Association of parental smoking behaviors and absences in school-age children: implications for the nurse practitioner

PURPOSE: To examine the association between reported absences and parental smoking in school-age children, aged 6-17, and to specifically explore the impact of maternal smoking on the health and attendance of school-age children. DATA SOURCES: The sample of 7488 parent-child dyads was randomly selected from the 2002 National Health Interview Survey, a multipurpose cross-sectional household interview survey conducted by the Centers for Disease Control and Prevention. The parent sample included 2673 men and 4375 women. Children's ages ranged from 6 to 17 with a mean of 11.7 years. CONCLUSIONS: Maternal, but not paternal, present and past smoking behavior significantly impacts the child's wellness and school attendance. The reasons for this disparity are unclear but may relate to synergistic effects of pre- and postnatal nicotine exposure, the traditional role of mother as caregiver, or specific smoking habits that increase environmental tobacco exposure. IMPLICATIONS FOR PRACTICE: Assessment and educational strategies for families regarding the hazards of childhood exposure to environmental tobacco smoke are indicated. Specific implications for the role of the nurse practitioner across diverse specialties are addressed with emphasis on the need for development of gender, age, and culturally sensitive smoking cessation programs and support networks.     

The effects of depression and smoking on pain severity and opioid use in patients with chronic pain

Depression and smoking are common comorbid conditions among adults with chronic pain. The aim of this study was to determine the independent effects of depression on clinical pain and opioid use among patients with chronic pain according to smoking status. A retrospective design was used to assess baseline levels of depression, clinical pain, opioid dose (calculated as morphine equivalents), and smoking status in a consecutive series of patients admitted to a 3-week outpatient pain treatment program from September 2003 through February 2007. Depression was assessed using the Centers for Epidemiologic Studies-Depression scale, and clinical pain was assessed using the pain severity subscale of the Multidimensional Pain Inventory. The study cohort (n = 1241) included 313 current smokers, 294 former smokers, and 634 never smokers. Baseline depression (P = .001) and clinical pain (P = .001) were greater among current smokers compared to former and never smokers, and the daily morphine equivalent dose was greater among smokers compared to never smokers (P = .005). In multivariate linear regression analyses, baseline pain severity was independently associated with greater levels of depression, but not with smoking status. However, status as a current smoker was independently associated with greater opioid use (by 27 mg/d), independent of depression scores. The relationship between depression, smoking status, opioid use, and chronic pain is complex, and both depression and smoking status may be potentially important considerations in the treatment of patients with chronic pain who utilize opioids.     

Associations between pain and current smoking status among cancer patients

There is growing empirical and clinical interest in purported associations between smoking and the aggravation of cancer symptoms and treatment side effects, such as pain. Both pain and smoking are highly prevalent among persons with cancer, and there is recent evidence to suggest that cancer patients who continue to smoke despite their diagnosis experience greater pain than nonsmokers. Accordingly, the main goal of this cross-sectional study was to examine associations between multiple levels of smoking status and several pain-related outcomes among a sample of 224 cancer patients about to begin chemotherapy. Patients completed self-report measures of pain severity, pain-related distress, and pain-related interference, as well as a demographics questionnaire. Results indicated that persons who continued to smoke despite being diagnosed with cancer reported more severe pain than never smokers, F (2, 215) = 3.47, p < .05. Current smokers also reported greater interference from pain than either former or never smokers, F (2, 215) = 5.61, p < .01. Among former smokers, an inverse relation between pain severity and the number of years since quitting smoking was observed, r (104) = −.26, p < .01. These data suggest that continued smoking despite a cancer diagnosis is associated with greater pain severity and interference from pain; however, future research is warranted to determine the directionality of this relationship.     

Predicting smoking status in a college-age population

OBJECTIVE: The purpose of this study was to determine the factors that predict smoking group membership in a college-age population. DESIGN: A nonexperimental cross-sectional design was used to examine factors that distinguished among four groups: never established (n = 591), former (n = 41), nondaily (n = 80), and daily (n = 76) cigarette smokers. SAMPLE: A pencil and paper questionnaire was returned by 788 randomly selected college students, 18-24 years of age. RESULTS: Significant differences were found among the groups on their mothers', fathers', siblings', and peers' smoking behaviors and attitudes toward smoking. The nondaily and daily smoking groups reported a greater number of risk behaviors than the never established and former smoking groups. The two groups of current smokers also were more likely to report an increased level of depressive symptoms compared with the nonsmoking groups. The number of high school and college friends who smoke and self-reported high-risk alcohol and drug behaviors predicted smoking group membership in a polytomous logistic regression. CONCLUSIONS: Strategies to alter the social environment and decrease the exposure of nonsmoking students to others who model smoking behaviors may help decrease smoking initiation and prevent relapse on college campuses.     

Nicotine dependence criteria and nicotine withdrawal symptoms in relation to pain among an adult general population sample

Background: Evidence has shown that people who have smoked at any point in life have a higher probability of pain than those who have never smoked. The goal of this study was to analyze whether there are associations between nicotine dependence including nicotine withdrawal with pain and the number of pain locations. Methods: Data stems from a cross‐sectional survey study with a probability sample of residents of a northern German area with 4075 study participants, aged 18–64 years (participation rate 70.2%). Face‐to‐face in‐home computer‐aided interviews (Composite International Diagnostic Interview) were used to assess single pain locations, the diagnostic criteria of nicotine dependence, alcohol dependence, depressive, and anxiety disorders according to the Diagnostic and Statistical manual of the American Psychiatric Association (DSM‐IV). Results: Ever smokers with three or more nicotine dependence criteria after controlling for alcohol dependence, depressive, anxiety disorders, age and gender revealed an odds ratio (OR) of 4.2 (95% confidence interval, CI, 2.0–9.0) compared to ever smokers without nicotine dependence criteria, and ever smokers with four or more nicotine withdrawal symptoms displayed an OR of 3.6 (CI 1.5–8.7) compared to ever smokers who had not experienced withdrawal symptoms. Current smokers who used 20 or more cigarettes per day had an OR of 0.5 (CI 0.3–0.8) of experiencing pain in three or more locations compared to former smokers. Conclusion: Nicotine dependence criteria are associated with a higher probability of pain than having no nicotine dependence criteria in this general population sample.     

血管回声跟踪技术评价主动与被动吸烟者股动脉弹性的研究

目的 探讨血管回声跟踪(ET)技术评价主动吸烟者与被动吸烟者股动脉血管弹性功能的应用价值.方法 利用ET技术检测40例主动吸烟者、40例被动吸烟者、40例健康对照组的股动脉,通过内-中膜厚度(IMT)、僵硬度(β)、压力-应变弹性系数(Eρ)、动脉顺应性(AC)、脉搏波放大指数(AI)及脉搏波传导速度(PWVβ)评价动...     

Prevalence and characteristics of chronic pain in the general Norwegian population

BACKGROUND: Population-based studies suggest that prevalence of chronic pain is increasing. The purpose of this study was to determine the prevalence of chronic pain in a sample drawn from the general Norwegian population. In addition, the characteristics of chronic pain, as well as differences in demographic characteristics and health-related variables between persons with and without chronic pain were evaluated. METHODS: A total of 4000 Norwegian citizens, were randomly drawn from the National Register, by Statistics Norway and were mailed a questionnaire. RESULTS: The response rate was 48.5%. The majority of the sample was female (51%), married (59%), and working for pay (69%) with a mean age of 45.2 years. The prevalence of chronic pain in the total sample was 24.4%, and 65% of the participants with chronic pain indicated that they had experienced chronic pain for over 5 years. The cause of the pain was not specified by 57% of the participants in chronic pain, and 31% reported no pain treatments. Women, older individuals, persons with less education, and those who were pensioned, reported chronic pain more frequently. The results of a logistic regression analysis indicate that the variables that provide unique contributions to predicting pain group memberships were: gender, education, being frequently ill, or having a chronic illness. CONCLUSIONS: These findings suggest that chronic pain is a significant problem in the general Norwegian population, and that gender, education, being frequently ill, or having a chronic illness are important variables in predicting pain group membership.     

The association between a lifetime history of a work-related neck injury and future neck pain: a population based cohort study

Objective

The purpose of this study was to investigate the association between a lifetime history of a work-related neck injury and the development of troublesome neck pain in the general population.

Methods

We formed a cohort of randomly sampled Saskatchewan adults with no or mild neck pain in September 1995. At baseline, participants were asked if they had ever injured their neck at work. Six and 12 months later, participants were asked if they had troublesome neck pain defined as grades II to IV on the Chronic Pain Grade Questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of work-related neck injury and the onset of troublesome neck pain while controlling for age and sex.

Results

Our cohort included 866 individuals at risk for developing troublesome neck pain. Of those, 73.8% (639/866) were followed up at 6 months, and 63.0% (546/866), at 1 year. We found a positive association between a history of a work-related neck injury and the onset of troublesome neck pain (age- and sex-adjusted hazard rate ratio [HRR], 2.4; 95% confidence interval, 1.3-4.7).

Conclusion

Our analysis suggests that a lifetime history of work-related neck injury is associated with an increased risk of troublesome neck pain. Occupational neck injuries can lead to recurrent episodes of neck pain.     

Cognitive complaints in a general population of older adults: Prevalence, association with pain and the influence of concurrent affective disorders

Previous studies examining the associations between pain and cognitive complaints have been in pain clinic outpatients; there has been no research in the general population setting. A cross-sectional postal survey of 7878 older adults, aged 50 years and over, registered with three general practices (n = 11230) in North Staffordshire using self-complete questionnaires was conducted. The questionnaire included the Alertness Behaviour Subscale from the Sickness Impact Profile to measure cognitive complaint, a full-body manikin to record presence and location of any recent pain (past 4 weeks) and the Hospital Anxiety and Depression Scale. The prevalence of any cognitive complaint was 46.5%; this increased with age (41.6% in 50–59 year olds to 63.4% in 80–100 year olds) and was higher in females than males (48.6% vs. 43.8%). Reporting recent pain was associated with a statistically significant increase in also reporting any cognitive complaint (odds ratio: 2.49; 95% confidence interval: 2.2, 2.8) and altered little after adjusting for age and gender. A dose-response relationship was seen when examining the association between pain and degree of cognitive complaint. Statistically significant associations between cognitive complaints and pain were seen across all anxiety and depression status. Cognitive complaints are common in a general population of older adults and are strongly related to the reporting of pain; a relationship which is independent of the presence of concurrent affective disorders. Taken together with previous work suggesting that subjective memory complaints are strongly correlated to risk of future cognitive decline, these results have implication for clinical practice in an aging population.     

Associations between recreational exercise and chronic pain in the general population: evidence from the HUNT 3 study

The evidence for an association between leisure-time physical activity and prevalence of pain is insufficient. This study investigated associations between frequency, duration, and intensity of recreational exercise and chronic pain in a cross-sectional survey of the adult population of a Norwegian county (the Nord-Trøndelag Health Study; HUNT 3). Of the 94,194 invited to participate, complete data were obtained from 46,533 participants. Separate analyses were performed for the working-age population (20-64 years) and the older population (65 years or more). When defined as pain lasting longer than 6 months, and of at least moderate intensity during the past month, the overall prevalence of chronic pain was 29%. We found that increased frequency, duration, and intensity of exercise were associated with less chronic pain in analyses adjusted for age, education, and smoking. For those aged 20-64 years, the prevalence of chronic pain was 10-12% lower for those exercising 1-3 times a week for at least 30 minutes duration or of moderate intensity, relative to those not exercising. Dependent on the load of exercise, the prevalence of chronic pain was 21-38% lower among older women who exercised, relative to those not exercising. Similar, but somewhat weaker, associations were seen for older men. This study shows consistent and linear associations between frequency, duration, and intensity of recreational exercise and chronic pain for the older population, and associations without an apparent linear shape for the working-age population.     

Number of pain sites is associated with demographic, lifestyle, and health-related factors in the general population

Research on widespread pain often relies upon case definitions bounded by duration limits or “cut-offs.” In clinical reality, however, there are no natural cut-off points between localized and widespread pain. Rather, pain is best represented by a continuum of “widespreadness” from localized pain to pain spread across the body. The objective of this paper was to describe the number of pain sites (NPS) reported in a population study and its association with demographic, lifestyle, and health-related factors. Using a cross-sectional design, the Standardized Nordic Questionnaire was used to measure musculoskeletal pain among seven age groups in Ullensaker, Norway (n = 2926). Results showed that women reported a higher mean NPS than men. A higher NPS was also found for individuals who were separated or divorced, undergoing rehabilitation, or who had a disability pension. Additionally, greater NPS was reported by smokers, individuals with less physical activity, and a higher BMI. A strong linear relationship was found between NPS and reduction in overall health, sleep quality, and psychological health. Results from a multivariate linear regression analysis showed that overall health, sleep quality, and gender demonstrated the strongest associations with increasing NPS, accounting for 31.4% of the variance. Our study indicates that the straightforward and simple method of counting the NPS could be important in managing the complex problem of musculoskeletal pain.     

Combined effects of major depression, pain and somatic disorders on general functioning in the general adult population

This study was carried out to assess the prevalence of major depressive disorder (MDD) in persons suffering from pain symptoms in various locations, both with and without comorbid somatic disorders and to analyze the single and combined effects of MDD, pain symptoms and somatic disorders on general functioning in the community. The 12-month prevalence of MDD, somatic disorders and pain symptoms, grouped according to location, were determined among 4181 participants from a community sample. Depression was assessed utilising the Composite International Diagnostic Interview. Pain symptoms were self-reported by participants whereas medical diagnoses were validated by medical examinations. General functioning was evaluated utilising the established MOS-SF-36 scale. The prevalence of MDD was significantly increased for persons with pain in any location. In the absence of a somatic disorder, MDD prevalence was highest in persons with abdominal/chest pain (9.3%) and arm or leg pain (7.9%) and lowest in persons with back pain (6.2%). Mental and physical well-being were lowest for persons with both MDD and a somatic disorder, irrespective of pain locations. Increasing numbers of pain locations impaired mental and physical well-being across all groups, but the effect on mental well-being was most marked in participants with MDD and comorbid somatic disorders. The presence of pain increases risk of associated MDD. The number of pain locations experienced, rather than the specific location of pain, has the greatest impact on general functioning. Not only chronic pain, but pain of any type may be an indicator of MDD and decreased general functioning.     

Headache and neck or shoulder pain - frequent and disabling complaints in the general population

Objective - to describe the prevalences of reported headache and neck or shoulder pain as unspecified complaints, and to explore the consequences of these complaints measured as unfitness for work.

Design - self-administered questionnaire as part of a general health screening.

Setting - all persons aged between 20 and 56 years, in the municipality of Tromsø were invited. Of 29026 invited, 21826 attended, and of these 20026 answered the questionnaire. Some 17700 answered the questions on headache, and 17650 on neck or shoulder pain.

Results - 6.0% of the males reported weekly or more frequent headache, and 15.4% reported neck or shoulder pain. The corresponding prevalences in women were 13.1% and 24.9%. This female preponderance was present also among subjects expressing the complaints daily or monthly. The prevalences of reported neck or shoulder pain increased significantly with age, while the prevalences of reported headache were not influenced by age. Of the subjects with weekly headache, as many as 30% of both sexes reported being »seriously hampered or unable to perform ordinary work«.

Conclusions - many people in the general population live with disabling complaints, but the numbers seeking medical care for them are far fewer. It is important to demonstrate the high prevalence of headache and neck or shoulder pain, and also to understand the complexity of the causal factors, and the reason why only a proportion of sufferers seek professional help.     

Pain-related fear in low back pain: a prospective study in the general population.

A cognitive behavioural account of chronic low back pain (CLBP) proposes that the relationship between pain catastrophizing and functional disability is mediated by fear of movement/(re)injury. Several clinical studies already demonstrated the contribution of pain catastrophizing and fear of movement/(re)injury in the development and maintenance of CLBP. This study included people with low back pain (LBP) in the general population, and aimed to investigate whether fear of movement/(re)injury mediated the relationship between pain catastrophizing and functional disability, by examining several prerequisites for mediation. Data from the Dutch population-based Musculoskeletal Complaints and Consequences Cohort (DMC(3)) study were used, including 152 people suffering from LBP who completed both a follow-up questionnaire and a baseline questionnaire 6 months previously. This study was unable to demonstrate that the relationship between pain catastrophizing and functional disability was mediated by fear of movement/(re)injury, since the prerequisite that pain catastrophizing and functional disability were related, was not fulfilled. However, pain catastrophizing was significantly related to fear of movement/(re)injury 6 months later, above and beyond other contributing variables such as fear of movement/(re)injury already present at baseline. On its turn, fear of movement/(re)injury was related to functional disability, in addition to pain intensity. Although this study leaves some indistinctness concerning the actual relationships between pain catastrophizing, fear of movement/(re)injury, and functional disability, it does provide some evidence for the contributing role of these factors in LBP in the general population.     

The association between IGF-I and insulin resistance: a general population study in Danish adults

OBJECTIVE

IGF-I has an almost 50% amino acid sequence homology with insulin and elicits nearly the same hypoglycemic response. Studies showed that low and high IGF-I levels are related to impaired glucose tolerance and to a higher risk of type 2 diabetes. The aim of the current study was to evaluate the association between IGF-I level and insulin resistance in a Danish general population.

RESEARCH DESIGN AND METHODS

Included were 3,354 adults, aged 19–72 years, from the cross-sectional Health2006 study. The homeostasis model assessment of insulin resistance (HOMA-IR) was used as the index to estimate insulin resistance. Serum IGF-I levels were determined by an immunoassay and grouped into quintiles (Q1–Q5). Linear or multinomial logistic regression analyses were performed.

RESULTS

In the study population, 520 subjects (15.5%) had increased HOMA-IR values above 2.5. After adjustment for age, sex, physical activity, and waist-to-height ratio, a U-shaped association between IGF-I and HOMA-IR was found. Low IGF-I (Q1: odds ratio [OR] 1.65 [95% CI 1.16–2.34], P < 0.01) as well as high IGF-I (Q5: 1.96 [1.38–2.79], P < 0.01) levels were related to a higher odds of increased HOMA-IR values compared with subjects with intermediate (Q3) IGF-I levels. These associations remained statistically significant after the exclusion of subjects with type 2 diabetes and by using the updated computer HOMA2-IR model.

CONCLUSIONS

Low- and high-normal IGF-I levels are both related to insulin resistance. The biological mechanism of this complex phenomenon has to be elucidated in more detail for future risk stratification.IGF-I, predominantly synthesized in the liver upon stimulation by growth hormone (GH), is usually bound to IGF-binding protein 3 (IGFBP-3) in circulation (1). IGF-I has an almost 50% amino acid sequence homology with insulin and elicits nearly the same hypoglycemic response (2). Several studies have investigated the effect of IGF-I on insulin sensitivity and its relation to type 2 diabetes. Large longitudinal studies, including the National Health and Nutrition Examination Survey (NHANES) III, reported a higher risk of insulin resistance, metabolic syndrome (MetS), and type 2 diabetes in subjects with low IGF-I serum concentrations or low IGF-I–to–IGFBP-3 ratios (3,4). A recent German study in 7,665 subjects, however, showed that low and high baseline IGF-I serum concentrations were both related to a higher risk of developing type 2 diabetes within 5 years (5). This U-shaped association seems to be likely in face of a higher prevalence of MetS or type 2 diabetes in patients with GH deficiency (6), a state of low IGF-I levels, as well as with acromegaly (7), a disease characterized by high IGF-I levels, although endogenous GH secretion may confound short-term glucose homeostasis in these patients. On the basis of these findings, we also hypothesize a U-shaped relation between IGF-I levels and insulin sensitivity as precursor to manifest type 2 diabetes.In general, the effects of IGF-I in the control of glucose homeostasis is well known. Animal models showed that a deletion of hepatic IGF-I production, resulting in 80% reduced IGF-I levels, led to hyperinsulinemia and abnormal glucose clearance (8,9). An epidemiological study reported a negative correlation between IGF-I levels and insulin resistance measured by the homeostasis model assessment of insulin resistance (HOMA-IR) (10). Confirming results were found in an Italian study that investigated subjects with and without type 2 diabetes as well as with impaired glucose tolerance (11). IGF-I levels were positively correlated with insulin sensitivity among all three groups. Unfortunately, both studies did not account for a possible U-shaped association and were relatively small, with study populations of 404 and 506 subjects. Therefore, the aim of the current study was to evaluate the possible U-shaped association between IGF-I serum concentration and insulin resistance assessed by HOMA-IR in a large Danish population of 3,354 adults aged 19–72 years.     

The association between schizophrenia and cigarette smoking: a review of the literature and implications for mental health nursing practice

Despite a fall in smoking activity among the general population, individuals with schizophrenia continue to smoke at alarming rates and suffer poor health as a consequence. It would appear that limited and conflicting knowledge, outdated perceptions, and ineffective interventions have hindered efforts to promote healthy behaviours among this group. This paper reviews the literature on the association between nicotine dependence and schizophrenia and explores explanations for the phenomenon. Complex psychopathological, biochemical, and neuropharmacological interactions between smoking and schizophrenia are revealed. The interface of schizophrenia and smoking behaviour, particularly among those hospitalized in mental health facilities, and rationales for the management of this manifestation are examined. In addition, inferences regarding the role of mental health nurses in the care of this population are reached, and implications for nursing practice are discussed.     

Gender moderates the association between depression and disability in chronic pain patients.

Pain-related anxiety and depression are important correlates of disability amongst chronic pain patients. Furthermore, women may differ in their experience of pain, anxiety and depression when compared to men. The aim of the current study was to determine the relative contribution of anxiety and depression on disability in male and female chronic pain patients. The sample consisted of 260 patients (101 males, 159 females) referred to the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases in Bath, UK. As part of an initial assessment, all patients completed measures of depression, pain-related anxiety and disability. As predicted, both anxiety and depression were found to be significant positive predictors of pain, number of medications used and disability. Although gender did not significantly predict disability, it did moderate the relationship between depression and disability, in that when depression was high, women report greater disability than men. Gender was also found to moderate the relationship between depression and number of medications used, in that a positive association was found for men, but not women. However, gender did not significantly moderate the relationship between anxiety and disability. Together these results not only suggest that gender is an important moderator of the relationship between emotional responses and disability, but that such associations may be related more to depression than anxiety.