The impact of educational message framing on adherence to continuous positive airway pressure therapy.

Although of proven health benefit to persons with obstructive sleep apnea (OSA), adherence to continuous positive airway pressure (CPAP) therapy is suboptimal, with patterns of use that are established early and that are not easily altered after the initial experience. In a randomized controlled trial, 70 participants with OSA and cardiovascular disease were assigned to receive either positively or negatively framed education about CPAP. Objective adherence was measured following 30 days of home CPAP therapy. Daytime sleepiness, dispositional optimism, self-efficacy, and depression were also evaluated at baseline and after 30 days. CPAP use was greater in the group receiving negative message framing (p = .015).

Factors Influencing the Phenotypic Characterization of the Oral Marker, PROP.

In the last several decades, the genetic ability to taste the bitter compound, 6-n-propyltiouracil (PROP) has attracted considerable attention as a model for understanding individual differences in taste perception, and as an oral marker for food preferences and eating behavior that ultimately impacts nutritional status and health. However, some studies do not support this role. This review describes common factors that can influence the characterization of this phenotype including: (1) changes in taste sensitivity with increasing age; (2) gender differences in taste perception; and (3) effects of smoking and obesity. We suggest that attention to these factors during PROP screening could strengthen the associations between this phenotype and a variety of health outcomes ranging from variation in body composition to oral health and cancer risk.

Risk factors for smoking in rural women.

BACKGROUND: This study examined the association between social, demographic, and psychologic factors and smoking status among Appalachian Ohio women. A secondary aim examined whether specific factors could be identified and segmented for future tailored treatment of tobacco dependence. METHODS: A cross-sectional survey (n=570) obtained information about social, demographic, and psychologic factors and smoking. Logistic regression described associations between these characteristics and smoking status. Chi-square automatic interaction detection (CHAID) analyses identified subgroups at risk for smoking. RESULTS: Fifty-two percent never smoked, with 20.5% and 27.5% categorized as former and current smokers, respectively. Women with low adult socioeconomic position (SEP) were more likely to smoke (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.74-5.34) compared to high SEP women. Other factors associated with current smoking included age 31-50 (OR 2.30, 95% CI 1.22-4.33), age 18-30 (OR 3.29, 95% CI 1.72-5.34), Center for Epidemiologic Studies Depression scale (CES-D) score≥16 (OR 1.99, 95% CI 1.31-3.05), and first pregnancy at age<20 (OR 1.74, 95% CI 1.14-2.66). The prevalence of smoking was 50% among those with four or more risk factors compared to 10% for those reporting no risk factors. CHAID analyses identified low adult SEP and depressive symptoms as the combination of risk factors most strongly associated with smoking; 49.3% of women in this subgroup currently smoked. CONCLUSIONS: Low SEP in adulthood, maternal circumstances, and depressive symptoms are associated with current smoking. Tailored cessation interventions that address these risk factors should be developed and further evaluated in an attempt to reduce disparities in smoking prevalence among this vulnerable group of women.

The cultural context of smoking among immigrants from the former Soviet Union.

The purpose of this descriptive, qualitative study was to gain understanding of the cultural context of smoking among immigrants from former Soviet Union countries now living in the Midwest United States. Semistructured interviews were conducted in focus group or individual settings (N = 14), including smokers and former smokers recruited from community settings. Social factors and stress management strongly motivated smoking behavior. Personal willpower was the most helpful cessation strategy, with firm lack of openness to pharmacologic approaches. Top past stressors included food insecurity and societal unrest, with the top current stressors being acculturative issues. The importance of social connectedness and the relatively low priority of prevention were also themes. Based on these interviews, interventions should include acculturative stress management and maintaining social connectedness, while addressing life experiences in the insecurity of basic needs. Smoking cessation interventions that are tailored beyond just language use and address these specific issues are suggested.

Poor use of cardiac rehabilitation among older adults: a self-regulatory model for tailored interventions.

BACKGROUND: A greater number of older adults now live with coronary heart disease (CHD). This poses a significant public health problem, because older adults are at high risk for CHD-related mortality and morbidity. Overwhelming data support the benefits of cardiac rehabilitation for secondary prevention, yet only a small portion of eligible older adults receive it. METHODS AND RESULTS: Whereas many studies examined factors that affect the use of cardiac rehabilitation among older adults, few interventions aimed to improve their cardiac rehabilitation participation rates. A substantial body of evidence indicates that an individual's illness perceptions play a pivotal role in health behavior, and may be a promising target for intervention. Drawing from the theoretic and empiric findings of others, a self-regulatory model is proposed that explicates how CHD perceptions of older adults may influence participation in cardiac rehabilitation. CONCLUSION: The model may provide a useful guide for the development of effective interventions tailored to older adults.

"Active labor" duration and dilation rates among low-risk, nulliparous women with spontaneous labor onset: a systematic review.

INTRODUCTION: Laboring women are often admitted to labor units under criteria that are commonly associated with the onset of active-phase labor (i.e., cervical dilatation of 3-5 cm in the presence of regular contractions). Beginning with these criteria through complete dilatation, this systematic review describes labor duration and cervical dilation rates among low-risk, nulliparous women with spontaneous labor onset. METHODS: Studies published in English (between 1990 and 2008) were identified via MEDLINE and CINAHL searches. Data were abstracted and weighted "active labor" durations (i.e., from 3-5 cm through complete dilatation) and linear dilation rates were calculated. RESULTS: Eighteen studies (n = 7009) reported mean "active labor" duration. The weighted mean duration was 6.0 hours, and the calculated dilation rate was 1.2 cm per hour. These findings closely parallel those found at the median. At the statistical limits, the weighted "active labor" duration was 13.4 hours (mean + 2 standard deviations) and the dilation rate was 0.6 cm per hour (mean - 2 standard deviations). DISCUSSION: These findings indicate that nulliparous women with spontaneous labor onset have longer "active" labors and therefore slower dilation rates than are traditionally associated with active labor when commonly used criteria are applied as the starting point. Revision of existing active labor expectations and/or criteria used to prospectively identify active phase onset is warranted.

Factors influencing cotinine half-life during smoking abstinence in African American and Caucasian women.

Cotinine, the proximate metabolite of nicotine, has been identified as an indicator of smoke constituent exposure. Higher cotinine levels in African American cigarette smokers have been identified. Because African Americans experience disproportionate smoking-related morbidity and mortality, it is important to examine potential factors influencing these higher levels of cotinine. The current study examined selected factors of ethnicity, menthol cigarette preference, body composition and alcohol-use history on cotinine half-life in 6 days of smoking abstinence in African American and Caucasian women. A 7-day inpatient protocol was conducted in the General Clinical Research Center, in which day 1 was ad lib smoking and days 2-7 were smoking abstinence (n = 32). Plasma cotinine was measured every 8 h throughout. Average cotinine half-life was 21.3 h, similar to previously reported 18-20 h. Three women exhibited >14 ng/ml cotinine after 136 h of smoking abstinence. Host factors explaining 52.0% of variance in cotinine half-life and associated with longer half-life were being an African American menthol smoker, fewer years of alcohol use and greater lean body mass. Among menthol smokers, baseline cotinine level and cotinine half-life were not significantly different in Caucasian and African American women. Intra-individual cotinine half-life variation and CYP2A6 genotype were examined in substudies. To improve accuracy in correctly classifying non-smokers with cotinine levels, a period of at least 7 days of smoking abstinence may be warranted.