Comparison of personal characteristics, tobacco use, and health states in Chaldean, Arab American, and non-Middle Eastern White adults.

This study compared and contrasted personal characteristics, tobacco use (cigarette and water pipe smoking), and health states in Chaldean, Arab American and non-Middle Eastern White adults attending an urban community service center. The average age was 39.4 (SD = 14.2). The three groups differed significantly (P < .006) on ethnicity, age, gender distribution, marital status, language spoken, education, employment, and annual income. Current cigarette smoking was highest for non-Middle Eastern White adults (35.4%) and current water pipe smoking was highest for Arab Americans (3.6%). Arab Americans were more likely to smoke both cigarettes and the narghile (4.3%). Health problems were highest among former smokers in all three ethnic groups. Being male, older, unmarried, and non-Middle Eastern White predicted current cigarette smoking; being Arab or Chaldean and having less formal education predicted current water pipe use.

Nursing interventions for smoking cessation.

BACKGROUND: Healthcare professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing-delivered smoking cessation interventions. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group specialized register and CINAHL in July 2007. SELECTION CRITERIA: Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow up of at least six months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed effect model and reported the outcome as a risk ratio (RR) with 95% confidence interval (CI). MAIN RESULTS: Forty-two studies met the inclusion criteria. Thirty-one studies comparing a nursing intervention to a control or to usual care found the intervention to significantly increase the likelihood of quitting (RR 1.28, 95% CI 1.18 to 1.38). There was heterogeneity among the study results, but pooling using a random effects model did not alter the estimate of a statistically significant effect. In a subgroup analysis there was weaker evidence that lower intensity interventions were effective (RR 1.27, 95% CI 0.99 to 1.62). There was limited indirect evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized patients also showed evidence of benefit. Nine studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Five studies of nurse counselling on smoking cessation during a screening health check, or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found nursing intervention to have less effect under these conditions. AUTHORS' CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses to patients, with reasonable evidence that intervention is effective. The evidence of an effect is weaker when interventions are brief and are provided by nurses whose main role is not health promotion or smoking cessation. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice, so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow up.

Intervenciones de enfermería para el abandono del hábito de fumar

Antecedentes: Los profesionales de la salud, incluidos los enfermeros, suelen aconsejar a las personas que mejoren su salud dejando de fumar. Dicho consejo puede ser breve o formar parte de intervenciones de mayor intensidad. Objetivos: Determinar la efectividad de las intervenciones para dejar de fumar realizadas por enfermeras en adultos. Establecer si las intervenciones para dejar de fumar realizadas por enfermeras son más efectivas que ninguna intervención; son más efectivas si la intervención es más intensiva; difieren en efectividad con el estado de salud y el entorno de los participantes; son más efectivas si incluyen seguimientos; son más efectivas si incluyen ayudas que demuestran el efecto fisiopatológico del tabaquismo. (AU)

Nursing interventions for smoking cessation.

BACKGROUND: Health care professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing-delivered smoking cessation interventions. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group specialized register and CINAHL in June 2003. SELECTION CRITERIA: Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. MAIN RESULTS: Twenty-nine studies met the inclusion criteria. Twenty studies comparing a nursing intervention to a control or to usual care found the intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.47, 95% CI 1.29 to 1.68). There was heterogeneity among the study results, but pooling using a random effects model did not alter the estimate of a statistically significant effect. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized patients also showed evidence of benefit. Five studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Five studies of nurse counselling on smoking cessation during a screening health check, or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found the nursing intervention to have less effect under these conditions. REVIEWER'S CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses to patients, with reasonable evidence that interventions can be effective. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice, so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow-up.

Nursing interventions for smoking cessation.

BACKGROUND: Health care professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing delivered smoking cessation interventions. SEARCH STRATEGY: The Cochrane Tobacco Addiction Group register was searched for studies of interventions using nurses or health visitors and an additional search made on CINAHL. SELECTION CRITERIA: Randomised trials with follow-up of at least 6 months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. MAIN RESULTS: Sixteen studies comparing nursing intervention to a control or usual care found intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.50, 95% CI 1.29-1.73). There was heterogeneity between the study results, but pooling using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non hospitalised patients also showed evidence of benefit. Five studies of nurse counseling on smoking cessation during a screening health check, not included in the main meta-analysis, found that under these conditions nursing intervention had less effect. REVIEWER'S CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that interventions can be effective. The challenge will be to incorporate smoking cessation intervention as part of standard practice so that all patients are given an opportunity to be queried about their tobacco use and to be given advice to quit along with reinforcement and follow-up.

Nursing interventions for smoking cessation.

BACKGROUND: Health care professionals frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing delivered smoking cessation interventions. SEARCH STRATEGY: The Cochrane Tobacco Addiction Group register was searched for studies of interventions using nurses or health visitors and an additional search made on CINAHL. SELECTION CRITERIA: Randomised trials with follow-up of at least 6 months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. MAIN RESULTS: Fifteen studies comparing nursing intervention to a control or usual care found intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.43, 95% CI 1.24-1.66). There was heterogeneity between the study results, but pooling using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non hospitalised patients also showed evidence of efficacy. Three studies of nurse counseling on smoking cessation during a screening health check, not included in the main meta-analysis, suggested that under these conditions nursing intervention was likely to have less effect. REVIEWER'S CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that interventions can be effective. The challenge will be to incorporate smoking cessation intervention as part of standard practice so that all patients are given an opportunity to be queried about their tobacco use and to be given advice to quit along with reinforcement and follow-up.

Nursing intervention and smoking cessation: A meta-analysis.

OBJECTIVE: To determine with meta-analysis the effects of nursing-delivered smoking cessation interventions. RESULTS: Fifteen studies comparing nursing intervention with a control or usual care found intervention to significantly increase the odds of smoking cessation. There was heterogeneity among the study results, but pooling by using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in nonhospitalized patients also showed evidence of efficacy. Nurse counseling on smoking cessation during a screening health check was likely to have less effect. The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that intervention can be effective.

Sense of coherence and life satisfaction: patient and spousal adaptation to home dialysis.

OBJECTIVE: This research examined the adaptation of 24 male patients and their spouses to end-stage renal disease and home/self-care dialysis. The research was conceptualized within the T-Double ABCX Model. Selected predictors included sense of coherence (SOC) (the degree to which one feels confident that life's challenges will be comprehensible, manageable, and worthy of a commitment of self), age, and socioeconomic status (SES). SETTING: Eleven of the 22 dialysis centers in the province of Ontario, Canada were invited to participate. Of these 11, seven agreed to participate. SAMPLE: Twenty-eight couples who were using home PD. DESIGN: A descriptive, correlational research design was used with data collected by mailed survey. METHOD: Adaptation, the health outcome of interest, was measured using perceived satisfaction with life (SWL). RESULTS: There was a large, positive relationship between patients' and spouses' SOC and adaptation. However, further analyses challenged the construct validity of the SOC instrument. A small, positive relationship was found between age and adaptation. CONCLUSION: Further research regarding the SOC is required prior to use in nursing practice.

Effects of relaxation intervention in phase II cardiac rehabilitation: replication and extension.

OBJECTIVES: To examine the effects of progressive muscle relaxation and guided imagery on psychological and physiologic outcomes in adults with cardiovascular disease who were participating in a phase II cardiac rehabilitation program. To examine tension levels, practice patterns, and perceived helpfulness of the intervention reported by subjects. DESIGN: Prospective, quasi-experimental, with random group assignment within sites. Independent replication and extension of a study by Bohachik (1984). SETTING: Four midwestern hospital-based phase II cardiac rehabilitation programs. PATIENTS: Fifty patients who within the preceding 12 weeks had had acute myocardial infarction or coronary artery bypass surgery or both, studied during 6 weeks of participation in a phase II cardiac rehabilitation program. OUTCOME MEASURES: Psychological measures included state and trait anxiety scores on the State-Trait Anxiety Inventory and reported symptoms on the Symptom Checklist-90-Revised. Physiologic measures were resting heart rate and blood pressure. Subjective tension levels before and after home practice, practice patterns, and perceived helpfulness of the intervention were examined. INTERVENTION: Individual instruction session in progressive muscle relaxation and guided imagery at the phase II cardiac rehabilitation program, followed by daily home practice with audiotape instructions over a 6-week period. RESULTS: No statistical differences at the p < or = 0.05 level were found in state anxiety scores or reported symptoms at study exit. However, reductions in mean subscale scores for interpersonal sensitivity (t [19] = 2.11, p < or = 0.05) and depression (t [19] = 2.07, p < or = 0.05) by paired t tests were found for the relaxation group (RG). The two groups differed at study exit in resting heart rate (t [42] = -2.02, p < or = 0.05) by independent t tests and in systolic blood pressure (F [1,42] = 5.13, p < or = 0.05) by analysis of covariance. The RG had a mean resting heart rate 8.6 beats/min lower than that of the control group (CG) and also had within-group reductions in mean heart rate (t [19] = 2.09, p < or = 0.05) by paired t tests. Contrary to expectation, the CG had a 3.5 mm Hg lower mean systolic blood pressure and within-group reductions in systolic (t [22] = 3.02, p < 0.01) and diastolic (t [22] = 3.83, p < 0.01) blood pressure by paired t tests. CG subjects had a greater number of dose increases in cardiac medications and fewer dose reductions than did RG subjects, who also had a higher number of dose reductions. RG subjects reported frequent practice of the technique, rated it as helpful, and reported lower subjective tension levels after practice. CONCLUSIONS: Findings in this study did not support those of Bohachik (who reported lowered state anxiety and fewer somatization, interpersonal sensitivity, and depression symptoms). More instruction sessions on the relaxation method may have resulted in more positive outcomes. However, the within-group scores for interpersonal sensitivity and depression, the reduction in heart rate, and the receptivity of subjects to this intervention suggest that it may be a feasible and helpful adjunctive therapy for participants in a phase II cardiac rehabilitation program.

Social context variables as predictors of smoking cessation.

OBJECTIVE: To examine positive and negative social support and other selected social context variables (age, education, marital status, gender, and exposure to other smokers inside and outside the home) as predictors of smoking cessation in non-hospitalised adults with diagnosed cardiovascular disease at follow up after one, six, and 12 months. DESIGN: Discriminant function analyses (DFA) and longitudinal "lag" analyses. SUBJECTS: 137 Non-hospitalised adults with diagnosed cardiovascular health problems. RESULTS: Examination of the concurrent DFAs revealed significant univariate F ratios for the predictor variables of gender and marital status at one year and low negative support at all three follow ups. Quitters reported significantly lower levels of negative support than non-quitters over the course of the year and tended to be male and married. Longitudinal "lag" analyses, however, revealed that higher positive social support at one month and higher negative support at six months were both predictive of smoking cessation at one year. At one year more men than women and more married than not married smokers were successful in quitting. No effects for age, education, or exposure to others smoking inside or outside the home were found on any of the concurrent DFAs or longitudinal analyses. CONCLUSION: A series of concurrent DFAs revealed that positive support was a significant predictor of quitting at one year and negative support was predictive of not quitting at all three follow ups. Longitudinal "lag" analyses showed that positive support at one month and negative support at six months both predicted quitting at one year. Being male and married were found to contribute to quitting on both sets of analyses. The effects for positive and negative support on the smoking behaviour of adults with cardiovascular disease tended to change over the course of a year. These findings suggest that positive and negative social support may have differential effects over time. As the smoker moves along the "quitting trajectory" it may be that more "nagging" or negative interactions are needed at some point to get smokers to quit, if positive support has not worked or is not working. Progression of disease also may have served as a stimulus for family members and friends to become more insistent and negative about the person's continued smoking. More research is needed to examine the quitting process to determine which and how social context variables contribute.

A comparison of nursing interventions for smoking cessation in adults with cardiovascular health problems.

OBJECTIVE: To examine the relative effectiveness of three different presentations of a smoking cessation program on the smoking behavior of adults with cardiovascular health problems. DESIGN: A 2 x 2 x 2 x 4 experimental design with stratification by sex, smoking history, and a cardiovascular event, and randomization to Individual, Group, Written, or No Intervention groups. SETTING: Six community hospital classrooms. SUBJECTS: 255 nonhospitalized adults. THEORETIC FRAMEWORK: Interaction Model of Client Health Behavior. MEASUREMENTS: Study Intake: Professional referral form, demographic questionnaire, smoking habits questionnaire, health history, perceived threat survey, perceived health status. Follow up: smoking cessation and health questionnaire, saliva thiocyanate testing. RESULTS: At 12-month follow-up, a nurse-client interaction was more effective than written self-help materials; however, smoking cessation rates were highest in the No Intervention control group, possibly related to having had coronary artery bypass graft surgery. Variables positively related to quitting were being male and married and having a higher income. With baseline factors considered, a quitter was most likely to be male and less than 48 years of age, have a high degree of perceived threat relative to medical diagnosis, and be in the individual intervention group. Only partial support for the study hypotheses was found.

Cigarette use among Arab Americans in the Detroit metropolitan area.

Use of cigarette tobacco by large proportions of the population of Middle Eastern countries has been reported; however, little is known about smoking behavior in one of America's fastest growing minorities, the Arab Americans. The purpose of this study was to examine cigarette smoking behavior of 237 randomly selected Arab American adults from a telephone listing in the Detroit area. Participants lived in the geographic Arab American community and identified with a Middle Eastern cultural heritage. Nurses, who spoke both English and Arabic, interviewed one adult family member using the 59-item self-report from the Cardiovascular Risk Factor Survey developed by Rice. Mean age of respondents was 40.4 years, 97 percent had been born in the Middle East, and 67 percent had been living in the United States 15 years or less. Current smokers rate was 38.9 percent, former smokers rate was 11.1 percent, never smokers rate was 50 percent, and the quit ratio (proportion of ever smokers who are former smokers) was 22.2 percent. Fifty-four percent of the current smokers were between 25 and 34 years of age; fewer women than men were former smokers, and the highest proportion of current smokers were Lebanese. Subjects who had smoked for the longest time were the least well educated. Arab Americans in this sample had a higher smoking rate, a lower quitting rate, and a much lower quit ratio when compared with national and State of Michigan data. With the growing numbers of Middle Eastern immigrants, there is potential for a dramatic increase in smoking-related health problems.

Preadmission self-instruction effects on postadmission and postoperative indicators in CABG patients: partial replication and extension.

Fifty adult coronary artery bypass graft surgery patients were randomly assigned to preadmission self-instruction or posthospital admission instruction of therapeutic exercises (e.g., coughing). Self-instructed subjects reported higher positive mood scores, performed correctly significantly more exercise behaviors, and required less teaching time following hospital admission. Postoperatively, no group differences were found on mood states, physical activity, analgesic use, or length of hospital stay. Both groups, however, tended to use less pain medication than that reported by other researchers and experience shorter hospital stays than that assigned under the Diagnostic Related Groups prescription.

Relaxation training and response to cardiac catheterization: a pilot study.

This pilot study evaluated the effects of relaxation-via-letting-go training on patients' state anxiety, observer-reported distress, and self-reported distress during cardiac catheterization. The sample consisted of 30 adults, 15 subjects in the relaxation training group and 15 subjects in the control group. A comparison of the control and relaxation training groups on the demographic variables of age and education, the preintervention variables of state anxiety and worry about the procedure, and number of days in the hospital prior to catheterization showed no differences between the groups. Relaxation training subjects did not indicate less anxiety prior to catheterization nor were they seen as less distressed during the procedure than control subjects. In addition, relaxation subjects did not report having less distress than control subjects.

Preadmission self-instruction booklets, postadmission exercise performance, and teaching time.

The relative effects of preadmission self-instructional information on levels of performance and time needed to achieve level of mastery of exercise behaviors were examined using a sample of 130 presurgical cholecystectomy and herniorrhaphy patients. Experimental interventions were (1) no preadmission information, (2) specific preadmission instructions, and (3) nonspecific preadmission instructions. Preadmission instructions consisting of either a specific or nonspecific booklet mailed to patients focused on techniques for coughing, deep breathing exercises leg movements, and ambulatory behaviors. During hospitalization, patients' exercise behaviors and the length of teaching time required for patients to perform the exercise steps were measured. Findings showed that subjects in the specific exercise instruction group performed significantly more of the exercise behaviors common to both booklets than subjects in the nonspecific exercise instruction group. Subjects in the specific instruction group also performed significantly more of the behaviors available to them than the nonspecific instruction group. Required postadmission teaching time did not differ significantly between the specific and nonspecific information groups, but both the groups required significantly less teaching time in the hospital than the no-preadmission instruction group.