Smoking-related activities in prenatal care programs

Smoking cessation education and training in obstetrics and gynecology residency programs in the United States

BACKGROUND

OB/GYN physicians should be involved in providing smoking cessation counseling to their patients who smoke, especially pregnant patients. However, the smoking cessation practices of OB/GYN physicians seem to be dependent on their education and training and not much is known about their training during medical school. Therefore, the purpose of this study was to assess the smoking cessation education provided by OB/GYN residency training programs in the United States.

METHODS

The investigators developed and mailed a valid and reliable survey to all allopathic and osteopathic OB/GYN Residency Directors in the US (n = 275). The internal reliability coefficients (Cronbach alpha) for the four major subscales ranged from 0.63 to 0.90. Best practices in survey research were used to achieve a final response rate of 58%.

RESULTS

The majority of residency programs (60%) did not have a formal, structured curriculum in tobacco topics and/or smoking cessation. In contrast, 40% of programs reported having a formal, structured tobacco education curriculum. Sixty-five percent of programs did not formally evaluate residents' competence in providing smoking cessation counseling to patients. A range of 42% to 57% of residency programs reported spending less than one hour/year on teaching various basic science and clinical science topics related to tobacco use. The majority of residency programs spent no time teaching residents about the socio-political aspects of tobacco use cessation. Lack of teaching time was identified by the majority (51%) of the residency directors as a barrier to teaching smoking cessation.

CONCLUSION

Although OB/GYN physicians are expected to provide smoking cessation counseling to their patients, the majority of OB/GYN residency programs in the United States provide minimal education and training in this area. Therefore, continuing medical education on smoking cessation counseling should be broadly implemented for OB/GYN physicians.

Effects of a DVD-delivered exercise intervention on physical function in older adults

BACKGROUND

Given the rapidly increasing demographic of older adults, it is vital to implement effective behavioral strategies to improve physical function to maintain activities of daily living. However, changing physical activity in older adults remains extremely difficult. The current trial tested the efficacy of a novel, 6-month, home-based, DVD-delivered exercise program focusing on flexibility, balance, and toning on the physical function of older adults.

METHODS

Older adults (N = 307) were recruited from 83 towns and cities throughout central Illinois. The trial consisted of 4 waves of recruitment and randomization from May 2010 through January 2012. Inclusion criteria included being inactive, at least 65 years of age, English speaking, providing physician's consent, and willingness to be randomized. Eligible participants were randomly assigned to 1 of 2 treatment conditions: the exercise intervention or a healthy aging, attentional control. Functional assessments were completed at baseline and following the 6-month DVD intervention. Measures included the Short Physical Performance Battery, assessments of flexibility and strength, and self-reported functional limitations.

RESULTS

Participants in the DVD intervention condition demonstrated significant improvements in the Short Physical Performance Battery (p = .005), lower extremity flexibility (p = .04), and upper body strength (p = .003). There were no effects of the intervention on self-reported functional limitations.

CONCLUSIONS

The exercise intervention produced a clinically significant improvement in the Short Physical Performance Battery and improvements in flexibility and strength, demonstrating the effectiveness of a low-cost DVD exercise program in improving physical function in older adults.

Physical activity and functional limitations in older women: influence of self-efficacy

This study examined the role of self-efficacy and physical function performance in the relationship between physical activity and functional limitations. Older women (age, M = 68.2 years) completed measures of physical activity, self-efficacy, physical function performance, and functional limitations at the baseline of an ongoing study. Analyses indicated that physical activity was associated with self-efficacy for exercise, efficacy for gait and balance, and physical function performance. Both measures of efficacy and physical functional performance were associated with functional limitations. Demographic and health status variables did not differentially influence these relationships. Although cross-sectional in nature, our findings suggest that physical activity, self-efficacy, and functional performance may all play a role in reducing functional limitations. Of particular relevance is the fact that both physical activity and self-efficacy represent important, modifiable factors that can enhance function.

Measuring disability and function in older women: psychometric properties of the late-life function and disability instrument

BACKGROUND

The recent development of the Late-Life Function and Disability Instrument (LL-FDI) was an important contribution to the measurement of function and disability in older adults. The present study examined the psychometric properties and construct validity of the LL-FDI measure in a sample of older women.

METHODS

Older black (n = 81) and white (n = 168) women completed the LL-FDI, several measures of physical function, and physical activity measures, and had their body mass index assessed at baseline of an ongoing prospective study. Confirmatory factor analyses (CFA) and correlational analyses were used to examine factorial and construct validity of the measure.

RESULTS

The CFA, using an iterative model modification technique, resulted in an acceptable 15-item solution for the function component and an 8-item solution for the disability component. This abbreviated instrument demonstrated high correlations with the original scales. Construct validity for the LL-FDI was supported. Participants who demonstrated better physical function, reported being more active, and had lower body mass index reported less disability and less difficulty with function on the LL-FDI.

CONCLUSIONS

The LL-FDI appears to be an effective instrument for assessing function and disability in older women, and the abbreviated version reported here may prove useful in certain circumstances due to its brevity. However, continued determination of the construct validity of the complete and abbreviated scales is recommended.