Benefits of collecting local data on breast cancer and mammography practices in northwestern Pennsylvania

OBJECTIVES: A randomized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking. METHODS: Thirty-two work sites were randomized to treatment or no treatment for 2 years. Treatment consisted of health education classes combined with a payroll-based incentive system. Evaluation was based on cohort and cross-sectional surveys. RESULTS: Of 10,000 total employees in treatment work sites, 2041 and 270 participated in weight control and smoking cessation programs, respectively. Weight losses averaged 4.8 lbs, and 43% of smoking participants quit. Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0% and 2.1% in cross-sectional and cohort surveys, respectively. No treatment effect was found for weight. Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs (r = .45 for smoking and r = .55 for weight). CONCLUSIONS: This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile.     

Work-site smoking policies: their population impact in Washington State

This article presents data from a population-based, random-digit dialing telephone survey of 1228 employed adults in Washington State, conducted 1989 through 1990. Eighty-one percent of men and 91% of women reported work-site smoking restrictions. Employees in work sites with no-smoking policies were less likely to be current smokers; men in work sites with policies restricting smoking smoked fewer cigarettes on both workdays and nonworkdays. Forty-eight percent of male and 53% of female smokers reported reduced smoking as a result of work-site policy. Work-site smoking policies, intended to protect against smoke exposure, may also reduce employee smoking.     

Immunocytochemical detection of advanced glycated end products in rat renal tissue as a function of age and diabetes

Lifestyle practices and the health promoting environment of hospital nurses This paper examined the lifestyle practices of hospital nurses and the impact of specific interventions in the hospital environment. The perception of nurse as health promoter and as carer of AIDS patients was also examined. A self-administered questionnaire was used to collect data at two different time periods. The sample represented 729 nurses (at pre- and post-time periods), both qualified and student nurses. Qualified nurses reported the highest stress levels while student nurses reported more negative lifestyle practices such as smoking, alcohol consumption and drug use. A greater number of current smokers (29%) consumed alcohol and used drugs than non-smokers. The impact of intervention strategies around compliance with smoking policy and work-site walk routes reduced exposure to passive smoking at work for qualified nurses and increased exercise participation for both groups of nurses. Workplace was identified as the main source of stress which included relationships at work and demands of the job. Hospital nurses experiencing high work stress were more likely to use professional support and personal coping (discuss problems with friends/family, have a good cry and eat more) than others. Nurses believed in the importance of health promotion as part of their work; however, qualified nurses felt more confident and gave more health related information than student nurses. Student nurses perceived a lower risk of contacting AIDS through work and a higher concern/worry in caring for AIDS patients than qualified nurses.     

Long-term effectiveness of two Dutch work site smoking cessation programs

This article reports on one of the few experimental studies in Europe to examine work site smoking cessation. The study examined whether a comprehensive intervention (self-help manuals, group courses, a mass media campaign, smoking policies, and a second-year program) is more effective than a minimal intervention (self-help manuals only). Eight work sites participated in the study. The effect of treatment on smoking cessation depended on nicotine dependency levels: Heavy smokers had more success with the comprehensive smoking cessation intervention than with the minimal intervention (with respect to both 14-month quit rate and 6-month prolonged abstinence). For heavy smokers, exposure to mass media exhibitions or to group courses had a beneficial effect on prolonged abstinence. Comprehensive programs may be most appropriate in Dutch work sites with large proportions of heavily addicted smokers.     

Evaluation of two school smoking education programmes under normal classroom conditions

OBJECTIVES: To assess the effectiveness of two school based smoking education projects in delaying onset of smoking behaviour and in improving health knowledge, beliefs, and values. DESIGN: Cluster randomised controlled trial of two projects taught under normal classroom conditions. Schools were allocated to one of four groups to receive the family smoking education project (FSE); the smoking and me project (SAM); both projects in sequence (FSE/SAM); or no intervention at all. SETTING: 39 schools in Wales and England matched for size and catchment profile. SUBJECTS: All first year pupils in the schools were included and were assessed on three occasions (4538 before teaching (1988), 3930 immediately after teaching (1989), 3786 at one year follow up (1990)). MAIN OUTCOME MEASURES: Self reported smoking behaviour (backed by saliva sample) and change in relevant health knowledge, beliefs, and values. RESULTS: No consistent significant differences in smoking behaviour, health knowledge, beliefs, or values were found between the four groups. For never smokers at baseline the rate of remaining never smokers in 1990 was 74% (594/804) in the control group, 65% (455/704) in the FSE group, 70% (440/625) in the SAM group, and 69% (549/791) in the FSE/SAM group (chi 2adj = 6.1, df = 3, p = 0.1). Knowledge about effects of smoking rose in all groups from a mean score of 5.4 in 1988 to 6.4 in 1989 and 6.5 in 1990. CONCLUSIONS: More comprehensive interventions than school health education alone will be needed to reduce teenage smoking. Other measures including further restrictions on access to cigarettes and on the promotion of tobacco products need to be considered. Further research will be needed to develop effective school based health education projects, which should be formally field tested under normal conditions before widespread dissemination.     

Cognitive–behavioral therapy to promote smoking cessation among African American smokers: A randomized clinical trial.

Objective: The health consequences of tobacco smoking disproportionately affect African Americans, but research on whether efficacious interventions can be generalized to this population is limited. This study examined the efficacy of group-based cognitive–behavioral therapy (CBT) for smoking cessation among African Americans. Method: Participants (N = 154; 65% female, M = 44 years old, mean cigarettes/day = 13) were randomly assigned to either (a) group CBT or (b) group general health education (GHE). Participants in both conditions received 6 sessions of counseling and 8 weeks of transdermal nicotine patches. The primary outcome variable was 7-day point prevalence abstinence (ppa), assessed at the end of counseling (2 weeks) and at 3- and 6-month follow-ups. Secondary outcomes included 24-hr ppa and 28-day continuous abstinence (assessed at 3 and 6 months). Results: Intent-to-treat analyses demonstrated the hypothesized effects, such that 7-day ppa was significantly greater in the CBT than the GHE condition at the end of counseling (51% vs. 27%), at 3 months (34% vs. 20%), and at 6 months (31% vs. 14%). Results of a generalized linear mixed model demonstrated a significant effect of CBT versus GHE on 7-day ppa (odds ratio = 2.57, 95% CI [1.40, 4.71] and also an effect of time (p     

Shared learning for community based maternity care

OBJECTIVE: To determine the effects of the job demands-control model on arterial blood pressure, serum total cholesterol, and smoking in male daytime and rotating-shift workers in Japan. METHODS: The survey was conducted for all employees of an electrical factory in Japan using a mailed questionnaire concerning three job stressors, i.e., job overload, work-pace control, and work-site social support. A blood sample was taken at the same time. Data on 1703 male daytime workers and 1 173 male rotating-shift workers were analyzed. Multiple logistic regression or analysis of covariance (ANCOVA) were employed to determine the effects of the job stressors on systolic and diastolic blood pressure, serum total cholesterol, and smoking with control for other covariates. RESULTS: Among daytime workers, systolic and diastolic blood pressures were highest in the "high-strain" (i.e., higher job overload + lower work-pace control) group; ANCOVA indicated that a two-way interaction between job overload and work-pace control was significant (P < 0.01). This tendency was not observed among rotating-shift workers. The number of cigarettes smoked per day was greater in groups with lower work-pace control and lower work-site social support among daytime workers (two-way interaction between these two job stressors, P < 0.05); it was greater in groups with lower work-site social support among rotating-shift workers (main effect of work-site social support, P < 0.05). CONCLUSIONS: Our study suggest that job strain as defined in the job demands-control model is associated with increased systolic and diastolic blood pressures in male daytime workers in Japan. Smoking might be affected by lower work-site social support.     

Efficacy of a smoking cessation program for hospital patients

BACKGROUND: Hospitalization may be an opportune time to change smoking behavior because it requires smokers to abstain from tobacco at the same time that illness can motivate them to quit. A hospital-based intervention may promote smoking cessation after discharge. METHODS: We tested the efficacy of a brief bedside smoking counseling program in a randomized controlled trial at Massachusetts General Hospital, Boston. The 650 adult smokers admitted to the medical and surgical services were randomly assigned to receive usual care or a hospital-based smoking intervention consisting of (1) a 15-minute bedside counseling session, (2) written self-help material, (3) a chart prompt reminding physicians to advise smoking cessation, and (4) up to 3 weekly counseling telephone calls after discharge. Smoking status was assessed 1 and 6 months after hospital discharge by self-report and validated at 6 months by measurement of saliva cotinine levels. RESULTS: One month after discharge, more intervention than control patients were not smoking (28.9% vs 18.9%; P=.003). The effect persisted after multiple logistic regression analyses adjusted for baseline group differences, length of stay, postdischarge smoking treatment, and hospital readmission (adjusted odds ratio, 2.19; 95% confidence interval, 1.34-3.57). At 6 months, the intervention and control groups did not differ in smoking cessation rate by self-report (17.3% vs 14.0%; P=.26) or biochemical validation (8.1% vs 8.7%; P=.72), although the program appeared to be effective among the 167 patients who had not previously tried to quit smoking (15.3% vs 3.7%; P=.01). CONCLUSIONS: A low-intensity, hospital-based smoking cessation program increased smoking cessation rates for 1 month after discharge but did not lead to long-term tobacco abstinence. A longer period of telephone contact after discharge might build on this initial success to produce permanent smoking cessation among hospitalized smokers.     

Long-Term Effects of Lifestyle Behavior Change in Coronary Artery Disease: Effects on Recurrent Coronary Events After Percutaneous Coronary Intervention.

This study evaluated the effects of a behaviorally oriented cardiac rehabilitation and secondary prevention program on lifestyle changes and on coronary recurrence rates. Patients recently treated with percutaneous coronary intervention (PCI) were randomized to an intervention with an aggressive focus on lifestyle changes (smoking, diet, exercise, and stress; n = 46) or to a standard-care control group (n = 42). Results showed that the intervention group had significantly larger overall lifestyle changes than the control group after 12, 24, 36, and 60 months. The intervention group had significantly lower rates of all coronary events (acute myocardial infarction, coronary artery bypass graft, PCI, cardiac death; 30.4% vs. 53.7%), and of cardiovascular mortality (2.2% vs. 14.6%). The need for future large-scale and long-term evaluations of lifestyle-oriented secondary prevention interventions of this kind is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between smoking and colonic involvement in inflammatory bowel disease

The effects of smoking on the onset and clinical course of inflammatory bowel disease (IBD) have been widely debated. Although smoking appears to have a clearly unfavorable effect on the course in Crohn's Disease (CD), the relationship between smoking and localization of the disease is less clear. AIM: To evaluate, in our group of patients, the relationship between smoking and the development of ulcerative colitis (UC) or CD, and between smoking and the localization of CD in the large bowel or in other sites. PATIENTS AND METHODS: The smoking habits of 171 patients at the time of diagnosis were assessed with a questionnaire. Subjects were classified into three subgroups as smokers, nonsmokers and ex-smokers. Current smokers were grouped according to their level of consumption as those who smoked fewer than or more than 10 cigarettes per day. A total of 161 patients were studied (UC n = 69, CD n = 92). Patients with CD were divided into those with colonic disease and those with no colonic involvement. We evaluated the relationship between smoking and the form of IBD, localization (colonic or noncolonic) and the presence of perianal disease (PAD) in CD. The results were analyzed with the chi-squared test. RESULTS: Smoking was more frequent in patients with CD than in those with UC (72.8% vs 31.9%). Among patients with CD, more patients without colonic involvement were smokers (84.6% vs 64.2%). However, among patients with CD involving the colon, smoking was significantly more common (64.2%) than among patients who had UC (31.9%). CONCLUSIONS: Our findings confirm a relationship between smoking and CD. Smoking seems to be associated with some degree of protection of the colonic mucosa, especially in heavy smokers.     

Effect of smoking cessation counseling on recovery from alcoholism: findings from a randomized community intervention trial

AIMS: To assess the effects of a smoking cessation program for recovering alcoholics on use of alcohol, tobacco and illicit drugs after discharge from residential treatment. DESIGN AND SETTING: A randomized community intervention trial design was employed in which 12 residential drug treatment centers in Iowa, Kansas and Nebraska were matched and then randomly assigned to the intervention or control condition. PARTICIPANTS: Approximately 50 adult residents (inpatients) from each site were followed for 12 months after treatment discharge. INTERVENTION: Participating residents in the six intervention centers received a 4-part, individually tailored, smoking cessation program while those in the six control sites received usual care. FINDINGS: Both moderate and heavy drinking rates were reduced in the intervention group. Intervention site participants were significantly more likely than controls to report alcohol abstinence at both the 6-month (OR = 1.59, 95%CI: 1.09-2.35) and 12-month assessment (OR = 1.84, 95%CI: 1.28-2.92). Illicit drug use rates were comparable. Effect of the intervention on tobacco quit rates was not statistically significant. CONCLUSIONS: Counseling alcoholics in treatment to quit smoking does not jeopardize the alcohol recovery process. However, low-intensity tobacco interventions are unlikely to yield high tobacco quit rates.     

Using the internet to assist smoking prevention and cessation in schools: A randomized, controlled trial.

Objective: To evaluate the impact of a classroom-based, Web-assisted tobacco intervention addressing smoking prevention and cessation with adolescents. Design: A two-group randomized control trial with 1,402 male and female students in grades 9 through 11 from 14 secondary schools in Toronto, Canada. Participants were randomly assigned to a tailored Web-assisted tobacco intervention or an interactive control condition task conducted during a single classroom session with e-mail follow-up. The cornerstone of the intervention was a five-stage interactive Web site called the Smoking Zine (http://www.smokingzine.org) integrated into a program that included a paper-based journal, a small group form of motivational interviewing, and tailored e-mails. Main Outcome Measure: Resistance to smoking, behavioral intentions to smoke, and cigarette use were assessed at baseline, postintervention, and three- and six-month follow-up. Multilevel logistic growth modeling was used to assess the effect of the intervention on change over time. Results: The integrated Smoking Zine program helped smokers significantly reduce the likelihood of having high intentions to smoke and increased their likelihood of high resistance to continued cigarette use at 6 months. The intervention also significantly reduced the likelihood of heavy cigarette use adoption by nonsmokers during the study period. Conclusion: The Smoking Zine intervention provided cessation motivation for smokers most resistant to quitting at baseline and prevented nonsmoking adolescents from becoming heavy smokers at 6 months. By providing an accessible and attractive method of engaging young people in smoking prevention and cessation, this interactive and integrated program provides a novel vehicle for school- and population-level health promotion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking cessation: What have we learned over the past decade?

Discusses developments in understanding smoking and smoking cessation, methodological issues, and intervention approaches over the past 10 yrs. Although effective multisession clinic interventions have been developed, such programs reach relatively few smokers. This has led to self-help, work-site, health care setting, and community interventions aimed at delivering less intensive programs to larger populations. Conceptual and empirical developments and trends within these above delivery contexts are reviewed, and avenues of research are identified. Nicotine replacement strategies have benefited from technological advances (e.g., transdermal patches) and present continuing challenges with respect to integration with behavioral strategies and incorporation into primary care medical settings. Research over the next decade should focus on the development of cost-effective interventions that can reach representative and high-risk smokers. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The effectiveness of a tobacco prevention program with adolescents living in a tobacco-producing region

OBJECTIVES: This study investigated the efficacy of a social-influences tobacco prevention program conducted with adolescents living in a high tobacco production area. METHODS: Students in 10 experimental schools completed the tobacco prevention program and a booster intervention. Control students received health education as usual. RESULTS: After 2 years of treatment, smoking rates in the treatment group (vs the control group) were lower for 30-day, 7-day, and 24-hour smoking. The intervention had more of an impact on those who were involved in raising tobacco than it did on those not involved in raising tobacco. CONCLUSIONS: Although modest, effects were achieved with minimal intervention time in a high-risk group, indicating that social-influences prevention programs may be effective in such groups.     

Respiratory response to cigarette smoking among adolescent smokers: a pilot study

BACKGROUND: Because cigarette smoking affects the respiratory system earlier than many other systems of the human body, an attempt was made to identify objective and subjective respiratory problems among adolescent smokers. METHODS: Two studies based on a pulmonary function test (PFT), respiratory symptom assessment, and other smoking-related variables were undertaken. Study 1 involved cigarette smokers (N = 18, 22% males, mean age 18.7 years) from a freshman college class who participated in an acute smoking experiment that involved performing a PFT before and after smoking a single cigarette. Study 2 was performed on a combined group of vocational-technical high school students and freshman college students (N = 44, 48% males, mean age 17.8 years) where PFT parameters, respiratory symptoms, and smoking-related health vulnerability were assessed among smokers vs nonsmokers. RESULTS: In Study 1, the average reduction across PFT parameters was 4.4% and the mean estimated lung age increased from 27.15 to 29.84 years. In Study 2, a consistent trend toward reduction of PFT values among smokers vs nonsmokers was observed; the mean forced expiratory volume in 1 sec/forced vital capacity ratio (90.51% vs 94.59%), peak expiratory flow rate (80.32% vs 92.06%), and flow rate of 50% of forced vital capacity (88.39% vs 102.81%) differed significantly. Significant differences in respiratory symptoms were also observed among smokers vs nonsmokers. CONCLUSIONS: The beginning of respiratory health disorders can be identified among adolescent smokers. These findings might provide important clues on how to improve outcomes from health care provider-based adolescent smoking cessation counseling.     

A brief image-based prevention intervention for adolescents.

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior–image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16–0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32–0.43, ps     

Stable transduction of recombinant adeno-associated virus into hematopoietic stem cells from normal and sickle cell patients

The effectiveness of a health education programme for prevention of alcohol abuse and tobacco smoking among adolescents was assessed by an intervention study with a non-randomized control group. The study was carried out among 7th-9th grade school students in a Local Health Unit of the Brescia province, North Italy. Students were enrolled in either the intervention or the control group, based on the participation of their teachers to the educational programme. A total of 428 students were involved in the programme representing the intervention group, and 658 students not involved in the programme formed the control group. The health education programme included the prevention of alcohol abuse in the first school year (1989-90) and the prevention of tobacco smoking in the second year (1990-91). Each part of the programme included a series of lessons taken by the teachers for about 20 hours. Alcohol use and smoking habits, knowledge about, and attitudes toward alcohol and tobacco use of the students have been assessed by anonymous questionnaires. The questionnaires have been administered during school time at the beginning and the end of each school year, giving a total of 6 questionnaires, from Q1 to Q6. All the questionnaires included the same questions on alcohol and tobacco use, knowledge and attitudes. Of the 1086 students who attended the 7th grade in the year 1989-90, 428 were enrolled as intervention group and 658 as control group. As regards alcohol, the following findings were observed: 1. no difference was found in the percentages of students drinking at least one glass of wine or beer daily between the 2 groups at Q6; 2. no substantial change in the percentage of students aware of the health risks of alcohol abuse from Q1 to Q6 was observed. As regards tobacco smoking, the results of the study showed: 1. no difference between the 2 groups was found at Q6 as regards the proportion of students who smoked one or more cigarettes a month; 2. the percentages of students planning to smoke in the future were similar in the 2 groups in Q6; 3.the percentage of students with a high score on the health consequences of smoking was higher in the intervention than the control group at Q4, but again no difference between the groups was evident at Q6. In conclusion, the health education programme seemed to be unsuccessful in modifying behaviors and attitudes regarding alcohol and tobacco use during the 3-year follow-up.     

Clinical trial of 2 tobacco use cessation interventions in primary care

OBJECTIVE: To study the efficacy of two types of intervention to stop tobacco dependency. DESIGN: Randomised clinical trial. SETTING: Primary care centre. PATIENTS AND OTHER PARTICIPANTS: Smokers recruited from among the health centre users through the preventive activities and health promotion programme. INTERVENTIONS: Independent variable: type of intervention. General variables: age, sex, marital status, educational level, work situation, cohabitation with children, smokers at home, number of years smoking, type of tobacco. There were two types of intervention: a) Minimal Intervention (MI). b) Advanced Intervention (AI). 54 patients were included, with 6 losses. 21 were assigned at random to the MI group and 27 to the AI group. Progress was measured at 15 days, 1 month, 3 months, 6 months and a year. RESULTS: In the MI, 23.8% were abstinent at 15 days; the same percentage at one month and 3 months; 19% at 6 months; and 14.3% remained abstinent after a year. In the AI, 51.9% were abstinent at 15 days; 48.1% at both one and 3 months; 25.9% at 6 months; and 22.2% were still not smoking after a year. No significant differences between the two interventions were found in any of the observations. CONCLUSIONS: These data do not show that one intervention is better than the other. With the passage of time the effect of the intervention decreased in both groups.     

Hospital smoking bans and employee smoking behavior: Results of a national survey

OBJECTIVE: To examine the impact of workplace smoking bans on smoking behavior of employees. PARTICIPANTS: A total of 1469 current or former smokers (intervention group) employed in smoke-free hospitals and 920 current or former smokers (comparison group) employed in non-smoke-free workplaces were surveyed to determine smoking behavior. DESIGN: This cross-sectional study is part of a larger, ongoing prospective study. The study design was quasi-experimental. We randomly selected sites consisting of a hospital and a corresponding community. Furthermore, we randomly selected subjects from hospitals and their corresponding communities. MAIN OUTCOME MEASURES: Postban quit ratio and progression along the stages-of-change continuum. METHODS: The Cox proportional hazards model was used to compare the postban quit ratio between the intervention and comparison groups. The Cochran-Mantel-Haenszel analysis of variance statistic was used to compare groups on the stages-of-change variables. RESULTS: Beginning with the smoking ban and continuing for 5 years after implementation, statistically significant differences in the postban quit ratio were observed between employees of smoke-free hospitals who were smokers and counterparts in the community (P<.001). Despite preban differences in smoking intensity, the overall difference in postban quit ratios remained significant even after multivariate adjustment for socioeconomic, demographic, and smoking intensity variables. For those sites that were 5 years postban, the quit ratio was 0.506 in smoke-free workplaces compared with 0.377 in workplaces where smoking was permitted. In all but 1 category, the intervention group was further along the stages-of-change continuum toward quitting smoking than the comparison group (P<.001). CONCLUSION: American hospitals' experiences with smoking bans, which directly affect more than 5 million workers, should be examined by other industries as a method of improving employee health. Workplace smoking bans could also be effective in saving lives, reducing health care costs, addressing safety concerns, and decreasing operating and maintenance expenses of employers.     

Predictors of brief smoking intervention in a midwifery setting

The aims of this study were: to assess current practice in smoking cessation interventions by midwives and to examine the relationship between the use of smoking intervention, practitioner characteristics and organizational factors. A mail-out survey was sent to a random sample of 500 midwives. The response rate was 85% (n = 425). The results indicated that most midwives used minimal interventions (advice and education) for at least some of their clients. However, the more skilled and more time-intensive forms of intervention such as counselling about methods to quit, negotiating a quit date and follow-up were infrequently utilized. Moreover, participants estimated that half their smoking clients were not offered any advice about smoking. Organizational factors such as: hospital policy for smoking intervention, type of hospital, size of hospital, cohesion of staff and work pressure predicted the use of smoking interventions. Self-reported ability to intervene for smoking and the level of assessment undertaken were practitioner characteristics which predicted the use of smoking interventions. The barriers that inhibit the use of smoking intervention by midwives are discussed and methods for change canvassed.