Health risk behaviors in relation to making a smoking quit attempt among adolescents

The primary aim of this study was to examine youth risk behaviors in relation to: (a) making a smoking quit attempt, and (b) successful cessation among adolescent smokers. Data were analyzed from the public use dataset of the 2003 national school-based Youth Risk Behavior Survey. The sample consisted of 2,033 students (weighted mean age of 16.3 years, 49.8% female, 73.6% White) who reported a history of daily smoking. While almost two-thirds (63.5%) of adolescent smokers reported making a quit attempt in the last year, only 10% of those were able to successfully quit. Factors associated with making a quit attempt included depression and participating in sports while high-risk sexual activity and engaging in substance use other than alcohol or marijuana were negatively related to making a quit attempt. Externalizing health behaviors (e.g., fighting, drug use, and high risk sexual activity) were associated with decreased likelihood of cessation. Findings from this study may inform efforts to develop more effective smoking prevention and treatment programs for youth.     

Cigarette smoking and the intention to quit among pregnant smokers

Research has demonstrated that smoking during pregnancy has deleterious effects on the health of the unborn child as well as the mother. The present study examined whether pregnant smokers would have a greater intention to quit smoking, whether the stage of pregnancy would influence the intention to quit, and whether variables which have predicted cessation among pregnant smokers would also predict intention to quit. The results indicated that pregnant women did not have a significantly greater intention to quit smoking compared to nonpregnant smokers, despite the health risks to their child. Women who were further along in their pregnancy and women who smoked more cigarettes on a daily basis demonstrated the least intention to quit. Notably, women in the first trimester showed the greatest intention to quit, suggesting that pregnant women may be most receptive to quitting during their first trimester.     

General practice counseling for patients with chronic obstructive pulmonary disease to quit smoking: Impact after 1 year of two complex interventions

Objective

To evaluate two counseling programs in general practice to help smokers with chronic obstructive pulmonary disease (COPD) to quit smoking.

Methods

Cluster randomized controlled trial including 68 general practices (667 patients) using a randomly assigned intervention program with counseling and advice about nicotine replacement therapy (and additional bupropion-SR in one of the programs) or usual care. Usual care consisted of periodic regular check-ups and COPD information. The main outcome measure was biochemically verified point prevalence at 12 months.

Results

The two intervention groups were treated as one in the analysis because they were equally effective. The intervention resulted in a significantly self-reported higher success rate (14.5%) compared to usual care (7.4%); odds ratio = 2.1, 95% confidence interval = 1.1-4.1. Biochemically verified quit rates were 7.5% (intervention) and 3.4% (usual care); odds ratio = 2.3, 95% confidence interval = 0.9-6.0.

Conclusion

The program doubled the cessation rates (statistically nonsignificant). Too few participants used the additional bupropion-SR to prove its effectiveness.

Practice implications

The protocols can be used for COPD patients in general practice, but expectations should be modest. If quitting is unsuccessful, a stepped care approach should be considered.     

Effect of one hour of passive cigarette smoking on lung function and airway responsiveness in adults and children with asthma

Summary We exposed 18 adults with bronchial asthma, 16 healthy controls and 11 children with asthma for 1 h either to ambient air (AA) or to environmental tobacco smoke (ETS). Exposure was performed at rest in an exposure chamber. Before and after exposure symptom scores and lung function were determined. After exposure bronchoprovocation tests with methacholine (adults) or histamine (children) were performed to determine the concentrations causing a 100% increase in SRaw (PC₁₀₀SRaw), and a 20% fall in FEV₁ (PC_2OFEV₁). In adult asthmatics mean (SD) SRaw before and after Sham was 8.8 (3.6) and 8.4 (3.6) cmH₂O · s, and mean FEV₁ (SD) was 3.18 (0.97) and 3.14 (0.9) 1, respectively. Before and after passive smoking mean SRaw (SD) was 7.5 (3.0) and 7.2 (2.7) cmH₂O · s, and mean FEV₁ (SD) was 3.31 (1.0) and 3.21 (0.88) 1, respectively. Geometric mean (SD) PC₁₀₀SRaw and PC_2OFEV₁ after Sham were 0.38 (4.5) and 0.29 (4.1) mg/ml, after passive smoking 0.39 (5.1) and 0.36 (4.7) mg/ ml, respectively. In healthy controls there was no consistent effect on the respective parameters during exposure. In children mean (SD) SRaw before and after Sham was 8.7 (3.6) and 9.0 (3.2) cmH₂O · s, and mean FEV₁ (SD) was 1.97 (0.32) and 1.98 (0.40) 1, respectively. Before and after passive smoking mean SRaw (SD) was 10.4 (5.3) and 9.4 (3.3) cmH₂O · s, and mean FEV₁ (SD) was 1.95 (0.37) and 1.94 (0.35) 1, respectively. Geometric mean (SD) PC₁₀₀SRaw and PC₂₀FEV₁ after Sham were 1.39 (3.0) and 0.70 (2.7) mg/ml, and after passive smoking 1.65 (2.5) and 0.96 (2.3) mg/ml, respectively. There were no significant differences in lung function and airway responsiveness between exposure to ambient air or ETS. The main symptoms during passive smoking were eye and nasopharyngeal irritation. Our observations suggest that in children and adults with mild to moderate bronchial asthma, 1 h of passive cigarette smoking does not cause airway obstruction or con sistent changes in bronchial responsiveness.Abbreviations AA ambient air (Sham) - ETS environmental tobacco smoke - SRaw specific airway resistance - FEV₁a one-second forced expiratory volume - PC₂₀FEV₁a provocative concentrations of histamine/methacholine to decrease FEV₁ by 20% - PC₁₀₀SRaw provocative concentrations of histamine/methacholine to increase SRaw by 100% Supported by Forschungsrat Rauchen und Gesundheit, Hamburg, Federal Republic of Germany     

The role of parent health literacy among urban children with persistent asthma

Health literacy (HL) affects adult asthma management, yet less is known about how parent HL affects child asthma care.     

The prevalence of waterpipe tobacco smoking among Polish youths

IntroductionWaterpipe smoking is gaining popularity among the youth in Poland and is evaluated for the first time in this work. The authors address the social and demographic factors that motivate young people to smoke and attempt to determine which of them contribute to habit formation.Material and methodsThe data were collected among school and university students in Poland during a global survey on various forms of tobacco use. Multivariable regression models were applied for odds-ratio evaluation. The data concern waterpipe and cigarette smoking habits.ResultsThe survey was completed by 19,097 respondents. The survey included 144 schools and 32 universities from 16 voivodeships in Poland. Respondent gender exhibited the highest ORs (95% Cl), both in the case of current and ever WP users: 2.11 (2.10–2.12) and 2.16 (2.15–2.17), respectively. The other important factor was a place of living: 1.83 (1.82–1.84) and 2.17 (2.16–2.18), respectively. All ORs were statistically significant for p = 0.05.ConclusionsThe prevalence of tobacco smoking among Polish youths is high. Waterpipe tobacco smoking was found to be the second most popular habit after cigarette smoking. Moreover, young smokers use other non-tobacco products in waterpipes, and drink alcohol during smoking sessions. Many young people try waterpipe smoking without previous experience with cigarettes.     

Intention to quit smoking: Is the partner’s smoking status associated with the smoker’s intention to quit?

Background: Smoking behavior among couples is often similar.Purpose: The aim of the study was to examine the relationship between the partner’s smoking status and the intention to stop smoking of the index person. Method: Cross-sectional data of 1,044 patients in a random sample of 34 general medical practices in northeastern Germany were analyzed.Results: Among smokers with a non-smoking partner (SNP), more intended to quit smoking in the next six months (37.0% vs. 31.4%), compared to smokers with a smoking partner (SSP). Also, more SNP intended to quit in the next four weeks (4.7% vs. 2.7%) compared to SSP. SNP were more active in the use of self-change strategies than SSP.Conclusion: The data confirm that the partner’s smoking status is related to the intention to quit smoking. Interventions should address the different needs of both smokers with a smoking partner and those with a non-smoking partner. This study is part of the Research Collaboration in Early Substance Use Intervention (EARLINT) funded by the German Federal Ministry of Education and Research (Grant No. 01EB0120, 01EB0420), the Social Ministry of the State of Mecklenburg-West Pomerania (Grant No. IX311 a 406.68.43.05), and the Krupp von Bohlen and Halbach foundation.     

Exposure to bisphenols and asthma morbidity among low-income urban children with asthma

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Impact of community respiratory viral infections in urban children with asthma

Background

Upper respiratory tract viral infections cause asthma exacerbations in children. However, the impact of natural colds on children with asthma in the community, particularly in the high-risk urban environment, is less well defined.

Feasibility of promoting smoking cessation among methadone users using multimedia computer-assisted education

Background

The prevalence of smoking is very high among methadone users. As a method of delivering health education, computers can be utilized effectively. However computer-assisted education in methadone users has not been evaluated systematically.

Objective

This study was aimed at assessing feasibility and patient acceptance of an interactive educational module of a multi-component smoking cessation counseling computer program for former illicit drug users treated in an outpatient methadone clinic.

Methods

The computer-mediated education for hazards of smoking utilized in this study was driven by major constructs of adult learning theories. The program interface was tailored to individuals with minimal computer experience and was implemented on a touch screen tablet PC. The number of consecutive methadone-treated current smokers enrolled in the study was 35. After providing socio-demographic and smoking profiles, the patients were asked to use the educational program for 40 minutes. The impact of the computer-mediated education was assessed by administering a pre- and post-intervention Hazards of Smoking Knowledge Survey (HSKS). An attitudinal survey and semi-structured qualitative interview were used after the educational session to assess the opinions of participants about their educational experience.

Results

The computer-mediated education resulted in significant increase of HSKS scores from 60.5 ± 16.3 to 70.4 ± 11.7 with t value 3.69 and P < .001. The majority of the patients (78.8%) felt the tablet PC was easy to use, and most of the patients (91.4%) rated the educational experience as good or excellent. After controlling for patient baseline characteristics, the effect of computer-mediated education remained statistically significant.

Conclusions

Computer-assisted education using tablet PCs was feasible, well-accepted, and an effective means of providing hazards of smoking education among methadone users.     

Asthmatic responses to passive cigarette smoke: Persistence of reactivity and effect of medications

The present study assessed the persistence of cigarette-smoke reactivity and the effects of drug pretreatment on bronchial responsiveness to environmental tobacco smoke (ETS). Two groups of subjects were chosen for the study. Group I consisted of 15 atopic smoke-sensitive subjects with asthma, six of whom were defined “reactors” and nine “nonreactors” to ETS challenge. Group II consisted of 15 atopic subjects without asthma and with documented upper respiratory tract symptoms on exposure to ETS. All subjects were challenged for 2 to 6 hours with mechanically generated ETS in a static inhalation chamber. Five / six subjects in group I, who were previously demonstrated as reactors 24 months earlier, remained reactive within 1 to 2 hours of continuous ETS exposure. Pretreatment with albuterol, cromolyn, and a combination of albuterol and cromolyn 30 minutes before ETS exposure significantly diminished airway reactivity to ETS. All nine previous nonreactors in group I remained nonreactive despite rechallenge with ETS for up to 6 hours. Group II subjects challenged under identical conditions did not reveal a significant decline in FEV, on challenge with ETS. These studies demonstrate the persistence of ETS reactivity during a 2-year period. Although cromolyn sodium and/or albuterol can protect against reactivity, mechanisms of ETS-induced airway reactivity remain unknown.     

Physical development in children and adolescents with bronchial asthma

Bronchial asthma is the most common chronic disease in children of developmental age. Data from the auxological literature indicate that children with disturbances in growth may also suffer from atopic disorders. The aim of the present study was to evaluate somatic growth in children with bronchial asthma using anthropological methods. The study was carried out using anthropometric measurements and information on the severity and course of the disease on 261 children with bronchial asthma. Mean body height was lower than in healthy peers and about 5% of subjects were short. Mean BMI and skinfold thicknesses were significantly higher and lean body mass was lower in the study group. Seventeen percent of the children were overweight or obese, and 8% were underweight. Body build was more robust in the girls examined. Longitudinal studies will help determine to what degree the disease itself directly affects physical development, and to what degree treatment does.     

螨变应原舌下特异性免疫治疗螨致敏哮喘患儿疗效的Meta分析

目的评价舌下特异性免疫治疗（SLIT）对螨致敏哮喘患儿的疗效,为临床治疗和开展相关研究提供参考。方法检索PubMed、EMBASE、The Cochrane Central Register of Controlled Trials（Clinical Trials）、中国生物医学数据库和中国期刊全文数据库等,查找螨变应原SLIT相关的RCT文献。依据文献纳入和排除标准,制定效应指标的评价标准。进行文献筛选和质量评价,用Revman4．2．10软件进行Meta分析。无法进行合并分析的资料进行描述性分析。结果共纳入11篇文献,文献质量为A级2篇,B级8篇,C级1篇。Meta分析结果显示,SLIT组与对照组比较：哮喘症状评分标准化均数差（SMD）为-1．74（95％CI：-2．83～-0．64）,提示SLIT组的哮喘症状评分较对照组明显降低。两组哮喘用药评分比较：SMD为-1．56（95％CI：-2．95～-0．17）,提示SLIT组哮喘用药评分较对照组显著降低。以第1秒用力呼气量（FEV1）作为衡量肺功能指标,FEV1：SMD为0．07（95％CI：-0．72—0．86）,FEV1％：SMD为-0．02（95％CI：-0．85～0．81）,提示SLIT组FEV1或FEV1％与对照组差异无统计学意义。血清抗体的变化比较：特异性IgESMD为0．72（95％CI：-0．82—2．25）,提示SLIT组和对照组特异性IgE水平差异无统计学意义;特异性IgG4SMD为5．05（95％CI：2．56—7．54）,表明SLIT组特异性IgG4水平较对照组显著升高。结论螨变应原SLIT有助于控制螨致敏哮喘患儿哮喘症状,减少哮喘用药,通过提高特异性IgG4水平恢复机体正常的免疫过程。与对照组比较,尚无足够证据表明螨变应原SLIT能显著影响螨致敏哮喘患儿特异性IgE及肺功能。     

Comparison of two approaches in achieving smoking abstinence among patients in an outpatient clinic: A Phase 2 randomized controlled trial

Objectives

To compare the effectiveness of quitting immediately and cutting down to quit in promoting smoking abstinence among smokers in an outpatient clinic.

特异性免疫治疗对变应性鼻炎合并哮喘患儿的影响

目的: 探讨屋尘螨变应原特异性免疫治疗对变应性鼻炎合并哮喘患儿血清白细胞介素 13(IL-13)、白细胞介素 4(IL-4)、干扰素 γ(IFN-γ)水平及鼻部症状和肺功能的影响。方法: 选择屋尘螨变应原阳性的变应性鼻炎合并支气管哮喘的患儿58例,其中35例接受屋尘螨特异性免疫治疗为免疫组,其余23例予局部糖皮质激素治疗为药物组。于治疗前及治疗1年后分别测定患儿血清IL-4、IFN-γ和IL-13水平,并评估鼻部症状和肺功能。结果: 经过1年治疗后,免疫组鼻部症状评分较治疗前明显减少(P<0.05),与药物组相比有显著差异(P<0.05);免疫组因哮喘急性发作而急诊就诊的频率明显少于药物组;与治疗前比较,免疫组血清IL-4和IL-13水平下降,IFN-γ水平及IFN-γ/IL-4升高 (P<0.05),肺功能改善明显(P<0.05);而药物组血清IL-4和IL-13水平较治疗前无明显下降 (P>0.05),肺功能无改善 (P>0.05)。结论: 特异性免疫治疗后患儿血清IL-4和IL-13下调, IFN-γ及IFN-γ/ IL-4上调,提示特异性免疫治疗可能调节体内T辅助细胞(Th)Th1/Th2细胞的平衡,从而改善患儿鼻部症状和肺功能。     

Posttraumatic stress symptoms in parents of children with acute burns

OBJECTIVE: To develop a model of risk factors for posttraumatic stress disorder (PTSD) symptoms in parents of children with burns. METHODS: Immediately following the burn and 3 months later, parents reported on their children's and their own psychological functioning and traumatic stress responses. RESULTS: Approximately 47% of the parents reported experiencing significant posttraumatic stress symptoms 3 months after the burn. Our model indicates three independent pathways to PTSD symptoms (i.e., parent-child conflict, parents' dissociation, and children's PTSD symptoms). Additionally, parents' anxiety predicted increased parent-child conflict, conflict with extended family and size of the burn predicted parents' dissociation, and size of the burn and children's dissociation predicted children's PTSD symptoms. CONCLUSIONS: This study suggests that many parents of children with burns suffer from posttraumatic stress symptoms. Interventions that target factors such as family conflict, children's symptoms, and parents' acute anxiety and dissociation may diminish the risk for PTSD.     

Maternal and neonatal risk factors of asthma in children: Nationwide population based study

BackgroundSmall population group-based cohorts have found that perinatal factors may contribute to the development of asthma in children. We aimed to investigate maternal and neonatal risk factors for the asthma phenotypes using two databases from the Taiwan's Maternal and Child Health Database (TMCHD) and the National Health Insurance Research Database (NHIRD).MethodsPerinatal data was obtained from 2004 to 2008 in the TMCHD and linked the NHIRD to obtain relevant medical information regarding maternal and neonatal risk factors of three asthma phenotypes which were identified as transient early asthma, persistent asthma, and late-onset asthma. A multivariate logistic regression analysis was conducted to adjust for covariates.ResultsThe percentage of non-asthmatic patients was 77.02% and asthmatic (transient early asthma, late onset asthma, and persistent asthma) patients were 8.96%, 11.64%, and 2.42%, respectively. Maternal risk factors—including Cesarean section, maternal asthma, maternal allergic rhinitis (AR), and premature rupture of membranes—and neonatal risk factors, such as male gender, gestational age 29–37 weeks, ventilator use, antibiotics use, AR, and atopic dermatitis, were associated with the development of these three asthma phenotypes. Twins and a gestational age of 28 weeks or less premature were associated with the development of transient early asthma and persistent asthma, but not late onset asthma. Triplets and above were associated with the development of transient early asthma, but not late onset or persistent asthma.ConclusionVarious asthma phenotypes have different risk factors; therefore, their distinct risk factors should be identified in order to early diagnosis and treatment.     

Impact of spirometry feedback and brief motivational counseling on long-term smoking outcomes: A comparison of smokers with and without lung impairment

Objective

We compared long-term outcomes among smokers with and without impaired lung functioning who received brief counseling highlighting their spirometric test results.

Methods

Participants in this analysis all received a brief motivational intervention for smoking cessation including spirometric testing and feedback (∼20 min), were advised to quit smoking, offered free access to a phone-based smoking cessation program, and followed for one year. Outcomes were analyzed for smokers with (n = 99) and without (n = 168) impaired lung function.

Results

Participants with lung impairment reported greater use of self-help cessation materials at 6 months, greater use of non-study-provided counseling services at 6 and 12 months, higher 7-day PPA rates at 6 months, and were more likely to talk with their doctor about their spirometry results.

Conclusion

Further research is warranted to determine if spirometry feedback has a differential treatment effect among smokers with and without lung impairment.

Practice implications

It is premature to make practice recommendations based on these data.