Is pregnancy a teachable moment for smoking cessation among US Latino expectant fathers? A pilot study.

OBJECTIVE: Pregnancy may be a time when US Latino expectant fathers consider quitting smoking. A 'teachable moment' is theorized to increase motivation to change a behavior through increased risk perceptions, emotional responses, and changes in self-image. DESIGN: We recruited 30 Spanish-speaking expectant fathers through their pregnant partners. We assessed expectant fathers' diet, exercise, and smoking and teachable moment constructs (risk perceptions, emotional responses, and self-image).We also tested correlations between teachable moment constructs and motivation to change behaviors. RESULTS: Latino expectant fathers had high-risk perceptions that their smoking harmed the pregnancy (M=4.4, SD=0.5 on five-point scale) and strong emotional responses about their smoking during pregnancy (M=3.9, SD=1.1). They also felt it was their role to make the pregnancy healthy (M=4.4, SD=0.8). They felt less strongly that their diet and exercise affected the pregnancy. The teachable moment constructs for smoking were strongly correlated with motivation to quit smoking; the same was not true for diet and exercise. CONCLUSIONS: Latino expectant fathers seem aware that their smoking could harm the pregnancy but seem less concerned about the effect of their diet and exercise on the pregnancy. Pregnancy may be a time to help Latino expectant fathers quit smoking.

Efficacy of a couple-based randomized controlled trial to help Latino fathers quit smoking during pregnancy and postpartum: the Parejas trial.

BACKGROUND: Although many Latinos in the United States smoke, they receive assistance to quit less often than non-Latinos. To address this disparity, we recruited Latino couples into a randomized controlled trial and provided a smoking cessation program during a teachable moment, when men's partners were pregnant. METHODS: We compared two interventions: (i) written materials plus nicotine replacement therapy (NRT) to (ii) materials, NRT, and couple-based counseling that addressed smoking cessation and couples communication. We recruited 348 expectant fathers who smoked via their pregnant partners from county health departments. Our primary outcome was 7-day point prevalence smoking abstinence and was collected from November 2010 through April 2013 and analyzed in February 2014. RESULTS: We found high rates of cessation but no arm differences in smoking rates at the end of pregnancy (0.31 vs. 0.30, materials only vs. counseling, respectively) and 12 months after randomization (postpartum: 0.39 vs. 0.38). We found high quit rates among nondaily smokers but no arm differences (0.43 vs. 0.46 in pregnancy and 0.52 vs. 0.48 postpartum). Among daily smokers, we found lower quit rates with no arm differences but effects favoring the intervention arm (0.13 vs. 0.16 in pregnancy and 0.17 vs. 0.24 postpartum). CONCLUSIONS: A less intensive intervention promoted cessation equal to more intensive counseling. Postpartum might be a more powerful time to promote cessation among Latino men. IMPACT: Less intensive interventions when delivered during teachable moments for Latino men could result in a high smoking cessation rate and could reduce disparities.

Challenging the quality of the quality indicator, "depression without treatment".

OBJECTIVE: To assess the validity of the Minimum Data Set (MDS)-based quality indicator, "depression without treatment," and examine whether a nonphysician-based educational intervention can improve the accuracy of MDS questions regarding depression and its treatment. SUBJECTS: All residents of a 538-bed urban, university affiliated, long-term-care (LTC) facility. Nursing and social work staff involved in completing the mood and behavior items on the MDS. DESIGN: Two retrospective chart review of psychotropic medications, psychiatric diagnoses, mental health evaluation, and treatment of all residents who were identified as displaying the MDS quality indicator, depression without treatment, before and 2 months after an educational intervention. The education consisted of three 1 1/2-hour sessions led by a psychiatric clinical nurse specialist to educate registered nurse assessment coordinators and social workers about psychotropic medications, clinical characteristics of psychiatric diagnoses, chart review, and coordination of resident medical care. RESULTS: The first MDS identified 66 residents as having depression without treatment. Clinical record review revealed that 11 of these residents were receiving an antidepressant. Twenty-two others were receiving a psychotropic medication consistent with their psychiatric diagnosis. Twenty-five of the remaining residents had not received mental health assessment for greater than 1 year. Two months after the educational intervention, 36 residents were identified as depression without treatment. Four of these residents were receiving an antidepressant; eight others were receiving a psychotropic medication consistent with their psychiatric diagnosis. Thirteen of the remaining residents had not received mental health assessment for greater than 1 year. CONCLUSIONS: This preliminary study reveals that the presence of the quality indicator, depression without treatment, may not accurately capture clinically depressed LTC residents in need of mental health intervention. An educational intervention may be able to assist staff in more accurately completing MDS questions regarding depression and its treatment.

Immune effects of escalating doses of granulocyte-macrophage colony-stimulating factor added to a fixed, low-dose, inpatient interleukin-2 regimen: a randomized phase I trial in patients with metastatic melanoma and renal cell carcinoma.

Previous studies in cancer patients demonstrated that granulocyte-macrophage colony-stimulating factor (GM-CSF) upregulated the interleukin (IL)-2 receptor on T lymphocytes and monocytes suggesting that subsequently administered IL-2 would produce greater immune effects. The authors treated 21 patients with metastatic renal cell carcinoma and melanoma on a randomized phase I study to test this hypothesis. All 21 patients received a fixed dose of IL-2 (72,000 IU/kg every 8 hours for 5 days) administered intravenously as an inpatient. Patients were randomized to receive IL-2 alone or in combination with GM-CSF at a dose of 125 or 250 mcg/m /d (Sargramostim; Immunex Corporation, WA, U.S.A.) daily for 7 days by subcutaneous injection starting on day 1, the day before IL-2 treatment. The results from this study demonstrated that GM-CSF did not worsen the toxicities produced by IL-2 alone. Grade 3 confusion occurred in four patients, three who received IL-2 alone. No partial or complete tumor responses were seen. Assays of serum soluble IL-2 receptor (sIL2R) and neopterin, measures of T cell and monocyte activation, respectively, demonstrated a significant increase in sIL2R but not neopterin, 24 hours after the first dose of GM-CSF. In combination with IL-2, the higher dose of GM-CSF (250 mcg/m ) produced higher sIL2R levels on days 3 and 7 than the 125-mcg/m dose of GM-CSF or IL-2 alone. Although neopterin levels did not increase after 1 day of GM-CSF, the addition of IL-2 resulted in a significantly increased neopterin level on day 3 at the higher dose of GM-CSF. On day 7, neopterin levels in all three groups were similarly increased over baseline. Ten days after treatment, neopterin levels had returned to normal, but sIL2R levels remained markedly increased (12 fold) over baseline in the higher GM-CSF dose group. The authors conclude that 1) monocyte activation was not significantly enhanced by 1 day of GM-CSF treatment; 2) the 250-mcg/m GM-CSF dose plus IL-2 produced superior T cell activation compared with a lower dose of GM-CSF plus IL-2 or to IL-2 alone; and 3) the combination of GM-CSF and IL-2 was safe and tolerable but was not associated with any clinical responses.