Psychometric Properties of Instruments That Measure Vaping Outcome Expectancies: A Systematic Review.

INTRODUCTION: Vaping is a growing public health concern. Interventions that address vaping must build upon rigorous research that uses psychometrically sound instruments to measure vaping-associated outcome expectancies. AIMS AND METHODS: The primary aim was to appraise the reporting of psychometric properties of instruments used to measure vaping outcome expectancies. Secondary aims were to distinguish the different types of outcome expectancies assessed across the measures, the conceptual underpinnings, and the evidence explaining e-cigarette use etiology. This systematic review was guided by an adapted version of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline and Risk of Bias Checklist. Five electronic databases were searched for peer-reviewed studies, dissertations, and theses that psychometrically evaluated instruments that measure vaping outcome expectancies. Studies that met the inclusion criteria were appraised based on their reporting of nine psychometric properties outlined in the COSMIN checklist. RESULTS: The review included 11 studies that described eight instruments and reported on two to five of nine predetermined psychometric properties. Structural validity, construct validity, and internal consistency were the most commonly reported properties. No studies reported test-retest, intrarater, or interrater reliability, measurement error, or responsiveness. Content validity and measurement invariance were only reported by two and four studies, respectively. The most commonly included subscales in the instruments were affect regulation, positive sensory experience, and negative health consequences. Many of the outcome expectancy subscales were associated with e-cigarette behaviors. CONCLUSIONS: There is limited reporting of psychometric testing of instruments that measure vaping outcome expectancies; however, utilization of the COSMIN guideline could enhance the quality of such reporting. IMPLICATIONS: Appraising the reporting of psychometric properties of instruments that measure vaping outcome expectancies is a first step to ensuring valid and reliable instruments are used to support rigorous research and build evidence-based knowledge. Future research should focus on testing for responsiveness, measurement error, and reliability, and on quality appraisal of the instruments. Studying vaping outcome expectancies may improve understanding of factors that influence and deter vaping. This may contribute to the development of effective interventions aimed at vaping cessation and prevention.

One-year follow-up of hospital nurses' work experiences during the COVID-19 pandemic: A qualitative study.

AIM: To follow up on the experiences of Registered Nurses (RNs) working after 1 year of the COVID-19 pandemic in Canadian and American hospitals. DESIGN: Semi-structured interviews were conducted, and transcripts were analysed through a reflexive thematic analysis (RTA). METHODS: RNs (n = 19) first interviewed in the spring of 2020 were re-interviewed 1 year after their original interviews (May 25, 2021-June 25, 2021). Participants consisted of nurses residing in Canada and working in Ontario (n = 12) or American hospitals (n = 7), i.e., both local and cross-border nurses. RESULTS: Five themes were identified: (1) "You call us heroes, but you forgot us": Nurses described experiences of disrespect and stigma from their communities, their government, and their workplaces. (2) "A whole new level of busy": Nurses reported stressors both at home and at work that had increased exponentially throughout the pandemic. (3) "Running on empty": Nurses described burnout and mental health struggles including depression, irritation, and suicidal ideation; they coped using both adaptive and maladaptive strategies. (4) "The job of nursing is painful": Ongoing pandemic issues led nurses to re-evaluate their commitments to their units, their hospitals and the profession itself. (5) "Surviving an un-survivable day": Nurses shared positive moments at work and home that helped give them the strength to carry on. CONCLUSION: Significant investments will be required from hospital organizations and governments to ensure that healthcare systems continue to function safely for patients, their families and nurses. IMPACT: The purpose of this study was to understand and describe nurses' experiences after 1 year of working during the COVID-19 pandemic. Nurses reported feeling disrespected, overwhelmed, and burned out; many were looking to leave the profession. These findings will be of interest to nurses working on the frontline of the pandemic as well as hospital managers and policy makers. NO PATIENT OR PUBLIC CONTRIBUTION: In this investigation, nurses were the participants.

Consequences of COVID-19 Vaccine Hesitancy Among Healthcare Providers During the First 10 Months of Vaccine Availability: Scoping Review.

BACKGROUND: Throughout the COVID-19 pandemic, healthcare providers (HCPs)-including nurses-have played important roles in the vaccination effort. It is expected that COVID-19 vaccine hesitancy among HCPs has numerous consequences; however, the scope of these consequences and their impacts on providers, patients, and the broader healthcare system remained unclear. PURPOSE: To identify existing and emerging evidence to understand the state of knowledge of the consequences of COVID-19 vaccine hesitancy among HCPs. METHODS: A scoping review was completed based upon the JBI scoping review methodology. The databases searched included OVID Medline, EBSCOhost CINAHL, ProQuest Nursing and Allied Health Source, ProQuest APA PsycInfo, and ProQuest Dissertations and Theses. The final literature search was completed on June 2, 2022. Studies were screened and retrieved based on predefined inclusion and exclusion criteria using Covidence reference management software. Data extraction followed criteria recommended in the JBI scoping review framework with additional relevant variables identified by the authors. RESULTS: A total of 33 sources were included in the review. Consequences of HCP COVID-19 vaccine hesitancy were grouped under three themes and seven subthemes. Consequences affecting HCPs included health-related, psychosocial, and employment-related consequences. Consequences affecting patients pertained to COVID-19 vaccination communication and COVID-19 vaccination practices of HCPs. Consequences to the healthcare system involved consequences to coworkers and employment/attendance/staffing-related consequences. CONCLUSIONS: Healthcare provider COVID-19 vaccine hesitancy was found to have numerous consequences. By understanding the scope and extent of these consequences, healthcare leaders, researchers, and HCPs can work together to protect providers, patients, and healthcare systems.

DNA methylation in complex disease: applications in nursing research, practice, and policy.

DNA methylation is an epigenomic modification that is essential to normal human development and biological processes. DNA methylation patterns are heritable and dynamic throughout the life span. Environmental exposures can alter DNA methylation patterns, contributing to the development of complex disease. Identification and modulation of environmental factors influencing disease susceptibility through alterations in DNA methylation are amenable to nursing intervention and form the basis for individualized patient care. Here we describe the evidence supporting the translation of DNA methylation analyses as a tool for screening, diagnosis, and treatment of complex disease in nursing research and practice. The ethical, legal, social, and economic considerations of advances in genomics are considered as a model for epigenomic policy. We conclude that contemporary and informed nurse scientists and clinicians are uniquely poised to apply innovations in epigenomic research to clinical populations and develop appropriate policies that guide equitable and ethical use of new strategies to improve patient care.

"I Called us the Sacrificial Lambs": Experiences of Nurses Working in Border City Hospitals During the First Wave of the COVID-19 Pandemic.

BACKGROUND: The first wave of the COVID-19 pandemic had a significant impact on the personal and professional lives of frontline nurses. PURPOSE: The purpose of this descriptive phenomenological study was to explore the experiences of Canadian Registered Nurses (RNs) working in Ontario or United States hospitals during the first wave of the COVID-19 pandemic. METHODS: Semi-structured interviews were conducted with 36 RNs living in Ontario and employed either at an Ontario or United States hospital. Three main themes were identified across both healthcare contexts. RESULTS: 1) The Initial Response to the pandemic included a rapid onset of chaos and confusion, with significant changes in structure and patient care, often exacerbated by hospital management. Ethical concerns arose (e.g., redeployment, allocation of resources) and participants described negative emotional reactions. 2) Nurses described Managing the Pandemic by finding new ways to nurse and enhanced teamwork/camaraderie; they reported both struggle and resiliency while trying to maintain work and home life balance. Community responses were met with both appreciation and stigma. 3) Participants said they were Looking Forward to a "new normal", taking pride in patient improvements, accomplishments, and silver linings, with tempered optimism about the future. Many expressed a reaffirmation of their identities as nurses. Differences between participants working in the US and those working in Ontario were noted in several areas (e.g., initial levels of chaos, ethical concerns, community stigma). CONCLUSIONS: The COVID-19 pandemic has been very difficult for nursing as a profession. Close attention to post-pandemic issues is warranted.

A Scoping Review of the Literature on Sleep Quality in Adult Lung Transplant Recipients.

Introduction: Lung transplant recipients face challenging postoperative complications and are at risk for poor sleep quality. Sleep quality, as a complex clinical phenomenon, has multiple subjective and objective connotations. Measures and definitions of sleep quality are not standardized. Objective: A scoping review methodology was used to systematically map the relevant literature, provide an overview of available sleep quality measures, and to identify knowledge gaps. Methods: A systematic search of published and gray literature enabled knowledge synthesis of the last 10 years of evidence documenting sleep quality in lung transplant recipients. The search revealed 246 articles with only 12 sources meeting the eligibility criteria. Results: Sources varied in terms of definitions and measures of sleep quality. Subjective, objective, or a combination of both measures were used across the relevant literature with findings confirming that poor sleep quality was common in lung transplant recipients. Significant associations with poor sleep quality included younger age, female gender, exposure to tacrolimus, anxiety, and depression. Discussion: Systematic literature assessing sleep quality in lung transplant recipients is sparse and lacks conceptual and operational definitions. Future research can focus on designing prospective observational studies. Subjective and objective measures for sleep quality need to be validated in lung transplant recipients. Further rigorous research is needed to standardize measures of sleep quality and to further examine potential risk factors that affect sleep after lung transplantation.

"My problems aren't severe enough to seek help": Stress levels and use of mental health supports by Canadian hospital employees during the COVID-19 pandemic.

Due to the unique set of stressors associated with the COVID-19 pandemic, healthcare workers in acute care settings may be facing elevated rates of mental health symptomatology. The purpose of this study was to assess levels of depression, anxiety, and stress in a sample of healthcare employees working in hospitals and their use of formal and informal mental health supports. Data was gathered over a three-week period in December 2020 as COVID cases began to rise sharply in Ontario, Canada. Results from an online survey of 650 healthcare employees suggested that overall levels of depression, anxiety, and stress were mild. However, a significant minority of participants reported severe or extremely severe levels of depression (14.4%), anxiety (21.8%), and stress (13.5%). Levels of distress were higher among women, younger participants, those who did not work directly with COVID+ patients, and those who were redeployed. Use of formal mental health supports (e.g., Employee Assistance Plans, teletherapy) was very low (<10%), with the most frequently-reported reason for not using supports being "problems not severe enough to require this service". Implications are considered for healthcare policy decisions as hospital systems attempt to address the mental health needs of their employees.

Strategies for talent engagement and retention of Brazilian Nursing professionals.

OBJECTIVE: To reflect on how human resource health managers and talent managers may engage and retain experienced nursing professionals in Brazil. METHODS: Reflection based on studies on global and Brazilian-specific nursing professionals and retention, before and during the COVID-19 pandemic. RESULTS: The pandemic worsened working conditions for all health professionals. Nursing professionals were particularly affected. Nurses have been viewed as "heroes" and "essential" frontline workers during the COVID-19 pandemic. However, despite the universal praise for their efforts, it seems uncertain if they were actually considered and managed like talent. FINAL CONSIDERATIONS: In order to develop a sustainable healthcare system supported by sufficient experienced nursing talent, healthcare human resource managers and talent managers must develop and implement impactful nursing talent retention and engagement strategies. We highlight possible strategies targeting experienced nursing talent that will help to sustain the Brazilian healthcare system, post-pandemic.

Nurse-pharmacist collaborations for promoting medication safety among community-dwelling adults: A scoping review.

Background: Despite good evidence that supports improved clinical health outcomes and the cost effectiveness of nurse-pharmacist collaboration for promoting medication safety among adults in acute care settings, there is limited research in community settings. Objective: This scoping review examines, maps, and identifies gaps in the existing literature on nurse-pharmacist collaboration to augment medication safety among community-dwelling adults. Design: Setting(s): Community setting. Participants: This review consists of 3,464 participants across 23 studies. Methods: We used the enhanced Arksey and O'Malley framework by Levac and colleagues. Studies from MEDLINE, CINAHL, ProQuest, Scopus, and PubMed databases implementing medication safety through nurse-pharmacist collaboration for community-dwelling adults were included. We extracted data according to country of origin, intervention, and relevance to the current review. Results: Twenty-three studies were included in this review. Nurse-pharmacist collaborations in community settings are still evolving and are in a nascent form. Five sub-themes emerged from literature review of collaboration between nurses and pharmacists in community settings for medication safety. They are creating new opportunities to address gaps in community medication safety, enabling complementary interprofessional roles in medication safety, facilitating of efficient and cost-effective measures for medication safety, diverse nature of assessments done by nurses and pharmacists, and incohesive teams due to poor collaborative practices. Conclusions: Nurse-pharmacist collaborations in community settings improved disease management, prevented adverse drug events, and reduced hospitalizations. They resulted in early identification and correction of medication safety related issues, reduced wait periods to see general practitioners, and enhanced chronic disease self-management skills among community-dwelling adults. There is a need to improve existing systems and policies through research for sustaining such collaborations especially in community settings.

Practical strategies and the need for psychological support: recommendations from nurses working in hospitals during the COVID-19 pandemic.

PURPOSE: Nurses working during the coronavirus disease 2019 (COVID-19) pandemic have reported elevated levels of anxiety, burnout and sleep disruption. Hospital administrators are in a unique position to mitigate or exacerbate stressful working conditions. The goal of this study was to capture the recommendations of nurses providing frontline care during the pandemic. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews were conducted during the first wave of the COVID-19 pandemic, with 36 nurses living in Canada and working in Canada or the United States. FINDINGS: The following recommendations were identified from reflexive thematic analysis of interview transcripts: (1) The nurses emphasized the need for a leadership style that embodied visibility, availability and careful planning. (2) Information overload contributed to stress, and participants appealed for clear, consistent and transparent communication. (3) A more resilient healthcare supply chain was required to safeguard the distribution of equipment, supplies and medications. (4) Clear communication of policies related to sick leave, pay equity and workload was necessary. (5) Equity should be considered, particularly with regard to redeployment. (6) Nurses wanted psychological support offered by trusted providers, managers and peers. PRACTICAL IMPLICATIONS: Over-reliance on employee assistance programmes and other individualized approaches to virtual care were not well-received. An integrative systems-based approach is needed to address the multifaceted mental health outcomes and reduce the deleterious impact of the COVID-19 pandemic on the nursing workforce. ORIGINALITY/VALUE: Results of this study capture the recommendations made by nurses during in-depth interviews conducted early in the COVID-19 pandemic.

Readmissions After Lung Transplantation.

Lung transplantation has evolved to become an acceptable therapy for individuals with end-stage lung disease. Readmissions rates after lung transplantation remain high as compared to other medical surgical populations. The purpose of this review is to synthesize the current body of knowledge about patterns, risk factors, and outcomes of readmissions after lung transplantation. The literature revealed that the most common admission diagnoses linked to lung transplant readmissions are infections followed by tachyarrhythmias, airway complications, surgical complications, rejection, thromboembolic events, gastrointestinal complications, and renal dysfunction. Risk factors for these readmissions include male gender, longer intensive care unit stay, reintubation, prolonged chest tube air leak, frailty, and discharge to a long-term care facility. Outcomes of multiple readmissions after lung transplantation are associated with decreased survival and increased risk of mortality. Further research is needed to better understand which readmission diagnoses are preventable and whether multidisciplinary interventions can reduce readmission rates among patients after lung transplantation.

High-Fidelity Simulation and Clinical Judgment of Nursing Students in a Maternal-Newborn Course.

Clinical judgment, one's ability to think like a nurse, is an essential skill for safe nursing practice. With the rise of simulation to replace clinical experiences, there is limited evidence regarding the effectiveness of simulation on the development of clinical judgment. This study explored differences in clinical judgment in maternal-newborn courses between undergraduate nursing students participating exclusively in simulation and those participating in hospital-based clinical experiences. Following completion of the clinical rotation, students participated in an evaluative maternal-newborn high-fidelity simulation experience that was recorded and evaluated using the Lasater's Clinical Judgment Rubric (2007). Lasater's Clinical Judgment Rubric scores between the simulation and clinical practice groups were compared using an independent sample t-test. There was no statistical difference in clinical judgment scores between the simulation and hospital-based clinical groups (t = -1.056, P = .295). Our findings suggest that simulation may be a comparable alternative to clinical experience in nursing education.

Postpartum Weight Retention in Primiparous Women and Weight Outcomes in Their Offspring.

INTRODUCTION: To explore the effect of prepregnancy body mass index (BMI) and gestational weight gain on postpartum weight retention in nulliparous women and weight-for-length percentiles of offspring to 2 years following birth. METHODS: A retrospective secondary analysis of a large, prospective longitudinal study of women conducted during pregnancy and after their first birth was completed to examine outcomes associated with postpartum weight retention. A chart review of the offspring of these women was completed to explore the relationship between maternal prepregnancy BMI and gestational weight gain on offspring weight-for-length percentiles. RESULTS: Data from 652 woman-infant dyads were available for analysis. Average postpartum weight retention was 4.0 kg at one year for all groups. At 6 weeks postpartum, women who were obese prior to pregnancy retained significantly less weight than did women who were normal weight prior to pregnancy (P < .05). Women who were normal weight or overweight at the onset of pregnancy and had gestational weight gain within Institute of Medicine recommendations retained significantly less weight at 6 weeks, 6 months, and 1 year postpartum (P < .01) when compared with women in those same weight groups who had a gestational weight gain in excess of the recommended guideline. Women who entered pregnancy obese and who had a gestational weight gain within the recommended weight range during pregnancy retained significantly less weight compared with women who were obese and who gained in excess of the guideline at 6 weeks postpartum only (P < .05). No statistically significant differences were seen in offspring weight-for-length percentiles at any time point based on maternal prepregnancy BMI or weight gain within guidelines. DISCUSSION: Many women retained weight up to one year postpartum. In this study, we saw no statistically significant differences between the prepregnant BMI groups or between gestational weight gain within guidelines or in excess of guidelines on offspring weight-for-length percentiles.

Physical assessment skills in nursing curricula: a scoping review protocol.

REVIEW OBJECTIVE: This review seeks to establish the current state of knowledge regarding physical assessment skills taught in nursing programs globally. It aims to explore the literature on physical assessment skills taught in nursing curricula globally, skills used by nurses in practice, skills used by students, and core physical assessment skills that are important to teach nursing students.

Effects of Maternal Vitamin D Supplementation on the Maternal and Infant Epigenome.

INTRODUCTION: Mothers and infants are at high risk for inadequate vitamin D status. Mechanisms by which vitamin D may affect maternal and infant DNA methylation are poorly understood. OBJECTIVE: This study quantified the effects of vitamin D3 supplementation on DNA methylation in pregnant and lactating women and their breastfed infants. MATERIALS AND METHODS: In this randomized controlled pilot study, pregnant women received vitamin D3 400 international units (IU) (n = 6; control) or 3,800 IU (n = 7; intervention) daily from late second trimester through 4-6 weeks postpartum. Epigenome-wide DNA methylation was quantified in leukocytes collected from mothers at birth and mother-infant dyads at 4-6 weeks postpartum. RESULTS: At birth, intervention group mothers showed DNA methylation gain and loss at 76 and 89 cytosine-guanine (CpG) dinucleotides, respectively, compared to controls. Postpartum, methylation gain was noted at 200 and loss at 102 CpGs. Associated gene clusters showed strongest biologic relevance for cell migration/motility and cellular membrane function at birth and cadherin signaling and immune function at postpartum. Breastfed 4-6-week-old infants of intervention mothers showed DNA methylation gain and loss in 217 and 213 CpGs, respectively, compared to controls. Genes showing differential methylation mapped most strongly to collagen metabolic processes and regulation of apoptosis. CONCLUSIONS: Maternal vitamin D supplementation during pregnancy and lactation alters DNA methylation in mothers and breastfed infants. Additional work is needed to fully elucidate the short- and long-term biologic effects of vitamin D supplementation at varying doses, which could hold important implications for establishing clinical recommendations for prenatal and offspring health promotion.

Vitamin D3 Supplementation During Pregnancy and Lactation Improves Vitamin D Status of the Mother-Infant Dyad.

OBJECTIVE: To identify the combined effect of prenatal and postnatal vitamin D3 supplementation on the vitamin D status of pregnant and lactating women and their exclusively breastfed infants. DESIGN: Double-blind, randomized controlled trial. SETTING: Upper Midwestern U.S., hospital-based obstetric practice. PARTICIPANTS: Pregnant women (N = 13) planning to exclusively breastfeed were randomized at 24 to 28 weeks gestation to receive vitamin D3 at a dosage of 400 IU (control group, n = 6) or 3,800 IU (intervention group, n = 7) daily through 4 to 6 weeks postpartum. Vitamin D status was determined at enrollment and in mother-infant dyads at 24 to 72 hours after birth and 4 to 6 weeks postpartum. METHODS: Serum 25-hydroxyvitamin D levels were measured to determine the effect of vitamin D3 supplementation on the vitamin D status of mothers and infants. Analysis of covariance was used to compare differences in 25-hydroxyvitamin D levels between the control and intervention groups. RESULTS: The mothers' vitamin D levels were significantly higher in the intervention group than in the control group at birth (p = .044) and at 4 to 6 weeks postpartum (p = .002). Infants in the intervention group had significantly higher vitamin D levels at birth (p = .021) and nonsignificant, clinically relevant increases at 4 to 6 weeks of age (p = .256). No differences were found between maternal groups in serum calcium or parathyroid hormone levels. CONCLUSION: Prenatal to postpartum vitamin D3 supplementation is an effective intervention to increase a mother's vitamin D status and to promote optimal vitamin D status in newborns and exclusively breastfed infants.

Strategies for talent engagement and retention of Brazilian Nursing professionals

ABSTRACT Objective: To reflect on how human resource health managers and talent managers may engage and retain experienced nursing professionals in Brazil. Methods: Reflection based on studies on global and Brazilian-specific nursing professionals and retention, before and during the COVID-19 pandemic. Results: The pandemic worsened working conditions for all health professionals. Nursing professionals were particularly affected. Nurses have been viewed as "heroes" and "essential" frontline workers during the COVID-19 pandemic. However, despite the universal praise for their efforts, it seems uncertain if they were actually considered and managed like talent. Final considerations: In order to develop a sustainable healthcare system supported by sufficient experienced nursing talent, healthcare human resource managers and talent managers must develop and implement impactful nursing talent retention and engagement strategies. We highlight possible strategies targeting experienced nursing talent that will help to sustain the Brazilian healthcare system, post-pandemic.

DNA Methylation Patterns in Peripheral Blood of Pregnant Women With Group B Streptococcus Colonization.

The primary risk factor for neonatal Group B streptococcus (GBS) infection, which is the leading cause of infectious neonatal morbidity and mortality, is maternal colonization. However, no definitive maternal risk factors for GBS colonization have been identified and no systematic efforts have been made to prevent maternal colonization. The purpose of this exploratory secondary analysis was to evaluate genome-wide DNA methylation patterns in maternal peripheral blood early in pregnancy for association with GBS colonization status in the third trimester. Genome-wide DNA methylation was analyzed from 18 nulliparous GBS-positive and -negative women (n = 9/group) recruited for a previous study. No statistically significant differences in baseline characteristics or DNA methylation in peripheral blood were identified between GBS-positive and -negative women in early pregnancy. The results suggest that DNA methylation patterns in peripheral blood are not associated with risk for GBS colonization.

First trimester vitamin D status and placental epigenomics in preeclampsia among Northern Plains primiparas.

AIMS: As maternal vitamin D status has been associated with preeclampsia, the purpose of this study was to determine variations in DNA methylation patterns and associated protein expression in placental genes regulating vitamin D metabolism. MAIN METHODS: A convenience sample of 48 pregnant nulliparous women, including 11 later diagnosed with preeclampsia, were recruited in this prospective study. Using a case-control design in two groups of women, we administered a food frequency questionnaire to determine vitamin D dietary intake. Laboratory measures included serum vitamin D levels (25[OH]D), DNA methylation patterns and protein expression in placental genes regulating vitamin D metabolism (1α-hydroxylase, CYP27B1; vitamin D receptor, VDR; retinoid X receptor, RXR) from placental tissue collected at delivery among those diagnosed with preeclampsia and those who remained normotensive throughout pregnancy. KEY FINDINGS: There were no significant differences in vitamin D dietary intake or mean serum 25[OH]D levels, although the proportion of women with deficient 25[OH]D levels was higher in the preeclampsia group (46%) than the normotensive group (20%). Placenta samples from women with preeclampsia also had increased DNA methylation of CYP27B1, VDR and RXR genes with lower protein expression levels limited to RXR. SIGNIFICANCE: Hypermethylation of key placental genes involved in vitamin D metabolism suggests uncoupling of processes that may interfere with placentation and availability of vitamin D at the maternal-fetal interface.

Disruption of androgen regulation in the prostate by the environmental contaminant hexachlorobenzene.

Hexachlorobenzene (HCB) is a persistent environmental contaminant that has the potential to interfere with steroid hormone regulation. The prostate requires precise control by androgens to regulate its growth and function. To determine if HCB impacts androgen action in the prostate, we used a number of methods. Our in vitro cell-culture-based assay used a firefly luciferase reporter gene driven by an androgen-responsive promoter. In the presence of dihydrotestosterone, low concentrations (0.5-5 nM) of HCB increased the androgen-responsive production of firefly luciferase and high concentrations of HCB (> 10 microM) suppressed this transcriptional activity. Results from a binding assay showed no evidence of affinity between HCB and the androgen receptor. We also tested HCB for in vivo effects using transgenic mice in which the transgene was a prostate-specific, androgen-responsive promoter upstream of a chloramphenicol acetyl transferase (CAT) reporter gene. In 4-week-old mice, the proportion of dilated prostate acini, a marker of sexual maturity, increased in the low HCB dose group and decreased in the high HCB dose mice. In the 8-week-old mice, there was a significant decrease in both CAT activity and prostate weight upon exposure to 20 mg/kg/day HCB. Therefore, in vitro and in vivo data suggest that HCB weakly agonizes androgen action, and consequently, low levels of HCB enhanced androgen action but high levels of HCB interfered. Environmental contaminants have been implicated in the rising incidence of prostate cancer, and insight into the mechanisms of endocrine disruption will help to clarify their role.