Joyce W. Hopp

Caffeine and nicotine: A review of their joint use and possible interactive effects in tobacco withdrawal

There is a strong, significant relationship between coffee consumption and smoking. In six epidemiological studies reviewed and analyzed here, 86.4% of smokers consumed coffee versus 77.2% of nonsmokers. Exsmokers use more coffee than nonsmokers but somewhat less than smokers. Seventeen experimental studies suggest that the pharmacologic effect of caffeine in coffee may be partially but not totally responsible for the relationship. Conditioning, a reciprocal interaction (caffeine intake increases anxiety/arousal--nicotine decreases it), or joint effect of a third variable (e.g., stress, alcohol) may account for the relationship. In abstinent smokers, blood caffeine levels increase and remain elevated for as long as 6 months. These higher caffeine plasma levels may be sufficient to produce caffeine toxicity syndrome. A review of 86 studies of nicotine withdrawal, caffeine withdrawal, and caffeine toxicity suggests that the symptoms are similar enough to be confused, and that reported nicotine withdrawal symptoms may be a mixture of nicotine withdrawal and caffeine toxicity.

The Impact of Including Incentives and Competition in a Workplace Smoking Cessation Program on Quit Rates

Purpose. To determine the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition. Design. A quasi-experimental design was employed to compare the effectiveness of three different smoking cessation programs, each assigned to separate worksites. Setting. The study was conducted from 1990 to 1991 at three aerospace industry worksites in California. Subjects. All employees who were current, regular tobacco users were eligible to participate in the program offered at their site. Intervention. The multicomponent program included a self-help package, telephone counseling, and other elements. The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 months of the program. The traditional program offered a standard smoking cessation program. Measures. Self-reported questionnaires and carbon monoxide tests of tobacco use or abstinence were used over a 12-month period. Results. The incentive-competition program had an abstinence rate of 41% at 6 months (n = 68), which was significantly better than the multicomponent program (23%, n = 81) or the traditional program (8%, n = 36). At 12 months, the quit rates for the incentive and multicomponent programs were statistically indistinguishable (37% vs. 30%), but remained higher than the traditional program (11%). Chi-square tests, t-tests, and logistic regression were used to compare smoking abstinence across the three programs. Conclusions. Offering a multicomponent program with telephone counseling may be just as effective for long-term smoking cessation as such a program plus incentives and competition, and more effective than a traditional program.

The impact of incentives and competitions on participation and quit rates in worksite smoking cessation programs.

Purpose. The purpose of this review is to determine whether incentive-based programs conducted at worksites increase participation and long-term smoking cessation rates. Methods. Published studies of workplace smoking cessation programs involving incentives and competition were identified through all available years up to winter of 1992 in MEDLINE (1966–1992), Psychlit (1967–1992), Smoking and Health (1960–1992), and Combined Health Information (1973–1992) computer databases and article reference lists. Programs were considered incentive programs when they involved either cash or other prizes paid to the participant for quitting smoking. Incentive competition programs typically involve groups contesting for prizes by having the greatest smoking cessation rates. Thirty studies were found, out of which 15 quasi-experimental and experimental studies are reviewed. The 15 studies that did not have comparison groups were excluded from this report. Results. Only eight studies had a comparison group in which the effects of incentives and competition were separated from the effects of other interventions. Only one study separated the effects of competition from incentives. Five of these studies evaluated smoking rates after six months, and three after 12 months from the program start. Three of these studies showed that incentives increased participation rates, and five enhanced smoking reduction. No study showed, however, that incentives and/or competition enhanced smoking cessation past six months. Conclusions. It appears that incentives/competition may be useful for increasing participation and smoking reduction. Further research needs to be conducted to determine whether incentives and/or competition enhance long-term quit rates, and what are the most effective types of incentive procedures.

The impact of caffeine use on tobacco cessation and withdrawal

Continuous caffeine consumption with smoking cessation has been associated with more than doubled caffeine plasma levels. Such concentrations may be sufficient to produce caffeine toxicity symptoms in smoking abstinence conditions. To test whether caffeine abstinence influences smoking cessation, 162 caffeine-using smokers were enlisted from American Lung Association smoking cessation programs. Volunteers were randomly assigned by clinic to caffeine-use and caffeine-abstinence conditions and measured for 3 weeks post-smoking cessation, at 6 months and one year. Results showed a significant linear increase in caffeine sputum levels across 3 weeks post cessation for those who quit smoking and continued using caffeine. Three weeks after cessation, concentrations reached 203% of baseline for the caffeine user. Typical nicotine withdrawal symptoms occurred during the first 16 days of cessation. The caffeine abstainers, but not continued users of caffeine, reported increased fatigue during the first 3 days of cessation. Among complete caffeine abstainers, compared with caffeine users, there was a significant increase in fatigue, a decrease in stimulation, and a marginal increase in caffeine craving immediately following tobacco cessation. There were no differences between the groups on other withdrawal symptoms or in cessation success at 16 days, 6 months, or 12 months.

Determinants of smoking behavior among nurses.

This article explores the determinants of smoking behavior among nurses and reviews the research documenting the history and current trends of cigarette use among nurses. National and international studies of cigarette use among nurses show them to smoke more than any other group of health professionals. Stress has been the primary theory of smoking causation among nurses. While some studies suggest this, there are also studies demonstrating no significant differences of stress among smoking and nonsmoking nurses. The literature offers other determinants, including socialization processes, the pharmacological action of nicotine, normative influences, the medical environment, and the feminist movement. A surprising late addition to this list is that nursing education itself may play a major role in the smoking behavior of student and graduate nurses. The failure of nursing education to emphasize health behaviors as well as the use of the medical model in nursing curriculum is suggested as an explanation for the findings that nurses are likely to perceive themselves more as the providers of care and help to the ill than as health models and educators. A summary of conclusions from studies of cigarette use among nurses is that student nurses should receive a specific learning experience which would focus on the role of health educator and exemplar in the nurses role of preventing smoking-related illnesses. Conclusions from the literature also repeat the recommendation that educational strategies for nurses should contrast the use of cigarettes with the concept that nurses assume a role of health advocacy in promoting wellness.

Saudi Women's Beliefs on the Use of Car Infant Restraints: A Qualitative Study

Objective: The focus of this study was to identify the salient beliefs of pregnant women in Saudi Arabia that may influence their intentions to use infant restraints for their children. These beliefs were later used to inform a subsequent quantitative study. Methods: This qualitative study employed Ajzens theory of planned behavior to elicit the salient behavioral, normative, and control beliefs of Saudi pregnant women regarding the use of infant restraints for their future children. Twenty-five pregnant women participated in 2 focus groups conducted in June 2013 at Dallah Hospital in Riyadh. Results: Lack of health education and law enforcement; cultural pressure and traditions; counsel from family, specifically from husbands and mothers; desire to stay close to the child; family size; and car size were key factors in deciding whether or not to use car seats; the high cost of car seats was not. Conclusions: Aside from providing awareness to future mothers and the general public, health interventions should target the specific beliefs identified in this study. Because participants identified husbands as significant referents, further studies are needed to examine the husbands’ attitudes and beliefs.

Values Clarification and the Cardiac Patient

This exploratory study tested the feasibility and potential of values- clarification methods in patient education with 20 chronic heart patients participating in the cardiac classes of a university medical center. Strengths and limitations of the methods were identified, with greater feasibility and responsiveness demonstrated in patients between 51 and 60 years of age, those who had accepted their cardiac problem, and in home visits rather than clinical settings.

Postpartum follow-up: can psychosocial support reduce newborn readmissions?

Purpose.To determine whether there was a relationship between postpartum psychosocial support from healthcare providers and the rate of normal newborn readmissions (NNRs), and whether there was a cost benefit to justify an intervention. Study Design and Methods.Data were abstracted for all normal newborn births from 1999 to 2006 (N = 14,786) at a community hospital in southern California at three different time periods: (1) at baseline prior to any intervention (1999–2000), (2) the 4 years during the comprehensive psychosocial support intervention (2001–2004), and (3) the 2 years during a limited psychosocial support intervention (2004–2006). A cost–benefit analysis was performed to analyze whether the financial benefits from the intervention matched or exceeded the costs for NNRs. Results.There was a significantly lower readmission rate of 1.0% (p = < .001) during the comprehensive intervention time period compared to baseline (2.3%) or to the limited intervention time period (2.3%). Although there was no significant difference in the average cost per newborn readmitted across the three study time periods, during the comprehensive intervention time period the average costs of a NNR were significantly lower (

Hypertension in a Caribbean population.

4,180, p = .041) for the intervention group compared to those who received no intervention (

Smoking behaviour of student nurses enrolled in diploma, associate degree and undergraduate nursing programmes

5,338). There was a cost benefit of