk thereafter for 24 wk to measure iron status and to elucidate the causes for alterations in iron status. Subjects had depleted iron stores throughout the study as indicated by their serum ferritin levels (< 15 ng.ml-1). Serum iron, total iron binding capacity and transferrin saturation were not compromised with exercise. Mean hemoglobin level in the Placebo/Ex group was significantly (P < 0.05) lower than the 50 Fe/Ex and the Meat/Ex groups by week 24. However, changes in serum albumin, haptoglobin, and erythropoietin data from the study cannot explain these changes.

Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: a pilot study.

BACKGROUND: African Americans have a higher prevalence and greater severity of hypertension than do other minorities and whites. This fact is particularly problematic when one realizes that the rate of control and treatment of hypertension in the US population is getting worse rather than better. Alternative strategies to promote blood pressure control need to be tested. OBJECTIVES: The purpose of this pilot study was to test the following hypothesis: Persons who participate in nurse-managed home telemonitoring (HT) plus usual care or who participate in nurse-managed community-based monitoring (CBM) plus usual care will have greater improvement in blood pressure from baseline to 3 months' follow-up than will persons who receive usual care only. METHODS: This study used a randomized controlled design; participants were randomly assigned to 1 of 3 groups that were stratified by use or nonuse of antihypertension medication. One-way analysis of variance (ANOVA) and analysis of covariance (ANCOVA) controlling for age and body weight were used to determine changes in blood pressure from baseline to 3 months. The sample contained 26 African Americans with a mean age of 59 years. RESULTS: Both the HT group and the CBM group had clinically and statistically significant (P <.05) drops in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 3 months' follow-up, with participants in the HT group demonstrating the greatest improvement (HT: baseline SBP 148.8 +/- 13.8, DBP 90.2 +/- 5.79; 3 months' follow-up SBP 124.1 +/- 13.82, DBP 75.58 +/- 11.4; CBM: baseline SBP 155.25 +/- 17.014, DBP 89.42 +/- 10.95; 3 months' follow-up SBP 142.3 +/- 12.1, DBP 78.25 +/- 6.86). There was little change in SBP or DBP at 3 months' follow-up in the usual care only group. CONCLUSION: These are important pilot results, which if replicated in a larger sample will significantly improve care for urban African Americans with hypertension.

A comparison of nursing interventions for smoking cessation in adults with cardiovascular health problems.

OBJECTIVE: To examine the relative effectiveness of three different presentations of a smoking cessation program on the smoking behavior of adults with cardiovascular health problems. DESIGN: A 2 x 2 x 2 x 4 experimental design with stratification by sex, smoking history, and a cardiovascular event, and randomization to Individual, Group, Written, or No Intervention groups. SETTING: Six community hospital classrooms. SUBJECTS: 255 nonhospitalized adults. THEORETIC FRAMEWORK: Interaction Model of Client Health Behavior. MEASUREMENTS: Study Intake: Professional referral form, demographic questionnaire, smoking habits questionnaire, health history, perceived threat survey, perceived health status. Follow up: smoking cessation and health questionnaire, saliva thiocyanate testing. RESULTS: At 12-month follow-up, a nurse-client interaction was more effective than written self-help materials; however, smoking cessation rates were highest in the No Intervention control group, possibly related to having had coronary artery bypass graft surgery. Variables positively related to quitting were being male and married and having a higher income. With baseline factors considered, a quitter was most likely to be male and less than 48 years of age, have a high degree of perceived threat relative to medical diagnosis, and be in the individual intervention group. Only partial support for the study hypotheses was found.

Expressive language development of children exposed to cocaine prenatally: literature review and report of a prospective cohort study.

It was hypothesized that prenatal exposure to cocaine and other substances would be related to delayed expressive language development. Speech and language data were available for 458 6-year olds (204 were exposed to cocaine). No significant univariate or multivariate differences by cocaine exposure group were observed. Classification and regression tree modeling was then used to identify language variable composites predictive of cocaine exposure status. Meaningful cut points for two language measures were identified and validated. Children with a type token ratio of less than 0.42 and with fewer than 97 word types were classified into a low language group. Low language children (n = 57) were more likely to be cocaine exposed (63.1%), with cocaine-exposed children 2.4 times more likely to be in the low language group compared with control children after adjustment for covariates. Prenatal cigarette, but not alcohol exposure, was also significantly related to expressive language delays.

Parents' perceptions of quality health care.

PURPOSE: To examine differences in definitions of health care quality and the importance of indicators of quality between consumers with dependent children and consumers with no dependents. STUDY DESIGN AND METHODS: This was an exploratory study using a convenience sample of 229 consumers--96 with one or more dependent children and 133 with no dependent children. Consumers were asked four open-ended questions as to their definitions of health care and nursing care quality. Consumers then rated the importance of 27 indicators of quality care. RESULTS: There were no differences between parents with dependent children and other consumers in how quality care was defined. Important indicators of quality nursing care to parents with children were: Being cared for by nurses who are up to date, well informed, and certified in their specialty; being able to communicate with the nurse; spending enough time with the nurse; and teaching by the nurse. Although having access to midwives was of lowest importance to consumers overall, it was significantly more important to subjects with children (p < 0.05). Getting care and services when needed was also more important to parents than to consumers without children (p = 0.05). Parents gave more importance to their interactions with the nurse than did subjects without children (t = 1.93, df = 229, p = 0.05). CLINICAL IMPLICATIONS: Parents and consumers without children have similar views of what constitutes quality nursing care--having nurses who are concerned about them and their children, demonstrating caring behaviors and staying attentive to their needs, being competent and skilled, communicating effectively, and providing the teaching needed for managing their own and their family's health problems.

Pain associated with venous ulcers in injecting drug users.

Pain is a concern among people with venous ulcers. Although the prevalence is unknown, venous ulcers occur in those who have a history of illicit injecting drug use. The purpose of this study was to (a) examine the relationship between venous ulcer characteristics and pain severity, (b) ascertain factors that cause pain, (c) determine methods to alleviate pain, and (d) explore beliefs about pain medications among people with a history of injection drug use. Thirty-two patients answered pain and demographic questionnaires and had their venous ulcers traced onto plastic to identify wound area. Greater current pain, worse pain in 24 hours, and higher levels of pain relief from medications were significantly related to larger wound areas. Ibuprofen, compression dressing Unna's boot, and heroin ranked highest in decreasing pain. The most painful activities were working, walking outside, standing, and stair climbing. Many patients (41%) did not like to bother others with their complaints of pain. Participants were generally satisfied with pain treatments and the response of care providers to their pain. People who have used injected drugs and have venous ulcers do have pain. Therefore, research must continue to evaluate this pain as well as the best ways to treat it.

Prevalence and types of wounds among children receiving care in the home.

The purpose of this study was to determine the number of children with wounds receiving home care, determine the types of wounds among these children, and identify wound care products used in the treatment of children. This study was a multi-site, descriptive, cross-sectional, collaborative, study involving 13 home healthcare agencies and a university. Nurses (n = 281) were systematically selected to collect data for patients receiving home care visits during a 1-week period. The nurses recorded data on 77 children who ranged in age from less than 1 year to 18 years (mean = 3.1 years, SD = 4.72). The children included 47 males and 30 females, most of whom were African-American (n = 59). Among the 77 children, 16.9% had wounds. Children with wounds were significantly older and had more reasons for the home healthcare visit than children without wounds. The presence of a wound was not significantly related to the length of the visit, gender, or race. The most common wound was a surgical incision. The wound care treatments used most were tap water and gauze. In conclusion, wound care is frequently part of the care for a child in the home. Therefore, nurses need to be aware of wound assessment and wound care protocols that match a child's growth and development and family needs.

Comparison of personal characteristics, tobacco use, and health states in Chaldean, Arab American, and non-Middle Eastern White adults.

This study compared and contrasted personal characteristics, tobacco use (cigarette and water pipe smoking), and health states in Chaldean, Arab American and non-Middle Eastern White adults attending an urban community service center. The average age was 39.4 (SD = 14.2). The three groups differed significantly (P < .006) on ethnicity, age, gender distribution, marital status, language spoken, education, employment, and annual income. Current cigarette smoking was highest for non-Middle Eastern White adults (35.4%) and current water pipe smoking was highest for Arab Americans (3.6%). Arab Americans were more likely to smoke both cigarettes and the narghile (4.3%). Health problems were highest among former smokers in all three ethnic groups. Being male, older, unmarried, and non-Middle Eastern White predicted current cigarette smoking; being Arab or Chaldean and having less formal education predicted current water pipe use.

Transtheoretical Model and substance use in HIV-positive youth.

The purpose of the study was to test constructs of the Transtheoretical Model (TTM) for predicting alcohol and other drug use in HIV-positive youth (ages 16-25). Questionnaires and interviews about alcohol and other drug use, stage of change, self-efficacy, emotional distress and social support were obtained from 64 HIV-positive youth. Structural equation modeling with standard errors determined by methods appropriate to small samples, demonstrated that self-efficacy mediated the relationship between stage of change and alcohol use and between social support and alcohol use. The same pattern of results emerged for marijuana use. The models predicted 47% of the variance in alcohol use and 69% of the variance in marijuana use. Results supported the TTM and highlight the potential of interventions that seek to boost self-efficacy and social support specific to reducing substance use.

Chronic venous insufficiency in persons with a history of injection drug use.

Persons with a history of injection drug use have many risk factors for the development of chronic venous insufficiency (CVI), yet this phenomenon has not been studied systematically in this population. Persons (N = 204) with a history of injection drug use who were in enrolled in a treatment center were examined for clinical manifestations of CVI. The CVI clinical classification was graded on a 7-point scale for each leg. Most participants (n = 179, 87.7%) exhibited clinical evidence of CVI. Significant predictors of CVI clinical manifestations were leg infections/cellulitis (rho =.53); years injection in the veins of the groin, legs, and feet (rho =.47); deep vein thrombosis (rho =.37); and total years injection heroin (rho =.27). There was a linear functional relationship between years of injection drug use and the CVI clinical classification, but only when the injections were in the veins of the groin, legs, or feet; otherwise, the specific mechanisms of this relationship were not evident. The findings indicate that CVI is a common occurrence in persons who have injected drugs.

Predicting success using individualized scheduled toileting for memory-impaired elders at home.

The purpose of this research was to evaluate the effectiveness of an individualized scheduled toileting (IST) program on incontinent, memory-impaired elders being cared for at home. Using a 2 x 2 mixed design analysis of variance (group by time), 118 patients were randomly assigned to experimental or control groups. Caregivers in the experimental group were taught the IST procedure. Urinary incontinence (UI) was measured at baseline and at 6 months. Weeklong voiding records were kept by caregivers and were used to calculate the percentage of times the incontinence occurred. UI significantly decreased in the experimental group, whereas in the control group it did not. The baseline cognitive ability, mobility, and consistency of implementing IST were entered into a discriminant function equation and significantly predicted patients who would improve with IST. Cognitive ability was the best predictor, with mobility also emerging as a meaningful predictor. Candidates for IST should be selected based on elders' cognitive ability and their ability to cooperate with toileting. Moderately cognitively impaired elders and ones able to cooperate with toileting protocols are prime candidates for IST.

Couples' adjustment to breast disease during the first year following diagnosis.

The objectives were to determine (a) the extent to which psychosocial, demographic, and medical variables predict women's and husbands' adjustment to breast disease during the first year following diagnosis; (b) the degree of autocorrelation among and intercorrelation between partners' adjustment scores; (c) the extent to which baseline levels of adjustment predict adjustment 1 year later; and (d) the extent to which one partner's adjustment affects the other partner's adjustment. A stress-coping framework guided this study. The sample consisted of 131 couples, 58 couples received a cancer diagnosis and 73 received a benign diagnosis. Couples were interviewed at 1 week, 2 months, and 1 year postdiagnosis. Structural equation modeling was used to analyze the data. The strongest predictors of adjustment for women were severity of the illness and hopelessness and for husbands, their own baseline level of adjustment. Husbands' and wives' levels of adjustment at 1 year had a significant direct effect on each other's adjustment.

Psychosocial adjustment, coping, and quality of life in persons with venous ulcers and a history of intravenous drug use.

OBJECTIVE/PURPOSE: Psychosocial adjustment, coping, and quality of life for persons with a venous ulcer and a history of intravenous drug use were examined. DESIGN: A cross-sectional design was used. SETTING AND SUBJECTS: Data were collected in an urban outpatient clinic. All eligible persons were asked to participate. Thirty-two patients agreed to participate, providing an 89% response rate. The mean age of participants was 44.6 years (SD = 4.3); 91% were African American, and 72% were male. INSTRUMENTS: Subjects responded to questions about their health and substance abuse history and completed the Quality of Life With a Leg Ulcer Questionnaire, Psychosocial Adjustment to Illness Scale (PAIS), Ways of Coping Instrument, and Pain Questionnaire. Leg ulcer tracings were measured with the SigmaScan computer program. METHODS: Questionnaires were read to participants. Leg ulcers were traced at their borders onto plastic. RESULTS: Wound area correlated significantly with the domestic environment (r = .43) and the psychosocial distress (r = .38) scores of the PAIS. Wound area was negatively correlated to Quality of Life With a Leg Ulcer Questionnaire score (r = -.52). Pain interference was significantly related to the self-controlling coping score (r = .40), domestic environment score of the PAIS (r = .51), and Quality of Life With a Leg Ulcer Questionnaire score (r = -.65). Cox and Wermuth's multiple regression modeling approach was used to summarize the study's variables. CONCLUSIONS: A larger wound area was associated with greater illness-induced difficulties in the home environment, greater psychological distress, and poor quality of life. Pain Interference was associated with a greater effort to regulate one's feelings and actions, difficulties in the home, and poor quality of life.

Important attributes of quality health care: consumer perspectives.

PURPOSE: Despite extensive research on defining and measuring health care quality, little attention has been given to consumers' perspectives of high-quality health care. The purposes of this study were to (a) identify the importance to consumers of attributes of health care quality and nursing care quality, and (b) examine the relationship of consumer perspectives to health status and selected demographic variables. DESIGN: Exploratory. Consumers (N = 239) were recruited from waiting rooms of clinics and in neighborhoods of a large metropolitan area in the Midwestern United States that included both urban and suburban populations. METHODS: Participants completed the Quality Health Care Questionnaire (QHCQ) and the SF-36 Health Survey. On the QHCQ, they rated the importance of 27 attributes of health care and nursing care quality. The SF-36 is a 36-item instrument for measuring health status in eight general areas. FINDINGS: The most important indicators of high-quality nursing care to consumers were: being cared for by nurses who are up-to-date and well informed; being able to communicate with the nurse; spending enough time with the nurse and not feeling rushed during the visit; having a nurse teach about the illness, medications, treatments, and staying healthy; and being able to call a nurse with questions. The lowest-rated item was having an opportunity to be cared for by nurse practitioners. Ratings differed by race, age, years of education, income, and health status. CONCLUSIONS: The importance that consumers place on teaching by the nurse was emphasized, particularly among people with less education, low income levels, and chronic illnesses.