Investigation of NOx precursor compounds and other combustion by-products in the primary combustion zone of a waste-incineration plant using on-line, real-time mass spectrometry and Fourier-transform infrared spectrometry (FTIR).

On-line analysis of trace and bulk gas compounds in the burning chamber of a waste-incineration plant has been performed, with high temporal resolution, by use of a variety of distinctly different measurement techniques. Time-of-flight mass spectrometry was performed with simultaneous use of three ionization techniques-resonance-enhanced multiphoton ionization (REMPI), single-photon ionization (SPI), and electron-impact ionization (EI). Chemical-ionization mass spectrometry (CIMS), Fourier-transform infrared spectrometry (FTIR), and electrochemical methods were also used. Sampling was conducted by means of a newly developed air-cooled stainless steel lance, to cope with the high temperatures and elevated particle concentrations at the sampling location. Nitrogen species were mainly nitrogen monoxide, ammonia, and hydrogen cyanide (HCN), with a small amount (approximately 0.3%) of aromatic nitrogen compounds. NO, NH(3), and HCN are the main contributors to the NO(x)-formation process in the postulated fuel-NO reaction scheme dominant at this location. The NO recycling process thereby plays a major role. Changes in plant operating conditions have a noticeable impact only when the air supply is varied. For example, reduction of oxygen leads to an increase in the HCN fraction of the total nitrogen content and a decrease in the NO fraction, and vice versa.

On-line analysis of gas-phase composition in the combustion chamber and particle emission characteristics during combustion of wood and waste in a small batch reactor.

The emission of particulate matter and gaseous compounds during combustion of wood and refuse-derived fuel in a small batch reactor is investigated by laser mass-spectrometric on-line measurement techniques for gas-phase analysis and simultaneous registration of physical aerosol properties (number size distribution). The gas-phase composition is addressed by a laser-based mass spectrometric method, namely, vacuum-UV single-photon ionization time-of-flight mass spectrometry (VUV-SPI-TOFMS). Particle-size distributions are measured with a scanning mobility particle sizer. Furthermore, a photoelectric aerosol sensor is applied for detection of particle-bound polycyclic aromatic hydrocarbons. The different phases of wood combustion are distinguishable by both the chemical profiles of gas-phase components (e.g., polycyclic aromatic hydrocarbons, PAH) and the particle-size distribution. Furthermore, short disturbances of the combustion process due to air supply shortages are investigated regarding their effect on particle-size distribution and gas-phase composition, respectively. It is shown that the combustion conditions strongly influence the particle-size distribution as well as on the emission of particle-bound polycyclic aromatic hydrocarbons.

Improving the self reporting of tobacco use: results of a factorial experiment.

OBJECTIVES: To examine divergent estimates of smoking prevalence in two random digit dial surveys for the same population. Based upon internal and external reviews of survey procedures, differences in survey introductions (general health versus tobacco specific introduction) and/or differences in the use of filter questions were identified as the most likely explanations. This prompted an experiment designed to investigate these potential sources of measurement error. DESIGN: A randomised 2 x 2 factorial experiment. SETTING: A random digit dial telephone survey from July to September 2000. SUBJECTS: 3996 adult Californian respondents. MAIN OUTCOME MEASURES: A series of smoking prevalence questions in the context of a tobacco or general health survey. RESULTS: Logistic regression analyses suggest that, among females, prior knowledge (from the survey introduction) that a survey is concerned with tobacco use may decrease self reported smoking prevalence (approximately 4% absolute prevalence difference). Differences in the use of filter questions resulted in almost no misclassification of respondents. CONCLUSIONS: The tobacco specific survey introduction is causing some smokers to deny their tobacco use. The data suggest that these smokers tend to be women that smoked occasionally. A desire by the participants to minimise their personal time costs or a growing social disapproval of tobacco use in the USA may be contributing to the creation of previously undetected survey artefacts in the measurement of tobacco related behaviours.

A randomized trial of a brief intervention to increase fruit and vegetable intake: a replication study among callers to the CIS.

BACKGROUND: Results are reported from a large randomized trial designed to increase fruit and vegetable consumption among callers to the National Cancer Institute's Cancer Information Service (CIS) (n = 1,717). METHODS: CIS callers assigned to the intervention group (n = 861) received a brief proactive educational intervention over the telephone at the end of usual service, with two follow-up mailouts. Key educational messages and print material derived from the NCI 5 A Day for Better Health program were provided to intervention participants. Participants were interviewed by telephone at 4 weeks (n = 1,307), 4 months (n = 1,180), and 12 months for follow-up (n = 1,016). RESULTS: Results obtained from a single-item measure of fruit and vegetable consumption indicate a significant intervention effect of 0.88 servings per day at 4 weeks follow-up (P < 0.001), 0.63 servings per day at 4 months follow-up (P < 0.001), and 0.43 servings per day at 12 months follow-up (P < 0.001). Using a 7-item food frequency measure, an intervention effect of 0.63 servings per day was obtained at 4 weeks follow-up (P < 0.001), compared with 0.39 servings per day at 4 months follow-up (P = 0.002) and 0.44 servings per day at 12 months follow-up (P = 0.002). A 24-h recall assessment included in the 4-month interviews also yielded a significant intervention effect of 0.67 servings per day (P = 0.015). The vast majority of callers (90%) endorsed the strategy of providing 5 A Day information proactively within the CIS. CONCLUSIONS: This brief educational intervention was associated with higher levels of self-reported fruit and vegetable intake at both short- and long-term follow-up. Additional research is recommended to test this or a similar intervention in diverse populations.

Examining the effectiveness of a community-based self-help program to increase women's readiness for smoking cessation.

This study investigated the effectiveness of two components of a smoking cessation intervention: a reading manual and a series of televised programs. Female smokers in the Chicago metropolitan area with a high school education or less were interviewed at 4 different times: baseline, immediate postintervention, and 6 and 12 months. We examined the effects of several baseline measures (race, age, number of cigarettes smoked, and stage of readiness to change) and exposure to the intervention components on subsequent stage of change. Race, baseline smoking rate, baseline stage, and exposure to both intervention components had direct effects on stage at immediate postintervention, with both intervention components increasing readiness to quit. Furthermore, exposure to the manual interacted with baseline stage, such that the manual benefited women at earlier stages more than women at later stages. Effects of both components were sustained at 6 months, and the effects of the manual were sustained at 12 months.

Changes in self-efficacy and readiness for smoking cessation among women with high school or less education.

The most common theory of smoking cessation postulates that readiness to quit begins with changes in attitudes that move the smoker toward behavioral change and eventual cessation. However, trends in smoking indicate that many who currently smoke are not ready to quit. Hence, strategies that both enhance readiness and focus on quitting are likely to be most effective. We hypothesize that an intervention addressed to motivating behavior change will enhance readiness to change, which will in turn increase the smokers self-efficacy regarding further change. A smoking cessation intervention that combined a self-help booklet and televised segments was developed to address these issues in a population of women smokers with high school or less education. Readiness to quit was measured prior to the intervention, immediately following the intervention, and again at six and 12 months after intervention. The results indicate that the intervention had its effects on readiness to quit, which in turn affected self-efficacy, which further enhanced readiness to quit. These findings indicate that interventions aimed at this group of smokers may need to provide achievable objectives that focus on preparing the smoker to quit as well as promote cessation.

Maintenance of a smoking cessation program in public health clinics beyond the experimental evaluation period.

OBJECTIVES: As phase 3 of a study to evaluate a smoking cessation program in public health practice, the authors assess the maintenance and impact of the It's Time smoking cessation program in seven public maternal and child health clinics in Chicago. METHODS: The authors interviewed 404 clinic patients in the study's baseline phase (prior to introduction of the It's Time intervention program), and 610 in the program maintenance phase (in the year after experimental evaluation had ended) to assess exposure to smoking cessation interventions offered at the clinic, and smoking cessation outcomes (quit, actions toward quitting, scores on action, motivation, readiness, and confidence scales). The authors controlled for clustering of smokers within clinics, smokers' characteristics prior to clinic visit, and type of clinic service. They compared outcomes by study group (control or intervention) to which each clinic had been assigned in the earlier experimental phase. RESULTS: Compared to baseline, smokers in the maintenance phase had greater exposure to posters, provider advice and booklet, and better outcomes on seven of eight smoking cessation measures, including quitting. These improvements were larger for clinics with prior experience implementing It's Time. CONCLUSION: Participation in the experimental evaluation of the It's Time program prepared and possibly motivated the clinics to continue the program. Continuing the program resulted in greater delivery of interventions and improved smoking cessation outcomes for smokers in the clinics.

Effectiveness and cost-effectiveness of multiple outcalls to promote mammography among low-income women.

A multiple outcall approach based on the Transtheoretical Model was used to encourage mammography behavior in low-income women in the state of Colorado. Women (n = 983) were recruited in person at grocery and discount stores and were then called over the telephone to receive the multiple outcall intervention. These women were compared with 3,080 women who were recruited by telephone and randomly assigned to three study groups: health survey only (control); single outcall; or advance card + single outcall. Subsequent mammography behavior was assessed through a telephone interview conducted 6 months after initiation of the protocol. After controlling for baseline differences between groups in age, education, income, health status, and previous mammography behavior, the multiple outcall intervention was significantly related to mammography behavior among women nonadherent at baseline (odds ratio, 2.58; 95% confidence interval, 1.45-4.60). Furthermore, women who received the multiple outcall intervention had higher "stage of change" at follow-up and more positive attitudes toward mammography. Cost-effectiveness analysis indicated that although the multiple outcall intervention was more costly to deliver ($14.84 per subject compared with about $7.00 for the single outcall interventions), it cost considerably less per subject converted from nonadherent to adherent. Despite study design limitations, the multiple outcall intervention appears to be an effective method of promoting mammography among previously nonadherent women. The results suggest that a combined approach, in which nonadherent women receive multiple calls promoting screening behavior, followed by single calls at the appropriate intervals to promote repeat screening, may be a useful strategy in defined populations.

The effect of a structured smoking cessation program, independent of exposure to existing interventions.

OBJECTIVES: This study assessed the effectiveness of a smoking cessation program for women in public health clinics, controlling for reported exposures to 4 common intervention components (provider advice, booklet, video segment, posters) among smokers in the control group. METHODS: After a baseline control period, 10 pair-matched clinics were randomly assigned to study groups. A total of 1042 smokers in the combined baseline and control groups and 454 smokers in the intervention group completed a preintervention questionnaire and a postintervention telephone interview 5 to 8 weeks later. Eight smoking outcomes, including quitting, were analyzed for the effect of reported exposure to intervention components, experimental program, and clinic service. RESULTS: Greater exposure to intervention components, being in the experimental program, and being seen in prenatal clinics independently improved smoking outcomes. CONCLUSIONS: The number of interventions reported by smokers in the control group ranged from none to 4 and varied across clinic services. The experimental program we tested produced better outcomes than the minimal smoking cessation interventions already existing in the control clinics, after we controlled for whether smokers were or were not exposed to these interventions.

Minimal smoking cessation interventions in prenatal, family planning, and well-child public health clinics.

OBJECTIVES: This study assessed the prevalence and effectiveness of smoking cessation interventions for women of childbearing age in public health clinics. METHODS: Smokers in prenatal, family planning, and well-child services in 10 public health clinics (n = 1021) were interviewed 5 to 8 weeks after a medical visit to assess their exposure to smoking cessation interventions and smoking cessation outcomes. RESULTS: Depending on clinic service and intervention component (poster, video segment, provider advice, booklet), 16% to 63% of women reported exposure to an intervention component during their visit. Women in prenatal services received more interventions and had better outcomes than those in the other services. CONCLUSIONS: Exposure to more interventions increased readiness and motivation to quit and the number of actions taken toward quitting.

Characteristics associated with exposure to and participation in a televised smoking cessation intervention program for women with high school or less education.

OBJECTIVES: This paper estimates the prevalence of exposure to and participation in a televised smoking cessation intervention targeting women with high school or less education and describes characteristics related to exposure and participation. METHODS: A random sample of the population of female smokers with high school or less education in the Chicago metropolitan area was used to estimate the prevalence of exposure to a targeted smoking cessation intervention with television and booklet components (n = 722). Multiple logistic regression analysis was used to examine characteristics related to exposure to each component and participation, defined as simultaneous use of both components, in a sample of population and registrants combined (n = 1,727). RESULTS: About one of every four women in the target population either saw the television series or called for the booklet (24.5%); 17.5% saw the television series, 9.4% called for the booklet, and 2.4% both saw the television series and called for the booklet. Independent predictors of booklet exposure were black, older age, annual income $40,000 or less, heavier smoking, and higher stage of readiness to quit. Adjusting for booklet exposure, independent predictors of television exposure were older age and nonblack. Independent predictors of participation were black, older age, and higher stage of readiness to quit. CONCLUSIONS: The intervention reached a substantial portion of low-educated female smokers. Women who were older, black, or at higher stages of readiness to quit were most likely to be exposed and to participate. Heavier smokers or lower income women were most likely to be exposed but not necessarily to participate.

Evaluation of a motivational smoking cessation intervention for women in public health clinics.

BACKGROUND: A multicomponent motivational smoking cessation intervention was evaluated in 33 prenatal, family planning, and pediatric services in 12 public health clinics. Clinic-based intervention components were implemented by clinic personnel as part of routine medical visits. METHODS: The evaluation design included pre- and postintervention measurements of multiple study outcomes in a baseline (all clinics prior to the start of the intervention) and an experimental period (matchedpair random assignment of clinics to intervention or control conditions). Subjects were 683 (baseline) and 1,064 (experimental) smokers with measurements of smoking outcomes at both times. Mixed-effects regressions analyzed individual outcomes clustered within clinics and services. RESULTS: Control and intervention clinics had similar outcomes in the baseline period. In the experiment, outcomes improved in the intervention but not in the control clinics. Compared to controls, smokers exposed to the intervention were more likely to have quit (14.5 versus 7.7%) or take actions toward quitting and had higher mean action, stage of readiness, and motivation to quit scores. These positive effects persisted when clustering within clinics and services was controlled. CONCLUSIONS: This intervention, implemented by clinic personnel as part of routine medical visits, was effective under these natural conditions across different types of clinic service.

The cancer information service research consortium: an emerging laboratory for cancer control research.

The Cancer Information Service (CIS) was established in 1975 by the National Cancer Institute (NCI) to provide accurate, up-to-date information about cancer to the nation. Although the CIS has in the past served as a venue for cancer communications research, up until very recently the research capacity of the CIS was underutilized. In 1993, this situation changed dramatically with funding from the NCI to form the Cancer Information Service Research Consortium (CISRC). In this article the CISRC is described for the first time, including its research agenda and administrative structure. Early indications from the CISRC suggest that the CIS can serve as one of the premiere laboratories in the country for cancer communications and cancer control research. Several factors are suggested for the early success of the CISRC in sustaining this collaborative effort with the CIS. The progress that has been made by the CISRC could provide a useful model for other large health information programs to maximize their contributions to behavioral science and health promotion research, as well as to establish their own program of policy-relevant research.

Cancer information service-initiated outcalls to promote screening mammography among low-income and minority women: design and feasibility testing.

BACKGROUND: The telephone information service of the Cancer Information Service (CIS) historically is most effective in eliciting calls from higher income, white women. This article describes the design and feasibility of a project that tested the use of telephone outcalls to extend the reach of the telephone information service to underserved women. METHODS: Neighborhoods throughout Colorado were identified using a geodemographic database (INFORUM) that allowed selection of census block groups according to demographic characteristics. Households were assigned randomly to: (1) a control group; (2) an outcall-only group, which received "cold" telephone outcalls promoting screening mammography; and (3) an advance card plus outcall group, which received a card introducing the program prior to the outcall. RESULTS: The use of INFORUM to target low-income, less educated, and black women was largely successful. While quality of intervention delivery was high, the protocol was labor intensive, requiring an average of 40 min to identify and counsel each eligible woman. The advance card did not increase acceptance of the outcalls. CONCLUSIONS: This approach successfully extended the CIS's audience; however, its labor intensity may limit its applicability. Strategies for increasing the efficiency of outcall efforts are suggested.

Effectiveness of a telephone outcall intervention to promote screening mammography among low-income women.

BACKGROUND: This study evaluated the impact of a telephone outcall intervention (based on the Transtheoretical Model) on screening mammography behavior among lower income, older women. METHODS: A geodemographic database, INFORUM, was used to identify low-income and minority neighborhoods throughout the state of Colorado. Residences were assigned randomly to three study groups: (1) control, (2) outcall only, and (3) advance "invitation" + outcall. Information Specialists of the Cancer Information Service implemented the protocol. Mammography adherence was assessed in telephone interviews conducted 6 months and 2 years after the initial call. RESULTS: Neither intervention had a significant effect on the main outcome, receipt of mammography in the 6-month follow-up period. At 6 months, intentions to have a mammogram were significantly stronger in the intervention groups compared with the control group, particularly among those who were precontemplators at baseline. The 2-year follow-up indicated a small increase in mammography adherence attributable to the advance invitation + outcall, but this effect was restricted to those adherent at baseline. Mammography behavior during the 6-month follow-up period was predicted strongly by decisional balance, intentions, receipt of a physical and clinical breast exam, and previous mammography behavior. CONCLUSIONS: The intervention promoted minimal movement in the stages of change for mammography. Outcall interventions may have promise for encouraging repeat mammography behavior, but more intensive interventions are likely to be necessary to promote behavior change among nonadherent women.

Prescribe for health. Improving cancer screening in physician practices serving low-income and minority populations.

OBJECTIVE: To evaluate a health maintenance organization (HMO)-sponsored intervention to improve cancer screening in private physician practices serving low-income, minority populations. DESIGN: A randomized controlled trial with preintervention and postintervention measurements. Measurements were obtained by abstracting information from independent random samples of medical charts (N = 2316 at preintervention and 2238 at postintervention). SETTING: Forty-seven primary care physician practices located in low-income and minority urban neighborhoods in Chicago, Ill. INTERVENTION: Practices were encouraged to adopt an office chart reminder system and to use a patient health maintenance card. Activities to facilitate the adoption of these items and for compliance with cancer screening guidelines included on-site training and start-up assistance visits, a physician continuing medical education seminar, and quality assurance visits with feedback to physicians. MAIN OUTCOME MEASURES: The proportions of patients with a chart-documented mammogram, clinical breast examination, Papanicolaou smear, or fecal occult blood slide test in the 2 years before preintervention and postintervention chart abstractions. RESULTS: Between baseline and postintervention, there was a net increase in the proportion of HMO members in the intervention, compared with the control practices, who received in the preceding 2 years a Papanicolaou smear (11.9%) and a fecal occult blood slide test (14.1%). There was a net increase in the proportion of non-HMO patients in the intervention compared with the control practices who received a clinical breast examination (15.3%) and a fecal occult blood slide test (20.2%). CONCLUSIONS: Implementation of an HMO-mediated, multicomponent intervention to improve cancer screening was feasible and effective for the Papanicolaou smear, fecal occult blood slide test, and the clinical breast examination, but not for mammography.

Sociopsychological correlates of motivation to quit smoking among low-SES African American women.

This article examines correlates of desire and plans to quit smoking among 248 young, low-socioeconomic status African American women, using variables derived from the health belief model (HBM) and the theory of reasoned action. Consistent with these theoretical models, stronger concern about the effect of smoking on one's health and having close others who want the smoker to quit increased motivation to quit smoking. However, motivation was not associated with specific HBM components regarding lung cancer. Heavier smoking and stronger perceptions regarding the functional utility of smoking decreased motivation to quit, but not as much as expected in this study population. Consistent with a process of change approach to smoking cessation, the factors that moved smokers from not planning to planning to ever quit were different from factors associated with further motivation level among the smokers who did plan to ever quit.

Measuring readiness and motivation to quit smoking among women in public health clinics: predictive validity.

We conducted an independent pilot test of the internal consistency, stability, and predictive validity of the instrument presented by Crittenden, Manfredi, Lacey, Warnecke, and Parsons (1994) using a two-wave panel of female smokers in 12 public health clinics. This instrument subdivides the precontemplation stage proposed by Prochaska and DiClemente into three more distinct stages: not contemplating quitting or cutting down, not contemplating quitting, and not contemplating quitting within 6 months. Findings confirm that the instrument is useful for evaluating movement toward quitting for populations that are largely concentrated in the precontemplative stage. The concurrent and predictive validity of the elaborated stages and the reliability and stability of smoking motivation and confidence indicate that the instrument is sensitive enough to track changes in readiness and motivation across the full readiness continuum.

Psychosocial factors and smoking cessation behaviors among smokers who have and have not ever tried to quit.

Relationships between smoking cessation behaviors and demographic characteristics and attitudes were analyzed among two groups of smokers, those who had and had not ever tried to quit. Telephone interviews were completed with 1501 smokers at baseline and at a 3 month follow-up. Multiple logistic regression analyses were used to identify factors that were associated with planning to quit, attempting to quit and quitting smoking within the two groups of smokers. Different patterns of correlates were found across groups and within the three outcome measures, indicating the potential importance of targeting interventions according to whether or not smokers have made a prior quit attempt. These findings also support the value of using multiple outcome measures in the smoking cessation process.

Cognitive aspects of recalling and reporting health-related events: Papanicolaou smears, clinical breast examinations, and mammograms.

This paper reports an examination of cognitive processes used by 178 women aged 50 years and older in retrieving information about the frequency with which they received Papanicolaou smears, mammograms, and clinical breast examinations. Women were selected from a health maintenance organization in which they had been enrolled for at least 5 1/2 years. The literature suggested that reporting of regular events such as these kinds of tests is likely to be based on schemas, which is an estimation technique in which events are reported in a format with generic content. Thus, if the procedure is believed to occur annually, the respondent will report receiving five tests in 5 years. The study attempted to evaluate whether use of episodic recall, in which respondents are forced to report individual events, would be more accurate than reports based on estimation using a schema format. The results indicated that most of the errors occurred in Papanicolaou smear reporting, which is consistent with the literature, and that the fewest errors occurred with mammograms. Regardless of the questionnaire format, respondents persisted in using schemas based on the date of annual physical examination. Most reporting errors occurred because the interval between examinations was estimated incorrectly.