Knowledge about the deleterious effects of smoking and its relationship to smoking cessation among pregnant adolescents.

Smoking cessation among pregnant adolescents remains a complex and unresolved issue. The purpose of this study was to examine adolescents' knowledge of the detrimental effects of smoking on pregnant women and fetuses and its relationship to efforts to quit smoking. The sample consisted of 71 pregnant adolescents, and a three-group randomized intervention design-Teen FreshStart (TFS), Teen FreshStart with buddy (TFSB), and usual care control (UCC)-was used. Instruments included a demographic questionnaire, a smoking history questionnaire, and an 11-item scale measuring knowledge of the effects of smoking during pregnancy. For the entire sample, knowledge scores increased significantly (p = .000) from T1 (preintervention) to T2 (postintervention), and the adolescents who quit smoking had significantly higher knowledge at T2 (p = .028) and greater increases (T1 to T2) in their knowledge (p = .019) than did those who did not quit. Together, the TFS and TFSB groups had significantly higher knowledge at T2 (p = .017) and a significantly greater increase in knowledge from T1 to T2 (p = .005) than did the UCC group. This also held true when the TFS and TFSB groups were examined individually. Each had significantly higher knowledge at T2 (TFS, p = .029; TFSB, p = .008) and a significantly greater increase in knowledge from T1 to T2 (TFS, p = .007; TFSB, p = .009) than did the UCC group. Furthermore, despite the small sample sizes, within-group comparisons showed (a) no significant differences between quitters and nonquitters in the UCC group, (b) significantly higher knowledge at T2 (p = .052) and a trend indicating greater increases in knowledge from T1 to T2 (p = .092) for the quitters compared with the nonquitters in the TFS group, and (c) a trend for adolescents in the TFSB group who quit smoking to have greater increases in knowledge compared with those who did not quit (p = .158). These results indicate the need for continued inquiry into the relationship between pregnant teenagers' health knowledge and decisions to stop smoking.

Factors relating to pregnant adolescents' decisions to complete a smoking cessation intervention.

Adolescence is a time when young people are confronted with critical health-related decision-making responsibilities. Choices associated with smoking behavior and cessation represent one specific family of relevant adolescent decision tasks. This study examined differences between pregnant girls who decided to complete a smoking cessation intervention and those who decided not to complete the program. The comparison was made across variables representing intrapersonal, familial, and peer domains. The sample consisted of 53 pregnant teenagers. Measures included a demographic questionnaire, the Spielberger State-Trait Anxiety Inventory (STAI), and selected items from a smoking history questionnaire and the Health Behavior Questionnaire: High School Form. Significant group differences were found for age (P = .01), race (P = .05), duration of smoking (P = .02), type of smoker (P = .01), and parents' approval of teenage smoking (P = .01). A trend in differences between the two groups was evident for religious attitudes (P = .09).

An assessment of nicotine dependence among pregnant adolescents.

Studies have reported that between 28 and 62% of pregnant teenagers smoke (Cornelius, Taylor, Geva, & Day, 1995; Trollestrup, Frost, & Starzyk, 1992). Because smoking is prevalent among pregnant teenagers, the purpose of this research is to assess nicotine dependence in this high-risk group. This study analyzed baseline data from a sample of pregnant teen smokers who had volunteered to participate in a smoking cessation study (N = 94). Nicotine dependence was measured by adapting the Fagerstrom Tolerance Questionnaire (FTQ; Prokhorov, Pallonen, Fava, Ding, & Niaura, 1996), and by a 6-item withdrawal symptom scale. The overall FTQ score found among pregnant adolescents was 3.10 (SD = 2.3) compared to the mean overall FTQ score among vocational-technical students of 4.27 (SD = 2.2) (Prokhorov et al., 1996). Duration of smoking in years was significantly correlated with the overall FTQ score (r = 0.43, p < .01). Quantity of smoking, as measured by average number of cigarettes smoked, significantly correlated with overall FTQ scores (r = 0.67, p < .01). Lighter smokers were more likely to have previously attempted to quit, however, among the quit attempters, those who smoked 10+ cigarettes per day reported greater severity of withdrawal symptoms than those who smoked less per day. Prenatal education and smoking cessation programs for pregnant teenagers, and pregnant women in general, need to consider that nicotine dependence is an important issue. Early pregnancy may be an opportune time to intervene among pregnant smokers; incentives may be necessary to attract those women who are the heaviest smokers, and possibly the most dependent on nicotine.

PIP: This study assessed nicotine dependence among pregnant adolescent smokers in order to enhance the efficacy of smoking-cessation programs. This study analyzed baseline data from a sample of 94 pregnant teen smokers who had volunteered to participate in a smoking cessation study. Nicotine dependence was measured by adapting Fagerstrom Tolerance Questionnaire (FTQ), and by a 6-item withdrawal symptom scale. The overall FTQ score found among pregnant adolescents was 3.10 (SD = 2.3) compared to the mean overall FTQ score among vocational-technical students of 4.27 (SD = 2.2). Duration of smoking in years was significantly correlated with the overall FTQ score. Quantity of smoking, as measured by average number of cigarettes smoked, significantly correlated with overall FTQ scores. Lighter smokers were more likely to have previously attempted to quit. However, among the attempters to quit, those who smoked 10+ cigarettes per day reported greater severity of withdrawal symptoms than those who smoked fewer per day. Prenatal education and smoking cessation programs for pregnant teenagers, and pregnant women in general, need to consider that nicotine dependence is an important issue. Early pregnancy may be an opportune time to intervene among pregnant smokers; incentives may be necessary to attract those women who are heaviest smokers, and possibly the most dependent on nicotine.

Consideration of factors prior to implementing a smoking cessation program.

This small feasibility study evaluated access, recruitment, and retention of pregnant African-American teens for a subsequent smoking cessation intervention program. A clinic and a school site were selected to assess these factors. Only the school site proved successful. Strengths of the school site included: structure and routine for students, a comfortable and familiar setting, recruitment by school personnel who had a relationship with students, and full support by administrators and staff.

Inhibition by interleukin-1 beta of noradrenaline release in rat spleen: involvement of lymphocytes, NO and opioid receptors.

Effects of indomethacin, N omega-nitro-L-arginine (NNA) and naloxone, and of pretreatment with cyclophosphamide (CY), on the interleukin (IL)-1 beta induced inhibition of exocytotic noradrenaline release were investigated in the isolated, vascularly perfused spleen of the rat. Neurotransmitter release was evoked by perivascular electrical stimulation (4 Hz) and the overflow of endogenous noradrenaline was determined by HPLC with electrochemical detection. Perfusion of the spleen with Tyrode's solution containing IL-1 beta (100 pg/ml) for 90 min caused an inhibition of the stimulation-evoked noradrenaline overflow which persisted for at least 20 min after washout of the IL. The evoked overflow was reduced in the presence of NNA 30 mumol/l, but remained unaffected by indomethacin 3 mumol/l, naloxone 0.1 mumol/l or treatment of the rats with CY (250 mg/kg). The opioid agonist etorphine 10 mumol/l inhibited the evoked overflow of noradrenaline and this effect was prevented by naloxone 0.1 mumol/l. The inhibition of evoked overflow by IL-1 beta was not affected by indomethacin but was reduced or even prevented in the presence of NNA or naloxone, or after lymphocyte depletion of spleens by CY. The results are compatible with the idea that in the rat spleen exocytotic noradrenaline release is accompanied by a concomitant secretion of a nitric oxide (NO)-like compound which, in turn, reinforces noradrenaline release, and that the release can be inhibited via prejunctional opioid receptors. The IL-1 beta induced inhibition of evoked release appears to be a complex process which involves as one of many steps a decrease of the facilitatory NO-like compound and the release of endogenous opioids probably from spleen lymphocytes.

Actualizing theory to practice: preparing for computerized information system research on a critical care unit.

In preparation for conducting research on the work of nurses before and after the installation of a computerized information system on a critical care unit, an actualizing process was applied. This process, derived from Actualizing Theory, provided the researchers with an opportunity to study congruence and appropriateness among the components of the intended research. Actualizing Theory uses twelve main strategies to assist in linking theory to a concrete situation. These strategies were employed as the research proposal was being developed and helped both to clarify the fitness of the main components of the research and in representing them in operational form.

Smoking among low-income, pregnant women: prevalence rates, cessation interventions, and clinical implications.

Smoking has a significant effect on the major causes of death and disability among women, including coronary heart disease, stroke, cancer, and osteoporosis. When pregnant women smoke, it adversely affects not only them but also the health, development, and functioning of their unborn and young children. Of the general population of pregnant women, between 20 and 45 percent smoke. Furthermore, among low-income and less educated pregnant women, the increase in prevalence of postpartum smoking relapse rates, continued smoking, and initiation of smoking underlies the need for developing effective interventions for prevention and cessation. Although self-help, stop-smoking materials demonstrated success in several trials, interventions used in conjunction with these materials were brief with little follow-up, and did not address the need for continued intervention to help maintain abstinence or cessation after birth. This article reviews the smoking cessation trials that have assessed the effects of various interventions on cessation rates among low-income pregnant women, and describes future research needs for clinic-based smoking interventions for those women and the clinical implications for health professionals.

Effects of human recombinant interleukins on stimulation-evoked noradrenaline overflow from the rat perfused spleen.

Experiments were carried out in the isolated spleen of the rat to study in a lymphoid organ the influence of interleukins (ILs) on noradrenaline release. Spleens were perfused with Tyrode's solution and the overflow of endogenous noradrenaline was determined by HPLC with electrochemical detection. Perivascular electrical stimulation (4 or 10 Hz, 20-28 mA, 2 min) caused an increase in noradrenaline overflow and in perfusion pressure, both of which were markedly reduced by perfusion with Ca(2+)-free solution, abolished by tetrodotoxin, unaffected by hexamethonium, and subject to alpha 2-adrenoceptor- and muscarinic receptor-mediated modulation as shown by the effects of rauwolscine and methacholine. Human recombinant IL-1 beta and IL-2 and mouse recombinant IL-2 10 ng/ml failed to affect the evoked overflow of noradrenaline after an exposure time of 15 min. In contrast, human recombinant IL-1 beta and IL-2 0.1 ng/ml reduced the evoked overflow after exposure for 80 min; the inhibition tended to increase 30 min later despite washout. Murine recombinant IL-2 1.2 ng/ml caused no change after contact with the tissue for 80 min but there was an inhibition 30 min later after washout. Human recombinant IL-6 (0.1 ng/ml) caused no significant change. The inhibitory effect of low concentrations of IL-1 beta and IL-2 supports the idea that locally produced mediators of the immune system may affect neuronal function.

Toward an understanding of the health status of black adolescents: an application of the stress-coping framework.

The transition from adolescence to adulthood for many urban black youth today contains a number of formidable barriers and often results in a variety of adverse developmental and behavioral outcomes. Nurses and other health providers have an obligation to answer the urgent need for improvements in the health status of black adolescents. This paper reviews the current psychosocial functioning of black youth while emphasizing the disadvantaged social contexts in which most live, which place them at a higher risk for a variety of negative outcomes. Data concerning mental and social health indicators for black adolescents suggest (a) a negative mental health trajectory with high rates of depression, psychiatric hospitalization rates, and suicides, and (b) a poor social health status with alarming school dropout and juvenile delinquency rates, and chronic violence exposure, substance use, and teen pregnancy. An application of the stress-coping framework to black adolescents is suggested as a way to conceptualize the relationship between stress factors and their influence on development. Because this framework places much emphasis on environmental factors as causes for psychological distress, it provides a means to account for the differential incidence of mental and social illnesses among black adolescents. Nursing interventions related to stress and coping among black adolescents may serve to increase well-being and actualize health promotion. However, research efforts are needed to discover which strategies are used by black youth to cope with the stressful experiences faced in their daily lives. Findings could enhance the design, planning, and implementation of prevention and educational programs, making them more consistent with the unique needs of black adolescents.

The efficacy of postoperative autotransfusion in total joint arthroplasty.

Although postoperative blood salvage is used routinely in orthopaedic surgical procedures, little data exists to evaluate this practice. The purpose of this study was to evaluate the effectiveness of the Solcotrans autotransfusion system following elective total joint arthroplasty. This study compared two groups of patients: 59 patients who used the Solcotrans Orthopaedic Drainage/Reinfusion System and 56 patients who used a standard drainage system. Based on the results of the study, the researchers questioned the clinical efficacy and cost-effectiveness of a postoperative wound drainage/reinfusion system in patients after elective total joint arthroplasty.

Breast cancer and cerebral laterality.

In reviewing and summarizing work at our institution, we have identified some surprising consistencies in patients with breast cancer. Breast cancer shows four features of cerebral laterality: excess left-handedness, atypical season-of-birth patterns, the risk factor of advanced maternal age, and an association with prenatal sex hormones. Since hypopigmentation also relates to cerebral laterality, a consequence of the association of breast cancer and cerebral laterality is that eye color should be measured as a function of side of disease and age at diagnosis in women with breast cancer.

Anxiety levels, health behaviors, and support systems of pregnant women.

The purpose of this correlational descriptive study was to assess health behaviors, anxiety levels, and social support of pregnant women, ages 20 to 40, who were without complications and were patients of four private obstetrical practices in a large metropolitan city. Although sampling was a nonprobability approach, various socioeconomic, racial, and religious groups were represented. The three instruments used to test the hypotheses included the State-Trait Anxiety Inventory (STAI), the Personal Resource Questionnaire (PRQ) and a detailed Health Behavior Demographic Questionnaire. Results of the data indicated no significant differences between pregnant smokers' and pregnant nonsmokers' STAI or PRQ scores. Significant positive correlations were revealed between the following variables: Trait anxiety with increased age of pregnancy (r = .77, p = .008); trait anxiety with high educational level (r = .72, p = .001); trait anxiety with state anxiety (r = .64, p = .001); trait anxiety with years married (r = .68, p = .018); trait anxiety with numbers of children (r = .82, p = .005); trait anxiety with high occupation level (r = .68, p = .001), increased age with PRQ support (r = -.88, p = .001); caucasian women examined breast more frequently (r = .47, p = .005); pregnant women who were smokers also were more likely to drink (r = .66, p = .03). Significant negative correlations were: Increased state anxiety with decreased social support (r = -.28, p = .05); higher trait anxiety with lower PRQ (r = -.59, p = .001), and more drinks of alcohol per day with decreased social support (r = .88, p = .04). The study indicated that the subjects who continue to smoke while pregnant were highly educated. All had at least two years of college with 45% having completed graduate school. All were working in managerial or professional jobs. This has implications for nursing interventions focused on enhancing health coping strategies at the workplace and specific health promotion activities designed to reduce job-related stress during pregnancy.