A 2-year efficacy study of Not On Tobacco in Florida: an overview of program successes in changing teen smoking behavior.

BACKGROUND: Adolescent smoking has been an issue of major concern in the United States. This has led to a need for the development, evaluation, and dissemination of effective youth cessation programs. The purpose of this paper is to report the results of a 2-year demonstration study (1999-2000) of the American Lung Association's teen smoking cessation program, the Not On Tobacco (NOT) program. METHODS: The study used a "matched" design wherein each NOT school was matched to a brief intervention (BI) school. The study consisted of 20 NOT and 20 BI Florida high schools encompassing 627 students. The primary outcome measures were carbon monoxide-validated quit and reduction rates for NOT and BI schools at 5.2 months postprogram. RESULTS: NOT smoking cessation and reduction outcomes were significantly better than those of the brief intervention. Further, data indicate that NOT was more effective than the brief intervention for females compared with males; males showed successful quit attempts in both intervention groups. Overall, more NOT youth either quit or reduced smoking than did BI youth. CONCLUSIONS: These positive smoking behavior changes suggest that NOT is an effective teen smoking cessation option.

Teen smoking cessation: making it work through school and community partnerships.

For the past several years, the West Virginia University Prevention Research Center has been collaborating with state and national partners to design, evaluate, and disseminate the American Lung Association's new teen smoking cessation program, Not On Tobacco (N-O-T). This article describes a process that began with a field-identified need followed by a formal needs assessment and literature review. It also details how partners worked together to identify important program components, implementation strategies, and the evaluation protocol. Finally, it describes the process by which the American Lung Association adopted and disseminated N-O-T across West Virginia and the United States.

Statewide demonstration of not on tobacco: a gender-sensitive teen smoking cessation program.

This study represented the largest statewide demonstration (n = 346) of the teen smoking cessation program Not On Tobacco (N-O-T) to date and one of the few systematically controlled teen smoking cessation trials reported in the literature. Results showed that N-O-T female teens were 4 times more likely to quit smoking almost 6 months after the program ended than female teens who received a brief intervention (BI). The quit rate for the N-O-T female groups was significantly higher than that for female brief intervention comparison groups. The study demonstrated that 2 times more N-O-T than BI teens quit smoking overall. Differences in the biochemically validated quit rate between the N-O-T groups and the brief intervention groups overall and for male participants were not statistically different, however. Furthermore, findings showed that N-O-T was more effective than the brief intervention in assisting youth with cigarette reduction. There was a significant difference in the reduction rate between the N-O-T and the BI groups on weekdays and weekends 6 months after the program ended. Overall, approximately 84% of N-O-T teens either quit or reduced smoking, compared with approximately 55% of BI teens. This study is 1 phase of an ongoing multiphase evaluation of N-O-T. This study resulted in several important findings that will help guide future teen cessation studies and tobacco cessation efforts of school health professionals.

Evaluation of a relationship between polymer bulk hydroxyl and surface oxygen content and in vitro serum-material interaction.

To evaluate serum-material interaction for six types of minimodule and to assess the relationship between the interaction and chemical composition, notably bulk polymer hydroxyl (-OH) percent of polymer, or surface oxygen (SO) percent, polymeric membranes with varying -OH and SO percents were evaluated with normal human serum. The membrane materials (-OH percent and SO percent) evaluated included polypropylene (PP; 0% and 1.9%), polyvinyl alcohol (PVA; 23.7% and 27.3%), ethylene vinyl alcohol (EVAL 4A and D; 30.4% and 25.3%), Cuprophan (CP; 31.5% and 37.4%), and Hemophan (HP; 30.9% and 23.6%), respectively. Data from serum perfusions expressed as percent changes to sham perfusion showed that solute percent decreases were less than 10% in all materials except PVA (10-22%). PVA and CP had higher C3a, C4a, and C5a, and C3a concentration increases, and had larger suppressive effects for all three mitogen-induced mononuclear cell transformation functions (MNCTF) and concanavalin A-induced MNCTF, respectively. PVA had higher SO percent than EVAL and CP was higher than HP, despite PVA and CP having lower or comparable bulk -OH percent to EVAL or HP. The results obtained in the serum material interaction studies related more with the SO percent of the polymer rather than bulk -OH percent. The differences for C4a and PHA-induced MNCTF observed between the two EVAL membranes may be associated with significantly different pore size and therefore different surface structural properties. These results suggest that surface chemical (SO percent on the materials) and structural property analyses are important factors in biocompatibility parameter studies.

Selective removal of cholesterol by plasmapheresis and the progression of atherosclerosis.

There is a strong correlation of plasma cholesterol levels with the risk of coronary heart diseases as shown by epidemiologic studies. This study was undertaken to evaluate the effect of plasma cholesterol lowering on the progression of atherosclerosis in the homozygous Watanabe heritable hyperlipidemic (WHHL) rabbit. The effect of cholesterol lowering, which was accomplished by thermofiltration (on-line plasma separation with plasma filtration at 39 degrees C) was evaluated by comparison between treated and untreated control groups. Thermofiltration reduced significantly the mean plasma level of total cholesterol (284 vs. 655 mg/dl, P = 0.0005) and the percent aortic area occupied by atherosclerotic plaque (15.0 vs. 44.2%, P = 0.0003). The total lipid and cholesterol contents in the aortas in the treated group were also significantly lower than those in the control group. Microscopically, thickness measurements of the lesions showed that the mean thickness of the fibrous cap and the ratio of the thickness of the intima to that of the media were smaller for the treated group than the control group. This study demonstrated the slowing or stopping of the progression of atherosclerosis by lowering the plasma total cholesterol level in WHHL rabbits.

Effects of single-dose infusion of pyridoxalated-hemoglobin-polyoxyethylene conjugate solution on canine renal function.

Pyridoxalated-hemoglobin-polyoxyethylene conjugate (PHP) is an acellular oxygen-carrying red blood cell substitute made from outdated human red blood cells. This study assessed the effect of PHP on renal function when PHP was infused with a clinically relevant dosage. A single dose of PHP that contains 8% wt/vol each of hemoglobin and maltose or an 8% maltose control solution was infused into the intact circulation of eight dogs (five dogs for PHP and three for the control; 20 ml/kg each, at the rate of 2.5 ml/h/kg for 8 h) in the awake state. Serial measurements of glomerular filtration rate (GFR) and renal plasma flow (RPF) were carried out before and after infusion for up to 2 weeks, along with determinations of urine volume flow rate, fractional excretion of sodium (FES), and free water clearance (CH2O). The results showed an elevation of plasma colloid osmotic pressure by an average of 4.4 mm Hg immediately postinfusion with PHP solution. An average 23% decrease in GFR, without notable changes in RPF immediately postinfusion, was observed in the PHP group; the value returned to the preinfusion level by 1 week postinfusion. Increases in parameters such as urine output, FES, and CH2O, which were more pronounced in the PHP group, were observed for 24 h after the infusion in both groups. Light microscopic examination of kidney specimens taken at 2 weeks postinfusion revealed a slight degree of vacuole formation in approximately 80% of the proximal tubules in the PHP group. The tubules were devoid of typical pathologic features of acute renal failure, and the vacuoles did not cause any observable changes in the assessed tubular functions.

Evaluation of materials for use in extracorporeal circulation. In vitro serum-material interaction.

Polymeric membranes used in extracorporeal circulation procedures of varying hydroxyl (-OH) percent were evaluated with normal human serum to detect differences between chemical composition and serum-material interactions. The materials were evaluated as hollow fibers built into modules, including polypropylene (PP; 0%), polyvinyl alcohol (PVA; 23.7%), ethylene vinyl alcohol (EVAL; 29.7%), Cuprophan (CP; 31.5%), and Hemophan (HP; 30.9%). Data from serum perfusions expressed as percent changes to sham (circuit minus module) showed that solute % decreases were from 0% to 10% in all materials except for PVA (10-22%). Complement activation product % increases were higher with PVA (606-4309%) and CP (48-567%), and mononuclear cell transformation functions (MNCTFs) were more suppressed with PVA (100 to 98%) and CP (10-18%). Despite EVAL and HP having an -OH %, complement activation products were relatively low with EVAL (less than 212%), HP (less than 13%), and PP (less than 131%). MNCTFs were stimulatory with the co-polymer of vinyl alcohol and ethylene (EVAL), and very suppressed by serums from PVA contact. Ethylene vinyl alcohol and modified cellulose (HP) had reduced complement activation despite higher or comparable bulk -OH. Bulk -OH content alone cannot explain the differences observed.

Immunomodulating effects of serum-material interactions.

The objective of this study is to evaluate an in vitro model to assess the effects of serum-material interactions on complement activation, macromolecular adsorption, and lymphocyte response. Minifilters of clinically available materials (PVA, EVAL-4A, and EVAL-D) used in extracorporeal therapies were evaluated. The test circuit consisted of a pump, sterile tubing, collection vessels, and the minifilter. A sham circuit similar to the test circuit was constructed, but without the filter. Serum flow rates and volumes processed were scaled down to those of clinical use. Post PVA serum showed the highest degree of complement activation, macromolecular solute adsorption, and lymphocyte suppressive response when incubated with Con-A, PHA, PWM, and Candida. Post EVAL-4A sera enhanced the response of lymphocytes to Con-A and PHA, while Post EVAL-D sera showed a slight suppression to these mitogens. Blood-material interactions have been shown to cause blood cellular changes. The in vitro model employed is simple to apply and does not require an animal or patient. The membrane modules used are a mini-type of clinically available extracorporeal filters, and there is a greater direct relevancy to clinical applications than there would be using specially formulated materials. This system would provide useful preclinical information in evaluating the effect of serum-material interactions.

Effect of anticoagulant on biocompatibility in membrane plasmapheresis.

The effect of heparin or citrate anticoagulation on blood cellular, complement pathway and coagulation pathway was investigated in a membrane plasma exchange procedure. Two membrane plasma separators constructed of cellulose di-acetate (CA) and polyvinyl chloride (PVC) were evaluated with heparin or citrate alone for anticoagulation in a 26 year old male with myasthenia gravis. Maximum white blood cell counts decrease was 21% at 30 min for the CA with heparin while no decrease was observed for the other schemes. Platelet counts changes were comparable between heparin and citrate, while the PVC groups showed less changes than the CA groups. The CA groups, regardless of the type of anticoagulant used, indicated that complement activation occurred via the classical pathway within the module in addition to the activation via alternative pathway for the CA with heparin. In the PVC groups, complement activation was noted to occur only when heparin was used for anticoagulation. PT and PTT showed slight increases with citrate, while they were remarkably prolonged with heparin. Citrate showed less changes in cellular and humoral factors compared to heparin. CA with heparin was the most activating combination of membrane material and anticoagulant, while the PVC with citrate was the least activating combination.

Effects of prostaglandin I2, superoxide dismutase, and catalase on ischemia-reperfusion injury in liver transplantation.

This study evaluated the effects of a prostaglandin I2 analogue (aPGI2), superoxide dismutase (SOD), and catalase (CAT) on hepatic injury after warm ischemia and reperfusion in terms of survival, mitochondrial function, serum enzymes, and histology. Hepatic ischemia was created in rats by clamping the hepatoduodenal ligament for 90 min with splenofemoral bypass. Reperfusion was induced by unclamping the vessels and disconnecting the splenofemoral bypass. Then aPGI2 (350 ng/kg/min) was infused for 60 min just before hepatic ischemia, and SOD and CAT (5,000 units/kg each) were administered immediately before the start of reperfusion. Serum enzyme and mitochondrial function assessments of livers were made just after ischemia, and after 2 hr of reperfusion. Survival rate was also assessed in a separate group of rats. Liver enzymes such as SGOT, SGPT, and LDH showed no correlation to liver viability. The administration of aPGI2 alone showed no effect on ischemically injured mitochondria; however, the free radical scavengers (SOD, CAT), in combination with aPGI2, showed significant improvement of mitochondrial function together with extension of survival. The ultrastructure of hepatocytes was better preserved in the treated groups. These agents improved the viability of ischemic-reperfused injured livers.

Anticoagulant and membrane effects on humoral and cellular changes during plasmapheresis.

Heparin (H) and citrate (C) anticoagulation with cellulose acetate (CA) and polyvinyl chloride (PVC) membrane devices were evaluated on three myasthenia gravis patients. Changes of white blood cell (WBC) and platelet (PLT) counts, complement activation, granulocyte elastase, and interleukin-1 beta (IL-1 beta) were studied sequentially. Changes in WBC and PLT counts were more dependent on the membrane material and surface area. Changes of C3a and C5a were more related to the anticoagulant used, whereas changes of C4a were membrane-material dominant phenomenon. Systemic elastase levels did not show significant differences among the groups but module outlet values were elevated for Ca + H. IL-1 beta did not show changes in all schemes. CA + H was the most activating and PVC + C was the least activating combination. Both the membrane materials and anticoagulant must be considered in evaluating humoral and blood cellular changes in plasmapheresis.