Radon awareness and mitigation in Vermont: a public health survey.

Radon exposure is associated with an increased incidence of lung cancer, and elevated levels may be found in as many as 1 out of 15 homes. The U.S. EPA recommends testing homes for radon and mitigating over the advisory level of 4 picocuries per liter (4 pCi L(-1), or 148 Bq m(-3)). A sample population from a list of Vermont residents who had tested their residence for radon through the Vermont Department of Health and who had elevated levels were mailed a survey to assess demographic characteristics, knowledge about radon, mitigation rates, types of mitigation, as well as barriers to mitigation. The response rate was 63%. Forty-three percent of respondents mitigated. Roughly half were not completely knowledgeable of radon based upon the ability to associate radon exposure with lung cancer risk. Reasons not to mitigate radon levels in homes were cost and lack of concern over elevated levels. A multivariate logistic regression analysis revealed factors associated with mitigating: an education level of college or higher (p = 0.02), concern that a high radon level would affect real estate value (p = 0.04), and home age less than 10 y (p = 0.05). In summary, less than half of Vermonters with elevated radon levels participating in the Department of Health program mitigated. We identify factors associated with radon mitigation that may lead to improved radon education and mitigation practice.

Biochemical verification of smoking status in pregnant and recently postpartum women.

The present study was conducted to examine several different methods and cutpoints for determining smoking status in pregnant and recently postpartum women. Self-reported smoking status, urine cotinine levels determined by gas chromatography (GC) and by enzyme immunoassay testing (EMIT), and breath carbon monoxide (CO) levels were assessed at 28 weeks antepartum and 12 and 24 weeks postpartum in 131 women enrolled in studies on smoking cessation and relapse prevention. Classifications based on urine-cotinine GC testing served as the standard in most analyses. Overall agreement between self-reported smoking status and classification based on urine-cotinine GC testing was excellent (> or =95%) at several cutpoints (50, 25, and 12.5 ng/ml) but highest at 25 ng/ml. Classifications based on EMIT urine cotinine levels were in nearly perfect (> or =98%) agreement with those made by GC when the cutpoint for the former was set at approximately 80 ng/ml (79-87 ng/ml). Classifications based on breath CO were in relatively poor agreement (< or =87%) with GC classifications at all cutpoints examined but best at 4 ppm. Overall, these results provide detailed information on several commonly used methods for classifying smoking in pregnant and recently postpartum women that should be practically useful to researchers and clinicians involved in efforts to eliminate smoking in this population.

Characterizing nicotine withdrawal in pregnant cigarette smokers.

Maternal smoking is a leading preventable cause of poor pregnancy outcomes and infant morbidity and mortality. Whereas pregnancy has been thought of as a "window of opportunity" when women are more motivated to change health behaviors such as smoking, only 20% of pregnant women quit smoking upon learning they are pregnant and remain abstinent at the end of the pregnancy. Greater understanding of possible obstacles to smoking during pregnancy, such as nicotine withdrawal, is needed. The symptoms of nicotine withdrawal have been well characterized in nonpregnant smokers, but there has been only 1 report conducted during pregnancy, and that was a retrospective study. The aim of the present study was to characterize nicotine withdrawal and craving in pregnant cigarette smokers. These data were collected as part of prospective clinical trials assessing the efficacy of voucher-based incentives to promote abstinence from cigarette smoking during pregnancy and postpartum. The authors examined results from the Minnesota Nicotine Withdrawal Scale (J. R. Hughes & D. K. Hatsukami, 1998) in 27 abstainers (reported no or very low levels of smoking, which was confirmed biochemically) and 21 smokers (smoked at >80% of their baseline smoking level) during the first 5 days of a cessation attempt. Abstainers reported more impatience, anger, and difficulty concentrating than did smokers. The results also suggest that pregnant smokers generally may have elevated baseline levels of withdrawal, which need to be considered in the design and analysis of future studies.

Stress and alcohol consumption in heavily drinking men: 2 years of daily data using interactive voice response.

BACKGROUND: The relationship between stress and alcohol consumption has been shown in recent research to be more complex than originally thought. Cross-sectional and short-term longitudinal studies may not provide adequate data to address subtle but important relationships that impact consumption frequency and/or quantity. METHODS: Participants were 33 males recruited from local bars who reported their alcohol consumption, stress, and other related variables every day for 2 years. Reports were provided by automated telephone to a computer-based interactive voice response (IVR) system. By closely monitoring call completion, we were able to collect over 95% of the daily calls. RESULTS: Using hierarchical linear modeling, daily stress was found to be associated with daily alcohol consumption, but in the opposite direction than would be predicted by a "drinking to cope" hypothesis. That is, same-day stress was found to be inversely related to consumption levels. Prior day's stress was not significantly associated with subsequent day's consumption; however, prior day's consumption was predictive of subsequent stress for up to 2 days. Similar analyses using week, rather than day, as the unit of measure paralleled these findings. CONCLUSIONS: This study highlights the utility of using long-term daily process data to address important research and clinical questions in the alcohol field.

Psychological symptoms following smoking cessation in pregnant smokers.

This study examined the relationship between smoking status and psychological symptoms in pregnant women across pregnancy. Participants were 45 women who quit smoking early in pregnancy (early quitters), 22 who quit later in pregnancy (later quitters), and 84 who smoked throughout pregnancy (never quitters). Assessments of smoking status and psychological symptoms (Brief Symptom Inventory and Beck Depression Inventory) occurred near first prenatal visit, second visit, and end of pregnancy. Results indicated that scores on the Global Severity Index of the Brief Symptom Inventory, several Brief Symptom Inventory subscales, and on the Beck Depression Inventory were highest among never quitters, lowest among early quitters, and intermediate for later quitters. Scores decreased across pregnancy, especially between first and second assessments. We found no evidence that quitting smoking increased psychological symptoms either in the immediate post-withdrawal period or later in pregnancy. These findings should temper concerns that quitting smoking may have detrimental psychological consequences during pregnancy.

A meta-analysis of voucher-based reinforcement therapy for substance use disorders.

AIMS: To systematically investigate the effectiveness of voucher-based reinforcement therapy for the treatment of substance use disorders. METHODS: Effect sizes and 95% confidence intervals were calculated for studies published between January 1991 and March 2004 that utilized voucher-based reinforcement therapy (VBRT) or related monetary-based incentives to treat substance use disorders (SUDs). FINDINGS: Thirty studies involved interventions targeting abstinence from drug use using experimental designs where effects on treatment outcome could be attributed to the VBRT intervention. The estimated average effect size (r) for those studies was 0.32 (95% CI 0.26-0.38). Analyses of variables thought to moderate VBRT effect sizes revealed that more immediate voucher delivery and greater monetary value of the voucher were associated with larger effect sizes. Additional studies were identified wherein VBRT was used to target clinic attendance (n = 6) or medication compliance (n = 4). VBRT studies targeting attendance produced average effect sizes of 0.15 (95% CI 0.02-0.28), while those that targeted medication compliance produced an average effect of 0.32 (95% CI 0.15-0.47). No significant moderators were identified for these 10 studies. CONCLUSIONS: Overall, VBRT generated significantly better outcomes than did control treatments. These results further support the efficacy of VBRT, quantify the magnitude of its effects, identify significant moderators and suggest potential directions for future research.

Maternal smoking and its association with birth weight.

OBJECTIVE: Maternal smoking has been associated with a reduction in newborn birth weight. We sought to estimate how the pattern of maternal smoking throughout pregnancy influences newborn size. METHODS: One hundred sixty pregnant smoking women were enrolled in a prospective study. We collected data on maternal age, education, prepregnancy body mass index, and parity, as well as alcohol and illicit drug use. Cigarette use was defined as self-reported consumption before pregnancy, at the time of study enrollment, and in the third trimester. Statistical analyses were performed based on bivariate correlations and multiple linear regression. RESULTS: Of the smoking parameters examined, maternal third-trimester cigarette consumption was the strongest predictor of birth weight percentile (partial r = -0.23, P < .001). For each additional cigarette per day that a participant smoked in the third trimester, there was an estimated 27 g reduction in birth weight. Prepregnancy smoking volume was not significantly associated with birth weight percentile in bivariate (r = -0.06, P = .47) or multivariable analyses. Additional factors contributing to birth weight include gestational age (partial r = 0.69, P < .001), maternal body mass index (partial r = 0.23, P < .001), and parity (partial r = 0.16, P < .004). In total, these 4 variables explain 61% of the variance in newborn birth weight. CONCLUSION: Maternal third-trimester cigarette consumption is a strong and independent predictor of birth weight percentile. This supports the hypothesis that reductions in maternal cigarette consumption during pregnancy will result in improved birth weight, regardless of the prepregnancy consumption levels. LEVEL OF EVIDENCE: III.

Characterizing and improving HIV/AIDS knowledge among cocaine-dependent outpatients.

The present study was an experimental test of efficacy of a brief education intervention for increasing HIV/AIDS knowledge among cocaine-dependent outpatients. Participants were randomly assigned to an HIV/AIDS education intervention (experimental condition) or a sham intervention (control condition). Control participants were subsequently crossed over to the HIV/AIDS education intervention. Experimental participants had higher scores on tests of HIV/AIDS knowledge after receiving the education intervention than did control participants. Further supporting the intervention's efficacy, control participant scores also increased once participants were crossed over and received the education intervention. Scores at follow-up were lower than at postintervention but remained higher than baseline scores. Results support the intervention's efficacy for increasing HIV/AIDS knowledge among cocaine-dependent outpatients. This intervention is brief, inexpensive, and easily implemented.

The influence of pregnancy on arterial compliance.

OBJECTIVE: To examine the effect of pregnancy and the interval between pregnancies on arterial compliance as measured by mean arterial pressure (MAP) and pulse pressure. METHODS: We conducted a 3-month chart review of deliveries at a tertiary care hospital (index pregnancies). Data collected included demographics, obstetric history, blood pressures, prepregnancy weight, weight gain, and neonatal outcome. If a subject's first delivery occurred at our institution, these records were reviewed in a similar fashion. Mean antepartum MAP and pulse pressure were calculated and compared for each trimester between index and first pregnancies. Statistical methods employed included repeated measures analysis of variance, repeated measures analysis of covariance, and correlation analysis. RESULTS: Two hundred eighty-five charts were reviewed. Forty-seven women had complete data covering both index and first pregnancy. Mean arterial pressure was significantly higher in all trimesters of first compared with index pregnancies (first pregnancy-first trimester 82.0 +/- 8.1 mm Hg, index pregnancy-first trimester 79.4 +/- 7.6 mm Hg, P = .032; first-second trimester 81.6 +/- 6.7 mm Hg, index-second trimester 78.7 +/- 6.6 mm Hg, P = .016; first-third trimester 83.9 +/- 6.9 mm Hg, index-third trimester 81.6 +/- 6.9 mm Hg, P = .047). Repeated measures analysis of covariance confirmed that pregnancy order contributed independently to differences in MAP. The interval between pregnancies was found to be inversely related to the difference in MAP from first to index pregnancies by trimester (r = -0.41, P = .004) and the change in MAP within pregnancy from first to third trimester (r = -0.31, P = .046). CONCLUSION: Mean arterial pressure is reduced in subsequent pregnancies compared with first pregnancies. This raises the possibility that pregnancy plays a role in modifying cardiovascular compliance. Consistent with this, the effect has temporal limitations in that the shorter the interval between pregnancies, the greater the reduction in MAP.

Examining interrelationships between abstinence and coping self-efficacy in cocaine-dependent outpatients.

Initial abstinence and self-efficacy predict treatment outcome in cocaine-dependent outpatients. Associations between abstinence and coping self-efficacy were examined among cocaine-dependent outpatients (N=126). Abstinence was verified by urinalysis. Coping self-efficacy was measured using a modified Situational Confidence Questionnaire (SCQ). The modified SCQ had good validity and reliability, and scores increased during treatment. In bivariate analyses, early abstinence and SCQ scores each predicted subsequent abstinence and confidence during treatment and posttreatment follow-up. Based on structural equation modeling, early confidence was a significant predictor of later confidence but not of later abstinence, whereas early abstinence was a significant predictor of later abstinence and confidence. Results suggest a unidirectional relationship wherein prior abstinence predicts subsequent abstinence and confidence.

Middle school students' perceptions of an ideal career and a career in nursing.

Many strategies are currently needed to address a profound nursing shortage that is threatening health care quality. One strategy is to increase the interest of youth in the profession of nursing. Middle school students' perception of nursing offers important clues toward successful recruitment of the next generation of nurses. The focus of this exploratory study was to compare a convenience sample of 301 male and female middle school students' perceptions of an ideal career versus a career in nursing. A post hoc analysis of variations by gender was also done. Perceptions of nursing and the ideal career were measured with an instrument developed by May, Champion, and Austin (1991), which has been assessed for reliability and validity in previous studies. Data were analyzed descriptively and inferentially, by using paired t tests and Bonferroni adjustments to control for multicolinearity. The respondents voiced statistically significant differences between nursing and the ideal career in key variables related to autonomy, respect, compensation, and "busyness." When comparing boys with girls, however, there was more congruence between boys' perception of nursing and ideal career than girls'. Implications for the development of timely and effective nursing recruitment campaigns targeting middle school students are offered.

Decline in alcohol consumption during two years of daily reporting.

OBJECTIVE: We conducted a formal analysis of the potential effects on alcohol consumption of daily reports to an Interactive Voice Response (IVR) system over a 2-year period. METHOD: Thirty-three white men who had been recruited from bars were invited to call a toll-free number daily to answer a 2-minute questionnaire regarding alcohol consumption the previous day, reasons for drinking or not drinking, mood and stress levels, and a few other relevant items. A recorded voice asked the questions and callers responded using the telephone keypad. During the 2-year study, all subjects were personally interviewed each quarter, including regular Timeline Follow Back (TLFB) assessments. We compared mean consumption levels reported for the first year with those reported the second year. RESULTS: Although there were consistent seasonal variations and holiday peaks, reported consumption declined over the 2 years of study. A comparison of average consumption across all subjects revealed significant declines in drinks per day, drinking days per week, and drinks per drinking day. Analysis of individuals showed at least some reduction in 82% of the subjects and statistically significant reductions in 45%. There was an estimated 19% reduction in consumption from Year I to Year 2 based on the IVR reports and a 21% reduction as ascertained by the TLFB. No significant changes were observed in nonalcohol-related measures. CONCLUSIONS: After exploring possible reasons for our results, we conclude that the most likely explanation of the decline in alcohol consumption is a reactivity effect due to reporting consumption regularly. The results suggest that IVR may have potential utility as an intervention for excessive alcohol consumption.