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Sutfin EL, Denlinger-Apte RL, Ross JC, Wagoner KG, Suerken CK, Spangler J, Wolfson M, Reboussin BA. Corrigendum to "Longitudinal latent class analysis of tobacco use and correlates among young adults over a 10-year period" [Drug Alcohol Depend. 236 (2022) 109474]. Drug Alcohol Depend 2022; 239:109593. [PMID: 35987084 DOI: 10.1016/j.drugalcdep.2022.109593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, USA.
| | | | | | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, USA
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, USA
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, USA
| | - Mark Wolfson
- Department of Social Medicine, Population, & Public Health, School of Medicine, University of California, Riverside, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, USA
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Wagoner KG, Reboussin BA, Ross JC, Denlinger-Apte R, Spangler J, Sutfin EL. Exposure to e-cigarette health claims and association with e-cigarette use and risk perceptions: A cohort study of young adults. Addict Behav 2022; 132:107359. [PMID: 35576816 PMCID: PMC9434727 DOI: 10.1016/j.addbeh.2022.107359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION E-cigarettes have been marketed illicitly as smoking cessation aids and reduced risk tobacco products in the United States. Our study assessed consumers' exposure to such claims and evaluated their impact on relative risk perceptions and e-cigarette use. METHODS Data are from the Assessment of the post-College Experience study, which followed a cohort of young adults since 2010 when they were college freshmen. We used data from survey waves 10 (fall 2017) through 14 (fall 2019) to assess past 6 month exposure to e-cigarette marketing that made smoking cessation or modified risk tobacco product (MRTP) claims. Logistic regression models examined if exposure to claims at waves 11 through 14 were predictors of e-cigarette use and relative risk perceptions at wave 14. RESULTS Exposure to MRTP (28.4% to 40.1%) and cessation claims (29.1% to 46.6%) increased, with participants reporting more exposure to cessation than MRTP claims at each wave. Multiple exposures were associated with perceptions that e-cigarettes are less harmful compared to cigarettes (Cessation: AOR = 1.12, CI: 1.01-1.23; p = 0.025; MRTP: AOR = 1.16; CI: 1.05-1.29; p = 0.003). Neither claim type was associated with past 30-day e-cigarette use. Claim exposure did not increase e-cigarette initiation among never e-cigarette users. However, current cigarette smokers who had never used e-cigarettes at wave 10 had 2.5 higher odds of initiating e-cigarette use by wave 14 for each exposure to a cessation claim (AOR = 2.53; CI: 1.43-4.45; p = 0.001). CONCLUSIONS Young adults reported increasing exposure to unauthorized e-cigarette health claims. Exposure was associated with reduced relative risk perceptions, but was not associated with past 30-day e-cigarette use. Cessation claims may motivate current cigarette smokers to try e-cigarettes.
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Affiliation(s)
- Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Beth A Reboussin
- Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Bellinger C, Foley KL, Dressler EV, Kittel C, Miller DP, Weaver KE, Sutfin EL, Petty WJ, Spangler J, Stone R, Anderson DM, Kehn H, Steenstra C, Panikkar R, Chiles C. Organizational Characteristics and Smoking Cessation Support in Community-Based Lung Cancer Screening Programs. J Am Coll Radiol 2022; 19:529-533. [PMID: 35247325 PMCID: PMC8983582 DOI: 10.1016/j.jacr.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Christina Bellinger
- Department of Pulmonology and Critical Care, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Kristie Long Foley
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carol Kittel
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David P Miller
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Weaver
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Jeffrey Petty
- Department of Thoracic Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rebecca Stone
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Heather Kehn
- Metro Minnesota Community Oncology Research Consortium
| | | | - Rajiv Panikkar
- Geisinger Cancer Institute National Cancer Institute Community Oncology Research Program
| | | | - Caroline Chiles
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Denlinger-Apte R, Suerken CK, Ross JC, Reboussin BA, Spangler J, Wagoner KG, Sutfin EL. Decreases in smoking and vaping during COVID-19 stay-at-home orders among a cohort of young adults in the United States. Prev Med 2022; 156:106992. [PMID: 35149114 PMCID: PMC8824729 DOI: 10.1016/j.ypmed.2022.106992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/12/2021] [Accepted: 02/06/2022] [Indexed: 11/26/2022]
Abstract
In Spring 2020, most US states and territories implemented stay-at-home orders to slow transmission of the novel coronavirus SARS-CoV2, the cause of COVID-19. Little is known about the impact of stay-at-home orders on tobacco and nicotine use including among young adults. The current study examined participants (N = 1727) completing three recent survey waves from a longitudinal cohort of young adults recruited in 2010 from North Carolina and Virginia, USA: Wave 13 (Spring 2019), Wave 14 (Fall 2019), and Wave 15 (Spring 2020) to assess changes in cigarette and e-cigarette use. We conducted logistic regression analyses to compare the odds that participants reported smoking or vaping in Wave 14 relative to Wave 13 to establish if there was a trend of use pre-pandemic. Then, we conducted logistic regression analyses to compare the odds that participants reported smoking or vaping in Wave 15 relative to Wave 14 to determine the impact of COVID-19 stay-at-home orders. When comparing the odds of reporting tobacco use at Wave 14 to Wave 13, no differences emerged (p > 0.05). However, when comparing tobacco use at Wave 15 to Wave 14, participants had 40% lower odds of reporting past 30-day cigarette use (p = 0.02) and 50% lower odds of reporting past 30-day e-cigarette use (p < 0.01). The current study provides initial evidence that young adults may have reduced their tobacco and nicotine use during the stay-at-home orders. However, more work is needed to determine the long-term impact of the COVID-19 pandemic on tobacco use and cessation in this population.
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Affiliation(s)
- Rachel Denlinger-Apte
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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King JL, Wagoner KG, Suerken CK, Song EY, Reboussin BA, Spangler J, Walker S, Ross JC, Wolfson M, Sutfin EL. Are Waterpipe Café, Vape Shop, and Traditional Tobacco Retailer Locations Associated with Community Composition and Young Adult Tobacco Use in North Carolina and Virginia? Subst Use Misuse 2020; 55:2395-2402. [PMID: 32969275 PMCID: PMC8073526 DOI: 10.1080/10826084.2020.1823417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We examined whether waterpipe café, vape shop, and traditional tobacco retailer (e.g. stores selling cigarettes, cigars, smokeless tobacco) locations were associated with census tract composition and tobacco use among young adults in North Carolina and Virginia. Methods: We identified waterpipe cafés, vape shops, and traditional tobacco retailers in North Carolina and Virginia and conducted multivariable analyses between community characteristics (gender, race, ethnicity, education, college enrollment, and poverty) and density per 1000 population. Using fall 2017 data from 1099 young adults residing in North Carolina and Virginia, we conducted logistic regression analyses to determine whether tobacco retailer density and proximity were associated with tobacco use. Results: Waterpipe café, vape shop, and traditional retailer density were higher in communities with more people who were Hispanic, college-educated, and college-enrolled (each p < .05). Waterpipe café and traditional retailer density were higher in communities with more people living below the poverty level (each p < .05). Waterpipe café density was higher in communities with more people who were male (p < .05), while traditional retailer density was lower (p < .05). Waterpipe café and vape shop proximity were associated with increased likelihood of waterpipe tobacco use in the past 6 months (each p < .05; unadjusted). Traditional retailer proximity and waterpipe café, vape shop, and traditional retailer density were not associated with tobacco use. Conclusions: Waterpipe cafés and vape shops are located in both impoverished and college-educated communities in North Carolina and Virginia, similar to where traditional tobacco retailers are located. Further research is needed to examine associations with tobacco use.
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Affiliation(s)
- Jessica L. King
- Department of Health & Kinesiology, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Kimberly G. Wagoner
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Cynthia K. Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Eunyoung Y. Song
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - John Spangler
- Department of Family Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephannie Walker
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark Wolfson
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, California, USA
| | - Erin L. Sutfin
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Foley KL, Miller DP, Weaver K, Sutfin EL, Petty WJ, Bellinger C, Spangler J, Stone RJ, Lawler D, Davis W, Dressler E, Lesser G, Chiles C. The OaSiS trial: A hybrid type II, national cluster randomized trial to implement smoking cessation during CT screening for lung cancer. Contemp Clin Trials 2020; 91:105963. [PMID: 32087340 PMCID: PMC7378998 DOI: 10.1016/j.cct.2020.105963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION When the Centers for Medicare and Medicaid Services announced coverage for low dose CT lung cancer screening, they also mandated that imaging centers offer smoking cessation services. We designed the Optimizing Lung Screening (OaSiS) trial to evaluate strategies to implement the Public Health Service Guidelines for Treating Tobacco Use and Dependence during CT screening for lung cancer. METHODS AND DESIGN OaSiS was implemented using a pragmatic effectiveness-implementation hybrid design in 26 imaging clinics across the United States affiliated with the National Cancer Institute's National Community Oncology Research Program (NCORP). The 26 sites selected for participation in the OaSiS trial were randomized to receive either a compendium of implementation strategies to add or enhance smoking cessation services during lung screening or to usual care. Usual care sites were given the option to receive the full compendium of implementation strategies at the conclusion of data collection. We have evaluated both the effectiveness of the implementation strategies to improve smoking cessation at six months among patients undergoing LDCT screening as well as the adoption and sustainability of evidence-based tobacco cessation strategies in imaging clinics. DISCUSSION The OaSiS trial was designed to identify opportunities for implementing evidence-based smoking cessation into LDCT lung cancer screening imaging facilities and to establish the effectiveness of these services. We report our study design and evaluation, including strengths of the pragmatic design and the inclusion of a diverse range of screening programs. Establishing these tobacco cessation services will be critical to reducing smoking related morbidity and mortality.
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Affiliation(s)
- Kristie Long Foley
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America.
| | - David P Miller
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America; Internal Medicine, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Kathryn Weaver
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America; Social Sciences and Health Policy, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Erin L Sutfin
- Social Sciences and Health Policy, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - W Jeffrey Petty
- Hematology and Oncology, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Christina Bellinger
- Pulmonology and Critical Care, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - John Spangler
- Family and Community Medicine, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Rebecca J Stone
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Donna Lawler
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Whitney Davis
- Wake Forest School of Medicine, Department of Implementation Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Emily Dressler
- Biostatistics and Data Science, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Glenn Lesser
- Internal Medicine, Medical Center Blvd., Winston-Salem, NC 27157, United States of America; Hematology and Oncology, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
| | - Caroline Chiles
- Radiology, Medical Center Blvd., Winston-Salem, NC 27157, United States of America
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Wagoner KG, Song EY, King JL, Egan KL, Debinski B, Wolfson M, Spangler J, Sutfin EL. Availability and Placement of Electronic Nicotine Delivery Systems at the Point-of-Sale. Nicotine Tob Res 2018; 20:1020-1024. [PMID: 29059443 DOI: 10.1093/ntr/ntx207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/08/2017] [Indexed: 01/24/2023]
Abstract
Introduction Electronic nicotine delivery systems (ENDS) are widely available and come in a variety of forms, including disposable cigalikes and refillable tank systems. However, little is known about their placement at the point-of-sale. We explored the placement of various ENDS types among tobacco retailers. Methods Systematic assessments at the point-of-sale were completed by trained data collectors in 90 tobacco retailers, including grocery stores, convenience stores, and pharmacies in North Carolina, United States. Availability and placement of various ENDS types including cigalikes, e-hookahs, tank systems, and e-liquids was recorded. Results Almost all retailers (97.8%) sold cigalikes; 41.4% sold devices labeled as e-hookahs; 54.4% sold tank systems; and 56.2% sold e-liquids. Fewer than half of stores placed ENDS exclusively behind the counter; significant differences in ENDS placement were found by store type. Grocery stores carried cigalikes, tank systems, and e-liquids and placed them exclusively behind the counter. Pharmacies only sold cigalikes; most placed them exclusively behind the counter (91.7%) with cessation aids and other tobacco products. Convenience stores carried all ENDS types and placed them with other tobacco products (55.1%) and candy (17.4%). Only about one-third of convenience stores placed ENDS exclusively behind the counter. Conclusions This exploratory study shows ENDS availability and placement at the point-of-sale varies by retailer type. Pharmacies placed cigalikes with cessation aids behind the counter suggesting their ability to aid in smoking cessation. Most convenience stores placed ENDS in self-service locations, making them easily accessible to youth. Findings highlight the need for ENDS regulation at the point-of-sale. Implications Our study highlights the need for regulatory efforts aimed at ENDS placement at the point-of-sale. While pharmacies and grocery stores offered fewer ENDS types and typically placed them in clerk-assisted locations, all ENDS types were found at convenience stores, some of which were placed in youth-friendly locations. Regulatory efforts to control ENDS placement and limit youth exposure should be examined, such as requiring products be placed in clerk-assisted locations and banning ENDS placement next to candy.
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Affiliation(s)
- Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Eunyoung Y Song
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jessica L King
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kathleen L Egan
- Department of Epidemiology, University of Florida, Gainesville, FL
| | - Beata Debinski
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Mark Wolfson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
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Wagoner KG, Sutfin EL, Song EY, King JL, Egan KL, Reboussin B, Debinski B, Spangler J, Wolfson M. Trends in point-of-sale tobacco marketing around college campuses: Opportunities for enhanced tobacco control efforts. J Am Coll Health 2018; 66:145-154. [PMID: 29020532 PMCID: PMC5922252 DOI: 10.1080/07448481.2017.1389734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Colleges have implemented policies to limit tobacco use on-campus; however, the off-campus environment is often overlooked in tobacco control efforts. We assessed availability, marketing, and promotion of cigarettes, snus, and traditional smokeless tobacco (SLT) in a sample of communities surrounding 11 college campuses in North Carolina and Virginia. PARTICIPANTS Between January-March of 2011, 2012 and 2013, 481 tobacco-selling retailers, including convenience stores, pharmacies and supermarkets, located near campuses were assessed. METHODS Trained observers completed annual point-of-sale assessments. RESULTS The percentage of stores selling (81.4% to 58.6%; p < .0001) and advertising snus (80.1% to 53.11%; p < .0001) significantly decreased over time. Convenience stores increased promotions of cigarettes (65.4% to 72.8%; p = 0.04) and SLT (3.1% to 23.3%; p = 0.02). CONCLUSIONS Off-campus environments have abundant tobacco availability and marketing. Colleges should collaborate with state and local tobacco control advocates to address tobacco promotion near campuses to potentially decrease product appeal and access among young adults.
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Affiliation(s)
- Kimberly G. Wagoner
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Erin L. Sutfin
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Eunyoung Y. Song
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Jessica L. King
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Kathleen L. Egan
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, Florida 32610, USA
| | - Beth Reboussin
- Wake Forest School of Medicine, Department of Biostatistical Sciences, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Beata Debinski
- Johns Hopkins University Bloomberg School of Public Health, Department of Health, Behavior and Society, 615 N. Wolfe St # E4527, Baltimore, MD 21205, USA
| | - John Spangler
- Wake Forest School of Medicine, Department of Family Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Mark Wolfson
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
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Suerken CK, Reboussin BA, Egan KL, Sutfin EL, Wagoner KG, Spangler J, Wolfson M. Marijuana use trajectories and academic outcomes among college students. Drug Alcohol Depend 2016; 162:137-45. [PMID: 27020322 PMCID: PMC4835174 DOI: 10.1016/j.drugalcdep.2016.02.041] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/26/2016] [Accepted: 02/28/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Marijuana is the most commonly used illicit drug by college students. Prior studies have established an association between marijuana use and poor academic performance in college, but research on the frequency of marijuana use over the entire college career is limited. The study objective was to examine the association of marijuana use trajectories on academic outcomes, including senior year enrollment, plans to graduate on time, and GPA. METHODS Data were collected from a cohort of 3146 students from 11 colleges in North Carolina and Virginia at six time points across the college career. Group-based trajectory models were used to characterize longitudinal marijuana use patterns during college. Associations between marijuana trajectory groups and academic outcomes were modeled using random-effects linear and logistic regressions. RESULTS Five marijuana trajectory groups were identified: non-users (69.0%), infrequent users (16.6%), decreasing users (4.7%), increasing users (5.8%), and frequent users (3.9%). Decreasing users and frequent users were more likely to drop out of college and plan to delay graduation when compared to non-users. All marijuana user groups reported lower GPAs, on average, than non-users. CONCLUSION These results identify marijuana use patterns that put students at risk for poor academic performance in college. Students who use marijuana frequently at the beginning of the college career are especially at risk for lower academic achievement than non-users, suggesting that early intervention is critical.
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Affiliation(s)
- Cynthia K Suerken
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States; Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - Kathleen L Egan
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - Mark Wolfson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
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Abstract
BACKGROUND The incidence of venous thromboembolism (VTE) is increasing among pediatric patients in the United States. Previous studies on obesity as a risk factor have produced mixed results. METHODS We completed a retrospective chart review of patients aged 2 to 18 years with VTE identified by using International Classification of Diseases, Ninth Revision, codes and confirmed by imaging. Patients were admitted between January 2000 and September 2012. Control subjects were matched on age, gender, and the presence of a central venous catheter. Data were collected on weight, height, and risk factors, including bacteremia, ICU admission, immobilization, use of oral contraceptives, and malignancy. Underweight patients and those without documented height and weight data were excluded. Independent predictors of VTE risk were identified by using univariate and multivariate analyses. RESULTS We identified 88 patients plus 2 matched control subjects per case. The majority of cases were nonembolic events (77%) of the lower extremity (25%) or head and neck (22%) confirmed by ultrasound (43%) or computed tomography scan (41%). A statistically significant association was found between VTE and increased BMI z score (P = .002). In multivariate analysis, BMI z score (odds ratio [OR]: 3.1; P = .007), bacteremia (OR: 4.9; P = .02), ICU stay (OR: 2.5; P = .02), and use of oral contraceptives (OR: 17.4; P < .001) were significant predictors. CONCLUSIONS In this single-institution study, the diagnosis of VTE was significantly associated with overweight and obesity. Further study is needed to fully define this association.
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Affiliation(s)
| | | | | | - Joseph A Skelton
- Departments of Pediatrics, Brenner FIT (Families in Training), Brenner Children's Hospital, Winston-Salem, North Carolina Epidemiology and Prevention, Division of Public Health Sciences, and
| | - Stephen Davis
- Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - John Spangler
- Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
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Biener L, Song E, Sutfin EL, Spangler J, Wolfson M. Electronic Cigarette Trial and Use among Young Adults: Reasons for Trial and Cessation of Vaping. Int J Environ Res Public Health 2015; 12:16019-26. [PMID: 26694438 PMCID: PMC4690975 DOI: 10.3390/ijerph121215039] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/30/2015] [Accepted: 12/10/2015] [Indexed: 11/29/2022]
Abstract
This paper identifies predictors of trial and current use, and reasons for trying and ceasing use of electronic cigarettes (e-cigarettes) among young adults, with particular attention to former and never smokers. Data are from a mail survey of a population-based sample of adults aged 18 to 35 (N = 4740) in three U.S. metropolitan areas. Survey items assessed trial and use of e-cigarettes, cigarette smoking status, and reasons for trial and for ceasing use of e-cigarettes. Almost 23% reported trial of e-cigarettes, and 8.4% reported using them in the past month. Current smokers were much more likely to have tried e-cigarettes (70.2%) than both former (32.3%) and never smokers (7.6%; p < 0.001) and to have used them in the past month (30.8%, 10.1%, 2.0% respectively; p < 0.001). Smoking status and scores on sensation seeking were significant independent predictors of both trial and current use of e-cigarettes. Never-smokers cite curiosity as the reason for trying e-cigarettes and also that their friends used them. The most frequent reason for ceasing use among never and former smokers was health concerns. For virtually none of them were e-cigarettes their first exposure to nicotine.
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Affiliation(s)
- Lois Biener
- Center for Survey Research, University of Massachusetts Boston, Boston, MA 02125, USA.
| | - Eunyoung Song
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Mark Wolfson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Sutfin EL, Sparks A, Pockey JR, Suerken CK, Reboussin BA, Wagoner KG, Spangler J, Wolfson M. First tobacco product tried: associations with smoking status and demographics among college students. Addict Behav 2015; 51:152-7. [PMID: 26265038 DOI: 10.1016/j.addbeh.2015.07.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 07/17/2015] [Accepted: 07/23/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION As the tobacco market expands, so too have the opportunities for youth to be introduced to nicotine. The goal of this study was to identify product choice for initial tobacco trial, correlates associated with product choice, and the relationship between first product and current cigarette smoking among college students. METHODS A cross-sectional web survey of 3146 first-year students at 11 universities in North Carolina and Virginia was conducted in fall 2010. RESULTS Weighted prevalence of ever use of tobacco was 48.6%. Cigarettes were the most common first product (37.9%), followed by cigars (29.3%), hookahs (24.6%), smokeless tobacco (6.1%), and bidis/kreteks (2.2%). Two thirds (65%) of current smokers initiated with cigarettes, but 16.4% started with cigars, 11.1% with hookahs, 5.7% with smokeless, and 1.7% with bidis/kreteks. Females were more likely to report their first product was cigarettes and hookahs, while males were more likely to start with cigars and smokeless tobacco. Compared to those whose first product trial occurred after the age of 18, younger age of initiation (17years or younger) was associated with cigarettes and smokeless as first products, while older age of initiation (18 or older) was associated with starting with hookahs and cigars. Dual or poly tobacco use was more common among those who initiated with hookahs and smokeless tobacco. CONCLUSIONS While over a third of students used cigarettes first, two thirds started with a non-cigarette product. Just about a third of current cigarette smokers initiated with a non-cigarette product, suggesting that those non-cigarette products may have facilitated escalation to cigarettes.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, USA.
| | - Alicia Sparks
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, and Abt Associates, Inc., Baltimore, MD, USA
| | | | - Cynthia K Suerken
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, USA
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, USA
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, USA
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, USA
| | - Mark Wolfson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, USA
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Wolfson M, Suerken CK, Egan KL, Sutfin EL, Reboussin BA, Wagoner KG, Spangler J. The role of smokeless tobacco use in smoking persistence among male college students. Am J Drug Alcohol Abuse 2015; 41:541-6. [PMID: 26375618 DOI: 10.3109/00952990.2015.1078345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Significant changes in the tobacco industry have led to heightened concern about co-use of cigarettes and smokeless tobacco (SLT) products. OBJECTIVES The aim of this study was to assess whether male cigarette smokers who also used SLT products, in the first semester of their first year of college, were more or less likely than male cigarette smokers who did not use SLT products to still be smoking by the first semester of their senior year. METHODS Using a longitudinal, observational study, we followed a cohort of undergraduate students from 11 four-year universities in North Carolina and Virginia through their college career. Mixed-effects logistic regression analysis was conducted to estimate the likelihood of being a current smoker fall of senior year for male students who used both cigarettes and SLT at baseline, compared to those who only smoked cigarettes, after adjustment for potential confounders (n = 274). RESULTS At baseline, 67.2% of participants were smoking cigarettes only (no SLT use) and 32.8% were dual users (cigarettes and SLT). A total of 62% were still smoking at senior year. Dual users were 30% more likely to be current smokers senior year compared to cigarette only users, although this difference was not statistically significant. Having at least one friend who smoked cigarettes and heavier cigarette smoking at baseline were significantly related to senior year smoking. CONCLUSIONS Our findings do not support the argument that SLT use may help male college smokers discontinue their smoking habit. In fact, it may contribute to smoking persistence.
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Affiliation(s)
- Mark Wolfson
- a Department of Social Sciences and Health Policy
| | | | | | | | | | | | - John Spangler
- c Department of Family and Community Medicine , Wake Forest School of Medicine , Winston-Salem, North Carolina , USA
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Sutfin EL, Reboussin BA, Debinski B, Wagoner KG, Spangler J, Wolfson M. The Impact of Trying Electronic Cigarettes on Cigarette Smoking by College Students: A Prospective Analysis. Am J Public Health 2015; 105:e83-9. [PMID: 26066954 DOI: 10.2105/ajph.2015.302707] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the impact of trying electronic cigarettes (e-cigarettes) on future cigarette smoking in a sample of smokers enrolled in college. METHODS In this longitudinal study, first-semester college students at 7 colleges in North Carolina and 4 in Virginia completed a baseline survey and 5 follow-up surveys between fall 2010 and fall 2013. Current cigarette smoking at wave 6 was the primary outcome. Participants (n = 271) reported current cigarette smoking at baseline and no history of e-cigarette use. We measured trying e-cigarettes at each wave, defined as use in the past 6 months. RESULTS By wave 5, 43.5% had tried e-cigarettes. Even after controlling for other variables associated with cigarette smoking, trying e-cigarettes was a significant predictor of cigarette smoking at wave 6 (adjusted odds ratio [AOR] = 2.48; 95% confidence interval [CI] = 1.32, 4.66), as were friends' cigarette smoking (AOR = 4.20; 95% CI = 2.22, 7.96) and lifetime use of other tobacco products (AOR = 1.63; 95% CI = 1.22, 2.17). CONCLUSIONS Trying e-cigarettes during college did not deter cigarette smoking and may have contributed to continued smoking.
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Affiliation(s)
- Erin L Sutfin
- Erin L. Sutfin, Beata Debinski, Kimberly G. Wagoner, and Mark Wolfson are with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC. Beth A. Reboussin is with the Department of Biostatistical Sciences, Wake Forest School of Medicine. John Spangler is with the Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Beth A Reboussin
- Erin L. Sutfin, Beata Debinski, Kimberly G. Wagoner, and Mark Wolfson are with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC. Beth A. Reboussin is with the Department of Biostatistical Sciences, Wake Forest School of Medicine. John Spangler is with the Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Beata Debinski
- Erin L. Sutfin, Beata Debinski, Kimberly G. Wagoner, and Mark Wolfson are with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC. Beth A. Reboussin is with the Department of Biostatistical Sciences, Wake Forest School of Medicine. John Spangler is with the Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Kimberly G Wagoner
- Erin L. Sutfin, Beata Debinski, Kimberly G. Wagoner, and Mark Wolfson are with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC. Beth A. Reboussin is with the Department of Biostatistical Sciences, Wake Forest School of Medicine. John Spangler is with the Department of Family and Community Medicine, Wake Forest School of Medicine
| | - John Spangler
- Erin L. Sutfin, Beata Debinski, Kimberly G. Wagoner, and Mark Wolfson are with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC. Beth A. Reboussin is with the Department of Biostatistical Sciences, Wake Forest School of Medicine. John Spangler is with the Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Mark Wolfson
- Erin L. Sutfin, Beata Debinski, Kimberly G. Wagoner, and Mark Wolfson are with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC. Beth A. Reboussin is with the Department of Biostatistical Sciences, Wake Forest School of Medicine. John Spangler is with the Department of Family and Community Medicine, Wake Forest School of Medicine
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Egan KL, Suerken CK, Reboussin BA, Spangler J, Wagoner KG, Sutfin EL, Debinski B, Wolfson M. K2 and Spice use among a cohort of college students in southeast region of the USA. Am J Drug Alcohol Abuse 2015; 41:317-22. [PMID: 26030768 DOI: 10.3109/00952990.2015.1043438] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND K2 and Spice consist of an herbal blend of plant matter and chemical synthetic cannabinoids. These substances emerged in the early 2000s as a popular alternative to marijuana among youth and young adults. OBJECTIVES This study sought to identify rates and correlates of K2 and Spice at college entry and first use during college. METHODS In Fall 2010, 3146 students at 11 colleges in North Carolina and Virginia were recruited to participate in a longitudinal cohort survey. The cohort was invited to participate in a total of six surveys over their college career. Random-effects logistic regression models were used to identify factors associated with lifetime K2 and Spice use at college entry and first use during college, adjusting for clustering within schools and sample weights. RESULTS Weighted lifetime prevalence of K2 and Spice use at college entry was 7.6%. An additional 6.6% of students reported first use during college. By the cohort's fourth year, 17.0% reported lifetime K2 and Spice use. While lifetime prevalence increased, past 6-month prevalence decreased substantially over time. K2 and Spice use at college entry was associated with sensation seeking; hookah, marijuana, and illicit drug use; and low religiosity. First use during college was associated with having a father with less than a four-year degree; alcohol and hookah use. CONCLUSION Universities should ensure that prevention efforts address current substance use, including K2/Spice, and that treatment options are available for first year students who use substances.
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Spangler J, Weaver KE, Case D, Lesser G, Burton GV, Dy IA, Dul C, Reddy P, Wade JL, Esparaz B, Shaw EG. Feasibility of using memantine in smoking cessation among cancer survivors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- John Spangler
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | - Doug Case
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Glenn Lesser
- Wake Forest University, School of Medicine, Winston-Salem, NC
| | | | | | - Carrie Dul
- Great Lakes Cancer Management Specialists, Grosse Point Woods, MI
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McNamara RS, Song EY, Reboussin BA, Spangler J, Pockey JR, Kimes C, Foley KL, Sutfin EL. Motivational interviewing intervention with college student tobacco users: providers' beliefs and behaviors. J Am Coll Health 2015; 63:286-290. [PMID: 25580630 PMCID: PMC4428958 DOI: 10.1080/07448481.2014.1003376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study assessed college student health providers' use of Motivational Interviewing (MI) with tobacco users, as well as their beliefs about the use of brief interventions to help college student tobacco users quit. MI is recommended by the United States Public Health Service to increase tobacco users' willingness to quit. PARTICIPANTS Participants included 83 clinicians from health clinics at 7 different universities in North Carolina. METHODS Paper-and-pencil baseline survey from a cluster randomized trial of college student health clinicians. RESULTS Twenty-two percent of respondents reported always or usually using MI during the past month for tobacco-using patients not ready to make a quit attempt. Student health providers also reported information with regards to their beliefs about tobacco cessation treatment, barriers to intervening with patients, and confidence in motivating students to consider quitting. CONCLUSIONS Results highlight the need to encourage clinicians' use of motivationally focused interventions with student tobacco users. [Table: see text].
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Affiliation(s)
- Robert S. McNamara
- Counseling Center, Wake Forest University, Winston-Salem, North Carolina
- Counseling Center, University of North Carolina Wilmington, Wilmington, North Carolina (current)
| | - Eun-Young Song
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Beth A. Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Caroline Kimes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristie L. Foley
- Medical Humanities Program, Davidson College, Davidson, North Carolina
| | - Erin L. Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Affiliation(s)
- John Spangler
- Professor of family and community medicine and professor of psychiatry and behavioral medicine, Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina;
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Spangler J, Song E, Pockey J, Sutfin EL, Reboussin BA, Wagoner K, Wolfson M. Correlates of smokeless tobacco use among first year college students. Health Educ J 2014; 73:693-701. [PMID: 25484378 PMCID: PMC4256530 DOI: 10.1177/0017896913513746] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Smokeless tobacco (SLT) use is associated with specific adverse health effects. Knowledge of student tobacco use, including SLT, may guide inquiry into other risky health behaviors, and provide opportunities for health education of students. DESIGN An incentivized email invitation to complete a web-based survey was sent to students at 11 colleges and universities in North Carolina and Virginia. METHODS In autumn 2010, emails were sent to all first-year students (n=29,536) at 11 colleges and universities in North Carolina and Virginia, inviting them to participate in a brief web-based survey to be used to establish a cohort for the parent study evaluating tobacco use over 4 years. Survey items elicited demographic characteristics, tobacco use and other health behaviors. RESULTS A total of 10,520 (36%) students responded. Past 30 day smoking and SLT use were 12% and 3%, respectively. Logistic regression analysis revealed that male gender (Adjusted Odds Ratio [AOR] = 11.6, 95% Confidence Interval [CI] = 8.16-16.59); current smoking (AOR = 5.5, 95% CI = 4.21-7.10), ever use of alcoholic energy drinks (AOR = 4.8, 95% CI = 3.63-6.43), and ≥ 5 days vs. < 3 days of physical activity a week (AOR = 1.5, 95% CI = 1.07-2.01) predicted risk of past 30 day SLT use. CONCLUSION While SLT use is relatively uncommon, knowledge of significant correlations between student tobacco use, including SLT and other risky health behaviors, might guide clinicians' inquiry and provide opportunities for health education of students.
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Affiliation(s)
- John Spangler
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Eunyoung Song
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | | | - Erin L Sutfin
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | | | | | - Mark Wolfson
- Wake Forest School of Medicine, Winston Salem, NC, USA
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Wagoner KG, Song EY, Egan KL, Sutfin EL, Reboussin BA, Spangler J, Wolfson M. E-cigarette availability and promotion among retail outlets near college campuses in two southeastern states. Nicotine Tob Res 2014; 16:1150-5. [PMID: 24847099 DOI: 10.1093/ntr/ntu081] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION E-cigarettes are relatively new products that simulate the smoking experience. This descriptive study assessed changes in e-cigarette availability and promotions among retailers in 11 college communities in North Carolina and Virginia during a 1-year period. METHODS During the spring of 2012 and 2013, observers completed assessments in 320 tobacco-selling retailers, including grocery and convenience stores, pharmacies, and tobacco shops. Assessors collected e-cigarette availability, advertising, price, and promotions. RESULTS E-cigarette availability increased among retailers from 24.7% in 2012 to 59.9% in 2013. They were available in the form of disposables and reusable kits and were most frequently available in tobacco shops, convenience stores, and pharmacies. The average price for disposables was $9.70 (SD = 1.07) in 2012 and $9.61 (SD = 2.10) in 2013; the average price for kits was $39.58 (SD = 15.79) in 2012 and $32.59 (SD = 18.65) in 2013. The presence of interior advertising increased from 12.7% to 50.6% (p < .0001), and the presence of exterior advertising increased from 7.6% to 22.8% (p = .0002). Convenience stores with gas (16.4%-70.4%; p < .0001) and without gas (6.0%-48.4%; p < .0001) had significant increases in the presence of interior advertising. Convenience stores with gas also had a significant increase in the presence of exterior advertising (8.2%-33.3%; p < .0001). Only 3% of retailers offered price promotions. CONCLUSIONS Availability of e-cigarettes, including rechargeable kits and disposables, more than doubled during the study. The presence of interior and exterior advertising also significantly increased. Results underscore the need for further surveillance to understand how these environmental characteristics impact individual exposure and use of e-cigarettes.
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Affiliation(s)
- Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC;
| | - Eunyoung Y Song
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kathleen L Egan
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mark Wolfson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
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Csákányi Z, Spangler J, Katona G. Tobacco intervention teachable moments for pediatric otolaryngologists: atopy and second hand smoke exposure among children. Int J Pediatr Otorhinolaryngol 2014; 78:407-9. [PMID: 24485173 PMCID: PMC4086153 DOI: 10.1016/j.ijporl.2013.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/31/2013] [Accepted: 11/09/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Pediatric otolaryngology clinics have tremendous access to children with allergic conditions, yet no research has evaluated in this setting environmental tobacco smoke and the occurrence of atopic diseases. METHODS Caregivers or parents of 201 consecutive patients in a Hungarian pediatric otolaryngology clinic were queried on otolaryngologic conditions; self-reported diagnoses of atopic diseases; and tobacco smoke exposure. RESULTS A history of asthma was reported in 10.3% of children; 38.7% had at least one parent who smoked. Fifteen out of the 20 children with asthma (75.0%) had at least one parent who smoked. Having a diagnosis of hay fever and having a parent who smoked greatly increased the odds of having a diagnosis of asthma. CONCLUSIONS Second hand smoke exposure among children in an otolaryngology clinic was common, and was associated with co-existing atopic conditions. Pediatric otolaryngologists have an important opportunity to address parental smoking as part their care of children.
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Affiliation(s)
- Zsuzsanna Csákányi
- Department of Otorhinolaryngology, Heim Pal Children's Hospital, 13 Delej utca, H-1089 Budapest, Hungary
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | - Gábor Katona
- Department of Otorhinolaryngology, Heim Pal Children's Hospital, 13 Delej utca, H-1089 Budapest, Hungary
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Spangler J, Csákányi Z, Rogers T, Katona G. Parental ease in asking others not to smoke and respiratory symptoms and illness among children. Int J Environ Res Public Health 2014; 11:1747-55. [PMID: 24503972 PMCID: PMC3945565 DOI: 10.3390/ijerph110201747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/24/2014] [Accepted: 01/26/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Childhood exposure to secondhand tobacco smoke (SHS) increases a child's burden of respiratory conditions, but parental smoking bans may reduce such morbidity. This study evaluated household smoking bans and their relationship to respiratory illness in an outpatient otolaryngology clinic. METHODS The study was performed at the Heim Pal National Children's Hospital, Ear, Nose and Throat (ENT) Department (Budapest, Hungary) from July to November, 2010. A consecutive series of children's caregivers were approached to participate in a survey measuring household smoking bans, upper and lower respiratory tract symptoms and illnesses, and socioeconomic factors. Bivariate and multivariate logistic regression analyses were performed. RESULTS Of the 215 caregivers recruited for the study, 208 agreed to participate (response rate of 96.7%). More than half of the children were male (54%), and 39% lived in a household with at least one member who smoked. Smoking was frequently banned inside the car (91.3%) and home (85.1%). Respondents felt it easiest to ask friends (97.1%) and family members not living in the household (98.1%) to refrain from smoking inside the home. Respondents also found it easier to ask a stranger (81.7%) or a family member (61.1%) not to smoke around the child. Logistic regression showed that respondents for children with a history of pneumonia found it less difficult to ask visitors in the home not to smoke compared to children without pneumonia (OR = 0.23, 95% CI = 0.06-0.98). Conversely, respondents for children who had had adenoidectomy found it over three times more difficult to ask strangers not to smoke near the child compared to those of children without adenoidectomy (OR = 3.20, 95% CI = 1.43-6.38). CONCLUSIONS In a population of children visiting an outpatient ENT clinic in Budapest, Hungary, we found a high degree of exposure to SHS. The ease with which caregivers felt towards asking others not to smoke predicted specific respiratory conditions. Since the ENT clinic offers a wonderful opportunity for clinicians to counsel parents on tobacco cessation, increased tobacco education of these providers is needed.
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Affiliation(s)
- John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA.
| | - Zsuzsanna Csákányi
- Department of Otorhinolaryngology, Heim Pal Children's Hospital, ENT Department Üllói út 86. H-1089 Budapest, Hungary.
| | - Todd Rogers
- RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, USA.
| | - Gábor Katona
- Department of Otorhinolaryngology, Heim Pal Children's Hospital, ENT Department Üllói út 86. H-1089 Budapest, Hungary.
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Antal M, Forster A, Zalai Z, Barabas K, Spangler J, Braunitzer G, Nagy K. A video feedback-based tobacco cessation counselling course for undergraduates-preliminary results. Eur J Dent Educ 2013; 17:e166-e172. [PMID: 23279406 PMCID: PMC4465381 DOI: 10.1111/j.1600-0579.2012.00776.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Hungary has one of the highest rates of tobacco use and decayed, missing and filled teeth in Europe, and the number of lung cancer-related deaths per annum is amongst the highest globally. As it is estimated that the rate of smokers who see their dentist or physician annually is about 70%, to involve all healthcare providers in tobacco intervention seems to be a promising strategy to reduce tobacco use in countries like Hungary. Such an intervention should obviously include the dental health team. It has already been suggested by experts on this topic that instruction in tobacco use prevention and cessation counselling for dental professionals and students of dentistry should be included in under- and postgraduate curricula. OBJECTIVES To present a novel, video feedback-based undergraduate cessation counselling programme, which has recently been introduced to the dental curriculum at the Faculty of Dentistry, Szeged, Hungary. METHODS Applying a problem-based learning approach, the programme consists of three main activities: a small-group interactive training session led by a faculty member, where students learn about the basic science and clinical aspects of tobacco use, including counselling skills; student interactions with professional actors (i.e. standardised patients) simulating real-life dental situations, which are recorded for post hoc evaluation; and finally an evaluation of the recorded performance of each student, with the participation of the actor, the student and a faculty member. RESULTS With the help of this new approach, students had the chance to learn about and develop a deeper understanding of tobacco-related professional dental communication in realistic, case-based dental scenarios. Students have reported increased confidence in tobacco counselling after having participated in this programme. Furthermore, this method appears to be an ideal tool for the evaluation of both verbal and non-verbal tobacco counselling skills. CONCLUSION To our knowledge, we are the first to have applied video feedback combined with behavioural modification methods in the teaching of tobacco cessation counselling. We conclude that teaching method can help dentists better understand smokers, gain confidence in tobacco cessation counselling and become more effective promoters of a smoke-free lifestyle. In addition, this method can be easily adapted to other healthcare educational settings, including other oral health training programmes.
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Affiliation(s)
- M Antal
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary.
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Ip EH, Marshall S, Vitolins M, Crandall SJ, Davis S, Miller D, Kronner D, Vaden K, Spangler J. Measuring medical student attitudes and beliefs regarding patients who are obese. Acad Med 2013; 88:282-9. [PMID: 23269296 PMCID: PMC3826984 DOI: 10.1097/acm.0b013e31827c028d] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Research shows obesity bias to undermine the patient-doctor relationship and lead to substandard care. The authors developed and tested an instrument to measure medical students' attitudes and beliefs about obese patients. METHOD The authors conducted a literature search to identify validated measures of obesity bias. Because they identified no appropriate scale, they decided to design a novel survey instrument: the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale. An expert panel generated items which focus groups of third-year medical students then discussed. Next, experienced medical educators judged and weighted the remaining revised items. Then, second- and fourth-year medical students completed the scale alongside two previously validated measures of obesity bias, the Anti-Fat Attitudes Questionnaire (AFA) and Beliefs About Obese Persons Scale (BAOP). Third-year students completed the NEW Attitudes Scale before and after a simulated encounter with an obese standardized patient instructor. The authors tested the validity and reliability. RESULTS The final instrument comprised 31 items. A sample of 201 judges rated the items. A sample of 111 second- and fourth-year medical students completed the survey (mean score 24.4, range -37 to 76 out of a possible -118 to 118; higher scores indicate more positive attitudes). Pearson correlations between the NEW Attitudes Scale and AFA and BAOP were, respectively, -0.47 and 0.23. Test-retest reliability was 0.89. Students scored 27% higher after completing the standardized patient-instructor encounter (P < .001). CONCLUSION The NEW Attitudes Scale has good validity and reliability and may be used in future studies.
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Affiliation(s)
- Edward H Ip
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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Weaver KE, Danhauer SC, Tooze JA, Blackstock AW, Spangler J, Thomas L, Sutfin EL. Smoking cessation counseling beliefs and behaviors of outpatient oncology providers. Oncologist 2012; 17:455-62. [PMID: 22334454 DOI: 10.1634/theoncologist.2011-0350] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Many cancer patients continue to smoke after diagnosis, increasing their risk for treatment complications, reduced treatment efficacy, secondary cancers, and reduced survival. Outpatient oncology providers may not be using the "teachable moment" of cancer diagnosis to provide smoking cessation assistance. PROVIDERS AND METHODS: Physicians and midlevel providers (n = 74) who provide outpatient oncology services completed an online survey regarding smoking cessation counseling behaviors, beliefs, and perceived barriers. Outpatient medical records for 120 breast, lung, head and neck, colon, prostate, and acute leukemia cancer patients were reviewed to assess current smoking cessation assessment and intervention documentation practices. RESULTS Providers reported commonly assessing smoking in new patients (82.4% frequently or always), but rates declined at subsequent visits for both current smokers and recent quitters. Rates of advising patients to quit smoking were also high (86.5% frequently or always), but <30% of providers reported frequently or always providing intervention to smoking patients (e.g., nicotine replacement therapy or other medications, self-help materials, and/or referrals). Only 30% of providers reported that they frequently or always followed up with patients to assess progress with quitting. Few providers (18.1%) reported high levels of confidence in their ability to counsel smoking patients. Patients' lack of motivation was identified as the most important barrier to smoking cessation. CONCLUSIONS Although beliefs about providing cessation services to smoking patients were generally positive, few providers reported commonly providing interventions beyond advice to quit. Additional training and clinic-based interventions may improve adherence to tobacco cessation practice guidelines in the outpatient oncology setting.
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Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Wells Fargo Building, 14th Floor, Winston-Salem, North Carolina 27157, USA.
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Sutfin EL, McCoy TP, Reboussin BA, Wagoner KG, Spangler J, Wolfson M. Prevalence and correlates of waterpipe tobacco smoking by college students in North Carolina. Drug Alcohol Depend 2011; 115:131-6. [PMID: 21353750 PMCID: PMC3089695 DOI: 10.1016/j.drugalcdep.2011.01.018] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 01/28/2011] [Accepted: 01/31/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Known most commonly in the U.S. as "hookah," waterpipe tobacco smoking appears to be growing among college students. Despite beliefs that waterpipe use is safer than cigarette smoking, research to date (albeit limited) has found health risks of waterpipe smoking are similar to those associated with cigarette smoking, including lung cancer, respiratory illness, and periodontal disease. The goals of this study were to estimate the prevalence of use among a large, multi-institution sample of college students and identify correlates of waterpipe use, including other health-risk behaviors (i.e., cigarette smoking, alcohol, marijuana, and other illicit drug use) and availability of commercial waterpipe tobacco smoking venues. METHODS A cross-sectional sample of 3770 college students from eight universities in North Carolina completed a web-based survey in fall 2008. RESULTS Forty percent of the sample reported ever having smoked tobacco from a waterpipe, and 17% reported current (past 30-day) waterpipe tobacco smoking. Correlates associated with current waterpipe use included demographic factors (male gender, freshman class); other health-risk behaviors (daily and nondaily cigarette smoking, alcohol use, marijuana use, other illicit drug use); perceiving waterpipe tobacco smoking as less harmful than regular cigarettes; and having a commercial waterpipe venue near campus. CONCLUSIONS The results highlight the popularity of waterpipe tobacco smoking among college students and underscore the need for more research to assess the public health implications of this growing trend.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States.
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Spangler J, Foley KL, Crandall S, Lane C, Walker K, MacRae M, Vaden K, Marion G. Implementing smokeless tobacco instruction into medical student education: addressing the gap. Teach Learn Med 2009; 21:33-37. [PMID: 19130384 PMCID: PMC4465384 DOI: 10.1080/10401330802573944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Despite the unique health and epidemiological aspects of smokeless tobacco use, medical education regarding this topic is virtually lacking. DESCRIPTION The purpose of this study is to develop a comprehensive tobacco curriculum that includes smokeless tobacco education. A thorough review of the literature was carried out to develop includes 8 modules in basic and clinical sciences that are evaluated by pretest/posttest increases in knowledge as well as standardized patient encounters and process evaluation. EVALUATION Pretest/posttest data indicate that students increased knowledge on specific smokeless tobacco questions. Students also scored well on interactions with standardized patients using the Tobacco Intervention Risk Factor Interview Scale, a validated instrument to assess medical students' tobacco counseling skills. Process evaluation data indicate that modules were generally well received. CONCLUSIONS This Web-based, comprehensive curriculum-the only curriculum we are aware of treating the topic of smokeless tobacco use-appears to be effective and well received. Smokeless tobacco should be included in medical education.
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Affiliation(s)
- John Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Abstract
BACKGROUND Mammography screening for asymptomatic older women has been shown to be effective in reducing breast cancer mortality. Physicians and patients report pain as a major barrier for many women in the screening process; however, few studies report both the degree and type of pain women experience during the screening. METHODS Two hundred women 40 years and older were interviewed immediately following screening mammography. They were questioned about the pain they experienced, the difference between their experience and their expectations, and the most stressful part of the entire procedure. RESULTS Seventy-two percent of the women reported the pain to rank 4 or less on a scale of 0 to 10 (mean +/- SD score, 2.95 +/- 2.09). The highest level of pain reported resulted from the compression of the breasts (3.25 +/- 2.43). Ninety-six percent reported that the pain was "less than" or "about as expected." Most (94%) said they were "very likely or somewhat likely to get a mammogram next year." The most stressful part of the procedure was waiting for the results, according to 39% of the women. CONCLUSIONS The relatively low level of pain reported is useful information for both patients and practitioners. Adherence to screening recommendations is more likely to occur when both parties are able to anticipate the most painful and stressful elements of mammography.
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Affiliation(s)
- Penny C Sharp
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Margull U, Spangler J, Prettl W. Intermittent breakdown of current-oscillation tori in n-type GaAs epitaxial layers. Phys Rev B Condens Matter 1994; 50:14166-14170. [PMID: 9975636 DOI: 10.1103/physrevb.50.14166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Spangler J, Margull U, Prettl W. Regular and chaotic current oscillations in n-type GaAs in transverse and longitudinal magnetic fields. Phys Rev B Condens Matter 1992; 45:12137-12140. [PMID: 10001244 DOI: 10.1103/physrevb.45.12137] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Cain J, Hood-Barnes J, Spangler J. Myelodysplastic syndromes: a review for nurses. Oncol Nurs Forum 1991; 18:113-7. [PMID: 2003103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The Myelodysplastic Syndromes (MDS) are a group of hematologic disorders that resemble hematologic malignancies but are often treated much differently. These syndromes result from a clonal disorder of certain stem cells in the bone marrow. Treatment can range from simple supportive care to new and innovative approaches such as immunotherapy. In general, treatment is dictated by the severity of the presenting disease. Oncology nurses, because of their familiarity with the manifestations of cancer, are particularly qualified to intervene for the patient and family experiencing MDS. Nursing interventions, based on a firm understanding of the underlying disease, include patients and family education. In addition, emotional support and symptom management are important nursing roles.
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Hurlbutt FR, Spangler J. Tubal ligation and mini-laparotomy in an outpatient setting. Hawaii Med J 1983; 42:156-7. [PMID: 6629755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Fenters JD, Ehrlich R, Findley J, Spangler J, Tolkacz V. Serologic response in squirrel monkeys exposed to nitrogen dioxide and influenza virus. Am Rev Respir Dis 1971; 104:448-51. [PMID: 4999754 DOI: 10.1164/arrd.1971.104.3.448] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Henry MC, Findlay J, Spangler J, Ehrlich R. Chronic toxicity of NO2 in squirrel monkeys. 3. Effect on resistance to bacterial and viral infection. Arch Environ Health 1970; 20:566-70. [PMID: 4985575 DOI: 10.1080/00039896.1970.10665663] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Henry MC, Spangler J, Findlay J, Ehrlich R. Effects of nitrogen dioxide and tobacco smoke on retention of inhaled bacteria. Inhaled Part 1970; 1:527-33. [PMID: 4950361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Spangler J. Technische Entwicklungstendenzen im chemischen Apparatebau Wie sie der Abnehmer sieht. CHEM-ING-TECH 1954. [DOI: 10.1002/cite.330260402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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