Susan A. Albrecht

A Preliminary Study of the Use of Peer Support in Smoking Cessation Programs for Pregnant Adolescents

&NA; This article describes preliminary findings of an experimental, randomized, three‐group, controlled design examining the effectiveness of a smoking cessation intervention for pregnant teens. The three groups are: Teen FreshStart with a buddy program (TFSB), a Teen FreshStart program (TFS) without peer support, and the Usual Care (UC) control group. Forty‐six subjects completed the post‐intervention assessment of smoking status. The TFSB group consistently achieved greater smoking cessation across all measures when compared to the subjects in the other two groups. These results indicate that the use of peer support may be an effective adjunct in smoking cessation programs for pregnant adolescents.

A randomized controlled trial of a smoking cessation intervention for pregnant adolescents

Background: The smoking prevalence rate among pregnant adolescents has been estimated at 59-62%, and 60-80% of these adolescents continue to smoke throughout their pregnancies. Objectives: The aim of this study was to evaluate the short- and long-term effects of smoking cessation strategies tailored to the pregnant adolescent to attain and maintain abstinence. The specific aim was to examine differences in short- and long-term smoking behaviors among three groups: Teen FreshStart (TFS), Teen FreshStart Plus Buddy (TFS-B), and Usual Care (UC) control. Methods: In this randomized controlled intervention study, a3-group (TFS, TFS-B, and UC) by 3-occasion (baseline, 8 weeks postrandomization, and 1-year following study entry) design was used. The study included 142 pregnant adolescents who were aged 14 to 19 years. Both self-reported smoking status collected on the Smoking History Questionnaire and saliva cotinine levels were used to identify smoking behaviors. Results: There were no significant differences among the three treatment groups at baseline in terms of the racial distribution, age, gestational age, age of menses initiation, number in family household, number of family members who smoked, or tobacco use. A significant difference between the UC group and the TFS-B group (p = .010) was seen in smoking behaviors measured 8 weeks following treatment initiation. At 1 year following study entry, however, there were no differences between the groups in smoking behaviors. Discussion: The TFS-B intervention was more effective in attaining short-term smoking cessation in the pregnant adolescent than TFS or UC. Findings suggest that the peer-enhanced programming had a limited effect but could not sustain the participant beyond postpartum (1 year following study entry). Future studies should include relapse prevention to sustain smoking abstinence into the postpartum period.

Handedness and the Laterality Of Breast Cancer in Women

In a pilot study of 138 women with mastectomies that explored the consistent finding of more left breast cancer in American women, associations were found among handedness, initial breast cancer laterality, and age. To test these findings further, 889 subjects were added to the original sample. The resulting sample of 1,027 consisted of 861 right-handed, 94 ambihanded, and 72 left-handed subjects aged 21 to 84. A chi-square test showed a statistically significant association between ipsilateral breast cancer before age 45 and contralateral breast cancer after age 44 in right-handers, x2 (1, n= 861) = 4.169, p<.05. The association was also significant for left-handers, x2 (1 n= 72) = 4.036, p <.05. In addition, a chi-square test showed a statistically significant association between handedness and earlier development of breast cancer, x2 (1, n = 933) = 13.9, p <01. Almost twice as high a percentage of left-handers as right-handers developed breast cancer before age 45. Log-linear analysis demonstrated no significant associations of nodes with either handedness or age. Overall, there was no statistically significant association between the laterality of breast cancer and a history of breast cancer in a primary relative, x2 (1, n = 1,024) = 1.38, p > .05. In some presently unknown way, lateral asymmetries of neurotransmitters may contribute to an explanation of the findings.

An Assessment of Nicotine Dependence Among Pregnant Adolescents

Studies have reported that between 28 and 62% of pregnant teenagers smoke (Cornelius, Taylor, Geva, & Day, 1995; Trollestrup, Frost, & Starzyk, 1992). Because smoking is prevalent among pregnant teenagers, the purpose of this research is to assess nicotine dependence in this high-risk group. This study analyzed baseline data from a sample of pregnant teen smokers who had volunteered to participate in a smoking cessation study (N = 94). Nicotine dependence was measured by adapting the Fagerstrom Tolerance Questionnaire (FTQ; Prokhorov, Pallonen, Fava, Ding, & Niaura, 1996), and by a 6-item withdrawal symptom scale. The overall FTQ score found among pregnant adolescents was 3.10 (SD = 2.3) compared to the mean overall FTQ score among vocational-technical students of 4.27 (SD = 2.2) (Prokhorov et al., 1996). Duration of smoking in years was significantly correlated with the overall FTQ score (r = 0.43, p < .01). Quantity of smoking, as measured by average number of cigarettes smoked, significantly correlated with overall FTQ scores (r = 0.67, p < .01). Lighter smokers were more likely to have previously attempted to quit, however, among the quit attempters, those who smoked 10+ cigarettes per day reported greater severity of withdrawal symptoms than those who smoked less per day. Prenatal education and smoking cessation programs for pregnant teenagers, and pregnant women in general, need to consider that nicotine dependence is an important issue. Early pregnancy may be an opportune time to intervene among pregnant smokers; incentives may be necessary to attract those women who are the heaviest smokers, and possibly the most dependent on nicotine.

Toward an understanding of the health status of black adolescents: an application of the stress-coping framework.

The transition from adolescence to adulthood for many urban black youth today contains a number of formidable barriers and often results in a variety of adverse developmental and behavioral outcomes. Nurses and other health providers have an obligation to answer the urgent need for improvements in the health status of black adolescents. This paper reviews the current psychosocial functioning of black youth while emphasizing the disadvantaged social contexts in which most live, which place them at a higher risk for a variety of negative outcomes. Data concerning mental and social health indicators for black adolescents suggest (a) a negative mental health trajectory with high rates of depression, psychiatric hospitalization rates, and suicides, and (b) a poor social health status with alarming school dropout and juvenile delinquency rates, and chronic violence exposure, substance use, and teen pregnancy. An application of the stress-coping framework to black adolescents is suggested as a way to conceptualize the relationship between stress factors and their influence on development. Because this framework places much emphasis on environmental factors as causes for psychological distress, it provides a means to account for the differential incidence of mental and social illnesses among black adolescents. Nursing interventions related to stress and coping among black adolescents may serve to increase well-being and actualize health promotion. However, research efforts are needed to discover which strategies are used by black youth to cope with the stressful experiences faced in their daily lives. Findings could enhance the design, planning, and implementation of prevention and educational programs, making them more consistent with the unique needs of black adolescents.

Higher Frequency of Left-Breast Cancer: A Possible Explanation:

A study of 1027 women with unilateral breast cancer showed that ipsilateral breast cancer was more common before age 45 and contralateral thereafter. The data suggest a possible explanation of the higher incidence of left-breast cancer in American women. A higher percentage of left-handed women developed breast cancer before age 45, but the over-all incidence of unilateral breast cancer was not greater in left-handed women than in right-handed or ambihanded subjects.

Implementing Evidence-Based Practice: Reducing Risk for Low Birth Weight Through Pregnancy Smoking Cessation

In 1989, the Association of Womens Health, Obstetric and Neonatal Nurses (AWHONN) developed a research utilization program to integrate evidence into practice areas where there were large discrepancies between research evidence and clinical practice. The current program, renamed Research-Based Practice (RBP), uses translational research methods to build from evidence such as that in the Cochrane database and to create protocols for integration of research directly into clinical practice. This article describes the development of the sixth project (RBP6), in which an evidence-based protocol to address smoking in pregnancy was integrated into clinical practice. The protocol includes screening women using descriptive statements and integrates the 5 As (ask, advise, assess, assist, arrange) into prenatal and postpartum care at every visit. By integrating smoking cessation counseling into care, nurses may reduce the risk of low birth weight among pregnant women in both the United States and Canada.

Is difficult childbirth related to postpartum maternal outcomes in the early postpartum period

Unplanned, adverse events during labor or delivery may generate a negative response during the early postpartum period, resulting in disruption of usual functioning and mood. High levels of maternal depressive symptoms are associated with parenting, infant attachment, behavioral problems and cognition (Beck 2002). The purpose of this study was to examine the relationship of adverse events in labor or delivery and depressive symptoms, functional status and infant care at 2-weeks postpartum. The secondary aim was to explore the role of social support as a possible moderator in the relationship between adverse birth events and maternal outcomes. A secondary analysis of data (n = 123) was performed using data collected in a prospective, observational study examining the effects of antidepressant use during pregnancy. Adverse events did not significantly predict depressive symptoms (odds ratio = 1.34, p = .536), functional status (R2 change = .001, p = .66), or infant care (R2 change = .004, p = .48) at 2-weeks postpartum when controlling for depression during pregnancy, antidepressant use at delivery, education level, age, and parity. Social support had significant effects on depressive symptoms (p = .02), functional status (p = .014), and infant care (p < .001) but did not moderate the effect of adverse events when predicting depressive symptoms (odds ratio = 1.01, p = .045), functional status (R2 change = .009, p = .056) and infant care (R2 change < .001, p = .92). Adverse events did not predict maternal outcomes at 2-weeks postpartum. Social support was related to depressive symptoms, functional status and infant care, but did not moderate the effects of adverse events.

Weighing worth against uncertain work: the interplay of exhaustion, ambiguity, hope and disappointment in mothers breastfeeding late preterm infants

Poor breastfeeding outcomes among late preterm infants (LPIs) have been attributed to inadequate breast milk transfer stemming from physiological immaturities. However, breastfeeding is more than a biological phenomenon, and it is unclear how mothers of LPIs manage other factors that may also impact the breastfeeding course. Using grounded theory methods and incorporating serial post-partum interviews with several novel data collection techniques, we examined breastfeeding establishment over a 6-8-week-period among 10 late preterm mother-infant dyads recruited from a maternity hospital in Pittsburgh, Pennsylvania, USA. We found that breastfeeding in the LPI population was a fluctuating, cascade-like progression of trial and error, influenced by a host of contextual factors and events and culminating with breastfeeding continuation (with or without future caveats for duration or exclusivity of breastfeeding) or cessation. The trajectory was explained by the basic psychosocial process Weighing Worth against Uncertain Work, which encompassed the tension among breastfeeding motivation, the intensity of breastfeeding work and the ambiguity surrounding infant behaviour and feeding cues. Several sub-processes were also identified: Playing the Game, Letting Him Be the Judge vs. Accommodating Both of Us and Questioning Worth vs. Holding out Hope. If valid, our theoretical model indicates a need for earlier, more extensive and more qualified breastfeeding support for mothers of LPIs that emphasizes the connection between prematurity and observed feeding behaviours.

The SUCCESS Program for Smoking Cessation for Pregnant Women

The Association of Womens Health, Obstetric, and Neonatal Nurses (AWHONN) developed an evidence-based practice program, Setting Universal Cessation Counseling Education and Screening Standards (SUCCESS), to educate nurses and other health care practitioners about smoking cessation interventions, increase the number of practitioners providing smoking cessation interventions, and deliver a smoking cessation intervention program to childbearing women who smoke. The development, implementation, and outcomes of the SUCCESS program are described.