Mary Ellen Wewers

Distribution of daily smokers by stage of change: Current Population Survey results

BACKGROUND Population-based national estimates of stage of change among daily smokers are unknown. This study described the proportion of U.S. daily smokers, 18 and older, by stage of change. Selected sociodemographic characteristics were delineated. METHODS Cross-sectional data were collected via telephone or face-to-face interview in daily smokers who responded to the Current Population Survey in 1992-1993 (n = 39,706), 1995-1996 (n = 34,865), or 1998-1999 (n = 30,153). Main outcomes included stage of change: (1) Precontemplation-not interested in quitting smoking in next 6 months; (2) Contemplation-interested in quitting smoking in next 6 months but not next 30 days; (3) Preparation-interested in quitting smoking in next 30 days and stopped at least 1 day during past year. RESULTS During 1992-1993, 59.1% of respondents were precontemplators, 33.2% contemplators, and 7.7% in preparation stage. This distribution was similar in subsequent surveys (1995-1996; 1998-1999). Gender differences were not apparent. Whites were more likely to be precontemplators. As education and income increased, the percentage in precontemplation decreased. Rural residents were more likely in precontemplation and less frequently in preparation. CONCLUSIONS Among daily smokers, little movement in stage of change was apparent in the United States during the 1990s. Tobacco control efforts must receive high priority to address these static patterns.

An acculturation scale for Southeast Asians.

SummaryThis article reports the development of an acculturation scale for Southeast Asian immigrants. From factor analyses of responses on 13 items obtained from samples of three different Southeast Asian ethnic groups, i.e., Cambodians, Laotians, and Vietnamese, two subscales were derived: (1) proficiency in languages (land of origin versus English), and (2) language, social and food (LSF) preferences. Inter-item reliability of the scales was demonstrated for each of the three ethnic groups, with Cronbach alpha coefficients of 0.76 or above. Construct validity was also established within each of the three ethnic groups by demonstrating expected associations of the subscales with current age, years in the USA, total years of education, percentage of lifetime in the USA, and age on entering the USA. Multivariate analyses within each of the ethnic groups revealed that, once controlling for years of education, percentage of lifetime in the USA, and type of health care coverage, although not significant for the Cambodians (P=0.08) males tended to show higher scores for the proficiency in language subscale in comparison to females. Similar multivariate analyses for the LSF preference subscale showed that although slightly higher for the males, the differences between the genders was not significant for the Cambodians (P=0.78); both the Laotian (P=0.23) and Vietnamese (P=0.01) females showed higher scores in comparison to males although only just reaching significance for the Vietnamese.

The effect of chronic administration of nicotine on antinociception, opioid receptor binding and met-enkelphalin levels in rats

The effect of chronic nicotine administration on (1) antinociception; (2) opioid receptor binding; and (3) met-enkelphalin levels in discrete brain regions in rats was investigated. Male and female Sprague-Dawley rats were treated with nicotine 0.3 mg/kg, 0.1 mg/kg, or saline three times a day subcutaneously during a 14-day protocol. Antinociception was measured by hotplate (HP) test on days 1, 2, 7, 10 and 14. After completion of the protocol, mu-opioid receptors were analyzed by [3H]-DAMGO binding studies and met-enkelphalin levels were determined by radioimmunoassay. Results indicated that hot-plate latency increased during the first 2 days of nicotine administration for male and female rats who were treated with 0.3 mg/kg nicotine. There was an up-regulation of mu-receptors (increased Bmax) in the striatum of rats treated with 0.3 mg/kg nicotine, compared to 0. 1 mg/kg nicotine and saline groups. An interaction effect of group by gender was noted. After 14 days of chronic nicotine administration, met-enkelphalin levels were significantly lower in striatum and midbrain of animals treated with 0.3 mg/kg nicotine, as compared to controls. These results suggest that chronic nicotine administration, in doses representative of human smoking, produces antinociception initially, and is accompanied by an upregulation of micro-opioid receptors in the striatum of rats. In addition, nicotine-induced tolerance to antinociception may be associated with a decrease in met-enkelphalin level over a period of time.

Tobacco interventions by oncology nurses in clinical practice

Tobacco use is an important risk factor in cancer, cancer recurrence, and increased treatment morbidity, but limited information is available about interventions for tobacco cessation used in oncology clinical practice. In 1996, the Agency for Health Care Policy Research (AHCPR) published the first evidence‐based smoking cessation guideline for use by health professionals. Using the AHCPR guideline as a framework, the authors describe the frequency of tobacco interventions provided by oncology nurses.

Cigarette Smoking in the HIV-Infected Population

As mortality due to AIDS-related causes has decreased with the use of antiretroviral therapy, there has been a rise in deaths related to non-AIDS-defining illnesses. Given the exceedingly high prevalence of cigarette smoking among individuals living with HIV infection, tobacco has been implicated as a major contributor to this paradigm shift. Evidence suggests that smoking-related illnesses, such as cardiovascular disease, respiratory illnesses, and certain malignancies, contribute substantially to morbidity and mortality among HIV-infected persons. In this review, we summarize the adverse health consequences of smoking relevant to HIV-infected individuals and discuss smoking cessation in this unique population, including a discussion of barriers to quitting and a review of studies that have examined smoking cessation interventions.

A smoking cessation intervention with hospitalized surgical cancer patients: a pilot study.

The purpose of this pilot study was to examine the effect of a structured smoking cessation intervention during hospitalization on short-term smoking abstinence. Hospitalized surgical oncology patients who smoked (n = 26) and were diagnosed with cancer were randomly assigned to either an experimental or control group. Experimental group subjects (n = 12) received a structured smoking cessation intervention during hospitalization followed by five weekly phone calls after discharge. Control group subjects (n = 14) received usual care from their health-care providers during hospitalization. Abstinence from smoking, as determined by saliva cotinine, the primary metabolite of nicotine, was measured at first postdischarge visit. Subjects with a saliva cotinine level of <10 ng/ml were classified as abstinent. At first postdischarge visit, 75% of experimental group subjects were abstinent compared with 42.9% in the usual care group, a 32% difference. These preliminary findings will assist in the design and further evaluation of cancer rehabilitation strategies promoting cessation in hospitalized postoperative cancer patients who continue to smoke.

Naltrexone administration affects ad libitum smoking behavior

Abstract Endogenous opioid peptides have been implicated in the reinforcement of smoking and opioid antagonists have been examined to determine their role in smoking behavior. To date, the relationship between smoking behavior and chronic opiate antagonist administration during ad libitum smoking has not been investigated. The purpose of this study was to examine the relationships between naltrexone, an opiate antagonist administered orally, and smoking behavior and mood states during ad libitum smoking. A repeated measures experimental design was used. Normal adult male and female volunteers, admitted to the Clinical Research Center, were randomly assigned to naltrexone-treated (n = 22) or placebo-control (n = 21) groups in a double-blind manner. Day 1 was considered acclimation to the unit and day 2 was baseline, or pre-drug administration. On days 3, 4, and 5, subjects received 50 mg naltrexone or a placebo at 0700 and 1600 hours. Plasma nicotine and expired air carbon monoxide levels were measured daily at 1900 hours. Number of cigarettes smoked, mood states, withdrawal symptomatology and self-reported satisfaction with smoking were also quantified daily. Results indicated that plasma nicotine levels (P = 0.005), number of cigarettes smoked daily (P = 0.003) and self-reported satisfaction with smoking (P = 0.043) were significantly lower among those treated with naltrexone, compared to the placebo-control group. Expired air carbon monoxide levels did not differ between the two groups. In addition, mood states and withdrawal symptoms did not differ between groups. These findings suggest that endogenous opioid peptides influence specific smoking behavior variables.

The Feasibility of a Nurse-Managed, Peer-Led Tobacco Cessation Intervention Among HIV-Positive Smokers

The purpose of this pilot study was to examine the effectiveness of an 8-week, nurse-managed, peer-led smoking cessation intervention among HIV-positive smokers. The intervention was based on the Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline and was delivered by an ex-smoker who was HIV positive and had been trained by an advanced practice nurse to deliver cessation counseling. Eight male HIV-positive smokers were assigned to the intervention group and received (a) 21 mg nicotine patch therapy for 6 weeks, (b) weekly face-to-face or telephone counseling, and (c) skills training that included substitute strategies for dealing with not smoking. Those participants assigned to the control group received written self-help materials for smoking cessation. Abstinence rates at end of intervention and 8 months were compared between groups. At end of treatment, 62.5% of intervention group participants were biochemically confirmed as abstinent from smoking compared with 0% in the control group. Eight-month abstinence rates were 50% among the intervention group compared with 0% in the control group.

Promoting tobacco dependence treatment in nursing education.

ISSUES There are 17.3 million nurses worldwide, the largest group of health-care professionals, and they have great potential to address the epidemic of tobacco use and its related morbidity and mortality. However, the evidence indicates that the educational preparation of nurses for tobacco control remains inadequate. APPROACH This paper provides an overview of the efficacy of nurses in the delivery of smoking cessation interventions, existing tobacco control content in nursing educational programs, model curricula, teaching resources and strategies for reducing barriers to curricular change. KEY FINDINGS Despite the efficacy of nursing intervention for tobacco cessation, lack of appropriate knowledge and/or skill presents a major problem for implementation. An important factor fostering this lack of preparation is limited tobacco control content in current nursing educational programs. Barriers to enhancing and building this curricula include lack of preparation of educators, low priority for this content in an already overloaded curricula, negative attitudes, continued smoking by nursing students and/or faculty and lack of tested curricula. The availability of new tobacco control resources, including those specifically tailored for nurses can assist educators in teaching this content and nurses in implementing interventions. IMPLICATIONS Research and changes in policy are needed to ensure that nursing education includes essential content on tobacco control. CONCLUSION Nurses can be effective in delivering tobacco cessation interventions. Efforts are needed to promote curriculum that ensures that all nursing students and practicing nurses receive tobacco control content and are competent in the delivery of interventions; and to disseminate resources to nursing educators

Tobacco policy in American prisons, 2007

Objective: To examine current tobacco policy in US prisons and explore changes in prison tobacco policies over time. Data source: Telephone survey of the 52 US departments of correction. Main outcome measures: Current tobacco policy; distribution of free tobacco; availability of smoking cessation programming and cessation aids. Participants: Complete responses were received from 51 of 52 (98%) departments, while one provided partial information. Results: The majority of correctional systems (60%) reported total tobacco bans on prison grounds, with most remaining facilities (27%) having an indoor ban on tobacco use. No prisons distributed free tobacco. No major violence was reported relating to the implementation of stricter tobacco policies; however many respondents noted that tobacco became a major contraband item following the implementation of a total ban. While most prison systems with an indoor tobacco ban (86%) reported having tobacco cessation programmes, few of those with total bans (39%) continued such programmes after the initial transition period. Conclusion: Total tobacco bans have often been accompanied by the termination of tobacco cessation programmes. Such actions undermine efforts to promote long-term cessation resulting in a missed public health opportunity.