Efficacy and cost-effectiveness of a clinic-based counseling intervention tested in an ethnically diverse sample of pregnant smokers

OBJECTIVE

Rates of cigarette smoking are higher among women who receive obstetric care through publicly funded prenatal clinics. This study compared smoking outcomes for pregnant women (n=105) who were randomized to receive either usual care (standard cessation advice from the health care provider) or an intervention conducted in the prenatal clinic consisting of 1.5 h of counseling plus telephone follow-up delivered by a masters prepared mental health counselor.

METHODS

Subjects were 105 low income, predominantly Hispanic, pregnant patients in an urban prenatal clinic. Smoking outcomes were assessed at end of pregnancy and 6 months post-partum.

RESULTS

At follow-up, 28.3% and 9.4% of participants in the experimental intervention and 9.6% and 3.8% of patients in usual care were abstinent at end of pregnancy (p=.015) and 6 months post-partum, respectively (p=.251). Cost of the intervention was $56 per patient and cost to produce a non-smoker at end of pregnancy was $299.

CONCLUSIONS

This model for intervention was cost-effective and was associated with significantly lower smoking rates at end of pregnancy.

PRACTICAL IMPLICATIONS

If these findings are replicated, prenatal clinics could offer the option for intensive smoking cessation treatment by training mental health counselors to deliver one extended smoking cessation counseling session.

Ethnic variation in socioenvironmental factors that influence adolescent smoking

PURPOSE

To compare black, Hispanic and white adolescent smokers on socioenvironmental factors associated with smoking.

METHODS

The study uses a cross-sectional design. A needs assessment of 1305 current, former and never adolescent smokers from four ethnically and geographically diverse sites in the United States was conducted in 1999. Two sites were selected because they represented urban cities in the Northeast and Midwest with a high proportion of black and Hispanic residents. Two additional sites were selected to recruit rural and suburban adolescents. From this larger sample, 181 subjects from three focal ethnic groups (white n = 138; black n = 24; Hispanic n = 19) who had smoked at least 100 cigarettes in their lifetime and were current smokers (smoked in the past 30 days) were included. The three ethnic groups were compared on the following variables of interest: peer and family influences on smoking, situational factors associated with smoking, places that were likely sites for smoking and perceptions of friends and family as potential support persons for quitting smoking. All data were analyzed with Chi-square analysis.

RESULTS

Almost all (96%) of the black adolescents lived with another smoker compared to 68% of Hispanic and 60% of whites (p = .004). Black teens were more likely to smoke with family members (50%) than Hispanics (5%) or whites (25%) (p = .003). In addition, 50% of black teens compared to 5% of Hispanics and 12% of white teens, reported smoking to fit in (p < .0001). Black teens in this study emphasized the familial and social pressures of smoking. Higher rates of acceptance of smoking by family members, role modeling by household members, more prevalent beliefs that smoking is a way to achieve belonging, and lack of perceived support for quitting by friends appear to influence cigarette smoking more for black than white or Hispanic youth.

CONCLUSIONS

These preliminary results indicate that familial and household norms play a critical role in influencing cigarette smoking among black teens.

Biologic therapy for psoriasis: a brief history, II

This article, the second in a 2-part series, will review interleukin 10 (IL-10) administration, the T-cell receptor mimic peptide, and CTLA4Ig. We also will review 4 of the most promising therapies currently being investigated for the treatment of psoriasis: infliximab, etanercept, efalizumab, and alefacept.

Narrowband UVB phototherapy for the treatment of psoriasis: a review and update

An advance in UVB-based phototherapy has been the introduction of fluorescent lightbulbs (Philips TL-01) that deliver monochromatic light at 311-nm UVB, a narrowband wavelength that seems to maximize clearing of plaques relative to its erythrogenic potential. Narrowband UVB phototherapy has considerable advantages over traditional treatment options such as broadband UVB and psoralen plus UVA (PUVA). It is clearly more effective than broadband UVB, safer than PUVA, and well tolerated by patients when taken at suberythemogenic doses. Narrowband UVB represents an important new therapy for psoriasis.

Biologic therapy for psoriasis: a brief history, I

This article, the first in a 2-part series, reviews the treatment of psoriasis with biologic therapy. Although extensive research in this venue of treatment is currently being conducted, we review some of the pioneering clinical trials dealing with immunotherapy, including the use of peptide T, anti-CD4 antibody (OKTcdr4a and hIgG1-CD4), and anti-Tac. For each of these therapies, an extensive summation is given of the research, taking note of the investigators' procedural course, results, and side effects seen. Through the results of these studies, a foundation was laid for the further exploration of the use of biologic therapy to combat psoriasis.

A review of the 308-nm excimer laser in the treatment of psoriasis

The 308-nm excimer laser is a new modality for the treatment of psoriasis. With the 308-nm UVB radiation generated by this laser, it is possible to clear psoriasis with as little as one treatment and to have a moderately long remission. In contrast to traditional phototherapy techniques, this handheld excimer laser UVB therapy is selectively directed toward lesional skin, thus sparing the surrounding normal skin from unnecessary radiation exposure. This modality may offer a new alternative in the treatment of limited psoriasis and other inflammatory diseases.

Hypokalemia in a Patient with Pheochromocytoma

OBJECTIVE

To report the occurrence of hypokalemia in a patient with pheochromocytoma.

METHODS

We present a case report and discuss the possible role of hyperepinephrinemia as a cause of hypokalemia.

RESULTS

A patient with pheochromocytoma had hypokalemia associated with vomiting, but hypokalemia recurred after repletion of potassium and cessation of vomiting. She had substantially increased epinephrine concentrations in the plasma and in the subsequently excised pheochromocytoma. Because evidence has shown that infusions of epinephrine induce hypokalemia in normal human subjects, the relationship between serum potassium and plasma epinephrine concentrations in 16 previous patients with pheochromocytoma and 4 patients with primary hyperepinephrinemia was studied. A significant negative correlation was noted.

CONCLUSION

The presence of hypokalemia and its potential role in predisposing to arrhythmias in patients with pheochromocytoma merit further study.