Smoking in urban African Americans: behaviors, gender differences, and motivation to quit.

OBJECTIVE: This study describes smoking behaviors and gender differences, and correlates these factors with motivation to quit smoking among African-American smokers at a community-based health center. DESIGN: A 62-item survey assessed depression, hassles, readiness to change, and demographics. METHODS: Participants (N = 81) were interviewed in an adult clinic waiting room. RESULTS: On average, participants smoked 13 cigarettes per day. Many reported attempts to reduce smoking-related health risks: 46% switched brands, 57% reduced their smoking, and 19% smoked only on some days. Fifty-nine percent indicated depressive symptoms. For women vs men, noteworthy differences were: reduction in number of cigarettes smoked (66.7% vs 40.0%; P = .023), switching brands (58.8% vs 23.3%; P = .003), number of attempts to quit in the past year (2.7 vs 1.2; P = .034), and high concern about weight gain (52.9% vs 26.7%; P = .047). Cigarettes smoked per day was negatively correlated with motivation to quit (P = .022). Variables positively correlated with motivation to quit included: harm reduction strategies (P = .002), intention to quit in 30 days (P<.0001), and intention to quit in 6 months (P<.0001). CONCLUSIONS: Women showed more potential indications of readiness to quit, including more attempts to quit, reductions in number of cigarette smoked, and brand switching. Knowledge of cessation barriers, gender differences, and correlates to motivation may prove useful for investigators conducting research in this population.

Documentation of smoking: role of age, gender, and ethnicity.

This study assessed the role of age, gender, and ethnicity in chart documentation of smoking by primary care providers. Clinic patients (n = 304) were asked their smoking status and medical records were reviewed. Twenty-nine percent of reviewed patients were smokers, 27.6% former smokers, and 43.1% nonsmokers. Providers were more likely to document smoking among males (OR = 4.6; 95% CI = 2.2-9.5), middle-aged patients (OR = 4.0; 95% CI = 1.4-11.0), and smokers (OR = 8.1; 95% CI = 4.1-16.0). Data revealed selective documentation of smoking in males and middle-aged patients by providers, suggesting gender and age bias in the recognition and documentation of this risky behavior. We conclude that providers should screen for smoking in all patients regardless of age or gender.

The use of nicotine patches with minimal intervention.

BACKGROUND: This paper describes a natural, prospective, open-label study designed to evaluate the impact of free nicotine patches with minimal support for smoking cessation. METHODS: Surveys were administered to 223 participants who received nicotine patches from the American Lung Association. All participants received a 6-week supply of 15-mg/16-h transdermal nicotine patches, a self-help book Freedom from Smoking, and information about area smoking cessation classes. Follow-up telephone surveys were administered 6 weeks after the patches were distributed. Abstinence was measured through self-report exclusively. RESULTS: The overall quit rate at 6-weeks was 21% (47/223). Among nonquitters, the mean number of cigarettes smoked per day dropped from 25 at baseline to 14 at 6 weeks. There was a significant difference in the average number of patches used by quitters and nonquitters (26 versus 11, P < 0.001). CONCLUSIONS: Nicotine patches with minimal support can be effective in smoking cessation and smoking reduction. The availability of patches may have motivated participants to quit. Efforts to increase access to and use of nicotine patches may result in increased attempts to quit and successful quitting.

Smoking cessation among African Americans: what we know and do not know about interventions and self-quitting.

BACKGROUND: Many studies on cessation interventions and self-quitting have been conducted, but few have focused on African Americans. The purpose of this review was to critically evaluate the available studies and make recommendations for future research. METHODS: Articles published from 1988 to 1998 were collected using Medline and other data bases, as well as personal communication. Studies were divided into two categories: evaluations of specific cessation interventions and examinations of self-quit behaviors and related factors. Studies were tabulated using author/year, study design/sample size, variables/results, and comments. RESULTS: In the intervention studies, church-based programs may provide an effective location for cessation interventions, but the studies to date did not demonstrate unequivocal effectiveness. In clinic programs, there do not appear to be any interventions that are particularly effective. In community-based interventions, there were no differences for African and Caucasian Americans. With regard to self-quitting, sociodemographic variables were similarly related to cessation as in the general population, as were smoking history variables. All other categories did not contain enough information for firm conclusions to be drawn. CONCLUSIONS: There are some interventions that appear to be useful, but little information is available on self-quitting. More research is needed on the natural history of quitting, on the social norms for smoking among African American groups, and on the conceptual dimensions of race in the context of this research.

Pharmacotherapy of smoking cessation.

Tobacco use is the number one cause of preventable diseases in the United States. Smoking accounts for more than 400,000 deaths yearly and 30% of all cancer deaths. Primary care physicians have access to 70% of smokers, approximately 60% of whom are perceived to be in excellent health. Recent advances in the pharmacotherapy of nicotine addiction, including nicotine nasal spray, nicotine inhaler, bupropion hydrochloride, and over-the-counter transdermal nicotine patches, have increased the treatment options physicians can offer to smokers. Physicians, especially those in primary care specialties, should familiarize themselves with these products to improve efforts to help their patients stop smoking. This article reviews scientific data on the efficacy of approved medications, benefits, adverse effects, and appropriate use of these products. We also discuss nicotine addiction and treatment for special populations, including women, ethnic minorities, light smokers, and patients with cardiovascular and pulmonary diseases.

Effects of a replication of a multicomponent model for preventing adolescent pregnancy in three Kansas communities.

CONTEXT: A significant amount of attention has been devoted to the complex issue of teenage pregnancy and to programs for reducing pregnancy among adolescents. Careful evaluations of such programs are needed to ascertain what strategies will be most effective at reducing teenage pregnancy. METHODS: A pretest-posttest comparison group design was used to analyze the effects of a comprehensive multicomponent school and community intervention on estimated pregnancy rates and birthrates among young people in three Kansas communities: Geary County, Franklin County and selected neighborhoods of Wichita. RESULTS: There were high levels of program activity in all three communities during the intervention period, including teacher training and sexuality education for students. Survey respondents rated highly such project interventions as the extension of school-linked clinic hours to accommodate student schedules and support groups established in middle schools. Between 1994 and 1997, the proportions of adolescents reporting that they had ever had sex decreased significantly among all ninth and 10th graders in Geary County, from 51% to 38% among females and from 63% to 43% among males. In Franklin County, more males in grades 11 and 12 reported using condoms in 1996 (55%) than had done so in 1994 (39%). Age at first intercourse remained relatively stable in Franklin and Geary counties during the intervention period. The estimated pregnancy rate among adolescents aged 14-17 decreased between 1994 and 1997 in Geary Country, while it increased in comparison areas. The estimated pregnancy rates among 14-17-year-olds decreased in both Franklin County and its comparison communities. The birthrate declined both in one target area of Wichita and in its comparison area from 1991-1993 to 1994-1996. Over the same time period, the birthrate increased in a second target area of Wichita, while it decreased in the comparison community. CONCLUSIONS: This evaluation of a comprehensive multicomponent program for adolescent pregnancy prevention contributes to our understanding of this model and its replicability in diverse communities. Ongoing program evaluation is important for developing initiatives and for refining strategies so they respond to local conditions.

PIP: This paper evaluates a multi-component program for reducing pregnancy among adolescents in the US. The study employed a pretest-posttest comparison group design to analyze the effects of a comprehensive multi-component school and community intervention on estimated pregnancy rates and birthrates among young people in three Kansas communities: Geary County, Franklin County and selected neighborhoods of Wichita. Results revealed high levels of program activity in all three communities during the intervention period, including teacher training and sexuality education for students. From 1994-97, the proportion of adolescents who reported that they had experienced sex decreased significantly among all 9th and 10th graders in Geary County. Condom use among males in grades 11 and 12 in Franklin County increased from 39% in 1994 to 55% in 1996. In Franklin County and its comparison areas, the estimated pregnancy rates decreased among adolescents aged 14-17 years. The birthrate declined both in one target area of Wichita and in its comparison area from 1991-93 and 1994-96. In general, this research contributed to an understanding on the impact of multi-component school- and community-based interventions on adolescent pregnancy rates.

Evaluating a statewide partnership for reducing risks for chronic diseases.

We describe a case study evaluation of Kansas LEAN, a statewide partnership with the mission of reducing risks for chronic diseases through dietary and exercise modification. We used a case study design to examine five primary questions related to process and outcome: (a) were the goals of the partnership important to constituents? (process), (b) were constituents satisfied with the partnership (process), (c) were community or systems changes (new or modified programs, policies, or practices) facilitated by partnership efforts (outcome)?, (d) were these changes important to the partnership's mission (outcome)?, and (e) what critical events helped facilitate community changes (outcome)? several measurement instruments--a monitoring and feedback system, constituent surveys, and semistructured interviews--were used to address key evaluation questions. Kansas LEAN is a strong statewide partnership with involvement from key representatives throughout Kansas. It is an ongoing, comprehensive health promotion program that plans and implements multiple components, in a variety of settings, to create awareness, behavior change, and a supportive environment. Kansas LEAN has facilitated several important community or systems changes related to its mission. We conclude with a discussion of the challenges of evaluating partnerships that seek to reduce risks for chronic diseases.

Using empowerment theory in collaborative partnerships for community health and development.

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development.