Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals.

BACKGROUND: Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. METHODS: This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended). RESULTS: Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. IMPLEMENTATION: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05) and reported decreased barriers to implementing smoking cessation services (p < 0.001). Qualitative comments were very positive ("user friendly," "streamlined," or "saves time"), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended. CONCLUSIONS: Given that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01309217.

Effectiveness of the Tobacco Tactics Program in the Trinity Health System.

INTRODUCTION: This study determined the effectiveness of the Tobacco Tactics intervention. DESIGN/SETTING/PARTICIPANTS: This was a pragmatic, quasi-experimental study conducted from 2010 to 2013 and analyzed from 2014 to 2015 in five Michigan community hospitals; three received the Tobacco Tactics intervention, and two received usual care. Smokers (N=1,528) were identified during hospitalization, and sent surveys and cotinine tests after 6 months. Changes in pre- to post-intervention quit rates in the intervention sites were compared with usual care control sites. INTERVENTION: The toolkit for nurses included: (1) 1 continuing education unit contact hour for training; (2) a PowerPoint presentation on behavioral and pharmaceutical interventions; (3) a pocket card entitled "Helping Smokers Quit: A Guide for Clinicians"; (4) behavioral and pharmaceutical protocols; and (5) a computerized template for documentation. The toolkit for patients included: (1) a brochure; (2) a cessation DVD; (3) the Tobacco Tactics manual; (4) a 1-800-QUIT-NOW card; (5) nurse behavioral counseling and pharmaceuticals; (6) physician reminders to offer brief advice to quit coupled with medication sign-off; and (7) follow-up phone calls by trained hospital volunteers. MAIN OUTCOME MEASURES: The effectiveness of the intervention was measured by 6-month 30-day point prevalence; self-reported quit rates with NicAlert(®) urinary biochemical verification (48-hour detection period); and the use of electronic medical record data among non-responders. RESULTS: There were significant improvements in pre- to post-intervention self-reported quit rates (5.7% vs 16.5%, p<0.001) and cotinine-verified quit rates (4.3% vs 8.0%, p<0.05) in the intervention sites compared with no change in the control sites. Propensity-adjusted multivariable analyses showed a significant improvement in self-reported 6-month quit rates from the pre- to post-intervention time periods in the intervention sites compared to the control sites (p=0.044) and a non-statistically significant improvement in the cotinine-verified 6-month quit rate. CONCLUSIONS: The Tobacco Tactics intervention, which meets the Joint Commission standards for inpatient smoking, has the potential to significantly decrease smoking among inpatient smokers. TRIAL REGISTRATION: This study is registered at www.clinicaltrial.gov NCT01309217.

Gardening/Yard Work and Depressive Symptoms in African Americans.

BACKGROUND: The purpose of this study was to examine the frequency of gardening/yard work in relation to depressive symptoms in African-Americans while controlling for biological and social factors. METHODS: A secondary analysis was performed on the National Survey of American Life (n=2,903) using logistic regression for complex samples. Gardening/Yard work was measured by self-reported frequency. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. RESULTS: Biological and social factors, not gardening/yard work, were associated with depressive symptoms. CONCLUSIONS: Biological and social factors may need to be addressed before the association between gardening/yard work and depressive symptoms can be determined.

Refusal to participate in heart failure studies: do age and gender matter?

AIMS AND OBJECTIVES: The objective of this retrospective study was to evaluate reasons heart failure patients decline study participation, to inform interventions to improve enrollment. BACKGROUND: Failure to enrol older heart failure patients (age > 65) and women in studies may lead to sampling bias, threatening study validity. DESIGN: This study was a retrospective analysis of refusal data from four heart failure studies that enrolled 788 patients in four states. METHODS: Chi-Square and a pooled t-test were computed to analyse refusal data (n = 300) obtained from heart failure patients who were invited to participate in one of the four studies but declined. RESULTS: Refusal reasons from 300 patients (66% men, mean age 65·33) included: not interested (n = 163), too busy (n = 64), travel burden (n = 50), too sick (n = 38), family problems (n = 14), too much commitment (n = 13) and privacy concerns (n = 4). Chi-Square analyses showed no differences in frequency of reasons (p > 0·05) between men and women. Patients who refused were older, on average, than study participants. CONCLUSIONS: Some reasons were patient-dependent; others were study-dependent. With 'not interested' as the most common reason, cited by over 50% of patients who declined, recruitment measures should be targeted at stimulating patients' interest. Additional efforts may be needed to recruit older participants. However, reasons for refusal were consistent regardless of gender. RELEVANCE TO CLINICAL PRACTICE: Heart failure researchers should proactively approach a greater proportion of women and patients over age 65. With no gender differences in type of reasons for refusal, similar recruitment strategies can be used for men and women. However, enrolment of a representative proportion of women in heart failure studies has proven elusive and may require significant effort from researchers. Employing strategies to stimulate interest in studies is essential for recruiting heart failure patients, who overwhelmingly cited lack of interest as the top reason for refusal.

Implementation of a Psychoeducational Program for Cancer Survivors and Family Caregivers at a Cancer Support Community Affiliate: A Pilot Effectiveness Study.

BACKGROUND: Psychoeducational interventions, tested for efficacy in randomized clinical trials, are seldom implemented in clinical practice where cancer survivors and their family caregivers can benefit from them. OBJECTIVE: This study examined the effectiveness of the FOCUS Program on cancer survivors' and their family caregivers' outcomes when implemented at a Cancer Support Community (CSC) affiliate by agency social workers. Study aims were to (1) test effects of the program on survivor and caregiver outcomes as a unit and (2) determine program feasibility in terms of enrollment, retention, intervention fidelity, and satisfaction. METHODS: A preintervention and postintervention pilot effectiveness study was conducted with 34 cancer survivor-caregiver dyads (ie, pairs). The FOCUS Program, originally delivered by nurses in dyads' homes, was modified to a small-group format and delivered by CSC social workers. The primary outcome was quality of life (QOL). Intermediary outcomes were benefits of illness/caregiving, communication, support, and self-efficacy. Analyses included repeated-measures analysis of variance. RESULTS: Dyads had significant improvements in total QOL; physical, emotional, and functional QOL; benefits of illness; and self-efficacy. Effect sizes were similar to prior randomized clinical trial findings. Although dyads were difficult to recruit (enrollment, 60%), both retention (92%) and intervention fidelity (94%) were high. CONCLUSIONS: It was possible to implement the FOCUS Program at a CSC affiliate by agency staff, obtain positive intervention effects, and maintain intervention fidelity. IMPLICATIONS FOR PRACTICE: Researchers and clinicians need to collaborate to implement more evidence-based interventions in practice settings for cancer survivors and their family caregivers.

Nurse-Enhanced Computerized Cognitive Training Increases Serum Brain-Derived Neurotropic Factor Levels and Improves Working Memory in Heart Failure.

BACKGROUND: Memory loss is common in heart failure (HF) patients, but few interventions have been tested to treat it. The objective of this study was to evaluate efficacy of a cognitive training intervention, Brain Fitness, to improve memory, serum brain-derived neurotropic factor (BDNF) levels, working memory, processing speed, executive function, instrumental activities of daily living, mobility, depressive symptoms, and health-related quality of life. METHODS AND RESULTS: Twenty-seven HF patients were randomly assigned to Brain Fitness and health education active control interventions. Data were collected at baseline and 8 and 12 weeks. Linear mixed models analyses were completed. Patients in the Brain Fitness group were older with lower ejection fraction. At 12 weeks, a group by time interaction effect was found for serum BDNF levels (P = .011): serum BDNF levels increased among patients who completed Brain Fitness and decreased among patients who completed health education. No differences were found in memory, but a group by time interaction (P = .046) effect was found for working memory. CONCLUSIONS: Findings support efficacy of Brain Fitness in improving working memory and serum BDNF levels as a biomarker of intervention response. A randomized controlled study is needed among a larger more diverse group of HF patients.

Protocol of a randomized controlled trial of hearing protection interventions for farm operators.

BACKGROUND: Hearing loss and tinnitus are prevalent in America, and noise-induced hearing loss is a leading cause of hearing loss. Noise-induced hearing loss has negative impact on quality of life, physical and emotional functioning, social life, and employment. In addition, noise-induced hearing loss results in heavy social and economic burdens on families and communities from all ethnic and socioeconomic groups. Farmers are a group that is particularly high risk for noise-induced hearing loss, and is underserved by programs designed to limit that risk. They are among the most noise-exposed group of workers, and experience the second highest prevalence of noise-induced hearing loss among all occupational categories. In agriculture, 1.5 million workers (43.3%) report exposure to hazardous noise. Although use of hearing protection devices (HPDs) would protect them from noise-induced hearing loss, use among farmers is low. METHODS/DESIGN: The purpose of this project is to compare the effectiveness of several approaches to influencing hearing protector use. Approaches include: a) an interactive, predictors-based intervention delivered via the Internet; b) a static informational web site; and c) a mailed sampler of hearing protectors. The goals are to further develop an intervention to promote farmers' use of HPDs, and compare the effectiveness of the interventions delivered in various combinations. Participants will include 701 farmers. Sites will be affiliates of a major farmer organization. Data will be collected at baseline, 6, and 12 months. A random intercept mixed model will be used to explore the fixed effects of the three NIHL prevention interventions over time while adjusting for age and gender. This project will involve a partnership between the University of Michigan and a major farmer organization to accomplish project aims. DISCUSSION: Results of this study will be used to inform future research-to-practice studies to increase hearing protector use. Increased use of hearing protectors is expected to reduce rates of noise-induced hearing loss and other negative effects of high noise exposure, and improve quality of life in this high-risk and underserved group. TRIAL REGISTRATION: Clinicaltrials.gov NCT01454895 Registered 14 October, 2011.

DEFENS - Drug Exposure Feedback and Education for Nurses' Safety: study protocol for a randomized controlled trial.

BACKGROUND: Three decades of research findings have documented the health effects of handling hazardous drugs. Oncology nurses are vulnerable due to frequent administration of antineoplastics, low adherence to equipment use, reported barriers to use, and perceived low risk of health effects. No interventions have been tested in a controlled, multi-site trial to increase nurses' use of protective equipment when handling hazardous drugs. The Drug Exposure Feedback and Education for Nurses' Safety (DEFENS) study will compare the efficacy of education (control) versus an audit and feedback intervention (treatment) on nurses' self-reported use of personal protective equipment when handling hazardous drugs. The treatment intervention will include tailored messages based on nurses' reported barriers to protective equipment use. METHODS/DESIGN: The DEFENS Study is a cluster randomized controlled trial. We are enrolling cancer centers and will recruit nurse participants in April 2015. Eligible cancer centers employ at least 20 eligible registered nurses in the chemotherapy infusion setting and have on-site phlebotomy resources. Eligible participants are nurses who work at least 0.40 full-time equivalent hours in the chemotherapy infusion setting and have not received an antineoplastic drug for a health problem in the past year. An encrypted, user-authenticated website will administer surveys and deliver control and treatment interventions. The primary endpoint is the change in score on nurses' reports of the Revised Hazardous Drug Handling Questionnaire between baseline and approximately 18 months later. A baseline survey is completed after informed consent and is repeated 18 months later. Nurses in all sites who experience a drug spill will also report incidents as they occur; these reports inform the treatment intervention. Plasma will be obtained at baseline, approximately 18 months later (the primary endpoint), and with drug spill occurrences to measure hazardous drugs levels and to inform the treatment intervention. Potential mediators include knowledge of hazardous drug handling and perceived risk of drug exposure. We will examine whether personal factors and organizational factors moderate the intervention effects. TRIAL REGISTRATION: Clinicaltrials.gov NCT02283164 , registered 31 October 2014.

Effectiveness of the tobacco tactics program for psychiatric inpatient veterans: an implementation study.

BACKGROUND: The objective of this study was to evaluate the effectiveness of the inpatient, nurse-administered Tobacco Tactics program for patients admitted for psychiatric conditions in two Veterans Affairs (VA) hospitals compared to a control hospital. METHODS: This is a subgroup analysis of data from the inpatient tobacco tactics effectiveness trial, which was a longitudinal, pre- post-nonrandomized comparison design with 6-month follow-up in the three large Veterans Integrated Service Networks (VISN) 11 hospitals. RESULTS: Six-month self-reported quit rates for patients admitted for psychiatric conditions increased from 3.5% pre-intervention to 10.2% post-intervention compared to a decrease in self-reported quit rates in the control hospital (12% pre-intervention to 1.6% post-intervention). There was significant improvement in self-reported quit rates for the pre- versus post-intervention time periods in the Detroit and Ann Arbor intervention sites compared to the Indianapolis control site (P=0.01) and cotinine results were in the same direction. CONCLUSION: The implementation of the Tobacco Tactics intervention has the potential to significantly decrease smoking and smoking-related morbidity and mortality among smokers admitted to VA hospitals for psychiatric disorders.

Evaluation and costs of volunteer telephone cessation follow-up counseling for Veteran smokers discharged from inpatient units: a quasi-experimental, mixed methods study.

BACKGROUND: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate the volunteer telephone smoking cessation counseling follow-up program implemented as part of the inpatient Tobacco Tactics intervention in a Veterans Affairs (VA) hospital. METHODS: This was a quasi-experimental, mixed methods design that collected data through electronic medical records (EMR), observations of telephone smoking cessation counseling calls, interviews with staff and Veterans involved in the program, and intervention costs. RESULTS: Reach: Of the 131 Veterans referred to the smoking cessation telephone follow-up program, 19% were reached 0-1 times, while 81% were reached 2-4 times. Effectiveness: Seven-day point-prevalence 60-day quit rates (abstracted from the EMR) for those who were reached 2-4 times were 26%, compared to 8% among those who were reached 0-1 times (p = 0.06). Sixty-day 24-hour point-prevalence quit rates were 33% for those reached 2-4 times, compared to 4% of those reached 0-1 times (p < 0.01). Adoption and Implementation: The volunteers correctly followed protocol and were enthusiastic about performing the calls. Veterans who were interviewed reported positive comments about the calls. The cost to the hospital was $21 per participating Veteran, and the cost per quit was $92. Maintenance: There was short-term maintenance (about 1 year), but the program was not sustainable long term. CONCLUSIONS: Quit rates were higher among those Veterans that had greater participation in the calls. Joint Commission standards for inpatient smoking with follow-up calls are voluntary, but should these standards become mandatory, there may be more motivation for VA administration to institute a hospital-based, volunteer telephone smoking cessation follow-up program. TRIAL REGISTRATION: ClinicalTrials.Gov NCT01359371.

African American women and prenatal care: perceptions of patient-provider interaction.

Poor patient-provider interaction among racial/ethnic minorities is associated with disparities in health care. In this descriptive, cross-sectional study, we examine African American women's perspectives and experiences of patient-provider interaction (communication and perceived discrimination) during their initial prenatal visit and their influences on perceptions of care received and prenatal health behaviors. Pregnant African American women (n = 204) and their providers (n = 21) completed a pre- and postvisit questionnaire at the initial prenatal visit. Women were also interviewed face to face at the subsequent return visit. Women perceived high quality patient-provider communication (PPC) and perceived low discrimination in their interaction with providers. Multiple regression analyses showed that PPC had a positive effect on trust in provider (p < .001) and on prenatal care satisfaction (p < .001) but not on adherence to selected prenatal health behaviors. Findings suggest that quality PPC improves the prenatal care experience for African American women.

Depressive Symptoms and Walking in African-Americans.

OBJECTIVE: Although increased frequency of physical activity is associated with fewer depressive symptoms in African-Americans, most studies do not focus on a specific type of activity. Identifying the activity can provide helpful information for designing interventions that focus on depressive symptoms. The objective of this study was to examine the odds of depressive symptoms in relation to walking in African-Americans. DESIGN AND SAMPLE: A secondary analysis was performed on the National Survey of American Life. The sample was made up of community-dwelling African-American women (n = 1,903) and men (n = 1,075) who did not meet the DSM-IV-TR criteria for depression. MEASURES: Walking was measured by self-reported frequency (i.e., never, rarely, sometimes, often). Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the odds of depressive symptoms in relation to walking. RESULTS: Women who reported often walking had lower odds for depressive symptoms than women who reported never walking (OR = 0.56, 95% CI = 0.38-0.82). Walking frequency was not related to depressive symptoms in men. CONCLUSIONS: Walking frequency is a modifiable risk factor for elevated depressive symptoms in African-American women.

A Pilot Intervention to Promote Safer Sex in Heterosexual Puerto Rican Couples.

Although the sexual transmission of HIV occurs in the context of an intimate relationship, preventive interventions with couples are scarce, particularly those designed for Hispanics. In this article, we present the effect of a pilot intervention directed to prevent HIV/AIDS in heterosexual couples in Puerto Rico. The intervention was theory-based and consisted of five three-hour group sessions. Primary goals included increasing male condom use and the practice of mutual masturbation as a safer sex method, and promoting favorable attitudes toward these behaviors. Twenty-six couples participated in this study. Fifteen were randomly assigned to the intervention group and eleven to a control group. Retention rates at post-intervention and follow-up were 82% for the whole sample. Results showed that there was a significant increase in the use of male condoms with main partners in the intervention group when compared with the control group. Couples in the intervention group also had better scores on secondary outcomes, such as attitudes toward condom use and mutual masturbation, HIV information, sexual decision-making, and social support. We found that these effects persisted over the three month follow up. A significant effect was also observed for the practice of mutual masturbation, but not for sexual negotiation. These results showed that promoting male condom use in dyadic interventions among heterosexual couples in Puerto Rico is feasible. Our findings suggest that because vaginal penetration has been constructed as the sexual script endpoint among many Hispanic couples, promoting other non-penetrative practices, such as mutual masturbation, may be difficult.

Web-enhanced tobacco tactics with telephone support versus 1-800-QUIT-NOW telephone line intervention for operating engineers: randomized controlled trial.

BACKGROUND: Novel interventions tailored to blue collar workers are needed to reduce the disparities in smoking rates among occupational groups. OBJECTIVE: The main objective of this study was to evaluate the efficacy and usage of the Web-enhanced "Tobacco Tactics" intervention targeting operating engineers (heavy equipment operators) compared to the "1-800-QUIT-NOW" telephone line. METHODS: Operating engineers (N=145) attending one of 25 safety training sessions from 2010 through 2012 were randomized to either the Tobacco Tactics website with nurse counseling by phone and access to nicotine replacement therapy (NRT) or to the 1-800-QUIT-NOW telephone line, which provided an equal number of phone calls and NRT. The primary outcome was self-reported 7-day abstinence at 30-day and 6-month follow-up. The outcomes were compared using chi-square tests, t tests, generalized mixed models, and logistic regression models. RESULTS: The average age was 42 years and most were male (115/145, 79.3%) and white (125/145, 86.2%). Using an intent-to-treat analysis, the Tobacco Tactics website group showed significantly higher quit rates (18/67, 27%) than the 1-800-QUIT NOW group (6/78, 8%) at 30-day follow-up (P=.003), but this difference was no longer significant at 6-month follow-up. There were significantly more positive changes in harm reduction measures (quit attempts, number of cigarettes smoked per day, and nicotine dependence) at both 30-day and 6-month follow-up in the Tobacco Tactics group compared to the 1-800-QUIT-NOW group. Compared to participants in the 1-800-QUIT NOW group, significantly more of those in the Tobacco Tactics website group participated in the interventions, received phone calls and NRT, and found the intervention helpful. CONCLUSIONS: The Web-enhanced Tobacco Tactics website with telephone support showed higher efficacy and reach than the 1-800-QUIT-NOW intervention. Longer counseling sessions may be needed to improve 6-month cessation rates. TRIAL REGISTRATION: Clinicaltrials.gov NCT01124110; http://clinicaltrials.gov/ct2/show/NCT01124110 (Archived by WebCite at http://www.webcitation.org/6TfKN5iNL).

Nursing knowledge, practice patterns, and learning preferences regarding chemotherapy-induced peripheral neuropathy.

PURPOSE/OBJECTIVES: To explore nurses' practice patterns, knowledge, and barriers related to chemotherapy-induced peripheral neuropathy (CIPN). DESIGN: Descriptive, cross-sectional. SETTING: The United States. SAMPLE: 408 oncology nurses. METHODS: A team of eight experts met and developed the CIPN nurse knowledge and preferences survey, which was electronically sent to randomly selected nurses. MAIN RESEARCH VARIABLES: The survey assessed nurses' knowledge and practice patterns regarding assessment strategies and barriers, evidence-based interventions, preferences for education, and perceived gaps in scientific knowledge. FINDINGS: Nurses in the survey lacked knowledge regarding neurotoxicity of specific agents and evidence-based treatments. CIPN-focused physical examinations and standardized measurement tools were infrequently used during assessment. The most frequently reported barriers to CIPN assessment included lack of access to measurement tools, lack of specialized skills needed for assessment, lack of confidence, and lack of time. Recommendations for future research included CIPN prevention research, exploration of CIPN-related effects on quality of life, and alternative treatments of CIPN. The majority of participants preferred online educational opportunities. CONCLUSIONS: Nurses do not consistently integrate evaluation and management of CIPN in their practices. IMPLICATIONS FOR NURSING: Educational offerings should incorporate web-based CIPN assessment and management content.

A tailored Web-based psychoeducational intervention for cancer patients and their family caregivers.

BACKGROUND: Most programs addressing psychosocial concerns of cancer survivors are in-person programs that are expensive to deliver, have limited availability, and seldom deal with caregivers' concerns. OBJECTIVE: This study examined the feasibility of translating an efficacious nurse-delivered program (FOCUS Program) for patients and their caregivers to a tailored, dyadic Web-based format. Specific aims were to (1) test the preliminary effects of the Web-based intervention on patient and caregiver outcomes, (2) examine participants' program satisfaction, and (3) determine the feasibility of using a Web-based delivery format. METHODS: A phase 2 feasibility study was conducted with cancer patients (lung, breast, colorectal, prostate) and their family caregivers (N = 38 dyads). The Web-based intervention provided information and support tailored to the unique characteristics of each patient, caregiver, and their dyadic relationship. Primary outcomes were emotional distress and quality of life. Secondary outcomes were benefits of illness/caregiving, communication, support, and self-efficacy. Analyses included descriptive statistics and repeated-measures analysis of variance. RESULTS: Dyads had a significant decrease in emotional distress, increase in quality of life, and perceived more benefits of illness/caregiving. Caregivers also had significant improvement in self-efficacy. There were no changes in communication. Participants were satisfied with program usability, but recommended additional content. CONCLUSIONS: It was possible to translate a clinician-delivered program to a Web-based format that was easy to use and had positive effects on dyadic outcomes. IMPLICATIONS FOR PRACTICE: The Web-based program is a promising way to provide psychosocial care to more patients and caregivers using fewer personnel. It needs further testing in a larger randomized clinical trial.

The impact of Sun Solutions educational interventions on select health belief model constructs.

The purpose of this study was to offer the Sun Solutions intervention to operating engineers (N = 232) to decrease sun exposure and skin cancer. The majority (82%) of the engineers worked outside between 10 a.m. and 3 p.m., 4 to 5 hours a day; 81.4% reported more than one sunburn during the past year and 70% sometimes or never used sunscreen compared to 30% who wore sunscreen approximately 50% or more of the time. Most reported that the intervention was helpful (97%), most were satisfied (96%) with the intervention, and 84% expressed a future intention to use sunscreen. Regarding sun protective behaviors, the intervention significantly improved perceived self-efficacy (p < .05) and increased perceived barriers (p < .05). Regarding sunburn and skin cancer, the intervention increased perceived benefits (p < .05), susceptibility (p < .05), and severity (p < .05) for sunburning, but not skin cancer (p > .10). The Sun Solutions intervention showed the potential to increase sunscreen use and decrease the risk of sunburn and skin cancer among operating engineers.

Effectiveness of the tobacco tactics program in the Department of Veterans Affairs.

PURPOSE: The purpose was to determine the effectiveness of the Tobacco Tactics program in three Veterans Affairs hospitals. METHODS: In this effectiveness trial, inpatient nurses were educated to provide the Tobacco Tactics intervention in Ann Arbor and Detroit, while Indianapolis was the control site (N = 1,070). Smokers were surveyed and given cotinine tests. The components of the intervention included nurse counseling, brochure, DVD, manual, pharmaceuticals, 1-800-QUIT-NOW card, and post-discharge telephone calls. RESULTS: There were significant improvements in 6-month quit rates in the pre- to post-intervention time periods in Ann Arbor (p = 0.004) and Detroit (p < 0.001) compared to Indianapolis. Pre- versus post-intervention quit rates were 4 % compared to 13 % in Detroit, were similar (6 %) pre- and post-intervention in Ann Arbor, and dropped from 26 % to 12 % in Indianapolis. CONCLUSION: The Tobacco Tactics program, which meets the Joint Commission standards that apply to all inpatient smokers, has the potential to significantly decrease smoking among Veterans.

The relationship of alcohol use and physical activity from an ecologic perspective.

PURPOSE: To determine the predictors of alcohol use (AU) and their relationship to physical activity (PA) among adolescents and to examine differences among groups using an ecologic model. DESIGN AND METHODS: Cross sectional secondary analysis of 11,432 adolescents (51% 8th and 49% 10th graders). RESULTS: Attitude, perception of risk, and academic performance were the strongest predictors of AU. PA did not moderate, but it had a positive influence on AU in 10th graders. Differences were observed among groups. PRACTICE IMPLICATIONS: Nurses can address individual and school factors in an effort to decrease AU and guide nurses in creating an individualized plan.

Patient-centered communication and health assessment with youth.

BACKGROUND: Patient-centered communication is fundamental to individualizing healthcare, but there has been limited evaluation of provider communication with youth. OBJECTIVES: The aim was to compare communication outcomes after use of an event history calendar (EHC) and Guidelines for Adolescent Preventive Services (GAPS) to structure interactions during a clinic visit. Patient and provider descriptions of EHC and GAPS communication experiences were also obtained. METHODS: This is a secondary analysis of data obtained during a randomized controlled trial. A sequential explanatory mixed-methods approach was used. A split-plot design with one between factor (EHC, GAPS) and one within factor (pretest, posttest) was used for the quantitative portion. Qualitative data were collected from open-ended questions, audiotaped visits, and exit interviews. Providers (n = 9) at three clinics were assigned at random and trained to implement either the EHC or GAPS protocol. Male and female youth (n = 186) were randomly assigned to the EHC or GAPS intervention. Before their clinic visit, youth completed assessments of past communication experiences with healthcare providers (pretest); communication during the current visit was assessed immediately after the visit (posttest). RESULTS: Communication outcomes from pretest to posttest improved for youth in both the EHC and GAPS groups. Post hoc subgroup analysis suggested that men and Arab Americans derived more benefit from the EHC intervention in some aspects of communication. Qualitatively, the EHC group identified improved outcomes in validating patient perspective, being viewed in context, reaching a shared understanding of needs and preferences, and being helped to share power in the healthcare interaction. DISCUSSION: EHC and GAPS provided effective frameworks for structuring communication during a clinic visit. Compared with GAPS, the integrated time-linked assessment captured by the EHC enhanced patient-centered communication in select groups.