Smoking habits and smoking cessation among North Carolina nurses

A 1987 questionnaire survey of a 1% random sample (n = 356) of registered nurses in North Carolina provided data on the smoking habits and smoking cessation. Fifty-six percent were never smokers; 19% were current smokers. Among the ever smokers, 31% had quit smoking for at least one year. Twenty-two percent of the former smokers had smoked less than 5 years and 39% less than 10 years before quitting. Anecdotal notes from never smokers suggested that their major deterrent to smoking was their own parents smoking. Concerns about the addictive smoking behavior and health effects of smoking observed in their parents as well as concerns about potential health risks to themselves deterred them from smoking. Concerns about the adverse consequences of smoking was the most influential factor influencing smoking cessation and reduction of cigarette smoking. Friends' and family's encouragement to stop smoking was the most influential external factor motivating nurses to quit or reduce cigarette consumption. Fifty-seven percent of the former smokers quit smoking after one or two attempts while 53 of the current smokers had tried to quit 3 or more times - 90% had tried at least once to quit smoking; however, only 18% of the current smokers had abstained for more than one year during any of their attempts to quit. Implications of the results include: (1) smoking cessation programs for nurses in the workplace may have considerable impact since the majority of nurses who smoke are tying to quit; (2) relapse prevention strategies need to be an integral part of such smoking cessation programs including involvement of family and friends to support the smokers in their cessation efforts.     

Occupational Health in North Carolina

Trend-surface computer maps were prepared to estimate the areal concentration isopleths of cadmium, copper, magnesium, manganese, lead, and zinc, suspended particulates, and the associated benzene-soluble concentrations which occurred on April 13, 1970. The samples were collected from a 17-station ambient air surveillance network in Houston and then analyzed. A comparison of maps indicates important areal differences in the distribution of all pollutants. Suggestions are made as to how these maps could be utilized for further studies based on areal data.     

Heat-related fatalities in North Carolina

We used medical examiner's records to identify heat-related fatalities (N=161) that occurred during the period January 1, 1977, to December 31, 2001, in North Carolina. Estimates of the population at risk were derived from US census data. Annual fatality rates increased with increases in average summer temperature and with the number of days per year at 90 degrees F or higher. Of the occupational heat-related fatalities (n=40), 45% occurred among farm laborers, many of whom died unnoticed and without medical attention.     

Genomics and public health practice: a survey of nurses in local health departments in North Carolina.

In order to examine the extent to which current public health practices incorporate information about genetic susceptibilities potentially obtained by a comprehensive family history, public health nurses in North Carolina were surveyed to assess the extent to which this information is routinely collected. In addition, we measured nurses' awareness of the Centers for Disease Control and Prevention's Genomic Competencies and assessed training needs related to genomics. A self-administered survey was distributed to all public health nurse supervisors, directors, consultants as well as Breast and Cervical Cancer Coordination Program managers in North Carolina. A 68.4% response rate (292/427) was obtained. The majority (88.7%) of nurses with regular patient contact report routine gathering of family history data for adult chronic diseases. Some key family history data components are routinely collected including the total number of affected relatives (76%), ethnicity information (57.5%), and age of chronic disease onset (31.8%). A minority of nurses (9%) reported awareness of the Genomic Competencies, and most (72.1%) acknowledged their need for training in order to achieve these competencies. Information collected by taking a family history can indicate a combination of genetic and environmental susceptibilities for chronic diseases.     

Partnering to meet training needs: a communicable-disease continuing education course for public health nurses in North Carolina

In 2004, the General Communicable Disease Control Branch of the North Carolina Division of Public Health and the North Carolina Center for Public Health Preparedness partnered to create a free continuing education course in communicable-disease surveillance and outbreak investigations for public health nurses. The course was a competency-based curriculum with 14 weeks of Internet-based instruction, culminating in a two-day classroom-based skills demonstration. In spring 2006, the course became mandatory for all public health nurses who spend at least three-fourths of their time on tasks related to communicable diseases. As of December 2006, 177 nurses specializing in communicable diseases from 74 North Carolina counties had completed the course. Evaluations indicated that participants showed statistically significant improvements in self-perceived confidence to perform competencies addressed by the course. This course has become a successful model that combines academic expertise in curriculum development and teaching technologies with practical expertise in course content and audience needs. Through a combination of Internet and classroom instruction, this course has delivered competency-based training to the public health professionals who perform as frontline epidemiologists throughout North Carolina.     

Characteristics of drowning deaths in North Carolina

A retrospective study of 1,052 unintentional drowning deaths in North Carolina during the period from 1980 through 1984 was carried out, with emphasis on the victims' activity and alcohol consumption, and the settings of the accidents. The data suggest that many drownings are preventable, and reinforce the etiologic importance of ethanol consumption in such deaths. The overall drowning rate for North Carolina residents during the period covered by the study was 3.2 per 100,000 persons. Nonwhite males had the highest rate, 8.8 per 100,000 population. The next highest rate was for white males, 4.7 per 100,000. Swimming and wading, involved in 41 percent of the drowning deaths, was the most frequently associated activity. Fishing was involved in 15 percent of the deaths, and motor vehicle accidents with 8 percent. Most occurred in freshwater settings, notably lakes and ponds, 39 percent, and rivers and creeks, 29 percent. Of the 752 victims 15 years and older tested for blood ethanol, 53 percent had positive tests and 38 percent had blood alcohol concentrations of 100 milligrams per deciliter or greater. Significant percentages of victims 15 years and older with blood alcohol concentrations greater than 100 milligrams per deciliter were found in all settings and activity groups.     

United Health Care of North Carolina

Physicians. While many of the rural physicians interviewed in North Carolina would prefer not to deal with HMOs at all, they are generally positive about their relationships with United Healthcare of North Carolina. These physicians chose to contract with the HMO to obtain new patients and to retain existing patients. They are satisfied that their participation has accomplished these goals. Their reimbursement arrangements are easy to understand, and most view the payment amounts as satisfactory. The physicians regard the size of the HMOs provider network and the open-access structure of the HMO as positive features that allow them to make referrals without the restrictions imposed by some other HMOs. To date, participation in United Healthcare of North Carolina has imposed few burdens on rural physicians. They are reimbursed on a fee-for-service basis, and their financial risk has been limited. They do not perceive that the HMO has had a significant impact on the way they practice medicine. This situation may change in the future if enrollees from United Healthcare of North Carolina and other HMOs constitute a greater proportion of their practices and if these HMOs move toward capitated reimbursement. The attitudes of rural physicians toward United Healthcare of North Carolina also may change if the HMO attempts to more actively manage the care provided to its enrollees. United Healthcare of North Carolina plans to eliminate physician risk sharing (in the form of withholds) and replace it with bonus payments. As one HMO executive said, the plan wants to “put incentives where they belong.” If rewarding good performance instead of punishing poor performance yields intended consequences, it may provide United Healthcare of North Carolina with a competitive advantage in rural areas. First, because such a change offers an opportunity to augment a physician's income instead of diminishing it, physicians might prefer to contract with the HMO rather than with other HMOs. Second, because bonus payments depend on performance, United Healthcare of North Carolina providers may produce outcomes that allow reductions in premium prices or expansions of benefits compared with the HMOs competitors. Hospitals. Rural hospitals cited similar motivations (attracting and retaining business) for participating in United Healthcare of North Carolina and similar levels of satisfaction with their relationships. In their experiences, the HMO has been fair in its negotiations and reimbursement. Although they contract with multiple HMOs, these rural hospitals do not perceive that HMO participation has had a significant impact on hospital operations. Because these hospitals, like many rural hospitals, rely heavily on Medicare (and, to a lesser degree, on Medicaid) as revenue sources, the future impact of managed care on their operations will depend in large part on the extent to which significant proportions of their Medicare and Medicaid patients enroll in HMOs.     

Cost-effectiveness of hospital vaccination programs in North Carolina

Although influenza and pneumonia are largely vaccine-preventable, vaccination coverage rates are well below Healthy People 2010 goals. The aim of this study was to examine the costs and cost-effectiveness of three provider-based vaccination interventions in the hospital setting: standing orders programs (SOPs), physician reminders (PRs), and pre-printed orders (PPOs). Data on program operating costs and the numbers of patients who received influenza or pneumococcal vaccinations were collected from nine North Carolina hospitals. Results demonstrated that the additional cost per patient vaccinated in 2004 was US dollars 58 for SOPs, US dollars 90 for PRs, and US dollars 412 for PPOs. These findings suggest that SOPs are a cost-effective approach for increasing adult vaccination coverage rates in hospital settings.     

Rickettsialpox in North Carolina: a case report

We report a case of rickettsialpox from North Carolina confirmed by serologic testing. To our knowledge, this case is the first to be reported from this region of the United States. Including rickettsialpox in the evaluation of patients with eschars or vesicular rashes is likely to extend the recognized geographic distribution of Rickettsia akari, the etiologic agent of this disease.     

Interagency collaboration in seven North Carolina counties.

This article describes the collaborative efforts of seven North Carolina counties involved in a home visitation program for new mothers. It explores factors that facilitated and impeded collaboration. Program staff reported strong leadership, shared vision, a heterogeneous mix of partners, establishment of trust, a positive attitude, role delineation, and open communication to be factors contributing to successful collaboration. Lack of guidance about how to collaborate, competition between programs and categorical funding, restrictive confidentiality policies that limit cross-agency access to information, and lack of time and energy were major barriers to achieving integrated service delivery systems.     

Water safety among Latino farmworkers in North Carolina

Latinos constitute the vast majority of North Carolina's farmworker population. Drowning is a significant occupational health hazard in agriculture. Recent reports also suggest a disproportionate number of drowning victims in North Carolina are Latinos. Survey data are used to examine the levels of farmworker participation in aquatic activities and water safety behaviors. Over one-third of the farmworkers reported that they did not know how to swim. About one-quarter of the farmworkers reported participation in aquatic activities, with a greater percentage of those knowing how to swim participating in these activities. Recommendations to increase farmworker water safety include providing information through their employers and health outreach workers.     

Housing Characteristics of Farmworker Families in North Carolina

Adequate housing is a basic human right and an important determinant of environmental health. Little research has documented the housing quality of immigrant Latino farmworker families. This analysis uses data from four surveys of North Carolina farmworker communities conducted in 2001 and 2003 to document aspects of housing quality that could affect farmworker family health. Three housing domains are considered: dwelling characteristics, household characteristics, and household behaviors. Most farmworker families live in mobile homes, and few own their dwellings. Many are located near agricultural fields. Most houses are small, but household size is large, containing adults, in addition to the nuclear family. Crowding is common among farmworker families. Many farmworker households lack basic facilities, such as washing machines. Farmworkers attempt to reduce exposure by frequently cleaning their dwellings. These findings suggest that the health of farmworker families is at risk due to inadequate housing. Further research on housing-related health effects among farmworker families is needed.