Smoking status, dietary intake, and physical activity in a sample of working adults.

The present study examined differences in dietary intake and physical activity by smoking status in a sample of 3,250 working adults. Cross-sectionally, current smokers consumed alcohol, dairy products, meat, eggs, and french fries more frequently, and engaged in leisure time physical activity less frequently, than former or never smokers. Over 2 years, current smokers increased their intake of meat, soft drinks, eggs, and total calories from high fat and high calorie foods compared to never to former smokers. Smokers who quit during the 2-year observation period increased their frequency of sweets consumption. Dietary and physical activity variables appear to be weak predictors of postcessation weight change. Implications for studies of chronic disease etiology and mechanisms of postcessation weight gain are discussed.

Reconciling conflicting findings regarding postcessation weight concerns and success in smoking cessation.

Correlates of concern about weight gain following smoking cessation and self-efficacy about controlling weight gain were examined in 940 men and 1,166 women who were surveyed on 2 occasions as part of a randomized trial of work-site interventions for smoking cessation. Weight concerns were positively associated with female sex, body weight, dieting for weight control, nicotine addiction, and social encouragement to quit. Bivariate analyses replicated prior findings that elevated weight concerns are associated with a reduced likelihood of quitting smoking, at least in women. Analyses controlling for demographics, nicotine dependence, and social factors replicated prior findings that weight concerns are not negatively related to smoking cessation and that some measures of concern are positively related to cessation. These analyses suggest that conflicting findings found in this literature are due primarily to how weight concerns are defined and whether covariates like nicotine addiction are used in data analyses.

Worksite intervention for weight control: a review of the literature.

PURPOSE: Published research on worksite weight-control programs is reviewed with the objective of assessing success in (1) reaching populations in need, (2) achieving sustained weight loss, and (3) improving employee health and productivity. SEARCH METHOD: Reviewed are 44 data-based articles published between 1968 and 1994. The initial search was part of a larger review on the health impact of worksite health promotion programs conducted by Centers for Disease Control and described in the introduction to this issue. We supplemented the resulting list with articles found in a search of our own reference files. IMPORTANT FINDINGS: Methodologically the literature is relatively weak, consisting largely of uncontrolled case studies. Worksite interventions appear to be successful in reaching large numbers of people: the median participation rate among overweight employees was 39% in the six studies that provided this type of information. Worksite programs produced reasonable short-term weight loss: typically 1 to 2 pounds per week. Long-term weight loss, reductions in sitewide obesity prevalence, and health or productivity benefits have yet to be demonstrated. MAJOR CONCLUSIONS: Recommendations for future research include improved methods, more attention to recruitment and secondary outcomes, more direct comparison of different programs, and more creative use of worksites as environments and social units in designing programs.

Barriers among nurses to providing smoking cessation advice to hospitalized smokers.

Nine focus groups were conducted with 75 staff nurses in three hospitals to determine the low participation rate of nurses in a smoking cessation programs directed at patients. Nurses felt that hospitalization was an appropriate time to offer quit-smoking advice to patients, particularly those with smoking related diseases. However, many felt advice should be given only to those receptive to it. The most common barriers to providing smoking cessation advice were lack of concrete techniques, or referral to provide and fear of alienating patients who were not receptive to hearing advice.

Intraclass correlation for measures from a worksite health promotion study: estimates, correlates, and applications.

Intervention trials that employ a group-randomized trial design require an adaptation of the usual analytic methods to account for the randomization of intact economic/social groups to study conditions and the positive ICC that is implied by such a design. In the absence of valid estimates of the ICCs for the outcomes of interest, investigators designing trials could only guess at how large a problem they faced and how much they would need to increase sample size to compensate. Aside from this paper, we are aware of only one other publication that provides such estimates, and that study provides estimates for only a handful of outcomes. Our purpose here has been to provide a replication and extension of those findings to a broader array of outcomes. The results presented here suggest that worksite-level ICCs for a variety of smoking and health-related outcomes are generally small and that these ICCs can generally be reduced by adjustment for individual-level characteristics. We have demonstrated how information about these ICCs can be incorporated in sample size calculations to avoid designing "underpowered" studies. Our results should assist investigators in planning studies to evaluate the effectiveness of worksite-based health promotion efforts.

Patient-provider interactions and patient outcomes.

Research shows that a number of provider interactional skills are empirically related to patient adherence, making interaction skills a necessary and important part of clinical competence. These skills fall into three broad categories: techniques to elicit and modify patients' health and treatment beliefs, to aid recall of information, and to aid adherence. Specific skills in each category are discussed. Research further shows that health care providers can be taught effective communication skills, and that one of the most effective teaching techniques is audio or video feedback in which the provider's interaction with a patient is judged by tutor and peers using explicit, empirically based criteria.

The relationships between high-risk and problem drinking and the occurrence of work injuries and related absences.

A review of studies on the relationship between alcohol and work injuries revealed that the evidence is contradictory and that many of the studies contain methodological flaws. The present study aimed to determine whether there are relationships between problem drinking and high alcohol consumption and outcomes such as work injuries and related absences. The sample consisted of 833 employees at an industrial worksite. Problem drinking was measured by the Mortimer-Filkins test, while alcohol consumption was measured by a 7-day retrospective diary. Work injury data were obtained from medical reports completed at the worksite medical center, while absences data were obtained from company records. Chi-square analyses revealed significant relationships between problem drinking and work injuries and injury-related absences, but not between high alcohol consumption and work injuries and related absences. Logistic regression analysis revealed that no variables were significant predictors of work injuries. However, when uninjured subjects were excluded, a second analysis revealed that Mortimer-Filkins test scores, recent stressful life events, age and job satisfaction were significant predictors of two or more injuries. Injured subjects were almost twice as likely to have two or more injuries if they had high numbers of recent stressful life events and low levels of job satisfaction. Logistic regression analysis revealed that age, Mortimer-Filkins test categories and job satisfaction significantly predicted injury-related absences. Problem drinkers were 2.7 times more likely to have injury-related absences than non-problem drinkers, and subjects with low levels of job satisfaction were 2.2 times more likely than others to have injury-related absences. The implications of the results for workplace alcohol policies and programs are discussed.

The smoking cessation process: longitudinal observations in a working population.

BACKGROUND: Few prospective studies have investigated variables related to the smoking cessation process in nonvolunteer samples. METHODS: Smoking history, behavioral intentions, degree of addiction, and demographic characteristics were examined over a 2-year period as predictors of four behavioral outcomes related to smoking cessation--participation in a smoking cessation program, attempting to quit, relapse, and success in quitting--in 802 working adults who were daily smokers at baseline. Change in behavioral intentions over the 2-year period was also examined. RESULTS: Sixty-four percent of smokers made a serious quit attempt in the 2-year study period, 16% succeeded in quitting, and an additional 9% shifted from daily to occasional smoking. Stated intention to quit at baseline was a powerful and consistent predictor of three of the behavioral outcomes, but several demographic and smoking-related variables were differentially associated with these three outcomes. CONCLUSIONS: Study findings indicate that smoking cessation is a dynamic process in which a majority of smokers are actively engaged. Smoking pattern and sociodemographic characteristics are predictors of whether smokers will participate in programs, make quit attempts, and succeed in quitting. Intention to quit is related to smoking outcomes in a manner that would be predicted by the Transtheoretical Model of Behavior Change.

Occasional smoking in a Minnesota working population.

OBJECTIVES: This study examined the prevalence of occasional smoking in a population of working adults, compared the characteristics of occasional and daily smokers, and prospectively examined the long-term smoking patterns of occasional smokers. METHODS: At 32 Minnesota work sites, 5681 randomly selected workers were surveyed at baseline; 5248 of these were surveyed again 2 years later. A cross-sectional sample of 5817 workers was also surveyed at follow-up. RESULTS: Occasional smokers constituted 18.3% of all smokers in the baseline sample and 21.5% of all smokers in the cross-sectional sample surveyed 2 years later. Baseline occasional smokers were significantly more likely than daily smokers to have quit at follow-up. Job monotony or repetitiveness was related to an increase to daily smoking at follow-up among baseline occasional smokers, and a change to a more restrictive workplace smoking policy was associated with quitting. CONCLUSIONS: The results confirm that a substantial proportion of smokers are low-rate users and suggest that the proportion may be rising. Further research on this group is warranted.

Prevalence and characteristics of women who have had a hysterectomy in a community survey.

A community survey of 8,896 households was undertaken in the Hunter region of New South Wales to assess women's health status. Consent was gained from 5,781 of the 6,361 eligible women between 18 and 69 years of age. The prevalence of hysterectomy in this sample was 16.9%, with 34.2% of women in their fifties having had a hysterectomy. Most hysterectomies (75%) were performed on women between the ages of 30 and 49 years. The demographic variables of parent's country of birth, educational level and employment status predicted recent hysterectomies after controlling for the effect of age.

Procedures and discrepancies of blood pressure measurements in two community health centers.

Three studies of blood pressure measurement were conducted in two primary care clinics. In study I, procedures for taking blood pressure were observed for seven nurses, and their readings were compared with readings taken in a standard manner. The results show that the nurses' procedure needed improvement; the systolic/diastolic discrepancies with the standard averaged 10.2/7.5 mmHg. In study II, the nurses were trained to improve their procedure, and readings were again compared. The results show improvement for moderate, but not for large, discrepancies in diastolic readings. In study III, two physicians' procedure for taking blood pressure indicated that their procedures could also be improved. Overall, there was little correlation between potential biases in providers' procedures and discrepancies with the standard. The discrepancies between the nurse and physician readings led to different treatment indicators in 22-26 per cent of the observations.

Nurses' attitudes concerning the delivery of brief cessation advice to hospitalized smokers.

BACKGROUND: Nurses have a unique opportunity to assist hospitalized smokers with cessation. However, relatively little is known about nurses' attitudes and beliefs toward their role in assisting patients with cessation. METHODS: A cross-sectional survey of staff nurses at four hospitals was conducted. Four scales based on constructs from the Theory of Planned Behavior were developed for this survey: attitudes toward offering cessation advice, beliefs about the outcome of offering advice, perceived normative beliefs, and perceived ability to offer advice. Other survey items included sociodemographics, employment characteristics (shift, unit worked), and personal smoking status. RESULTS: Of the nurses surveyed, 397 (68%) returned completed questionnaires. Nurses had a relatively positive attitude toward helping patients to quit smoking, 63% believed that hospitalization was an ideal time for patients to try to quit smoking, and 59% believed a nurse had an obligation to advise patients to quit smoking. In the final multiple linear regression model, self-reported delivery of cessation advice was related to attitudes toward offering cessation advice, perceived ability to offer advice, and unit worked. CONCLUSIONS: Efforts should be made to educate staff nurses about the efficacy of brief cessation advice and current smoking cessation methods and practices.

Assessing women's health needs.

It has been argued that women have specific health needs aside from those of the community as a whole. As a consequence, a move towards increased "earmarked" funding for women's health has occurred. However, some debate exists about the areas of women's health that are most in need of additional funding and about appropriate mechanisms to determine priority areas. The present study explored community perceptions of women's health needs. A sample of 157 women, who had been selected at random, were asked a series of questions about the health and social problems that are experienced by women. The questions assessed the self-reported prevalence of the problems and asked women to nominate those problems which were priorities for them personally, and for Australian women in general. The areas that were identified as priorities by this community survey were compared with those that were identified by means of other methods of needs analysis.

Patient recall versus physician documentation in report of smoking cessation counselling performed in the inpatient setting.

OBJECTIVES: To determine rates of patient reported and physician documented counselling; to identify predictors of each report; and to identify the impact of each report on smoking cessation attempts after discharge from the hospital. DESIGN: Stickers on subjects' charts prompted physicians to give brief smoking cessation counselling to patients in the hospital. Patients reported counselling received and quit attempts in a phone interview conducted 7-18 days after discharge. Rates of counselling and correlations were calculated, and multivariate analysis identified predictors of patient report, physician documentation, and quit attempts. SETTING: Four hospitals in the Minneapolis/St Paul metropolitan area. SUBJECTS: 682 hospital patients who had smoked more than 100 cigarettes in their lifetime and had smoked in the last three months. RESULTS: 71.0% of patients reported counselling, and physicians documented counselling in the charts of 46.2% of patients (correlation = 0.15, kappa = 0.13). Patient report was predicted by specific hospital, belief that their hospitalisation was smoking related, diagnosis of a smoking related disease, and physician documentation of counselling. Physician documentation was predicted by female patient, specific hospital, longer hospital stay, and marginally predicted by smoking related disease. Quit attempts were predicted by patient report of counselling, but not physician documentation. CONCLUSIONS: Physicians document counselling in the hospital at a lower rate than patients report it, and the correlation between reports is very low, making an accurate assessment of true rates of counselling difficult. While it is important to increase physician documentation, it is even more important to increase patient recall, as this is the only report that predicts a quit attempt.

The effects of gender on diagnosis of psychological disturbance.

This research examines the effect of patient gender on the detection of psychological disturbance. In Study 1, primary-care patients were requested to complete the General Health Questionnaire (GHQ), a measure of nonpsychiatric psychological disturbance, prior to their consultation. The patient's GHQ score was compared with physician judgments about the level of disturbance in that patient (N = 1913). Although there were a similar number of GHQ high scorers among males and females, the physicians classified significantly more females than males as disturbed. The doctors classified as disturbed a larger proportion of nondisturbed women than nondisturbed men. In order to explore the behavior of recent medical graduates, Study 2 examined the detection behavior of interns in an outpatient department with 384 of their patients. The interns behaved in a similar manner to the primary-care physicians.

Smokers with multiple behavioral risk factors: how are they different?

OBJECTIVE: The first aim of the present investigation was to examine cross-sectional differences between smokers who engage in additional health risk behaviors (i.e., high-fat diets and low physical activity levels) and those who do not that could affect readiness for smoking cessation treatment and treatment prognosis. The second aim was to examine prospective associations between risk factor status and smoking outcomes (i.e., cessation and quit attempts). DESIGN: Data were derived from baseline and 1-year follow-up surveys for the SUCCESS project, a randomized trial of worksite smoking interventions conducted in 24 worksites in Minneapolis/St. Paul, Minnesota. Included in the analyses were 2,149 study participants who reported smoking at baseline. METHODS: Current smokers were categorized into one of three "risk groups": the "1 additional risk factor" group (i.e., either low physical activity level or high dietary fat intake), the "2 additional risk factor" group (i.e., both low physical activity and high dietary fat intake), and the "smoker only" group (i.e., neither low physical activity nor high dietary fat intake). Mixed model regression analyses examined cross-sectional associations between risk group status and baseline demographic variables, smoking dependency, social environments for smoking, and health problems. Prospective associations between baseline risk group status and 1-year follow-up cessation attempts and quits were also examined. RESULTS: At baseline, risk factor status was associated with smoking dependency for both men and women. Women smokers with at least one additional risk factor reported a greater number of cigarettes smoked per day, higher Fagerstrom Nicotine Dependence scores, and lower self-efficacy for refraining from smoking in a variety of situations compared with smokers with no additional risk factors. Men smokers with at least one additional risk factor reported higher Fagerstrom Nicotine Dependence scores compared with smokers with no additional risk factors. Women smokers with at least one additional risk factor were more likely to report being encouraged to quit by co-workers compared with smokers with no other risk factors. No relationship between risk factor status and social pressure to quit was observed among men. Prospective analyses indicated that baseline risk factor status was marginally related to smoking outcome at 1-year follow-up; however, these relationships were attenuated considerably when controlling for smoking dependence. Relationships between risk factor status and smoking outcomes were stronger for men. CONCLUSION: Results indicated that the presence of multiple health risk behaviors was related to more serious problems with smoking. However, the presence of additional risk factors did not strongly affect prognosis for smoking cessation.

Biomarkers of tobacco exposure or harm: application to clinical and epidemiological studies. 25-26 October 2001, Minneapolis, Minnesota.

Adverse outcomes from tobacco use may take decades to develop. Biomarkers are measures that can be used in the early stages of tobacco use to assess exposure to tobacco toxins or to predict adverse health outcomes with which they are associated. Examples of biomarkers include specific chemical components of tobacco or their metabolites; early biochemical, histological, or physiological effects; and early health effects. Mechanistically relevant and quantitatively valid biomarkers are essential for assessing the ultimate impact of new products, treatments, preventive measures, and public health policies on tobacco-related disease. The tobacco industry's recent introduction of a variety of new tobacco products or devices with implied claims of reduced health risks highlights the need to develop methods for assessing their potential for benefit or harm. A wide variety of biomarkers for tobacco exposure or harm has been studied. Although many questions about their use remain unanswered, substantial data exist regarding their validity and utility. This conference reviewed both the general issues surrounding biomarker use and the current state of knowledge regarding the most widely studied and promising biomarkers.

Associations between exercise and health behaviors in a community sample of working adults.

BACKGROUND: The present study examined the associations between leisure-time exercise and a range of health behaviors and reports of illness and injury in a sample of community working adults. METHODS: The study population included 4907 women and 4136 men who completed surveys in 24 worksites in the Minneapolis-St. Paul metropolitan area. RESULTS: Participants in the study were ranked by gender according to their exercise score and grouped into quartiles. Women and men in the highest activity quartiles were more highly educated and were younger. High-activity men were more likely to be unmarried. Higher levels of leisure-time exercise were positively associated with seat belt use and inversely related to smoking, dietary fat intake, reported stress, and obesity. In men only, leisure-time exercise was related to greater reports of injuries resulting in restriction of usual activities. In women only, leisure-time exercise was positively associated with daily alcohol use. Most of the significant associations were seen in the two highest quartiles of exercise. CONCLUSIONS: These findings suggest that associations between leisure-time exercise and health behaviors occur at the higher levels of exercise and interventions may need to promote this higher level of leisure-time exercise to impact overall public health.

The effects of community policies to reduce youth access to tobacco.

OBJECTIVES: This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking. METHODS: A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32-month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates. RESULTS: Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant. CONCLUSIONS: This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates.

Age of initiation, smoking patterns, and risk in a population of working adults.

BACKGROUND: Early age of initiation is a significant risk factor for long-term dependent smoking and may also relate to other unhealthy behaviors and increased likelihood of illness, independent of duration of smoking. METHODS: The current study assessed age of initiation in relation to cigarette dependence, interest in quitting, social environment pertaining to smoking, behavioral risk factors, and current health problems. Subjects were 2120 current daily smokers in 24 worksites in the Minneapolis/St. Paul, Minnesota, metropolitan area. RESULTS: Findings were surprisingly consistent with early age of initiation predicting more dependent smoking, less interest and confidence in ability to quit, poorer diet, less use of seat belts, more illness and hospitalization, and greater likelihood of smoking among partner/spouse, friends, and co-workers. CONCLUSIONS: The overall strength of the findings was unexpected. Early initiation of regular smoking predicted a significant constellation of risk factors throughout adulthood. Interventions that significantly delay smoking onset, even in the absence of permanent prevention, could have important public health implications.