Feasibility of a text-based smoking cessation intervention in rural older adults.

Text-based interventions are effective for smoking cessation, but have not been tested in rural older adults. The purpose of this study was to compare the feasibility, acceptability and preliminary efficacy of a text-based Scheduled Gradual Reduction (SGR) program to a non-SGR text messaging support condition among rural older adults. Adults over 60 years were randomized to either: (i) the SGR program (n = 20), a text-based program to reduce smoking over 4-weeks plus text-based support messages; or (ii) control (n = 20), receipt of text-based support messages only. Participants completed surveys at baseline and end of program to assess feasibility and acceptability of the intervention, and biochemically validated 7-day point prevalence cessation was assessed at end of treatment. Most participants (81%) reported reading all the messages they received. Participants found both interventions useful in quitting smoking (SGR = 57%, Control = 63%) and would recommend it to a friend (SGR = 72%, Control = 79%). Although not statically significant, the SGR group had a higher rate of biochemically validated cessation (SGR = 15%, Control = 5%, Cohen d = 0.67). Among those still smoking, the median percent reduction in cigarettes was 33.3% for both groups. Text-based cessation interventions are feasible, acceptable and can be easily disseminated to rural older adult tobacco users.

The epidemiology of weight counseling for adults in the United States: a case of positive deviance.

Weight counseling for adults is uncommonly performed by primary-care providers (PCPs), despite recommendations. In order to design effective primary-care interventions, a full understanding of the epidemiology of weight counseling in primary care is needed. Our objective was to measure the frequency of weight counseling at the level of the PCP. We performed a cross-sectional study of 21 220 US adult outpatient primary-care visits with 954 PCPs in 2007-2008, using data from the National Ambulatory Medical Care Survey (NAMCS). Most (58%) PCPs performed no weight counseling during any patient visits. A total of 85 (8.9%) PCPs provided 52% of all weight counseling and were categorized as 'positive deviant' (PD) physicians. Patients seeing PD physicians were older, less likely to be female and more likely to have hypertension, diabetes and obesity. Adjusting for patient characteristics strengthened the association between PD status and receipt of weight counseling during visits (adjusted odds ratio=13.2 (95% confidence interval 11.5-15.7)). In conclusion, a minority of PCPs provide the majority of primary-care weight counseling in the United States. Studies of these PCPs may help to identify practical methods to increase weight counseling in primary-care settings.

Gender differences in the processes of change for condom use: patterns across stages of change in crack cocaine users.

Interventions to increase condom use in crack users have had mixed results. For interventions to achieve greater success, the mechanisms of behavior change in this population need to be understood. One mechanism, the processes of change, was examined across stages of change for condom use. Results from the analysis of variance for males and females revealed that stage of change was associated with different levels of three experiential processes: consciousness raising, social liberation and self-reevaluation. However, these analyses found that male and females seem to have different patterns of behavioral process use. Specifically, females in the preparation stage were different from those in precontemplation, whereas this difference was not pronounced in males. In general, people had high levels of experimental processes in every stage of change. The patterns of behavior process use mimicked patterns found for other behaviors with a linear increase across the stages of change. This may indicate that for maintaining condom use, more emotional and behavioral activities are required throughout the process of acquisition and maintenance than are necessary for other health-related activities. Implications of this research are that interventions for increasing condom use in drug users may target behavioral steps differently for males and females.

How do residents prioritize smoking cessation for young "high-risk" women? Factors associated with addressing smoking cessation.

BACKGROUND: Sixty-seven percent of physicians report advising their smoking patients to quit. Primary care residents' priorities for preventive health for a young "high-risk" female are unknown. Factors related to residents addressing smoking also need examining. METHODS: One hundred residents completed a survey about preventive health issues for a woman in her 20s "who leads a high-risk lifestyle." Residents indicated which topics they would address, and the likelihood that they would address each of 12 relevant preventive health topics, their outcome expectancies that the patient would follow their advice on each topic, their confidence that they could address the topic, and perceived barriers for addressing the topic. RESULTS: Residents listed STD prevention most frequently. Drug use and smoking cessation were second and third most frequently listed. Residents who believed that the patient would follow their advice were more likely to list smoking cessation than residents who had lower outcome expectancies for that patient. Higher barriers were negatively related to addressing smoking cessation. CONCLUSIONS: When time is not a barrier, residents are likely to address smoking cessation. Teaching residents how to incorporate this subject into their clinical practice is needed. Raising residents' outcome expectancies may increase their likelihood of addressing smoking cessation.

Reasons for quitting smoking among low-income African American smokers.

The psychometric characteristics of the Reasons For Quitting scale (RFQ) were assessed among a sample of African American smokers with low income (N=487). The intrinsic and extrinsic scales and their respective subscales were replicated. As hypothesized, higher levels of motivation were associated significantly, in patterns that supported the measure's construct validity, with advanced stage of readiness to quit smoking, greater perceived vulnerability to health effects of smoking, and greater social support for cessation. On the basis of the present study, the RFQ might best predict short-term cessation among older and female smokers. Refinement of the RFQ is needed to assess intrinsic motivators other than health concerns and to identify salient motivators for young and male smokers.

Women's perceived and partners' reported support for smoking cessation during pregnancy.

Studies of the influence of social support on successful smoking cessation have been based on the smoker's perceptions only. In this pilot study of 58 couples, pregnant women who had smoked in the 30 days before pregnancy and their partners reported the positive and negative support for cessation they had received (women) or provided (partners). Mean levels of the women's and partners' perceptions of support were compared, and correlations of the two reports were analyzed while controlling for the effect of the couple's smoking status. Women's and partners' reports were similar except partners reported wanting the women to stop smoking more than women perceived. Women's and partners' perceived negative support were moderately correlated (r approximately equal to .48, p approximately equal to .001). Partner-reported positive support also was associated with women's perceived negative support (r approximately equal to .30, p approximately equal to .03). These relationships remained signif cant after controllingfor partners' and women's smoking status. Generally, partners reported giving more positive and less negative support than women perceived. Results suggest the need for further examination of couples' perceptions of support and the impact on smoking cessation during pregnancy.

Relationships among breast cancer perceived absolute risk, comparative risk, and worries.

When trying to predict breast cancer screening, it may be important to understand the relationships between perceived breast cancer risks and worries about getting breast cancer. This study examines the extent to which women's worries about breast cancer correlate with perceptions of both absolute (assessment of own) and comparative (self versus other) 10-year and lifetime risks. As part of a larger randomized intervention trial concerning hormone replacement therapy, 581 women participated in a telephone baseline survey to assess their perceptions of breast cancer risks and worries. Worries about getting breast cancer in the next 10 years and in one's lifetime were related positively to both absolute and comparative 10-year and lifetime risks. The magnitude of these relationships did not differ by time frame. Worry about breast cancer is a function of both how a woman views her own risk and how she compares her risk with that of other women. Some practitioners may encourage women to get screened for breast cancer by using emotional appeals, such as heightening women's worries about breast cancer by using risk information. Our data suggest that they should give careful consideration how best to combine, if at all, information about absolute and comparative risks. For example, if the motivation to screen is based on a sequential assessment of risk beginning with comparative and then absolute risk, creating communications that heighten perceived risk on both of these risk dimensions may be needed to evoke sufficient worry to initiate breast cancer screening.

Causal relationships of processes of change and decisional balance: stage-specific models for smoking.

This study, a secondary analysis of prospective data of smokers, tested whether the causal relationships between the processes of change and decisional balance of the transtheoretical model of change (TTM) are stage-specific. It was expected that for smokers in the contemplation stage, higher levels of experiential processing cause the cons of smoking to become more important and the pros of smoking to become less important. In other words, the level of experiential process use was expected to causally influence decisional balance (pros minus cons) for people in the contemplation stage. For ex-smokers in the action stage, when the cons outweigh the pros (cons become more important while pros become less important), they should increase their behavioral process use: decisional balance was expected to causally influence use of behavioral processes. Cross-lagged panels were analyzed using structural equation modeling. Results indicate that experiential process use has causal predominance over decisional balance for smokers in the contemplation stage. For those in the action stage, however, neither decisional balance nor behavioral process had apparent causal predominance. Mean-level invariance indicates that the contemplation and action stages are different. Further analysis investigated smokers who progressed from contemplation to either preparation or action or from preparation to action. For these smokers who had progressed toward action, decisional balance did causally influence use of behavioral processes. This evidence provides support for the use of the TTM as the basis for planning interventions that target specific stage-dependent causal mechanisms.

Prenatal smoking cessation counseling by Texas obstetricians.

BACKGROUND: Smoking during pregnancy causes 20 to 30 percent of low birthweight and 10 percent of infant mortality in the United States. Brief counseling can reduce rates of smoking. The study objectives were to describe Texas obstetricians' pregnancy smoking cessation counseling activity and to identify attributes associated with consistent, effective counseling. METHODS: A survey was mailed to a random sample of Texas obstetricians. RESULTS: A response rate of 44 percent (n = 204) was attained. A counseling coverage-effectiveness index was created based on the percentage of smokers counseled and use of specific techniques. Almost all respondents reported asking about smoking; fewer, however, reported counseling smokers. Physicians with low index scores, indicating inconsistent coverage, ineffective counseling, or both were dissatisfied with their current counseling, did not perceive counseling to decrease smoking, were not aware of the risks of smoking, and were unfamiliar with expert reports and recommendations for prenatal care. CONCLUSIONS: Obstetricians who are not reached by expert reports and guidelines from groups outside their specialty or who do not perceive the seriousness of maternal smoking are less likely to counsel consistently and to use the most effective techniques. Continuing medical education at local, state, and national levels should be directed toward increasing knowledge and skills about smoking cessation counseling of pregnant women.