An evaluation of the relationship between self-report and biochemical measures of environmental tobacco smoke exposure

To evaluate the relationship between self-reported exposure to environmental tobacco smoke and saliva cotinine concentrations, we studied 186 nonsmokers. Each participant completed an exposure questionnaire, kept a daily exposure diary for 7 days, and provided a saliva sample for cotinine analysis. Salivary cotinine concentrations were measured using gas chromatography/mass spectrometry. Of the volunteers, 30% lived with one or more smokers, and 84% were regularly exposed to smokers at work. Eighty-three percent of the volunteers had detectable saliva cotinine concentrations (> or = 0.5 ng/ml) (median = 1.1; range = 0.5-7.4 ng/ml). Cotinine concentrations were related to exposure in the household and at the workplace. Volunteers who lived with smokers had significantly higher cotinine levels (median = 1.0; range = < 0.5-7.4 ng/ml) than those who did not (median = < 0.5; range = < 0.5-4.7 ng/ml). Volunteers who reported regular exposure at work had higher cotinine levels (median = 0.8; range = < 0.5-7.4 ng/ml) than those who did not (median = < 0.5; range = < 0.5-3.0 ng/ml). Cotinine concentrations were predicted by a regression equation that included the number of smokers at home and work and the number of minutes of exposure recorded in the daily diary (r2 = 0.29).

The impact of organizational characteristics on smoking policy restrictions in midwestern hospitals

Purpose. The relationship between hospitals' organizational characteristics and adoption of restrictive smoking policies was examined. Design. Self-administered questionnaires and telephone interviews were conducted prior to and following the target date for policy implementation. Setting. The Director of Regional Medical Services of a community network of hospitals requested in the summer of 1989 that the 57 member hospitals voluntarily implement a policy prohibiting all smoking in hospital buildings as of January 1, 1990. Subjects. Subjects were the 49 hospital CEOs (86%) who provided data at both time points. Intervention. The Director of Regional Medical Services made a personal request of the CEO during a routine visit at each hospital. Measures. Measures included structural aspects of the hospitals (e.g., number of employees, number of beds, presence of chemical dependency and psychiatric units); orientation toward employee health; support for smoking restrictions among various groups; and extent of CEO authority to set smoking policy. Results. Fifty-one percent of hospitals increased the restrictiveness of their smoking policy; 35% adopted a complete indoor smoking ban. Stepwise multiple regression analysis demonstrated that adoption of additional smoking restrictions was related to CEOs' and perceived board of directors' support of smoking restrictions, absence of a chemical dependency unit, and experience of financial difficulties in the previous two years. Conclusions. It is important to educate top decision makers as to the necessity of restrictive smoking policies. Barriers to smoking restrictions in organizations with chemical dependency units deserve particular attention from health promotion practitioners and researchers.

Improvement in pulmonary function following smoking cessation

This study investigated improvement in pulmonary function following smoking cessation. It employed three indices of lung function that are sensitive to improvement following smoking cessation and that can be easily assessed within a clinical setting: maximum mid-expiratory flow (MMF), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). Smoking status was verified by saliva thiocyanate analysis. Significant improvement in MMF was evident after 3 months of cessation and was maintained at the 6-month follow-up. This study demonstrates that significant improvement in at least one parameter of lung function occurs within the time span typically used in smoking cessation programs.

Smokers who are hospitalized: a window of opportunity for cessation interventions

BACKGROUND

Medical illness has often been thought to provide smokers with motivation to quit smoking. However, the actual impact that illness and hospitalization has on smokers' interest in cessation is not clear. Further, little is known about the role that hospital staff play in encouraging cessation.

METHODS

This article is a descriptive study examining smoking prevalence and interest in cessation among 304 inpatients hospitalized in a specialized cardiovascular disease unit and a general medical unit. In addition, the efforts of hospital staff in promoting cessation were assessed.

RESULTS

The overall smoking prevalence among this order sample was 16%. Although the majority of smokers (79%) indicated a desire to quit smoking, there was little interest in using formal treatment options to quit. Quitting on one's own was the most preferred cessation strategy. Approximately one-third of the smokers expressed interest in receiving cessation counseling from their physicians. Patient reports indicated that both physicians and nurses on the general medical unit intervened on smoking less frequently than staff on the cardiovascular disease unit. Seventy-one percent of all smokers reported that the medical resident did not discuss smoking with them.

CONCLUSION

Despite the small number of smokers in this sample, this study has implications for development of training programs for hospital staff on delivery of brief smoking interventions.

Exposure to environmental tobacco smoke in naturalistic settings

BACKGROUND

Exposure to environmental tobacco smoke (ETS) has been identified as a risk factor for chronic disease among nonsmokers. Results of epidemiological surveys suggest that the majority of nonsmokers have regular ETS exposure. However, little is known about the topography of exposure.

METHODS

An exposure diary was used by 186 nonsmokers to self-monitor ETS exposure over a 7-day period. Subjects also completed a questionnaire that assessed their patterns of ETS exposure.

RESULTS

The primary source of ETS exposure was the workplace, except when there was a smoker in the household, in which case the household was the primary source. The presence of a smoker in the household resulted in higher levels of exposure both at work and in other locations when compared with subjects without household exposure. Subjects' assessments of exposure on the questionnaire were consistently lower than their self-monitored levels. This finding suggests that general exposure ratings underestimate exposure.

CONCLUSIONS

This study provides a new understanding of the patterns of ETS exposure and may help guide the development of policies and interventions designed to reduce ETS exposure.

Endorsement and strength of alcohol expectancies

It has been suggested that the strength of alcohol-related expectancies can be ascertained from the number of items endorsed on subscales consisting of multiple items. In the present study, subjects were asked to rate the strength of their beliefs in addition to indicating whether or not they endorsed the items on a measure of alcohol-related expectancies. Three issues were addressed: (1) Do strength ratings and endorsements predict the perceived likelihood of drinking when their correlated effects are taken into consideration and do these responses interact? (2) Do the endorsements and strength ratings form higher order factors? and (3) Do men and women with various drinking habits rate the strength of their beliefs for a moderate and a large dose of alcohol in a way that mirrors their endorsements? The results suggest that the strength of an alcohol-related expectancy must be measured in its own right and cannot be inferred from the pattern of endorsements. Interactions of endorsements and strength ratings produce unique information that is not deducible from either measure alone.

Smoking cessation and cardiovascular reactivity to stress

Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) reactivity to mental arithmetic and deep knee bends were monitored in a sample of smokers prior to and 6 months following smoking cessation. There was no reduction in cardiovascular reactivity to either stressor following cessation. However, heightened pretreatment DBP and HR reactivity to mental arithmetic and SBP reactivity to deep knee bends were associated with relapse by the 6-month follow-up. Demographic and smoking history variables and pretreatment nicotine dependence were not associated with treatment outcome. Further exploration of cardiovascular reactivity to stress among smokers may elucidate the process of relapse.

Relapse prevention versus broad spectrum treatment for smoking cessation: a comparison of efficacy

The efficacy of a smoking cessation relapse prevention (RP) program, emphasizing cognitive-behavioral coping skills, was compared to that of a broad spectrum (BS) program, which emphasized behavioral skills. It was hypothesized that the RP program would be more effective in producing long-term abstinence, compared to the BS package. Abstinence rates validated by saliva thiocyanate and carbon monoxide, as well as self-report of smoking reduction, were measured at posttreatment, 3 and 6 months. No differences in posttreatment quit rates were found between the two groups, although both programs produced significantly higher quit rates than the wait-list control group. Contrary to prediction, the BS group produced marginally significantly greater abstinence at 3 months. No differences in abstinence were found at 6 months. Reduction in cigarette consumption was marginally significantly greater for the BS group at 3 and 6 months. Various mediators of treatment outcome were not found to influence success in quitting. There was a significant weight gain in those who quit.

Chronic active hepatitis associated with etretinate therapy

Acute hepatitis developed in a patient taking etretinate for severe psoriasis. Discontinuation of therapy was followed by progression of the histological changes to chronic active hepatitis, despite improvement of his clinical and laboratory status. This is the third reported case of chronic active hepatitis associated with etretinate therapy, and the second patient in our group of twenty-two etretinate-treated patients with severe psoriasis to develop clinically significant hepatic disease. Immunological evaluation revealed a marked increase in the patient's OKMI-staining population of peripheral mononuclear cells and augmentation of Con A-induced lymphocyte blastogenesis in the presence of etretinate.