Smoking cessation counseling as a teachable moment for skin cancer prevention: pilot studies

OBJECTIVE: To conduct pilot research examining smoking cessation counseling as a teachable moment for skin cancer prevention. METHODS: Study I surveyed 199 beachgoers regarding skin cancer protection. Study II compared a standard smoking cessation treatment against one that incorporated skin cancer education (N=35). RESULTS: In Study I, smokers were less likely than nonsmokers to wear sunscreen or perform skin self-examinations. In Study II, participants were satisfied with the integrated program; smoking cessation treatment efficacy was not compromised; and skin cancer knowledge and self-efficacy increased. CONCLUSIONS: Further study of smoking cessation as a teachable moment for other health behavior change is warranted.     

The effects of a multiple treatment program and maintenance procedures on smoking cessation

This study evaluated the efficacy of a multiple treatment smoking cessation program and three maintenance strategies. Phase I of the study involved 51 subjects who participated in a 5-day smoking cessation project. The program consisted of lectures, demonstrations, practice exercises, aversive smoking, and the teaching of self-control procedures. In Phase II, all subjects were randomly assigned to one of three maintenance conditions: a 4-week support group which offered an opportunity to discuss feelings and thoughts, a 4-week telephone contact system which enabled group members to call one another, and a no-contact control group. To evaluate efficacy, extensive follow-up data were collected at the end of treatment and at 2, 4, 6, and 12 months post-treatment. The treatment program was extremely effective; 100% of the subjects were abstinent at the end of treatment, and at 1 year post-treatment, 63% of the subjects reported total abstinence. As to sex differences, at the 1-year period 66% of the women and 59% of the men were ex-smokers. Recidivists reported a smoking rate that was 52% of baseline at the 6-month follow-up. At 2 months post-treatment, 40% of the abstainers reported that the quitting experience was easy, and subjects reported an average weight gain of only 4.69 lb. The authors offer suggestions for future smoking cessation research based upon the promising findings of this study.     

The crisis of health in a crisis ridden region

The overall picture of the Arab world today is dire; no Arab country is free from political strife, foreign intervention, or the threat of terrorism. Continuing instability and the failure of national governments to uphold the rule of law and deliver on development are tearing apart the fabric of Arab societies. Internally, Arab regimes’ agendas are shaped by security and their makeup by kinship and loyalty, pushing people to seek refuge within their primordial loyalties. From the outside, foreign meddling in the name of “democracy” is deepening the Arab world’s instability, therefore providing justification for opponents of change to discredit the values of human rights and power sharing. In such an environment, the voiceless majority becomes the main victims, with detrimental effects on their physical and mental wellbeing. A domino-like breakdown of the Arab region, with serious consequences for world’s stability, is becoming an increasingly likely scenario.     

Inhibition of tumor angiogenesis as a cancer treatment]

Angiogenesis is the process of new vessel formation from pre-existing vasculature. In preclinical as well as clinical research it has been demonstrated that tumour growth and formation of metastases are angiogenesis dependent. High microvessel density in most tumour types is associated with a bad prognosis. A variety of angiogenic stimuli and inhibitors have been discovered and are expressed in tumours of cancer patients. In addition to specific angiogenic factors, the synthesis and breakdown of the extracellular matrix, the adherence of endothelial cells, the coagulation process and the immune system are important for tumour-induced angiogenesis. Preclinical research has demonstrated that tumour growth can be inhibited by angiogenesis inhibitors. These findings stimulated the development of angiogenesis inhibitors, which are currently under investigation in phase I, phase II and phase III studies for toxicity and efficacy. In the future angiogenesis inhibitors, like insulin therapy in diabetes, may be used to inhibit tumour growth and to induce stabilization of the disease.     

The effectiveness of a telephone-based tobacco cessation program offered as part of a worksite health promotion program

Extensive research on tobacco cessation affirms the effectiveness of interventions, although the literature is more limited concerning the impact of programs designed specifically for the workplace. The present study examines the effectiveness of a telephone-based health coaching tobacco cessation program that was provided as part of worksite health promotion programs by 10 large employers. The participants were recruited based on their health risks as identified by health assessments, and the program was personalized to meet their individual needs and stages of change. The results indicate that at 12 months, health coaching program participants achieved a 32% quit rate, compared to 18% for nonparticipants. The quit rate was highest (44%) among program completers who were ready to change at baseline. These results suggest that a tobacco cessation program offered as part of a worksite health promotion program can be highly effective, especially for those who are ready to change. However, the relatively low annual participation rate may indicate that tobacco users remain among the most difficult to engage and to support in their efforts to complete programs. Therefore, implementing a variety of engagement strategies, such as policy changes, as well as social and financial incentives and penalties will most likely have a positive effect at the population level.     

Life crisis as a precursor to child abuse.

A number of theories have been proposed on the causation of child abuse, and many of these theories assign some role to stress. Stress is variously conceptualized as a continuous state resulting from poverty, poor housing, and the like, or as an immediate crisis such as an argument or the breakdown of an appliance. An alternate perspective on stress identifies it with life change events which require readjustment in the lifestyle of a person. When an excessive number or magnitude of such life change events occur, the person affected may be said to be in a state of life crisis. Such states of life crisis have been found to be associated with the onset of physical illness and with the occurrence of accidents and injuries. In this study, a questionnaire was administered to 35 abusing parents and 35 matched controls who had experienced problems with their children but had not been abusive. The two groups were compared for their life change scores on the Social Readjustment Rating Scale for the year before their abuse or problems began with their children. The mean score of the nonabusers was 124, which does not indicate a life crisis. For the abusers, the mean score was 234, which indicates a moderate life crisis. These means are significantly different at the .001 level by the t test. The role of symbiosis, an emotiontional attachment in which a person seeks to be taken care of by another person, was also explored. It is argued that abusive parents are competing with each other and with their children for the role of being cared for. This kind of behavior seems to make the person particularly vulnerable to life changes, which in turn produce stress. Support for this view was found in the responses to the questionnaire. Prevention strategies aimed at reducing change and stress might include better provision of crisis-intervention services, measures aimed at reducing unemployment or lack of opportunity, effective health maintenance services, and greater provision of counseling and mental health services. Use of the Social Readjustment Rating Scale in a preventive program of early intervention is also possible.     

Hospitalization as a life crisis for the preschool child

Review of the literature on the psychological effects of hospitalization on children reveals that it has not increased substantially in quality or quantity since Vernon and his associates published their extensive review a decade ago. More recent research supports the earlier contentions that children between the ages of 6 months and 4 years are especially vulnerable to upset but are also more amenable to change and growth than other age groups. Maternal separation appears to be the primary stressor, but the presence of emotional disturbance prior to hospitalization and the child's level of cognitive development at the time may also be significant factors. Attempts to prepare children for hospitalization and surgery have met with some success, but not for preschool children.The need for some comprehensive theoretical perspective on which to base research is evident. Studies to date appear to have been based either on the concept of anticipatory worry or on some form of modeling theory. The author suggests that hospitalization can be considered as a life crisis for a child, a crisis that may result in blocks or distortions in his development if not mastered properly. Crisis theory provides a meaningful and useful model for understanding the experience of hospitalization for young children and for providing a basis for intervention.The psychopathology present in some children and their families is made apparent during such a crisis as hospitalization; this may present the only time when they are accessible to mental health professionals.Ms. Goslin is a doctoral candidate in clinical psychology at Florida State University, currently interning as a clinical fellow in psychology at Harvard Medical School (Children's Hospital) in Boston, Mass. This review was completed in partial fulfillment of the requirements for the doctoral degree, under the guidance and supervision of Lee B. Sechrest, Ph.D., and other members of her doctoral committee.     

Age of smoking onset as a predictor of smoking cessation during pregnancy

OBJECTIVE: To assess age of smoking onset as a predictor of smoking cessation during pregnancy. METHODS: Multivariate logistic regression analysis of cross-sectional data for 35,687 women 15-34 years old from the 2000 and 2001 National Household Survey on Drug Abuse. RESULTS: Pregnant women (1805) were twice as likely to abstain as nonpregnant women (47.7% vs 23.3%). Initiation of smoking at >15 years old was associated with increased likelihood of 30-day abstinence during pregnancy (OR=1.75) after adjusting for confounders. CONCLUSIONS: The earlier a woman starts smoking, the more likely it is that she will smoke during pregnancy, underscoring the need for early prevention to protect mothers and the fetuses.     

Parenting in a crisis: conceptualising mothers of children with cancer

Much research on the experiences of parents of children with cancer has been conducted within a discourse of psycho-pathology, or has tended to see parents mostly as a proxy source of information on the well-being of their children. Using empirical data from semi-structured interviews with 20 mothers of a child with cancer, in one area of the UK, we draw on sociological literatures on motherhood, childhood, caring, and chronic illness to suggest a more helpful and informative way of understanding their experiences. We suggest that mothers, although not ill themselves, experience many of the consequences of chronic illness. Biographical disruption begins for them when they first notice something wrong with their child, and intensifies with diagnosis, altering their sense of self and their social identity. The diagnosis brings with it a set of new responsibilities and role expectations, including an obligation of 'proximity'-being physically close to their child at all times to provide 'comfort' and 'keep-watch'. For mothers, caring evokes an intense emotional interdependence with their sick child, and involves a range of technical tasks and emotional work, including acting as 'brokers' of information for their child and managing their cooperation with treatment. Managing these obligations was achieved at high cost to the mothers themselves, and resulted in severe role strain by compromising their ability to function in other roles, including their role as the mother of their other children. Against the backdrop of a severe and life-threatening illness, everyday concerns about their child's diet or appropriate discipline take on a new significance and carry a heightened potential for generating conflict and distress for mothers. In presenting their accounts, mothers draw on prevailing cultural discourses about motherhood, childhood and cancer, and these clearly influence the context in which they care for their child, and shape their reflexive constructions of their experiences. Caring for a child with cancer had many adverse implications for the quality of life of the women we studied. Mothers of a child with cancer warrant study in their own right, and such study benefits from interpretive perspectives.     

Evaluation of a minimal self-help smoking cessation intervention following cervical cancer screening.

OBJECTIVE: This study was undertaken to evaluate a smoking cessation intervention provided to women smokers as follow-up to cervical cancer screening. METHODS: Women who had had a Pap test in the prior month (N = 4,053) were called to complete a survey that assessed smoking status; 580 identified smokers were randomized to receive Usual care (n = 292) or a Self-help intervention (n = 288) that included a self-help booklet, a smoking and reproductive health information card, and three telephone counseling calls. Women were followed up at 6 and 15 months post-base line. RESULTS: Cessation rates in the Usual care (UC) and Self-help (SH) groups did not differ at the 6-month (UC 10.5% vs SH 10.9%, P = 0.56) or 15-month follow-up (UC 15.5% vs SH 10.6%, P = 0.17). Among women with an abnormal Pap test result there were no differences by study group in cessation rates at 6-month (UC 9.8% vs SH 11.0%, P = 0.71) or 15-month follow-up (UC 14.6% vs SH 13.4%, P = 0.96). CONCLUSION: Integrating interventions into the clinical setting and involving providers at the point of care may have greater potential for capitalizing on this "teachable moment." Copyright 1999 American Health Foundation and Academic Press.     

Smoking cessation and lung cancer mortality in a cohort of middle-aged Canadian women

PURPOSE: To determine the impact of smoking cessation on lung cancer mortality among women. METHODS: Survival analysis is used to assess the effect of smoking cessation on lung cancer death in the dietary cohort of 49,165 women aged 40 to 59 years enrolled in the Canadian National Breast Screening Study. RESULTS: During an average of 10.3 years of follow-up, 106 women died of lung cancer. The risk of lung cancer mortality among women who quit before age 50 (HR=0.26; 95% CI, 0.13-0.55 among women who quit at ages 40-49) or quit in the previous 10 years (HR=0.39; 95% CI, 0.22-0.69) is substantially lower than the risk among current smokers. Women who quit after age 40 or have quit for less than 20 years are at substantially higher risk of lung cancer mortality compared with never smokers. Both duration of smoking cessation and age at quitting have independent effects on lung cancer mortality, after controlling for number of cigarettes smoked per day and number of years smoked, as well as other potential confounding variables. CONCLUSION: These findings suggest that programs and policies to promote early cessation of smoking and prevention of relapse should be a public health priority.