Factors Predicting Dependence on Waterpipe Smoking Among Waterpipe Exclusive Smokers.

ABSTRACT: The current study targeted a sample of waterpipe (WP) exclusive smokers to identify the levels and predictors of dependence on this smoking pattern and to examine the relationship between WP smoking (WPS) dependence and depressive symptoms. A cross-sectional research design was employed with a community sample of 270 subjects who are currently WP exclusive smokers. Assessment of WPS dependence and depressive symptoms was performed using self-report measures. About 62.6% of the subjects were WPS dependent. The unique significant predictors of WPS dependence were age, depression levels, age of starting WPS, duration of WPS, income, smoking WP daily, the belief of being attracted to WPS, and the desire to stop WPS. These predictors explained 35% of the variance in WPS dependence. WPS dependence was associated with increased depressive symptoms. Although few studies have been conducted, the WPS dependence prevalence appears to be alarmingly high among WP exclusive smokers. Factors associated with WPS dependence provide useful information that can be used to tailor WP prevention interventions.

A Survey on Cardiovascular Nursing Occupational Standard: Meeting the Needs of Employers.

Occupational standard is the result of the agreement between relevant stakeholders in the labor market and education on optimal content for a particular occupation. While drafting occupational standard, the primary instrument for researching competencies at a workplace is a survey on occupational standard. This study identifies key competencies, roles, and responsibilities that are deemed necessary by employers of cardiovascular nurses. The survey addressed the responses of 41 organizations from 11 out of 21 counties in Croatia which were represented by the head nurses of cardiology departments in the hospitals. The survey consisted of 24 questions that covered the main responsibilities, competencies, generic skills, and psychometric abilities. Descriptive statistics were used to analyze the data. Conducting diagnostic and therapeutic procedures, health care, education, administration of medications, monitoring, and documentation were listed as the main responsibilities of cardiovascular nurses. The most common skills included assessment, monitoring patient's condition, knowledge of the diagnostic or therapeutic procedures and cardiovascular diseases, interpreting the electrocardiograms, preparing patients for checkups, conducting patient's education, and following practice guidelines. Generic skills included communication and organizational skills, teamwork, and responsibility. Reaction time and attention span were the most assessed psychomotor abilities. Artificial lighting and radiation were the most important environmental risk factors. The most appropriate level of education for cardiovascular nursing was specialist graduate studies. The results of the study could be used to develop occupational standards for cardiovascular nursing and to guide the curriculum for the educational program development.

Mild Depression Predicts Long-Term Mortality After Acute Myocardial Infarction: A 25-Year Follow-Up.

BACKGROUND: Past studies have found that depression is an independent predictor of death in patients after acute myocardial infarction (AMI). Our aim was to investigate whether the adverse effect upon mortality of depression, including mild levels, persisted up to 25 years. METHODS: We used an historical design to study patients who had been consecutively admitted to hospital after transmural AMI during the 1980s and enrolled in an exercise training trial. The Beck Depression Inventory (BDI) was administered to 188 patients in the third week after hospital admission. Scores were trichotomised and classified as low (0-5), mild (6-9) or moderate to severe (≥10) depression. The Australian National Death Index was used to determine mortality status. Cox proportional-hazards modelling was undertaken to determine the relationship between the trichotomised BDI-I scores and all-cause mortality over five time periods up to 25 years. RESULTS: The mean age of patients was 54.15 years. One hundred fourteen (114) (60.4%) had low or no depression, 47 (25.2%) mild depression and 27 (14.3%) moderate to severe depression. The mortality status of 185 (98.4%) patients was established. Depression was a significant predictor of death, independently of age and severity of myocardial infarction, at 5, 10 and 15 years but not at 20 or 25 years. Patients with mild depression had greater mortality than those with low or moderate to severe depression. CONCLUSIONS: Early identification of depression, including milder levels, is important since patients remain at increased risk for many years. They require ongoing monitoring and appropriate treatment.

Knowledge, attitudes, beliefs and patterns of waterpipe use among Jordanian adults who exclusively smoke waterpipes.

BACKGROUND: Widespread waterpipe smoking (WPS) is reported worldwide. Although remarkable numbers of waterpipe smokers do not smoke cigarettes, very few studies have explored the phenomenon of WPS in people who smoke water pipes exclusively. The aim of this study was to assess levels of knowledge, attitudes, beliefs and patterns of WPS among Jordanian waterpipe-only smokers. METHODS: A cross-sectional descriptive design was used; with 247 participants who were recruited through convenience sampling from 23 cafés offering waterpipes. An interview and self-reported questionnaire was used to collect data. RESULTS: The average age for starting WPS was 19.4 ± 5.6 years, of whom 71% started as teenagers. Participants like WPS because they like its flavor and social environment (46.3% and 29.5% respectively). The majority of participants reported that they smoked a waterpipe for the first time with their friends (66.8%), they usually smoke in the company of others (63.2%), and believe that quitting cigarettes smoking is harder than quitting WPS (61.6%). More than half (56.7%) of participants have extremely poor knowledge about the health effects of WPS. Participants who had smoked cigarettes in the past, were more knowledgeable than those who had never smoked cigarettes. The majority of participants, and specifically women, have high positive feelings and emotions (attitude) toward WPS, and 88.3% of them reported that it is a socially acceptable behavior. CONCLUSIONS: Waterpipe smoking participants started WPS at an early age, and are attracted to the social environment that accompanies WPS. Participants have high positive attitude about WPS however they lack knowledge about harmful health effects of WPS.

Knowledge and perception of cardiovascular disease risk among patients with rheumatoid arthritis.

Patients with rheumatoid arthritis are at increased risk for cardiovascular disease. The prerequisites for reducing the risk of cardiovascular disease are adequate levels of knowledge and being aware of the risk. In this study, the levels of knowledge about cardiovascular disease among patients with rheumatoid arthritis and the perception were evaluated in relation to their actual 10-year risk of cardiovascular disease. This cross-sectional study of 200 patients with rheumatoid arthritis was conducted in a university-affiliated hospital in South Korea. The patients' actual risk of cardiovascular disease was estimated using the Framingham Risk Score. The most common risk factor was physical inactivity, with 77% of the patients not engaging in regular exercise. The patients lacked knowledge about the effects of physical inactivity and anti-inflammatory medication on the development of cardiovascular disease. Misperceptions about the risk of cardiovascular disease were common, i.e., 19.5% of the patients underestimated their risk and 41% overestimated. Hypertension, diabetes, obesity, and smoking were the most prevalent among the patients who underestimated their risk, and these same patients had the lowest level of knowledge about cardiovascular disease. This study demonstrated the rheumatoid arthritis patients' lack of knowledge about the effects of physical inactivity and anti-inflammatory medications on the development of cardiovascular disease, and their misperception of cardiovascular risk was common. As a preventive measure, educational programs about cardiovascular disease should be tailored specifically for patients with rheumatoid arthritis, and behavioral interventions, including routine exercise, should be made available at the time of diagnosis.

Perceived and actual risk of cardiovascular disease in patients with rheumatoid arthritis in Korea: A cross-sectional study.

The purposes of this study were to compare the perceived and actual 10-year risk for cardiovascular disease (CVD) and to evaluate the influence of cardiovascular risk factors on perceived CVD risk in patients with rheumatoid arthritis (RA) in Korea. Additionally, the attainment of CVD prevention guideline goals by 3 levels of CVD risk (low, moderate, and high) was presented.For this cross-sectional study, data were collected from 208 patients with RA. Actual CVD risk was estimated with the Systematic Coronary Risk Evaluation (SCORE), and goal attainment was assessed based on the European League Against Rheumatism guidelines. Actual CVD risk and perceived risk were compared with cross-tabulation. Chi-square tests were used to evaluate differences in cardiovascular risk factors by perceived risk. Levels of goal attainment were presented in percentages.Among patients with RA, 13.9% were identified as being at high risk for CVD, whereas 39.9% were at moderate risk, and 46.2% were at low risk. The majority of those at high risk (96.6%) underestimated their risk for CVD. The use of antihypertensive or lipid-lowering medications and having a parental history of CVD significantly increased the likelihood that subjects with RA would perceive themselves as being at high risk for CVD. Diabetes, smoking, physical inactivity, and obesity did not affect perceived risk. A substantial proportion of the subjects with RA did not meet the prevention guideline goals.Patients with RA who are at increased risk of developing CVD must be managed as soon as possible to attain the guideline goals and, accordingly, lower their risk of future CVD.

Adherence to institution-specific ventilator-associated pneumonia prevention guidelines.

BACKGROUND: Various institution-specific guidelines have been developed to prevent ventilator-associated pneumonia. However, the availability of guidelines does not ensure adherence to recommended strategies. OBJECTIVE: To identify factors that influence adherence to guidelines for prevention of ventilator-associated pneumonia, with a focus on oral hygiene, head-of-bed elevation, and spontaneous breathing trials. METHODS: A cross-sectional descriptive study of critical care nurses at 8 hospitals in Northern California was conducted. A survey was created to gather information on possible facilitators of and barriers to adherence to institution-specific guidelines for preventing ventilator-associated pneumonia. User factors, guideline qualities, and contextual factors were explored and tested for possible relationships. RESULTS: A total of 576 critical care nurses participated in the survey. Each hospital had unique guidelines for preventing ventilator-associated pneumonia. In general, nurses had positive attitudes and reported adhering to the guidelines always or most of the time. Factors associated with adherence differed according to the intervention implemented. The score on the user attitude scale was the strongest and most consistent predictor of adherence across interventions (odds ratio, 3.49-4.75). Time availability (odds ratio, 1.54) and the level of prioritization (odds ratio, 1.86) were also significant predictors. CONCLUSION: The most consistent facilitator of adherence to guidelines for prevention of ventilator-associated pneumonia was nurses' positive attitude toward the guidelines.

Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association.

BACKGROUND: Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome. METHODS AND RESULTS: Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes. CONCLUSIONS: Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.

Enteral nutritional intake in adult korean intensive care patients.

BACKGROUND: Nutritional support is important for maximizing clinical outcomes in critically ill patients, but enteral nutritional intake is often inadequate. OBJECTIVE: To assess the nutritional intake of energy and protein during the first 4 days after initiation of enteral feeding and to examine the relationship between intake and interruptions of enteral feeding in Korean patients in intensive care. METHODS: A cohort of 34 critically ill adults who had a primary medical diagnosis and received bolus enteral feeding were studied prospectively. Energy and protein requirements were determined by using the Harris-Benedict equation and the American Dietetic Association equation. Energy and protein intake prescribed and received and the reasons for and lengths of feeding interruptions were recorded for 4 consecutive days immediately after enteral feeding began. RESULTS: Although the differences between requirements and intakes of energy and protein decreased significantly, patients did not receive required energy and protein intake during the 4 days of the study. Energy intake prescribed was consistently less than required on each of the 4 days. Enteral nutrition was withheld for a mean of 6 hours per patient for the 4 days. Prolonged feeding interruptions due to gastrointestinal intolerance (r= -0.874; P < .001) and procedures (r= -0.839; P = .005) were negatively associated with the percentage of prescribed energy received. CONCLUSIONS: Enteral nutritional intake was insufficient in bolus-fed Korean intensive care patients because of prolonged feeding interruptions and underprescription of enteral nutrition. Feeding interruptions due to gastrointestinal intolerance and procedures were the main contributors to inadequate energy intake.

Why patients in critical care do not receive adequate enteral nutrition? A review of the literature.

Enteral nutrition is frequently used to provide nutrients for critically ill patients. However, only about half of critically ill enterally fed patients receive their energy requirements. Underfeeding is associated with detrimental clinical outcomes including infection, pressure ulcers, impaired wound healing, prolonged hospital stays, and increased morbidity and mortality. This literature review was conducted to identify major barriers to adequate enteral nutrition intake in critically ill adults and to identify gaps in the research literature. Studies (n = 30) reviewed addressed adult patients in critical care, published since 1999, and written in English. Findings showed that factors that explain inadequate enteral nutritional intake include delayed initiation of enteral nutrition and slow advancement of infusion rate, underprescription, incomplete delivery of prescribed nutrition, and frequent interruption of enteral nutrition. Frequent interruption was caused by diagnostic tests, surgical procedures, gastrointestinal intolerance, feeding tube problems, and routine nursing procedures. There are no standardized protocols that address these barriers to receiving adequate enteral intake. Such protocols must be developed, implemented, and tested to address undernutrition and mitigate the negative consequences of inadequate enteral intake.

Adequacy of early enteral nutrition in adult patients in the intensive care unit.

AIMS AND OBJECTIVES: To evaluate the adequacy of energy and protein intake of patients in a Korean intensive care unit in the first four days after initiation of enteral feeding and to investigate the factors that had impact on adequate intake. BACKGROUND: Underfeeding is a common problem for patients hospitalised in the intensive care unit and is associated with severe negative consequences, including increased morbidity and mortality. DESIGN: A prospective, cohort study was conducted in a medical intensive care unit of a university hospital in Korea. METHODS: A total of 34 adult patients who had a primary medical diagnosis and who had received bolus enteral nutrition for the first four days after initiation of enteral nutrition were enrolled in this study. The data on prescription and intake of energy and protein, feeding method and feeding interruption were recorded during the first four days after enteral feeding initiation. Underfeeding was defined as the intake <90% of required energy and protein. RESULTS: Most patients (62%) received insufficient energy, although some (29%) received adequate energy. More than half of patients (56%) had insufficient protein intake during the first four days after enteral feeding was initiated. Logistic regression analysis showed that the factors associated with underfeeding of energy were early initiation of enteral nutrition, under-prescription of energy and prolonged interruption of prescribed enteral nutrition. CONCLUSION: Underfeeding is frequent in Korean critically ill patients owing to early initiation, under-prescription and prolonged interruption of enteral feeding. RELEVANCE TO CLINICAL PRACTICE: Interventions need to be developed and tested that address early initiation, under-prescription and prolonged interruption of enteral nutrition. Findings from this study are important as they form the foundation for the development of evidence-based care that is badly needed to eliminate underfeeding in this large vulnerable Korean intensive care unit population.

Accuracy of peak VO2 assessments in career firefighters.

BACKGROUND: Sudden cardiac death is the leading cause of on-duty death in United States firefighters. Accurately assessing cardiopulmonary capacity is critical to preventing, or reducing, cardiovascular events in this population. METHODS: A total of 83 male firefighters performed Wellness-Fitness Initiative (WFI) maximal exercise treadmill tests and direct peak VO2 assessments to volitional fatigue. Of the 83, 63 completed WFI sub-maximal exercise treadmill tests for comparison to directly measured peak VO2 and historical estimations. RESULTS: Maximal heart rates were overestimated by the traditional 220-age equation by about 5 beats per minute (p < .001). Peak VO2 was overestimated by the WFI maximal exercise treadmill and the historical WFI sub-maximal estimation by ~ 1MET and ~ 2 METs, respectively (p < 0.001). The revised 2008 WFI sub-maximal treadmill estimation was found to accurately estimate peak VO2 when compared to directly measured peak VO2. CONCLUSION: Accurate assessment of cardiopulmonary capacity is critical in determining appropriate duty assignments, and identification of potential cardiovascular problems, for firefighters. Estimation of cardiopulmonary fitness improves using the revised 2008 WFI sub-maximal equation.

Factors predicting blood pressure control in older Chinese immigrants to the United States of America.

AIM: This paper is a report of a study of the extent to which demographic characteristics, medication-related factors, hypertension-related knowledge and medication adherence predict systolic and diastolic blood pressure. BACKGROUND: Little is known about predictors of hypertension control in Chinese elders. METHODS: A longitudinal study with a 3-month follow-up was conducted with 90 Chinese immigrants to the United States of America aged ≥65 years and recruited from 2006 to 2007. The independent variables were measured at baseline. Blood pressure was measured at 3 months. Multiple linear regression analysis was used to evaluate the independent effects of seven variables on change in blood pressure at 3 months. RESULTS: Participants ranged in age from 66 to 92 years (Mean 76.7, sd 6.6). The overall regression model for systolic blood pressure was statistically significant (R² = 0.32, F = 4.37, P < 0.01). A higher number of prescribed oral medications (sr² = 0.06, t = 2.42, P = 0.02) and lower medication adherence (sr² = 0.07, t = -2.60, P = 0.01) were statistically significant determinants of an increased systolic blood pressure. The overall regression model for diastolic blood pressure was statistically significant (R² = 0.21, F = 2.39, P = 0.03). Male gender (sr² = 0.06, t = 2.26, P = 0.03) and lower medication adherence (sr² = 0.11, t = -3.03, P < 0.01) were statistically significant determinants of an increased diastolic blood pressure. CONCLUSION: A greater number of prescribed medications and lower adherence predicted higher level of systolic blood pressure. Male gender and lower adherence were significantly associated with higher level of diastolic blood pressure. These predictors should be considered when designing interventions to help Chinese elders achieve better hypertension management.

Gender and racial differences in psychosocial factors of low-income patients with heart failure.

BACKGROUND: Heart failure (HF) is a debilitating chronic disease with incidence and prevalence continuing to increase, particularly in low-income, minority groups. Psychosocial variables have recently emerged as important predictors of cardiovascular risk and health outcomes in HF. However few data exist in this group. Thus, the purpose of this study is to examine the sociodemographic and psychosocial variables in low-income patients with HF. METHODS: This is a descriptive, cross-sectional study using 1-time interviews. Subjects with HF were recruited from 3 cardiology clinics and 1 community hospital. RESULTS: Fifty-five percent of the sample (n=65) were women with a mean (standard deviation) age of 59 years (14); 35% were non-white, 86% were unemployed, 56% had an annual income < $10,000, and 52% were uninsured. Most reported having high social support (83%), poor health perception (82%), and severe depressive symptoms (70%). Non-white men seemed to have worse health perceptions and more depressive symptoms. CONCLUSION: Low-income patients with HF, particularly non-white men, have poor health perception and more depressive symptoms. This is important because HF has been associated with increased morbidity and mortality in patients. Future research is necessary to explore ways in designing effective interventions to improve health outcomes.

Patient perception of symptoms and quality of life following ablation in patients with supraventricular tachycardia.

OBJECTIVES: It remains unclear which symptom experiences and aspects of quality of life (QOL) change after ablation in patients with supraventricular tachycardia (SVT). To determine how patient perceptions of symptoms and QOL change after ablation, we used a single group pretest-posttest design. METHODS: Patients with SVT (n=52; mean age 41+/-17 years; 65% female) completed generic and disease-specific measures at baseline and 1 month after ablation. RESULTS: Significant improvement after ablation was noted on virtually all measures (P <.05). Patients reported decreases from baseline regarding frequency and duration of episodes, number of symptoms, and impact of SVT on routine activities. All symptoms decreased in prevalence; however, no symptoms were completely eliminated at 1-month follow-up. Women, more so than men, reported larger changes in symptom and QOL scores after ablation. CONCLUSIONS: Despite the small sample, statistically significant improvement was found after ablation in a variety of patients with different symptoms and QOL indices.

Cardiovascular risk factors among career firefighters.

Sudden cardiac death is the leading cause of on-duty death among firefighters. Determining firefighters' risk of cardiovascular death or all-cause mortality, cardiovascular risk factor profiles, and energy demands while firefighting may aid in understanding why this occupational group is at risk for on-duty sudden cardiac death. A literature review conducted between 2006 and 2009 did not demonstrate that firefighters are at increased risk of all-cause death compared to the general population. In addition, cardiovascular risk profiles of firefighters are similar to those of the general population. Firefighters may be part of the national obesity epidemic; their hypertension and hypercholesteremia often are not diagnosed or are undertreated. The combination of personal cardiovascular risk factors and extreme physical work demands may contribute to sudden cardiac death in this population.

Using an existing data set to answer new research questions: a methodological review.

The vast majority of the research methods literature assumes that the researcher designs the study subsequent to determining research questions. This assumption is not met for the many researchers involved in secondary data analysis. Researchers doing secondary data analysis need not only understand research concepts related to designing a new study, but additionally must be aware of challenges specific to conducting research using an existing data set. Techniques are discussed to determine if secondary data analysis is appropriate. Suggestions are offered on how to best identify, obtain, and evaluate a data set; refine research questions; manage data; calculate power; and report results. Examples from nursing research are provided. If an existing data set is suitable for answering a new research question, then a secondary analysis is preferable since it can be completed in less time, for less money, and with far lower risks to subjects. The researcher must carefully consider if the existing data set's available power and data quality are adequate to answer the proposed research questions.

Frequency of nurses' smoking cessation interventions: report from a national survey.

AIMS AND OBJECTIVES: To describe the frequency of nurses' delivery of tobacco cessation interventions ('Five A's': Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses' awareness of the Tobacco Free Nurses initiative. BACKGROUND: Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web-based resources about tobacco control. DESIGN: Cross-sectional survey of nurses (n = 3482) working in 35 Magnet-designated hospitals in the USA (21% response rate). METHOD: A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse's delivery of smoking cessation interventions ('Five A's') was adapted for use on the web. RESULTS: The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy. Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1.55, 95% CI 1.27, 1.90) and recommending medications (OR = 1.81, 95% CI 1.45, 2.24). CONCLUSIONS: Nurses' delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions. Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence-based interventions into clinical practice to help smokers quit. These findings support the value of Tobacco Free Nurses in providing nurses with information to support patients' quit attempts.

Characteristics of nurses who used the Internet-based nurses QuitNet for smoking cessation.

BACKGROUND: Smoking among nurses is higher than other health care professionals but nurse-specific cessation programs are limited. Nurses QuitNet, launched in January 2004, provided an evidence-based online smoking cessation program for nurses and nursing students. OBJECTIVES: To describe Nurses QuitNet registrants and relationships among the demographic and smoking characteristics, program dissemination strategies, and site utilization patterns. DESIGN: Cross-sectional study. SAMPLE: 1,790 Nurses QuitNets registrants. MEASUREMENTS: Demographics and smoking characteristics on the Nurses QuitNet intake questionnaire. RESULTS: Most registrants were female (92.5%), 45-54 years old (34.3%), Caucasian (84.5%), and college graduates (57.5%). Over 68% smoked 10-20 cigarettes/day; 66.4% smoked within 30 min of waking. Half of those with previous quit attempts did not use evidence-based methods; 30% had not made a quit attempt in the past year. "Read-only" social support was the most frequently used Nurses Quitnet feature. CONCLUSIONS: The Internet can be a viable option to support nurses' cessation and is available to accommodate their work schedules. The sample is similar to the general nursing population, except for higher levels of education. Efforts are needed to assist nurses struggling with nicotine addiction and disseminate cessation resources, particularly targeting nurses with the highest prevalence of current smoking, for example licensed practical nurses.

Factors contributing to adolescent obesity.

Obesity in children is a significant public health concern. The prevalence of overweight and obesity in Jordanian children, and adolescents has increased in the last decade. The consequences of obesity to health in childhood and adulthood have both medical, and economic cost to individuals and society. This paper reviews the factors that contribute to adolescent obesity and emphasizes behavioral and environmental factors. An individual's behaviors such as increased consumption of high caloric foods, increased sedentary activity while decreasing physical activity has been identified as key issues in the development of obesity. Additionally, the current environment in homes, schools, and neighborhoods tend to discourage a healthy lifestyle. A comprehensive approach that involves the whole community is the best strategy for preventing adolescent obesity. Nurses are in a unique position to provide leadership in developing programs for healthier lifestyle choices for adolescents' and adoption of these goals into their daily lives.