Disadvantaged women and smoking.

High rates of smoking are found among disadvantaged women, and there is a demand for cessation interventions specifically targeted to meet their needs. This project used a number of information sources to examine the factors associated with these women's smoking behaviours and the potential barriers and supports to cessation. Few of the women-centred cessation programs whose representatives were contacted were appropriate for, or available to, disadvantaged women in Canada. Interviews with 386 disadvantaged women revealed that their smoking was intimately linked with their life situation of poverty, isolation and caregiving; smoking was a mechanism for coping with the stress of their lives. Agencies outside traditional tobacco control organizations, such as women's centres, were well positioned to initiate or expand services that support smoking cessation for these women and were trusted by the women who used their services. The findings have implications for programs, research and policy.

Smoking among disadvantaged women: causes and cessation.

This study aimed to identify social-psychological factors associated with smoking and smoking cessation among disadvantaged women. Individual and group interviews were conducted with disadvantaged women in Atlantic Canada. Participants were predominantly poor, unemployed, geographically isolated, and single parents. The factors associated with smoking included coping with stresses, loneliness, powerlessness, low self-efficacy, social pressures, and addiction. Support from peers (i.e., women in similar circumstances) and partners was considered important. Health professionals and traditional cessation programs were not perceived as supportive. Participants viewed women's centres and women's agencies as appropriate deliverers of cessation programs. Methodological issues are discussed.

Why do pregnant women smoke and can we help them quit?

As observed by Dr. Linda Dodds (see pages 185 to 190 of this issue), there has been little change in recent years in the smoking rate of about 30% among pregnant women in Nova Scotia. Women who smoke during pregnancy tend to be young, unmarried, undereducated and multiparous and tend not to go to prenatal classes. Many pregnant women find it extremely difficult to stop smoking even when they understand the risks to the fetus. Routine advice given by physicians on smoking cessation is clearly ineffective. However, informed physicians who recognize the difficulty of quitting and offer support and advice in a systematic way can help women to progress through the stages of the smoking cessation process.

HSOs, HMOs, and CHOs: The Continuing History of Capitation-Funded Health Care.

Ontario Health service organizations (HSOs) provide physician services funded by monthly payments per enrollee and one-third the cost of hospital days saved. They reduce hospitalization rates, but are providing less multidisciplinary care than expected. American health maintenance organizations (HMOs) provide both physicians' services and hospital care. They reduce hospitalizations, and their physicians manage greater patient loads, while patients receive equivalent ambulatory care. Comprehensive health organizations (CHOs) in Ontario provide almost all health services for their current per capita cost. Greater cost-effectiveness is expected through greater use of management, deinstitutionalization, auxiliary personnel, and health promotion. Proponents of organized medicine have strong reservations about the expected results. The ethics of providing incentives (i.e., capitation) to underservice patients should also be considered.

[Influence of glucose infusions on proinsulin and insulin syntheses in the islands of langerhans in the rat]. / Der Einfluss von Glukoseinfusionen auf die Proinsulinund Insulinsynthese in den Langerhansschen Inseln bei der Ratte

Experiments on RNA synthesis and the observation of an increased secretion of proinsulin during stimulated synthesis of insulin in islets of Langerhans in vitro led to the supposition that insulin synthesis in vivo may be increased to a higher extent than synthesis in vitro. This investigation evaluates the effect of long time infusions of glucose on the synthesis of proinsulin and insulin in islets of Langerhans from the rat. The following results were obtained: 1. the rate of synthesis of proinsulin and insulin increased due to glucose infusions by a factor of 2 after 6 hours and by a factor of 4 after 24 hours; 2. prolonged infusion led to a decrease of insulin synthesis and serum insulin concentrations; 3. the turnover of proinsulin into insulin remained unaffected by the glucose infusion; 4. a specific stimulatory effect on the synthesis of one of the two insulins of the rat was not observed. The conclusion was made, that glucose in vivo stimulates enzyme induction, followed by increased RNA synthesis and mitotic activity. These combined factors lead to an increased insulin synthesis.