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CORK Bibliography: Patient Education

66 citations. January 2009 to present

Prepared: September 2011

Allen B; Cruz TB; Leonard E; Unger JB. Development and validation of a scale to assess attitudes and beliefs about menthol cigarettes among African American smokers. Evaluation & the Health Professions 33(4): 414-436, 2010. (28 refs.)

To develop more effective smoking cessation interventions for the 70% of African American smokers who smoke menthol cigarettes, it is important to understand smokers' reasons for choosing menthols verses nonmenthols. This study conducted a focus group of African American smokers about their attitudes and beliefs about menthol cigarettes. These attitudes and beliefs, along with others from the literature, were included in a survey of 720 African American smokers in Los Angeles County, California. Five common factors emerged-Medicinal Effects, Image, Less Harmful, Tradition, and Taste/Sensation. Menthol smokers had significantly higher scores on the Taste/Sensation, Medicinal Effects, and Less Harmful scales than nonmenthol smokers did. Men were significantly more likely than women to endorse Medicinal Effects, Image, and Tradition, whereas women were significantly more likely to endorse Taste/Sensation. Education was inversely associated with endorsement of Medicinal Effects, Image, Less Harmful, and Tradition. Respondents aged 40 years or older had significantly higher scores on Medicinal Effects, Image, and Less Harmful, compared with younger respondents. Smoking cessation interventions for African American menthol smokers should address commonly held myths that menthols have medicinal effects and are less harmful than nonmenthols, especially among smokers who are older, male, and/or have low levels of education. The new measures presented in this article could be useful for tailoring cessation interventions to individual smokers' attitudes and beliefs about menthol cigarettes.

Amen DG. High resolution brain SPECT imaging in a clinical substance abuse practice. Journal of Psychoactive Drugs 42(2): 153-160, 2010. (26 refs.)

Brain SPECT imaging is a nuclear medicine study that uses isotopes bound to neurospecific pharmaceuticals to evaluate regional cerebral blood flow (rCBF) and indirectly metabolic activity. With current available technology and knowledge SPECT has the potential to add important clinical information to benefit patient care in many different areas of a substance abuse practice. This article explores the clinical controversies and limitations of brain SPECT, plus seven ways it has the potential to be immediately useful in clinical substance abuse practice, including: adding valuable information to the prevention, evaluation, and treatment of substance abusers; helping clinicians ask better questions; helping them in making more complete diagnoses and preventing mistakes; evaluating underlying brain system pathology in individual patients; decreasing stigma and increasing compliance; visualizing effectiveness via follow-up evaluations; and encouraging the exploration of innovative and alternative treatments

Azuri J; Peled S; Kitai E; Vinker S. Smoking prevention and primary physician's and patient's characteristics. American Journal of Health Behavior 33(6): 710-717, 2009. (24 refs.)

Objective: To describe relationships between primary physician and patient characteristics and the approach to prevention and quitting of smoking. Methods: A questionnaire composed of descriptions of cases and clinic activities was given to primary physicians. Results: Fewer smoking physicians use written materials, yet former smokers more often recommend smoking cessation groups. Greatest efforts are invested in high-risk patients. However, former smokers invest greater efforts among youth and pregnant women. Workload and patient's main complaint exert great influence on raising the subject. Conclusions: The various attitudes of physicians emphasize the importance of physician education that should be according to their smoking habits.

Bansal-Travers M; Cummings KM; Hyland A; Brown A; Celestino P. Educating smokers about their cigarettes and nicotine medications. Health Education Research 25(4): 678-686, 2010. (28 refs.)

The objective of this study was to test the efficacy of specially designed educational materials to correct misperceptions held by smokers about nicotine, nicotine medications, low tar cigarettes, filters and product ingredients. To accomplish this, 682 New York State Smokers' Quitline callers were randomized to one of two groups: control group received counseling, nicotine patches and quit smoking guide; and experimental group received counseling, nicotine patches, quit guide, plus information about cigarette characteristics mailed in a brand-tailored box. Participants were contacted 1 month later to assess knowledge about cigarettes and actions taken to alter smoking behavior. The results found that respondents in the experimental condition were more likely to report using and sharing the test materials with others compared with the control condition. Overall mean knowledge scores for the experimental group were slightly higher compared with those who received the standard materials. Knowledge of cigarette ingredients was not related to quit attempts or quitting smoking. This study found that the experimental materials were better recalled and contributed to higher levels of knowledge about specific cigarette design features; however, this did not translate into changes in smoking behavior.

Belenko S; Dugosh KL; Lynch K; Mericle AA; Pich M; Forman RF. Online illegal drug use information: An exploratory analysis of drug-related website viewing by adolescents. Journal of Health Communication 14(7): 612-630, 2009. (54 refs.)

Given the uncertain effects of antidrug media campaigns, and the ease of finding online illegal drug information, research is needed on the Internet role in disseminating drug information to youths. This exploratory study analyzes National Survey of Parents and Youth (NSPY) data on drug website viewing among 12-18 year olds (N=7,145). Approximately 10.4% reported drug-related website exposure: 5.4% viewed only websites that communicated how to avoid drugs or bad things about drugs (antidrug websites); 1.7% only viewed websites that communicated how to use drugs and good things about drugs (prodrug websites); and 3.2% viewed both types of websites. The low rates of viewing antidrug websites occurred despite efforts in the National Youth Antidrug Media Campaign (NYAMC) to encourage youths to visit such websites. Prodrug website viewers had used inhalants and been offered marijuana, perceived little risk in trying marijuana, intended to use marijuana, had close friends who used drugs, reported low parental monitoring, and had been exposed to antidrug media messages. Viewing antidrug websites was related to gender, income, likelihood of using marijuana in the next 12 months, having close friends who use drugs and talking to friends about avoiding drugs, parental monitoring, and drug prevention exposure. Prior prevention exposure increased drug website viewing overall, perhaps by increasing general curiosity about drugs. Because adolescents increasingly seek health information online, research is needed on how they use the Internet as a drug information source, the temporal relationships of prevention exposure and drug website viewing, and the effects of viewing prodrug websites on drug risk.

Bize R; Burnand B; Mueller Y; Walther MR; Cornuz J. Biomedical risk assessment as an aid for smoking cessation. (review). Cochrane Database of Systematic Reviews 2009(2): article CD004705, 2009. (80 refs.)

Background: A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e. g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. Objectives: To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. Search strategy: We systematically searched the Cochrane Collaboration Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials 2008 Issue 4, MEDLINE (1966 to January 2009), and EMBASE (1980 to January 2009). We combined methodological terms with terms related to smoking cessation counselling and biomedical measurements. Selection criteria: Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. Data collection and analysis: Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. Results were expressed as a relative risk (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate a pooled effect was estimated using a Mantel-Haenszel fixed effect method. Main results: We included eleven trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that CO measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other seven trials. One trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12; 95% CI 1.24 to 3.62). One trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77; 95% CI 1.04 to 7.41) but enrolled a population of light smokers. Five trials failed to detect evidence of a significant effect. One of these tested CO feedback alone and CO + genetic susceptibility as two different intervention; none of the three possible comparisons detected significant effects. Three others used a combination of CO and spirometry feedback in different settings, and one tested for a genetic marker. Authors' conclusions: There is little evidence about the effects of most types of biomedical tests for risk assessment. Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial. Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment. Only two pairs of studies were similar enough in term of recruitment, setting, and intervention to allow meta-analysis.

Black JH. Evidence base and strategies for successful smoking cessation. (review). Journal of Vascular Surgery 51(6): 1529-1537, 2010. (85 refs.)

The burden of tobacco dependence can be measured in premature deaths due to accelerated atherosclerotic disease and cancer, and economic costs of lost productivity and intensified medical care. Smoking cessation efforts have benefited from continued pharmacologic developments, increased public awareness of stop-smoking programs, aggressive counter-campaigns to illustrate the toll of cigarette smoking, and recognition of the many primary and secondary effects of smoking exposure on the general public. Vascular surgeons and interventionalists, as well as vascular medicine specialists, are uniquely positioned to engage and educate the patient to promote cessation, monitor for continued abstinence, and assist in efforts to avoid relapses. This article reviews the effects of tobacco dependence on peripheral arterial disease, perioperative considerations in smokers, as well as common clinical interventions such as counseling and pharmacotherapy to encourage tobacco cessation.

Bot M; Milder IEJ; Bemelmans WJE. Nationwide implementation of Hello World: A Dutch email-based Health Promotion Program for pregnant women. Journal of Medical Internet Research 11(3): e24, 2009. (33 refs.)

Background: In November 2006, an email-based health promotion program for pregnant women was implemented nationally in the Netherlands. The program consisted of emails containing quizzes with pregnancy-related questions tailored to the number of weeks of pregnancy. Emails were sent out once every 4 weeks, up to a maximum of nine emails. Objectives: The aims of the study were (1) to assess the recruitment of participants and their representativeness of the Dutch population and (2) to study differences in recruitment, program use, and program appreciation among women with different levels of education. Methods: Data from 13,946 pregnant women who enrolled during the first year of the program were included. Upon registration, participants were asked how they found out about the program and subsequently received an email questionnaire to assess demographic, lifestyle, and Internet characteristics. Program use was tracked, and participants were classified into five user groups (inactive to very active). Program appreciation (low, intermediate, and high) was assessed twice with an email questionnaire that was sent after the woman had received her third and sixth quiz email. Information about pregnant women and their characteristics was obtained from Dutch registries to assess representativeness of the study population. Results: About 8% of the pregnant women in the Netherlands enrolled in the program. Immigrants were underrepresented, and women with a low level of education seemed to be slightly underrepresented. Most women knew about the program from a promotional email sent by the organization (32%), followed by the Internet (22%) and midwives (16%). Women with little education were more often inactive users of the program than were highly educated women (15% vs 11%, P < .001), whereas highly educated women were more often very active users compared with women with little education (25% vs 20%, P < .001). However, women with less education were more likely than women with more education to have a high appreciation of the program after receiving three quiz emails (52% vs 44%, P = .001). Conclusions: In this real-life setting, pregnant women can be reached through ail email-based health promotion program. Selective engagement by education level remains a challenge. NB. Information about drinking during pregnancy is included.

Boyce N. Health warnings for people who use heroin. (editorial). Lancet 377(9761): problem ?e-article CD001006, 2011. (0 refs.)

Brooks AC; Ryder D; Carise D; Kirby KC. Feasibility and effectiveness of computer-based therapy in community treatment. Journal of Substance Abuse Treatment 39(3): 227-235, 2010. (29 refs.)

Computerized therapy approaches may expand the reach of evidence-based treatment; however, it is unclear how to integrate these therapies into community-based treatment. We conducted a two-phase pilot study to explore (a) whether clients' use of the Therapeutic Education System (TES), a Web-based community reinforcement approach (CRA) learning program, would benefit them in the absence of counselor support and (b) whether counselors and clients would use the TES in the absence of tangible research-based reinforcement. In Phase 1, clients in the TES condition (n = 14) demonstrated large improvements in knowledge, F(1, 20) = 8.90, p = .007, d = 1.05, and were significantly more likely to select CRA style coping responses, F(1, 20) = 11.95, p = .002, d = 1.16, relative to the treatment-as-usual group (n = 14). We also detected small, nonsignificant, between-group effects indicating TES decreased cocaine use during treatment. In Phase 2, counselors referred only around 10% of their caseload to the TES, and the modal number of completed modules in the absence of tangible reinforcement was three. Computer-based therapy approaches are viable in community-based treatment but must be integrated with incentive systems to ensure engagement.

Caban-Martinez AJ; Davila EP; Zhao W; Arheart K; Hooper MW; Byrne M et al. Disparities in hypertension control advice according to smoking status26. Preventive Medicine 51(3-4): 302-306, 2010. (26 refs.)

Objectives. Hypertension is the most common modifiable cardiovascular risk factor. Blood pressure (BP) reduction, particularly among smokers, is highly effective at preventing cardiovascular diseases. We examined the association between patient smoking status and hypertension management advice. Methods. Adults who participated in the 2007 Behavioral Risk Factor Surveillance System with self-reported hypertension were examined (n = 51,063). Multivariable logistic regression analysis controlling for age, gender, race/ethnicity, education, marital status, insurance status, body mass index, alcohol use, self-reported general health and survey design were conducted to examine the association between smoking status (never, former, or current) and receipt of hypertension control advice. Results. After controlling for potential confounders, being a current smoker was significantly associated with lower odds of receiving advice to lower salt intake (Adjusted Odds Ratio, AOR, 0.91 [95% confidence interval = 0.84-0.99]), exercise (AOR 0.89 [0.80-0.98]), and to take hypertensive medication (AOR 0.80 [0.66-0.98]) compared to never smokers. However, hypertensive smokers had greater odds of receiving advice to reduce alcohol consumption (AOR 1.23 [1.10-1.45]). Conclusions. Although healthcare providers are in an optimal position to provide patient education to improve BP control, hypertensive smokers may be less likely to receive important BP control lifestyle modification messages from their healthcare provider than non-smokers.

Calderon C; Balague L; Cortada JM; Sanchez A. Health promotion in primary care: How should we intervene? A qualitative study involving both physicians and patients. BMC Health Services Research 11: article 62, 2011. (46 refs.)

Background: The effects of tobacco, physical exercise, diet, and alcohol consumption on morbidity and mortality underline the importance of health promotion and prevention (HPP) at the primary health care (PHC) level. Likewise, the deficiencies when putting such policies into practice and assessing their effectiveness are also widely recognised. The objectives of this research were: a) to gain an in-depth understanding of general practitioners' (GPs) and patients' perceptions about HPP in PHC, and b) to define the areas that could be improved in future interventions. Methods: Qualitative methodology focussed on the field of health services research. Information was generated on the basis of two GP-based and two patient-based discussion groups, all of which had previously participated in two interventions concerning healthy lifestyle promotion (tobacco and physical exercise). Transcripts and field notes were analysed on the basis of a sociological discourse-analysis model. The results were validated by triangulation between researchers. Results: GPs and patients' discourses about HPP in PHC were different in priorities and contents. An overall explanatory framework was designed to gain a better understanding of the meaning of GP-patient interactions related to HPP, and to show the main trends that emerged from their discourses. GPs linked their perceptions of HPP to their working conditions and experience in health services. The dimensions in this case involved the orientation of interventions, the goal of actions, and the evaluation of results. For patients, habits were mainly related to ways of life particularly influenced by close contexts. Health conceptions, their role as individuals, and the orientation of their demands were the most important dimensions in patients' sphere. Conclusions: HPP activities in PHC need to be understood and assessed in the context of their interaction with the conditioning trends in health services and patients' social micro-contexts. On the basis of the explanatory framework, three development lines are proposed: the incorporation of new methodological approaches according to the complexity of HPP in PHC; the openness of habit change policies beyond the medical services; and the effective commitments in the medium to long term by the health services themselves at the policy management level.

Calsyn DA; Hatch-Maillette MA; Doyle SR; Cousins S; Chen T; Godinez M. Teaching condom use skills: Practice is superior to observation. Substance Abuse 31(4): 231-239, 2010. (19 refs.)

Men exposed to a condom skills practice exercise were hypothesized to perform better on condom skills measures than those exposed only to a demonstration or to no intervention. As part of a larger National Institute on Drug Abuse (NIDA) Clinical Trials Network HIV Prevention protocol, men in substance abuse treatment were administered male and female condom use skills measures (MCUS, FCUS) at preintervention, 2 weeks, 3 months, and 6 months postintervention. The MCUS and FCUS scores were compared for 3 intervention exposure groups (demonstration only [DO, n = 149], demonstration plus practice [D+P; n = 112], attended no sessions [NS, n = 139]) across the 4 assessment time points using a mixed effects linear regression model. There is a statistically significant intervention group-by-time effect (P .0001) for both the MCUS and FCUS. Post hoc, pairwise linear trends across time indicated that for both the MCUS and the FCUS, the D+P group is significantly superior to the DO group and the NS group.

Cheng DA; Kettinger L; Uduhiri K; Hurt L. Alcohol consumption during pregnancy: Prevalence and provider assessment. Obstetrics and Gynecology 117(2, Part 1): 212-217, 2011. (19 refs.)

OBJECTIVE: To estimate the prevalence of prenatal alcohol consumption and the extent of provider screening and discussion about alcohol use during pregnancy. METHODS: Data were obtained from a stratified random sample of 12,611 mothers from Maryland who delivered live infants during the years 2001-2008 and completed the Maryland Pregnancy Risk Assessment Monitoring System survey. Analyses were conducted using Proc Surveyfreq in SAS 9.2. RESULTS: Nearly 8% (95% confidence interval 7.1-8.4) of mothers from Maryland reported alcohol consumption during the last 3 months of pregnancy. The highest prevalence of late-pregnancy alcohol consumption was reported by mothers who were non-Hispanic white, (10.9%, confidence interval 9.8-11.9), aged 35 years or older (13.4%, confidence interval 12.4-14.4), and college graduates (11.4%, confidence interval 10.2-12.6) (P<.001). Nineteen percent (confidence interval 17.6-21.0) of mothers reported that their prenatal care provider did not ask whether they were drinking alcoholic beverages, and 30% (confidence interval 28.3-30.8) reported that a healthcare provider did not counsel them about the consequences of alcohol use on the child. Reported screening and counseling were least prevalent among mothers who were non-Hispanic white, aged 35 years or older, and college graduates (P<.01). CONCLUSION: Despite the substantial number of women who continue to drink alcohol during pregnancy, healthcare providers do not routinely assess alcohol consumption or counsel all women about its harmful effects. Counseling was least prevalent among the same groups of women with the highest rates for drinking. Provider alcohol assessment, as recommended by the U. S. Surgeon General to prevent alcohol misuse, needs further promotion as a routine part of prenatal care.

Deitz DK; Cook RF; Hendrickson A. Preventing prescription drug misuse: Field test of the SmartRx web program. Substance Use & Misuse 46(5): 678-686, 2011. (36 refs.)

Purpose of the project was to test a Web-based program designed to prevent prescription drug misuse. Study sample consisted of 346 working women randomized into either an experimental or wait-list control condition. Analysis of covariance and logistic regression were used to compare responses. Women receiving the intervention had greater knowledge of drug facts and greater self-efficacy in medication adherence and ability to manage problems with medications compared with controls. Women receiving the intervention also had reduced symptoms reported on the CAGE for prescription medications. Findings suggest that multimedia Web-based programs can be a beneficial addition to substance misuse prevention services. The study's limitations are noted.

Doumas DM; McKinley LL; Book P. Evaluation of two Web-based alcohol interventions for mandated college students. Journal of Substance Abuse Treatment 36(1): 65-74, 2009. (46 refs.)

This study evaluated the efficacy of two Web-based interventions aimed at reducing heavy drinking in mandated college students. Mandated students were randomly assigned to one of two conditions: Web-based personalized normative feedback (WPNF) or Web-based education (WE). As predicted, results indicated that mandated students in the WPNF condition reported significantly greater reductions in weekly drinking quantity, peak alcohol consumption, and frequency of drinking to intoxication than students in the WE condition at a 30-day follow-up. Although not statistically significant, there was a similar trend for changes in alcohol-related problems. Mandated students in the WPNF group also reported significantly greater reductions in estimates of peer drinking from baseline to the follow-up assessment than students in the WE group. In addition, changes in estimates of peer drinking mediated the effect of the intervention on changes in drinking. Findings provide support for providing Web-based personalized normative feedback as ail intervention program for mandated college students.

Ferguson SG; Gitchell JG; Shiffman S; Sembower MA; Rohay JM; Allen J. Providing accurate safety information may increase a smoker's willingness to use nicotine replacement therapy as part of a quit attempt. Addictive Behaviors 36(7): 713-716, 2011. (14 refs.)

Aim: Previous studies have reported that smokers who are misinformed about the safety of Nicotine Replacement Therapy (NRT) are less likely to report using it. In this study, we examined whether providing information that counters these concerns might impact on intentions to use NRT. Participants: 900 smokers recruited from a market research database. Design and setting: Participants completed an online survey that asked about their views about NRT. Smokers with safety and efficacy concerns were queried to determine whether accurate information might increase their interest in using NRT. Findings: Misperceptions of NRT safety were common: 93% of smokers did not know that smoking while wearing the nicotine patch does not cause heart attacks; 76% that nicotine gum/lozenge are not as addictive as cigarettes; and 69% that NRT products are not as dangerous as cigarettes. Over half of the smokers with misperceptions reported that they would be more likely to use NRT to help them quit smoking if they were exposed to information correcting their concerns (53%, 58% and 66%, respectively, for each of the misperceptions). Conclusions: These data suggest that while a sizeable proportion of smokers are still misinformed about the safety of NRT, misinformed smokers would increase consideration of NRT if these misperceptions are addressed by corrective information.

Frank E; Elon L; Spencer E. Personal and clinical tobacco-related practices and attitudes of US medical students. Preventive Medicine 49(2-3): 233-239, 2009. (39 refs.)

Objectives. medical students' tobacco-related practices particularly matter because practicing physicians' smoking predicts their tobacco counseling; the objective of this study was to determine when this relationship between personal and clinical tobacco practices develops, and to determine predictors of medical students' personal smoking habits, and predictors of their patient tobacco counseling practices. Methods. We surveyed the Class of 2003 between 1999 and 2003, at freshman orientation (n = 1836), entrance to wards (n = 1616), and senior year (n = 1441) in a nationally representative sample of 16 U.S. medical schools (response rate = 80.3%). Tobacco use questions came from Centers for Disease Control and Prevention datasets, and tobacco counseling questions from validated instruments. Results. 12% of female and 15% of male U.S. medical students report smoking, with no differences in usage over time. More tobacco counseling training and strongly believing in prevention significantly predicted both more perceived counseling relevance and frequency. Additionally, intention to practice primary care predicted relevance (OR = 3.5, 95% CI: 2.5-4.9), and tobacco users were 77% (95% CI: 64%-94%) as likely as non-users to report frequently counseling smokers. Conclusions. U.S. medical students are less likely to smoke than other young U.S. adults, but more likely than U.S. physicians, and showed no clear decrease during medical school. It is encouraging that medical students with more exposure appreciate tobacco counseling's importance more, and are more likely to counsel. Students' personal tobacco use was also associated with counseling frequency. These data should help educators seeking better methods to reduce tobacco use.

Freour T; Dessolle L; Jean M; Barriere P. Smoking among French infertility specialists: habits, opinions and patients' management. European Journal of Obstetrics, Gynaecology and Reproductive Biology 155(1): 44-48, 2011. (33 refs.)

Objective: The deleterious effects of tobacco on fertility are now largely demonstrated. Little is known, however, about how infertility doctors communicate on smoking and about their own smoking habits. In this study, we examined smoking habits among French infertility specialists and their attitudes towards infertile couples' exposure to tobacco. Study design: A postal survey was sent in 2009 to the 803 French certified physicians (gynaecologists, urologists, endocrinologists and embryologists) specializing in infertility. Demographical data, smoking habits and attitude towards patients' smoking were recorded. Statistical analysis and multiple correspondence analysis were performed in order to identify differences among physicians according to age, gender, occupation or smoking status. Results: Response rate was 42.3%. Half of the respondents were male, 41% were under 45 years, 37% were embryologists and 53.3% were gynaecologists. Thirteen percent reported current smoking. More than 80% always asked their patients about smoking status and cannabis consumption. Most physicians specifically informed infertile couples on tobacco, advised them to quit and proposed smoking cessation therapies. Only 24% refused care unless smoking cessation occurred. Statistical analysis showed some differences among subgroups according to gender, occupation or age. Surprisingly, results were comparable according to smoking status. Conclusion: Most infertility specialists are aware of the deleterious effects of tobacco on fertility and ask their patients to quit. The heterogeneity in infertile patients' management, however, underlines the need for better professional and patients' information on smoking.

Fu SS; Burgess DJ; van Ryn M; Rhodes K; Widome R; Ricards JJ et al. Smoking-cessation strategies for American Indians: Should smoking-cessation treatment include a prescription for a complete home smoking ban? American Journal of Preventive Medicine 39(6, supplement 1): S56-S65, 2010. (65 refs.)

Background: The prevalence of cigarette smoking is particularly high among American Indian communities in the Upper Midwest. Purpose: To evaluate the predictors of smoking cessation among a population-based sample of American Indians in the Upper Midwest during a quit attempt aided with nicotine replacement therapy (NRT). Methods: This study used the subsample of American Indian adults (n=291, response rate=55.4%) from a cohort study of smokers engaging in an aided NRT quit attempt. Eligible participants filled an NRT prescription between July 2005 and September 2006 through the Minnesota Health Care Programs (e. g., Medicaid). Administrative records and follow-up survey data were used to assess outcomes approximately 8 months after the NRT fill date. This analysis was conducted in 2009-2010. Results: Approximately 33% of American Indian respondents trying to quit smoking reported complete home smoking bans. Adoption of a complete home smoking ban and greater perceived advantages of NRT were cross-sectionally associated with 7-day smoking abstinence in univariate and multivariate analyses. Consistent with previous research, older age was a significant predictor of 7-day abstinence. Having a history of clinician-diagnosed anxiety in the past year was associated with decreased likelihood of 7-day abstinence in the unadjusted analysis, but not significant in multivariate analyses. Conclusions: Results of this study suggest potential modifiable targets of interventions for future research to help American Indians quit smoking: (1) improved delivery of behavioral interventions to increase the intensity of smoking cessation treatment; (2) promotion and adoption of complete home smoking bans; and (3) education to increase awareness of the benefits of NRT.

Gaston RL; Best D; Manning V; Day E. Can we prevent drug related deaths by training opioid users to recognise and manage overdoses? Harm Reduction Journal 6(26), 2009. (30 refs.)

Background: Naloxone has been evidenced widely as a means of reducing mortality resulting from opiate overdose, yet its distribution to drug users remains limited. However, it is drug users who are most likely to be available to administer naloxone at the scene and who have been shown to be willing and motivated to deliver this intervention. The current study builds on a national training evaluation in England by assessing 6-month outcome data collected primarily in one of the participating centres. Methods: Seventy patients with opioid dependence syndrome were trained in the recognition and management of overdoses in Birmingham (n = 66) and London (n = 4), and followed up six months after receiving naloxone. After successful completion of the training, participants received a supply of 400 micrograms of naloxone (in the form of a preloaded syringe) to take home. The study focused on whether participating users still had their naloxone, whether they retained the information, whether they had witnessed an overdose and whether they had naloxone available and were still willing to use it in the event of overdose. Results & Discussion: The results were mixed - although the majority of drug users had retained the naloxone prescribed to them, and retention of knowledge was very strong in relation to overdose recognition and intervention, most participants did not carry the naloxone with them consistently and consequently it was generally not available if they witnessed an overdose. The paper discusses the reasons for the reluctance to carry naloxone and potential opportunities for how this might be overcome. Future issues around training and support around peer dissemination are also addressed. Conclusion: Our findings confirm that training of drug users constitutes a valuable resource in the management of opiate overdoses and growth of peer interventions that may not otherwise be recognised or addressed. Obstacles have been identified at individual (transportability, stigma) and at a systems level (police involvement, prescription laws). Training individuals does not seem to be sufficient for these programmes to succeed and a coherent implementation model is necessary.

Guarino H; Deren S; Mino M; Kang SY; Shedlin MG. Training drug treatment patients to conduct peer-based HIV outreach: An ethnographic perspective on peers' experiences. Substance Use & Misuse 45(3): 414-436, 2010. (23 refs.)

From 2005 to 2008, the Bienvenidos Project trained Puerto Rican patients of New York City and New Jersey Methadone Maintenance Treatment Programs to conduct peer-based community outreach to migrant Puerto Rican drug users to reduce migrants' HIV risk behaviors. Ethnographic research, including focus groups, individual interviews, and observations, was conducted with a subset of the patients trained as peers (n = 49; 67% male; mean age 40.3 years) to evaluate the self-perceived effects of the intervention. Results of the ethnographic component of this study are summarized. The role of ethnographic methods in implementing and evaluating this kind of intervention is also discussed.

Hagarty DE; Clark DJ. Using imagery and storytelling to educate outpatients about 12-Step programs and improve their participation in community-based programs. Journal of Addictions Nursing 20(2): 86-92, 2009. (32 refs.)

The longer a patient remains engaged in recovery activities the greater the success of long-term abstinence. Self-help community programs that use the 12-steps such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are known in the addictions field to contribute to sustained abstinence. Connecting patients to 12-step programs in early stages of recovery increases the chance of prolonged involvement. A nurse working in an outpatient substance abuse clinic developed a unique method to inform and educate patients about the 12-step process. A story and image metaphorically describe this journey. The cleaning of a vessel and subsequent discovery of tools along the way provide an uncomplicated look at the 12-steps. Nurses can use the image and story to develop the necessary tools of honesty, open-mindedness, and willingness for patients to embrace the 12-step journey.

Hagedorn H; Leighton T; Heim L. Assessment of a hepatitis educational group for veterans with substance use disorders. American Journal of Drug and Alcohol Abuse 36(1): 57-60, 2010. (16 refs.)

Background: In 2005 the substance use disorders (SUD) clinic at the Minneapolis Veterans Affairs Medical Center launched the Liver Health Initiative in an effort to improve hepatitis education, screening, prevention, and treatment referral services for veterans receiving SUD services. One component of the Liver Health Initiative is an hour-long educational group; the Healthy Liver Group. Objectives: After the Healthy Liver Group was firmly established, an evaluation took place in order to measure: 1) change in patient knowledge, 2) participant satisfaction, and 3) attitudes toward hepatitis A and B vaccinations. Methods: From August 2007 to May 2008, 102 veterans filled out a paper survey before and after their experience in the Healthy Liver Group. Significance and Conclusions: The results of this survey show an increase in basic knowledge of hepatitis, high levels of patient satisfaction, and strong acceptance of vaccinations for hepatitis A and B. Overall, the survey indicates that the Healthy Liver Group is providing an important service and is generally well accepted by patients.

Harris AHS; Bradley KA; Bowe T; Henderson P; Moos R. Associations between AUDIT-C and mortality vary by age and sex. Population Health Management 13(5): 263-268, 2010. (33 refs.)

We sought to determine the sex-and age-specific risk of mortality associated with scores on the 3-item Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questionnaire using data from a national sample of Veterans Health Administration (VHA) patients. Men (N = 215,924) and women (N = 9168) who completed the AUDIT-C in a patient survey were followed for 24 months. AUDIT-C categories (0, 1-4, 5-8, 9-12) were evaluated as predictors of mortality in logistic regression models, adjusted for age, race, education, marital status, smoking, depression, and comorbidities. For women, AUDIT-C scores of 9-12 were associated with a significantly increased risk of death compared to the AUDIT-C 1-4 group (odds ratio [OR] 7.09; 95% confidence interval [CI] = 2.67, 18.82). For men overall, AUDIT-C scores of 5-8 and 9-12 were associated with increased risk of death compared to the AUDIT-C 1-4 group (OR 1.13, 95% CI = 1.05, 1.21, and OR 1.63, 95% CI = 1.45, 1.84, respectively) but these associations varied by age. These results provide sex-and age-tailored risk information that clinicians can use in evidence-based conversations with patients about the health-related risks of their alcohol consumption. This study adds to the growing literature establishing the AUDIT-C as a scaled marker of alcohol-related risk or "vital sign" that might facilitate the detection and management of alcohol-related risks and problems.

Hollands GJ; Hankins M; Marteau TM. Visual feedback of individuals' medical imaging results for changing health behaviour. (review). Cochrane Database of Systematic Reviews 1: CD007434, 2010. (42 refs.)

Background: Feedback of medical imaging results can reveal visual evidence of actual bodily harm attributable to a given behaviour. This may offer a particularly promising approach to motivating changes in health behaviour to decrease risk. Applicable behaviours include smoking cessation, skin self-examination, sun protection behaviour, dietary intake, physical activity and medication usage. The current review assembles and evaluates the evidence concerning the behavioural impact of showing and explaining images, in order to determine whether their communication is an effective intervention approach. Objectives: To assess the extent to which feedback to individuals of images of their own bodies created during medical imaging procedures increases or decreases a range of health behaviours. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3 2009), MEDLINE (1950 to 14 September 2009), EMBASE (1980 to 14 September 2009), CINAHL (1982 to 9 October 2009), PsycINFO (1806 to 14 September 2009) and reference lists of articles. We also contacted authors of selected papers, and searched the ProQuest Dissertations and Theses database on 1 October 2009 for grey literature. Selection criteria: Randomised or quasi-randomised controlled trials involving adult (18 years and over) non-pregnant individuals undergoing medical imaging procedures assessing risk of disease or of an existing condition, for which personal risk may be reduced by modification of behaviour. The sole or principal component of included interventions is visual feedback of individuals' medical imaging results, defined as individuals being shown, and having explained, source images (still or moving images) of their bodies generated by the procedure. Data collection and analysis: Two authors searched for studies and independently extracted data from included studies, with disagreements resolved by consensus and a third author acting as arbiter. The risk of bias of included studies was assessed and reported in accordance with the guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. We conducted a narrative synthesis of the included studies, dividing them into clinical and non-clinical population groups and presenting major characteristics and results. Where the studies were sufficiently similar in terms of population, inclusion criteria, interventions and/or outcomes, we pooled the data statistically. Main results: We included nine trials involving 1371 participants. Overall, results were mixed. Regarding five trials in clinical populations, three assessed smoking cessation behaviours, all featuring arterial scanning procedures to assess cardiovascular risk, and reported a statistically significant effect favouring the intervention, producing a pooled odds ratio (OR) of 2.81 (95% confidence interval (CI) 1.23 to 6.41, P = 0.01). One of these trials also measured physical activity and reported no statistically significant difference between the groups. A further trial measured skin examination behaviour following a skin photography procedure for assessing moles, and reported a statistically significant increase in favour of the intervention, with an OR of 4.86 (95% CI 1.95 to 12.10, P = 0.0007). The final clinical population trial measured a range of dietary intake and medication usage behaviours and featured an arterial scanning procedure assessing cardiovascular risk, and reported no statistically significant effects. Among the four trials in non-clinical populations, all featuring ultraviolet (UV) photography to highlight UV-related skin damage, a statistically significant result favouring the intervention was found in one trial for reducing tanning booth use, producing a mean difference (MD) of -1.10 (95% CI - 1.90 to -0.30, P = .007) and one trial reported an outcome on which the control condition was favoured, with an MD of 0.45 (95% CI 0.04 to 0.86, P = 0.03) on intentional hours spent in the sun. In two further trials, no statistically significant behavioral effects were reported regarding time spent in the sun or sun protection behaviours. There was no evidence of significant adverse effects in the included trials, although this was not well reported. Authors' conclusions: Due to the limited nature of the available evidence and the mixed results that were found, no strong statements can be made about the effectiveness of communicating medical imaging results to change health behaviour. Only three trials in clinical populations were similar enough in term of setting, intervention and outcome to allow meta-analysis. We suggest, however, that targeted interventions using medical imaging technologies may be effective in certain contexts, or as applied to certain behaviours, but that this should be considered on an intervention by intervention basis, and not assumed as a general principle.

Ivsins A; Roth E; Nakamura N; Krajden M; Fischer B. Uptake, benefits of and barriers to safer crack use kit (SCUK) distribution programmes in Victoria, Canada-A qualitative exploration. International Journal of Drug Policy 22(4): 292-300, 2011. (75 refs.)

Background: Crack use is prevalent amongst street drug users in Canadian cities, and associated with severe drug use, health and social problems. Whilst few targeted interventions are available for crack use, the common use and sharing of hazardous makeshift paraphernalia are a key concern, as these risks may be associated with oral injury and blood-borne virus (BBV) - e.g., hepatitis C virus (HCV) - transmission amongst users. Recently, distribution programmes of so-called 'safer crack use kits' (SCUMs) have been initiated in select Canadian cities, primarily to reduce the use of unsafe materials and paraphernalia sharing amongst crack users. This study explored uptake and benefits of, barriers to, and possible improvements to two recently implemented SCUK distribution programme in Victoria, Canada. Methods: N=31 regular crack smokers were recruited through community-based efforts between June and August 2010, and assessed via an interviewer-administered protocol involving quantitative and qualitative data items. Descriptive analyses were completed with the quantitative data, and thematic content analyses were conducted with the qualitative data in order to identify and extract prominent themes and issues. Results: The sample indicated high levels of socio-economic marginalization, poly-substance use, health problems, lengthy crack use histories and common crack paraphernalia sharing. Most participants exclusively utilized the SCUK programme including glass-stems in addition to other paraphernalia materials. Participants described: lesser need to share - or to commit property crimes to obtain resources for - crack to paraphernalia, increased health awareness, and increased personal and community safety as benefits experienced from SCUK use. Limitations in SCUK resources and distribution, shortcomings in materials, and police interference were cited as barriers to current SCUK program delivery. Conclusions: SCUM distribution in Victoria appears to result in a variety of individual and community health benefits. These benefits could be solidified by addressing current programme limitations, including better resourcing, expanding geographic distributions and eliminating police interference.

Jones SC; Telenta J; Cert G; Shorten A; Johnson K. Midwives and pregnant women talk about alcohol: What advice do we give and what do they receive? Midwifery 27(4): 489-496, 2011. (39 refs.)

Background: the Australian National Health and Medical Research Council (NHMRC) recently revised its guidelines for alcohol consumption during pregnancy and breast feeding, moving from a recommendation of minimising intake to one of abstinence. Women are potentially exposed to a variety of messages about alcohol and pregnancy, including from the media and social contacts, and are likely to see midwives as the source of expert advice in understanding these contradictory messages. Objective: to explore the advice that midwives believe they give to pregnant women about alcohol consumption, and the advice that pregnant women believe they receive; the knowledge and attitudes of both groups regarding alcohol consumption and the consistency with the NHMRC guidelines; and the receptivity and comfort of both groups in discussing alcohol consumption in the context of antenatal appointments. Design: individual semi-structured interviews with midwives and pregnant women. Setting: face-to-face interviews with midwives and telephone interviews with pregnant women were conducted in two regional areas of New South Wales in 2008-2009. Participants: 12 midwives and 12 pregnant women. Findings: midwives and pregnant women consistently agreed that conversations about alcohol are generally limited to brief screening questions at the first visit, and the risks are not discussed or explained (except for high-risk women). Key conclusions: both groups expressed comfort with the idea of discussing alcohol consumption, but lacked knowledge of the risk and recommendation, and it appears that this opportunity to provide women with information is under-utilised. Implications for practice: there is a need to provide midwives with accurate information about the risks of alcohol consumption during pregnancy and effective communication tools to encourage them to discuss the risks and recommendations with their patients.

Kalichman SC; Amaral CM; White D; Swetsze C; Pope H; Kalichman MO et al. Prevalence and clinical implications of interactive toxicity: Beliefs regarding mixing alcohol and antiretroviral therapies among people living with HIV/AIDS. AIDS Patient Care and STDs 23(6): 449-454, 2009. (18 refs.)

Alcohol use is a barrier to medication adherence. Beyond the cognitive effects of intoxication, people living with HIV/AIDS who believe that alcohol should not be mixed with their medications may temporarily stop taking medications when drinking. To examine the effects of alcohol-treatment beliefs on HIV treatment adherence. People living with HIV/AIDS who were receiving treatment (n = 145) were recruited from community and clinical services during the period between January 2006 and May 2008 to complete measures of substance use and alcohol-antiretroviral (ARV) interactive toxicity beliefs (e.g., alcohol breaks down HIV medications so they will not work). Medication adherence was monitored using unannounced telephone-based pill counts. Forty percent of participants were currently using alcohol and nearly one in four drinkers reported stopping their medications when drinking. Beliefs that mixing alcohol and medications is toxic were common among drinkers and nondrinkers, with most beliefs endorsed more frequently by non-drinkers. Hierarchical regression analysis showed that stopping ARVs when drinking was associated with treatment nonadherence over and above quantity/frequency of alcohol use and problem drinking. Beliefs that alcohol and ARVs should not be mixed and that treatments should be interrupted when drinking are common among people living with HIV/AIDS. Clinicians should educate patients about the necessity of continuing to take ARV medications without interruption even if they are drinking alcohol.

Karow A; Reimer J; Schafer I; Krausz M; Haasen C; Verthein U. Quality of life under maintenance treatment with heroin versus methadone in patients with opioid dependence. Drug and Alcohol Dependence 112(3): 209-215, 2010. (46 refs.)

Background: There is increasing evidence that health-related quality of life (HRQOL) is associated with a successful treatment and better outcome in opioid addiction. The aim of the present study was the longitudinal investigation of HRQOL in patients with severe dependence who were randomly assigned to four groups of medical and psychosocial treatment heroin (diacetylmorphine) versus methadone and case management (CM) versus psychoeducation (PSE) respectively. Methods: HRQOL (MSQoL) and physical health (OTI) were Investigated in 938 subjects who participated in the German multi-centre study examining the effects of heroin-assisted treatment in patients with severe opioid dependence. Data for the present analysis were taken from baseline and 12-month follow up. Results: Under both forms of maintenance and psychosocial treatment HRQOL improved significantly during the observation period. HRQOL improvement under maintenance with heroin exceeded improvement under methadone especially with regard to subjective physical health HRQOL improvement was significantly associated with better expert-rated physical health. Further analyses showed significant better improvement of HRQOL in subjects treated with PSE compared with CM. Conclusions: The advantage of heroin with regard to the improvement of HRQOL may be partially explained by a better Improvement of physical health under maintenance with heroin compared with methadone which highlights the importance of a comprehensive model of health care for patients with severe opioid dependence. Future studies need to investigate the benefits of PSE for patients in maintenance therapy.

Khazaal Y; Chatton A; Cochand S; Coquard O; Fernandez S; Khan R et al. Brief DISCERN, six questions for the evaluation of evidence-based content of health-related websites. Patient Education and Counseling 77(1): 33-37, 2009. (19 refs.)

Objective: To extract and to validate a brief version of the DISCERN which could identify mental health-related websites with good content quality. Method: The present study is based on the analysis of data issued from six previous studies which used DISCERN and a standardized tool for the evaluation of content quality (evidence-based health information) of 388 mental health-related websites. After extracting the Brief DISCERN, several psychometric properties (content validity through a Factor analysis, internal consistency by the Cronbach's alpha index, predictive validity through the diagnostic tests, concurrent validity by the strength of association between the Brief DISCERN and the original DISCERN scores) were investigated to ascertain its general applicability. Results: A Brief DISCERN composed of two factors and six items was extracted from the original 16 items version of the DISCERN. Cronbach's alpha coefficients were more than acceptable for the complete questionnaire (alpha 0.74) and for the two distinct domains: treatments information (alpha = 0.87) and reliability (alpha 0.83). Sensibility and specificity of the Brief DISCERN cut-off score >= 16 in the detection of good content quality websites were 0.357 and 0.945, respectively. Its predictive positive and negative values were 0.98 and 0.83, respectively. A statistically significant linear correlation was found between the total scores of the Brief DISCERN and those of the original DISCERN (r = 0.84 and p < 0.0005). Conclusion: The Brief DISCERN seems to be a reliable and valid instrument able to discriminate between websites with good and poor content quality. Practice implications: The Brief DISCERN is a simple tool which could facilitate the identification of good information on the web by patients and general consumers.

Klein B; White A; Kavanagh D; Shandley K; Kay-Lambkin F; Proudfoot J et al. Content and functionality of alcohol and other drug websites: Results: of an online survey. Journal of Medical Internet Research 12(5): e-article 51, 2010. (23 refs.)

Background: There is a growing trend for individuals to seek health information from online sources. Alcohol and other drug (AOD) use is a significant health problem worldwide, but access and use of AOD websites is poorly understood. Objective: To investigate content and functionality preferences for AOD and other health websites. Methods: An anonymous online survey examined general Internet and AOD-specific usage and search behaviors, valued features of AOD and health-related websites (general and interactive website features), indicators of website trustworthiness, valued AOD website tools or functions, and treatment modality preferences. Results: Surveys were obtained from 1214 drug (n = 766) and alcohol website users (n = 448) (mean age 26.2 years, range 16-70). There were no significant differences between alcohol and drug groups on demographic variables, Internet usage, indicators of website trustworthiness, or on preferences for AOD website functionality. A robust website design/navigation, open access, and validated content provision were highly valued by both groups. While attractiveness and pictures or graphics were also valued, high-cost features (videos, animations, games) were minority preferences. Almost half of respondents in both groups were unable to readily access the information they sought. Alcohol website users placed greater importance on several AOD website tools and functions than did those accessing other drug websites: online screening tools (chi(2)(2) = 15.8, P < .001, n = 985); prevention programs (chi(2)(2) = 27.5, P < .001, n = 981); tracking functions (chi(2)(2) = 11.5, P = .003, n = 983); self help treatment programs (chi(2)(2) = 8.3, P = .02, n = 984); downloadable fact sheets for friends (chi(2)(2) = 11.6, P = .003, n = 981); or family (chi(2)(2) = 12.7, P = .002, n = 983). The most preferred online treatment option for both the user groups was an Internet site with email therapist support. Explorations of demographic differences were also performed. While gender did not affect survey responses, younger respondents were more likely to value interactive and social networking features, whereas downloading of credible information was most highly valued by older respondents. Conclusions: Significant deficiencies in the provision of accessible information on AOD websites were identified, an important problem since information seeking was the most common reason for accessing these websites, and, therefore, may be a key avenue for engaging website users in behaviour change. The few differences between AOD website users suggested that both types of websites may have similar features, although alcohol website users may more readily be engaged in screening, prevention and self-help programs, tracking change, and may value fact sheets more highly. While the sociodemographic differences require replication and clarification, these differences support the notion that the design and features of AOD websites should target specific audiences to have maximal impact.

Kontos EZ; Emmons KM; Puleo E; Viswanath K. Determinants and beliefs of health information mavens among a lower-socioeconomic position and minority population. Social Science & Medicine 73(1): 22-32, 2011. (47 refs.)

People of lower-socioeconomic position (SEP) and most racial/ethnic minorities face significant communication challenges which may negatively impact their health. Previous research has shown that these groups rely heavily on interpersonal sources to share and receive health information; however, little is known about these lay sources. The purpose of this paper is to apply the concept of a market maven to the public health sector with the aims of identifying determinants of high health information mavenism among low-SEP and racial/ethnic minority groups and to assess the information they may be sharing based on their own health beliefs. Data for this study were drawn from the baseline survey (n = 325) of a US randomized control intervention study aimed at eliciting an understanding of Internet-related challenges among lower-SEP and minority individuals. Regression models were estimated to distinguish significant determinants of health information mavenism among the sample. Similarly, bivariate and logistic multivariable models were estimated to determine the association between health information mavenism and accurate health beliefs relating to diet, physical activity and smoking. The data illustrate that having a larger social network, being female and being older were important factors associated with higher mavenism scores. Additionally being a moderate consumer of general media as well as fewer years in the US and lower language acculturation were significant predictors of higher mavenism scores. Mavens were more likely than non-mavens to maintain accurate beliefs regarding diet; however, there was no distinction between physical activity and smoking beliefs between mavens and non-mavens. These results offer a unique understanding of health information mavenism which could better leverage word-of-mouth health communication efforts among lower-SEP and minority groups in order to reduce communication inequalities. Moreover, the data indicate that health information mavens may serve as an ideal point of intervention in attempts to modify health beliefs with the goal of reducing health disparities among these populations.

Kuehn BM. Patients warned about risks of drugs used for analgesia, fevers, addiction. (news item). Journal of the American Medical Association 301(22): 2315-2316, 2009. (0 refs.)

In addition to being used in the treatment of opioid addiction for more than 40 years, methadone more recently has found increasing use as a therapy for patients with moderate to severe pain. And as the drug has entered wider use, the number of methadone-related adverse events has increased. Between 1999 and 2005 the number of annual poisoning deaths involving methadone increased by 468% to 4462, according to the National Center for Health Statistics. Although methadone use for addiction is tightly regulated (most patients receive their doses under direct clinician supervision at a certified treatment program), less stringent regulation of the medication when used to treat pain may allow greater misuse or abuse of the drug. To help curb this trend, SAMHSA and the FDA have launched a campaign to educate patient about the safe use of methadone (http://www.dpt.samhsa.gov/methadonesafety/print_materials.aspx). The campaign emphasizes taking the drug exactly as instructed and not sharing it with others.

Kuehn BM. Rethinking Drinking. (news). Journal of the American Medical Association 301(16): 1647-1647, 2009. (0 refs.)

Description of new web site of NIAAA that helps individuals identify whether their levels of alcohol consumption put them at risk of developing alcohol dependence and help such persons develop a plan to change their drinking habits.

Lee JM; Chen SH; Liu HH; Hung JY; Huang MY. Effects of health risk information on addictive goods consumption: A case of tobacco, alcohol, and betel nuts in Taiwan. Contemporary Economic Policy 28(3): 406-413, 2010. (28 refs.)

This paper empirically investigates the relationship between the dissemination of information about the health risks of tobacco, alcohol, and betel nuts and their consumption in Taiwan. To estimate cross-elasticities, the paper uses the Central Bureau of Statistics demand system model. Empirical results indicate that an increase in the dissemination of information on the health risks of tobacco, alcohol, and betel nuts substantially reduces real consumption. Empirical evidence from the cross-elasticity of price also confirms that a complementary relationship exists in Taiwan among these three addictive products.

Levy DT; Graham AL; Mabry PL; Abrams DB; Orleans CT. Modeling the impact of smoking-cessation treatment policies on quit rates. American Journal of Preventive Medicine 38(3, Supplement 3): S364-S372, 2010. (31 refs.)

Background: Smoking-cessation treatment policies could yield substantial increases in adult quit rates in the U.S. Purpose: The goals of this paper are to model the effects of individual cessation treatment policies on population quit rates, and to illustrate the potential benefits of combining policies to leverage their synergistic effects. Methods: A mathematical model is updated to examine the impact of five cessation treatment policies on quit attempts, treatment use, and treatment effectiveness. Policies include: (1) expand cessation treatment coverage and provider reimbursement; (2) mandate adequate funding for the use and promotion of evidence-based, state-sponsored telephone quitlines; (3) support healthcare system changes to prompt, guide, and incentivize tobacco treatment; (4) support and promote evidence-based treatment via the Internet; and (5) improve individually tailored, stepped-care approaches and the long-term effectiveness of evidence-based treatments. Results: The annual baseline population quit rate is 4.3% of all current smokers. implementing any policy in isolation is projected to increase the quit rate to between 4.5% and 6%. By implementing all five policies in combination, the quit rate is projected to increase to 10.9%, or 2.5 times the baseline rate. Conclusions: If fully implemented in a coordinated fashion, cessation treatment policies could reduce smoking prevalence from its current rate of 20.5% to 17.2% within 1 year. By modeling the policy impacts on the components of the population quit rate (quit attempts, treatment use, treatment effectiveness), key indicators are identified that need to be analyzed in attempts to improve the effect of cessation treatment policies.

Mahabee-Gittens EM; Vaughn L; Gordon JS. Youths' and parents' views on the acceptability and design of a video-based tobacco prevention intervention. Journal of Child & Adolescent Substance Abuse 19(5): 391-405, 2010. (55 refs.)

The purpose of this study was to evaluate the acceptability of a brief, video-based parental intervention that modeled parent-child communication about tobacco, delivered within an emergency department (ED) setting. While waiting to be seen by a physician in the ED, 20 parent-youth dyads watched the video together and then private, semi-structured focused interviews were conducted around the take-home message and views on the settings, actors, and content of the videos. Dyads agreed that the design, delivery, and content of the video intervention were acceptable, realistic, and useful in providing parental reinforcements about the importance of parent-youth tobacco communication, and the ED was considered to be a good setting for watching the video. Findings support the development and delivery of such an ED intervention and aids in determining content and scenarios for future intervention development.

McBride CM; Koehly LM; Sanderson SC; Kaphingst KA. The behavioral response to personalized genetic information: Will genetic risk profiles motivate individuals and families to choose more healthful behaviors? (review). Annual Review of Public Health 31: 89-103, 2010. (83 refs.)

This report describes the use of information emerging from genetic discovery to motivate risk-reducing health behaviors. Most research to date has evaluated the effects of information related to rare genetic variants on screening behaviors, in which genetic risk feedback has been associated consistently with improved screening adherence. The limited research with common genetic variants suggests that genetic information, when based on single-gene variants with low-risk probabilities, has little impact on behavior. The effect on behavioral outcomes of more realistic testing scenarios in which genetic risk is based on numerous genetic variants is largely unexplored. Little attention has been directed to matching genetic information to the literacy levels of target audiences. Another promising area for research is consideration of using genetic information to identify risk shared within kinship networks and to expand the influence of behavior change beyond the individual.

Nyamathi AM; Nandy K; Greengold B; Marfisee M; Khalilifard F; Cohen A et al. Effectiveness of intervention on improvement of drug use among methadone maintained adults. Journal of Addictive Diseases 30(1): 6-16, 2011. (45 refs.)

The purpose of this study is to evaluate the effectiveness of three interventions (individual motivational interviewing, group motivational interviewing, or nurse-led hepatitis health promotion) in reducing drug use. A randomized, controlled trial was conducted with 256 methadone maintained moderate-to-heavy alcohol-using adults attending one of five MM outpatient clinics. Drug use in the overall sample was significantly reduced from baseline to 6-month follow-up, as assessed by a 30-day recall (p 0.0001), with a trend apparent for 6-month recall (p = 0.09). The group and individual programs revealed significant decreases in drug use at the 30-day recall.

Ogel K; Coskun S. Cognitive behavioral therapy-based brief intervention for volatile substance misusers during adolescence: A follow-up study. Substance Use & Misuse 46(Supplement 1): 128-133, 2011. (29 refs.)

Of 62 males admitted for treatment in Turkey in 2008 with a diagnosis of volatile substance misuse (VSM) dependency, half were randomly allocated to receive a cognitive behavioral therapy (CBT)-based brief intervention and an education program and half participated only in the education program. One year after treatment, 38.2%% of the experimental group and 58.1%% of the control group had continued VSM during the last three months. This statistically significant difference indicates that CBT-based brief intervention is associated with reducing VSM in adolescents. Factors associated with abstinence after treatment are identified and study limitations are noted.

Panconesi A; Bartolozzi ML; Guidi L. Alcohol and migraine: What should we tell patients? (review). Current Pain and Headache Reports 15(3): 177- 184, 2011. (52 refs.)

Alcoholic drinks are a migraine trigger in about one third of patients with migraine in retrospective studies on trigger factors. Many population studies show that patients with migraine consume alcohol in a smaller percentage than the general population. Moreover, research has shown a decreased prevalence of headache with increasing number of alcohol units consumed. The classification criteria of alcohol-related headaches remain problematic. We discuss the role and mechanism of action of alcohol or other components of alcoholic drinks in relation to alcohol-induced headache. In accordance with data from a recent prospective study, we believe that reports overestimate the role of alcohol, as well as other foods, in the triggering of migraine. If a relationship between the intake of alcohol and the migraine attack is not clear, a small dose of alcohol is not contraindicated either for enjoyment or its protective effect on cardiovascular disease.

Parker WA; Steyn NP; Levitt NS; Lombard CJ. They think they know but do they? Misalignment of perceptions of lifestyle modification knowledge among health professionals. Public Health Nutrition 14(8): 1429-1438, 2011. (82 refs.)

Objective: The present study aimed to evaluate the knowledge and practices of public-sector primary-care health professionals and final-year students regarding the role of nutrition, physical activity and smoking cessation (lifestyle modification) in the management of chronic diseases of lifestyle within the public healthcare sector. Design: A comparative cross-sectional descriptive quantitative study was conducted in thirty primary health-care facilities and four tertiary institutions offering medical and/or nursing programmes in Cape Town in the Western Cape Metropole. Stratified random sampling, based on geographical location, was used to select the health facilities while convenience sampling was used to select students at the tertiary institutions. A validated self-administered knowledge test was used to obtain data from the health professionals. Results: Differential lifestyle modification knowledge exists among both health professionals and students, with less than 10% achieving the desired scores of 80% or higher. The majority of health professionals seem to be promoting the theoretical concepts of lifestyle modification but experience difficulty in providing practical advice to patients. Of the health professionals evaluated, doctors appeared to have the best knowledge of lifestyle modification. Lack of time, lack of patient adherence and language barriers were given as the main barriers to providing lifestyle counselling. Conclusions: The undergraduate curricula of medical and nursing students should include sufficient training on lifestyle modification, particularly practical advice on diet, physical activity and smoking cessation. Health professionals working at primary health-care facilities should be updated by providing lifestyle modification education as part of continuing medical education.

Payne JM; France KE; Henley N; D'Antoine HA; Bartu AE; O'Leary CM et al. RE-AIM evaluation of the Alcohol and Pregnancy Project: Educational resources to inform health professionals about prenatal alcohol exposure and fetal alcohol spectrum disorder. Evaluation & the Health Professions 34(1): 57-80, 2011. (29 refs.)

The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals. The authors used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate the project. The educational resources were effective in producing a 31% increase in the proportion of health professionals who routinely provided pregnant women with information about the consequences of drinking alcohol during pregnancy. One hundred percent of the settings adopted the project, it reached 96.3% of the target population, it was implemented as intended, and the resources were maintained (http: www.ichr.uwa.edu.au/alcoholandpregnancy). The educational resources for health professionals have potential to contribute to reducing prenatal alcohol exposure and FASD.

Peretti-Watel P; Garelik D; Baron G; Spire B; Ravaud P; Duval X et al. Smoking motivations and quitting motivations among HIV-infected smokers. Antiviral Therapy 14(6): 781-787, 2009. (24 refs.)

Background: The aim of this study was to examine smoking motivation and motivation to quit, and determinants of these motivations among HIV-infected cigarette smokers. Methods: We conducted a 1-day cross-sectional survey on cigarette smoking in a representative sample of HIV-infected outpatients of French hospitals. A cluster analysis was used to characterize respondents' smoking motivation. A logistic regression was performed to study the factors associated with motivation to quit, including the clusters describing smoking motives. Results: We found four clusters of smoking motivation. These included intellectual/emotional support (22% of respondents), automatic/stress relief (22%; characterized by heavy smoking and strong dependency); weight control (29%; characterized by frequent symptoms of fat accumulation because of antiretroviral therapy) and pleasure/conviviality (27%; corresponding to 'lighter' smokers). In the logistic regression model, among other significant covariates (cigarette consumption level, tobacco dependence and perceived risk of developing a smoking-related disease), the automatic/stress relief cluster was negatively correlated to the motivation to quit (odds ratio 0.39), whereas the weight control cluster was strongly associated to this motivation (odds ratio 2.87). Conclusions: The diversity of HIV-infected smokers' profiles suggests that different types of anti-tobacco measures should be implemented in this population, such as information campaigns on specific risks incurred by HIV-infected smokers, non-specific and comprehensive measures for those for whom smoking is combined with other difficulties, and alternative therapeutic solutions for those who smoke to deal with lipodystrophy.

Phillips P; Glover C; Allan T; Khoo ME. Using a group approach to preventing heroin overdose in North London. Drugs: Education, Prevention and Policy 16(4): 328-342, 2009. (41 refs.)

Aims: This study used group psycho-education methods to assist injecting heroin users in preventing, and responding to overdose. Methods: An 'OD Prevention' group was advertised in a London prescribing service and associated primary care unit. The intervention took place in a small group over one afternoon (3.5 hours), and trained participants in recognizing, and responding to heroin overdoses (defining overdose, discussing known risk factors and on-site instruction in cardio-pulmonary resuscitation (CPR). Participants were all injecting heroin users in service contact with the primary care unit, drug dependence unit, or hostels for the homeless in central London. Participants self-referred, or were referred by key workers. Participants completed pre- and post-group questionnaires concerning their personal experience of overdose, the witnessing of others' overdoses and fatalities, their current response in overdose situations, and their overall confidence in helping others who have overdosed. Findings: In total 107 people attended the group. of these, 42% had witnessed others' overdose, and 29% had witnessed one or more deaths as a result of overdose. Following the group intervention more participants reported feeling 'quite or very confident' in managing an OD situation, confident in undertaking CPR with someone who had overdosed, and were less likely to pursue 'folklore' remedies to overdose. Conclusions: Using psycho-educational group approaches can be an effective tool in attempts to prevent and respond to heroin overdoses, and is seen as useful by users.

Ritchie L; Evans MK; Matthews J. Nursing students' and clinical instructors' perceptions on the implementation of a best practice guideline. Journal of Nursing Education 49(4): 223-227, 2010. (23 refs.)

A university nursing program in Ontario, Canada initiated the process of implementing the Registered Nurses' Association of Ontario best practice guideline (BPG) on smoking cessation into the curriculum. This study explored nursing students' and clinical instructors' perceptions regarding the implementation of the BPG in their practice to support faculty in the development of a curriculum that promotes smoking cessation and the competencies necessary for graduates to implement health promotion skills in practice. Four student nurses and two clinical instructors participated in semistructured interviews. Four major themes were identified through the data analysis process: personal and professional self, health "preaching," developmental perspective, and environmental constraints. This study presents a curricular model for health promotion practice incorporating the components of primary health care, health promotion counseling, smoking cessation BPG, and sociopolitical context.

Rutten LJF; Augustson EM; Doran KA; Moser RP; Hesse BW. Health information seeking and media exposure among smokers: A comparison of light and intermittent tobacco users with heavy users. Nicotine & Tobacco Research 11(2): 190-196, 2009. (30 refs.)

Introduction: We examined population-based data to assess potential differences between light and intermittent smokers as compared with moderate to heavy tobacco users in health information-seeking behavior and attitudes and media exposure. Methods: Data from the 2003 and 2005 Health Information National Trends Surveys were combined to examine the information-seeking characteristics of light daily smokers (n = 594), intermittent smokers (n = 532), and moderate to heavy daily smokers (n = 1,131). Results: Compared with moderate to heavy daily smokers, intermittent smokers reported less exposure to television, greater trust in doctors as a source of health information, and greater intention to quit smoking. No differences in information-seeking experiences and preferences were observed between light daily smokers and moderate to heavy daily smokers. Intermittent smokers were distinct from moderate to heavy smokers in their information-seeking experiences and preferences. Discussion: The insight into the media use and information preferences of different smoking populations lays the groundwork for conducting further research to examine the information needs and preferences of smoking groups and to more effectively develop and deliver smoking cessation interventions.

Scott-Sheldon LAJ; DeMartini KS; Carey KB; Carey MP. Alcohol interventions for college students improves antecedents of behavioral change: Results from a meta-analysis of 34 randomized controlled trials. Journal of Social and Clinical Psychology 28(7): 799-823, 2009. (85 refs.)

The current meta-analysis examined the effects of individual-level alcohol interventions on college students' knowledge and psychological outcomes at first post-intervention assessment. Data from 34 randomized-control led trials published between 1980 and June 2007 (N = 8,569) were included. independent raters coded participant characteristics, design and methodological features, and intervention content. Weighted mean effect sizes, using both fixed- and random-effects models, were calculated; positive effect sizes indicated greater improvement in alcohol-related knowledge or psychological outcomes. Compared to controls, alcohol interventions improved participants' alcohol-related knowledge, attitudes toward drinking, and descriptive norms (vis-a-vis national college students), and intentions to consume alcohol but did not improve alcohol expectancies or self-efficacy. Several sample, study, and intervention characteristics moderated the knowledge and psychological outcomes. Implications of these findings are discussed.

Scranton RE; Farwell WR; Gaziano JM. Lack of cholesterol awareness among physicians who smoke. International Journal of Environmental Research and Public Health 6(2): 635-642, 2009. (14 refs.)

Cigarette use is a known risk factor for the development of coronary artery disease (CAD) as it adversely affects HDL cholesterol levels and promotes thrombogenesis. Smoking may also be associated with behavioral characteristics that potentiate the risk of CAD. A lack of cholesterol knowledge would indicate an aversion to a prevention-oriented lifestyle. Thus, our goal was to determine the association between tobacco use and knowledge of self-reported cholesterol among male physicians. Using the 1982 and follow-up questionnaires from the physician health study, we report the changes in the frequencies of awareness of self-reported total cholesterol and cardiovascular risk factors among the 22,067 participants. We classified physicians as being aware of their cholesterol if they reported a cholesterol level and unaware if the question was left unanswered. In 1997, 207 physicians were excluded, as the recorded cholesterol was not interpretable, leaving 21,860 for our follow up analyses. Using unadjusted logistic models, we determined the odds ratios (OR) and 95% confidence intervals (CI) of not reporting a cholesterol level in either 1982 or 1997 for each specified risk factor. We then evaluated whether the lack of cholesterol awareness at both time points was associated with the use of tobacco throughout the study. After 14-years of follow up, cholesterol awareness increased from 35.9 to 58.6 percent. During this period, the frequency of hypertension and hyperlipidemia treatment increased (13.5 to 40.5% and 0.57% to 19.6% respectively), as did the diagnosis of diabetes (2.40 to 7.79%). Behavioral characteristics such as a sedentary lifestyle and obesity also increased (27.8 to 42% and 43.5 to 53.5%, respectively), however the proportion of current smokers deceased from 11.1 to 4.05%. The percentages of individuals being unaware of their cholesterol decreased in all risk factor groups. However, individuals were likely to be unaware of their cholesterol at both time points if they were current smokers (1982 OR 1.44, CI 1.4-1.7; 1997 OR 1.71, CI 1.48-1.97), past smokers (1982 OR 1.12, CI 1.05-1.18; 1997 OR 1.13, CI 1.06-1.20), overweight (BMI 25 kg/m(2)) or sedentary. In addition, physicians who never quit smoking were likely to be unaware of their cholesterol throughout the study (OR 1.42, CI 1.21-1.67). Cholesterol awareness in general and among those with CAD risk factors improved after 14-years of follow-up. However, the likelihood of being unaware was greater among smokers at both time points. Therefore, smokers do not appear to take advantage of other preventive strategies that would minimize their risk of developing CAD.

Sherman SG; Gann DS; Tobin KE; Latkin CA; Welsh C; Bielenson P. "The life they save may be mine": Diffusion of overdose prevention information from a city sponsored programme. International Journal of Drug Policy 20(2): 137-142, 2009. (28 refs.)

Background: Overdose remains the leading cause of death among injection drug users (IDUs) in the United States. Overdose rates are consistently high in Baltimore, MD,. The current qualitative study examines diffusion of information and innovation among participants in Staying Alive, an overdose prevention and naloxone: distribution programme in Baltimore, MD. Methods: In-depth interviews were conducted between June 2004 and August, 2005 with 25 participants who had completed the Staying Alive training and had reported using naloxone to revive an overdose victim. Interviews were taped and transcripts were transcribed verbatim. Results: Participants were 63% male, 63% African American, and the median age was 41 years old. Participants successfully shared information on overdose prevention and management, particularly the use of naloxone, to their peers and family. Conclusions: The current study demonstrates IDUs' interest in and ability to diffuse overdose prevention information and response skills to the injection drug use community. The study underscores the importance of promoting the diffusion of information and skills within overdose prevention programmes.

Shibly O. Effect of tobacco counseling by dental students on patient quitting rate. Journal of Dental Education 74(2): 140-148, 2010. (27 refs.)

Tobacco use has widespread, devastating effects on the body, including the oral cavity. Today's dental professional must be trained to counsel patients on tobacco cessation, but dental health professionals and students do not feel confident in their counseling, abilities. The University at Buffalo School of Dental Medicine (SDM) established the Tobacco Counseling Cessation Protocol (TCCP), which vas implemented in the dental curriculum, and dental Students were trained in its use. The goal of this project vas to assess the effectiveness of the TCCP by surveying both patients and dental students. Students and patients were contacted to determine the effect of the TCCP on the quitting rate. Third- and fourth-year dental students were surveyed through the school c-mail system and asked to report on their tobacco cessation counseling, practices. Patients who received TCCP received follow-up telephone calls to obtain their input on the program and also to determine if they had quit. According to the follow-up survey, 14 percent of patients reduced the number of cigarettes smoked per day, and 22 percent quit entirely. Fifty-one percent of those who received the TCCP made a commitment to quit at the lime of the intervention; 32 percent of those receiving the TCCP were still smoke-free at six months, but 19 Percent had returned to smoking. If predoctoral students receive appropriate training, they call he effective in motivating patients to quit smoking. Dental students are generally receptive to the educational material on tobacco use and smoking cessation counseling, yet only half report routinely implementing the TCCP More needs to be done to incorporate tobacco cessation counseling into routine dental care. The culture of dentistry must be changed to view tobacco use as a dental problem.

Smith P; Bansal-Travers M; O'Connor R; Brown A; Banthin C; Guardino-Colket S et al. Correcting over 50 years of tobacco industry misinformation. American Journal of Preventive Medicine 40(6): 690- 698, 2011. (44 refs.)

Background: In 2006, a U. S. Federal Court ruled that the major domestic cigarette manufacturers were guilty of conspiring to deny, distort, and minimize the hazards of cigarette smoking to the public and ordered corrective statements to correct these deceptions. Purpose: This study evaluates the effectiveness of different versions of corrective statements that were proposed to the Court. Methods: 239 adult smokers (aged 18-65 years) were randomized to view one of five different versions of corrective statements on five topics (health risks, addiction, low-tar cigarettes, product manipulation, and secondhand smoke); change in knowledge and beliefs were measured before and after viewing the statements, as well as 1 week later. Three of the versions were text-based statements recommended by different parties in the case (Philip Morris, U. S. Department of Justice [DOJ], Interveners), whereas two others were developed at Roswell Park Cancer Institute (RPCI) for this study and utilized pictorial images (emotive and neutral). Data collection and analysis were conducted in Buffalo NY from 2008 to 2009. Results: Regardless of which corrective statement was seen, exposure resulted in a consistent pattern of increased level of knowledge and corrected misperceptions about smoking, although the effects were not large and diminished back toward baseline levels within 1 week. The DOJ, Interveners, and emotive statements elicited a stronger affective response and were rated by respondents as more persuasive (p-value<0.05). The emotive statement was better recalled and drew the respondents' attention in the shortest amount of time. Conclusions: Each of the proposed corrective statements tested helped correct false beliefs about smoking, but sustained impact will likely require repeated exposures to the message.

Stade BC; Bailey C; Dzendoletas D; Sgro M; Dowswell T; Bennett D. Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy. (review). Cochrane Database of Systematic Reviews 2009(2): article CD004228, 2009. (91 refs.)

Background: It is estimated that more than 20% of pregnant women worldwide consume alcohol. Current research suggests that alcohol intake of seven or more standard drinks (one standard drink = 13.6 grams of absolute alcohol) per week during pregnancy places the baby at risk of serious, lifelong developmental and cognitive disabilities. Psychological and educational interventions may help women to reduce their alcohol intake during pregnancy. Objectives: To determine the effectiveness of psychological and educational interventions to reduce alcohol consumption during pregnancy in pregnant women or women planning pregnancy. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2008), CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE (1966 to November 2007), EMBASE (1980 to November 2007), CINAHL (1982 to November 2007), Counsel. Lit (1980 to November 2007), PsycLIT (1974 to November 2007) and PsycINFO (1967 to November 2007) and checked cited references from retrieved articles. Selection criteria: Randomized controlled trials examining the effectiveness of psychological and educational interventions for reducing consumption of alcohol among pregnant women, or women planning for pregnancy. Data collection and analysis At least two review authors independently extracted information from the results sections of the included studies. Main results: Four studies met the inclusion criteria (715 pregnant women), and reported on at least one of the outcomes of interest. We performed no meta-analyses as the interventions and outcomes measured in the studies were not sufficiently similar. For most outcomes there were no significant differences between groups; and results relating to abstaining or reducing alcohol consumption were mixed. Results from individual studies suggest that interventions may encourage women to abstain from alcohol in pregnancy. There was very little information provided on the effects of interventions on the health of mothers and babies. Authors' conclusions: The evidence from the limited number of studies suggests that psychological and educational interventions may result in increased abstinence from alcohol, and a reduction in alcohol consumption among pregnant women. However, results were not consistent, and the paucity of studies, the number of total participants, the high risk of bias of some of the studies, and the complexity of interventions limits our ability to determine the type of intervention which would be most effective in increasing abstinence from, or reducing the consumption of, alcohol among pregnant women.

Strauss SM; Harris G; Katigbak C; Rindskopf DM; Singh S; Greenblum I et al. Alcohol education provided to opioid treatment program patients: Results of a nationwide survey. Journal of Drug Education 40(4): 379-393, 2010. (29 refs.)

Alcohol-related problems are especially common among opioid treatment program (OTP) patients, suggesting that educating OTP patients about alcohol and its harmful effects needs to be a priority in OTPs. Using data collected in interviews with a nationwide U. S. sample of OTP directors (N = 200) in 25 states, we identified factors that differentiate OTPs that provided this education to all OTP patients from those that did not. Findings indicate that these factors include (1) providing this education in a greater variety of ways, (2) having a larger percent of staff knowledgeable about alcohol-related issues, (3) having a director who views alcohol issues as a high priority, and (4) having a written OTP policy.

Tamakoshi A; Kawado M; Ozasa K; Tamakoshi K; Lin YS; Yagyu K et al. Impact of smoking and other lifestyle factors on life expectancy among Japanese: Findings from the Japan Collaborative Cohort (JACC) Study. Journal of Epidemiology 20(5): 370-376, 2010. (36 refs.)

Background: A number of lifestyle factors, including smoking and drinking, are known to be independently associated with all-cause mortality. However, it might be more effective in motivating the public to adopt a healthier lifestyle if the combined effect of several lifestyle factors on all-cause mortality could be demonstrated in a straightforward manner. Methods: We examined the combined effects of 6 healthy lifestyle behaviors on all-cause mortality by estimating life expectancies at 40 and 60 years of age among 62 106 participants in a prospective cohort study with a 14.5-year follow-up. The healthy behaviors selected were current nonsmoking, not heavily drinking, walking 1 hour or more per day, sleeping 6.5 to 7.4 hours per day, eating green leafy vegetables almost daily, and having a BMI between 18.5 to 24.9. Results: At age 40, we found a 10.3-year increase in life expectancy for men and a 8.3-year increase for women who had all 6 healthy behaviors, as compared with those who had only 0 to 2 healthy behaviors. Increases of 9.6 and 8.2 years were observed for men and women, respectively, at age 60 with all 6 healthy behaviors. When comparing currently nonsmoking individuals with 0 to 1 healthy behaviors, the life expectancy of smokers was shorter in both men and women, even if they maintained all 5 other healthy behaviors. Conclusions: Among individuals aged 40 and 60 years, maintaining all 6 healthy lifestyle factors was associated with longer life expectancy. Smokers should be encouraged to quit smoking first and then to maintain or adopt the other 5 lifestyle factors.

Tobin KE; Sherman SG; Beilenson P; Welsh C; Latkin CA. Evaluation of the Staying Alive programme: Training injection drug users to properly administer naloxone and save lives. International Journal of Drug Policy 20(2): 131-136, 2009. (14 refs.)

Background: In response to the high rates of opiate-related overdoses and deaths in the United States, a number of overdose prevention programmes have been implemented that include training drug users to administer naloxone, an opiate antagonist. The purpose of this study was to evaluate the Staying Alive (SA) programme in Baltimore, Maryland, which trained drug users to prevent and respond to opiate overdose using techniques including mouth-to-mouth resuscitation and administration of naloxone. Methods: Participants for the SA programme were recruited from multiple locations by Baltimore City Health Department Needle Exchange programme staff. A 1-h training was conducted by two facilitators. Participants who successfully completed the programme were provided with a kit that contained naloxone. Participants in the evaluation study were enrolled prior to the training session. The present analysis includes 85 participants who completed a pre- and post-test evaluation survey. Results: At both time points, 43 participants reported having witnessed an overdose. Post-training, naloxone was administered by 19 with no reported adverse effects. Post-training, a greater proportion of participants reported using resuscitation skills taught in the SA programme along with increased knowledge specifically about naloxone. Conclusions: Results from this study provide additional evidence to support the effectiveness of overdose prevention training programmes that include skills building for drug users to administer naloxone.

Tsui JI; Vittinghoff E; Hahn JA; Evans JL; Davidson PJ; Page K. Risk behaviors after hepatitis C virus seroconversion in young injection drug users in San Francisco. Drug and Alcohol Dependence 105(1/2): 160-163, 2009. (13 refs.)

Background: The rationale for screening populations at risk for hepatitis C virus infection (HCV) includes the possibility of altering risk behaviors that impact disease progression and transmission. This study prospectively examined young injection drug users (IDU) to determine if behaviors changed after they were made aware of HCV seroconversion. Methods: We estimated the effects of HCV seroconversion coupled with post-test counseling on risk behaviors (alcohol use, non-injection and injection drug use, lending and sharing injecting equipment, and having sex without a condom) and depression symptoms using conditional logistic regression, fitting odds-ratios for immediately after disclosure and 6 and 12 months later, and adjusting for secular effects. Results: 112 participants met inclusion criteria, i.e. they were documented HCV seronegative at study onset and subsequently seroconverted during the follow-up period, with infection confirmed by HCV RNA testing. HCV seroconversion was independently associated with a decreased likelihood of consuming alcohol (OR=0.52; 95% CI: 0,27-1.00,p =0.05) and using non-injection drugs (OR=0.40; 95% CI: 0.20-0.81, p=0.01) immediately after disclosure, however, results were not sustained over time. There were significant (p < 0.05) declines in the use of alcohol, injection and non-injection drugs, and sharing equipment associated with time that were independent from the effect of seroconversion. Conclusions: Making young IDU aware of their HCV seroconversion may have a modest effect on alcohol and non-injection drug use that is not sustained over time.

Vorobjov S; Uuskula A; Abel-Ollo K; Talu A; Ruutel K; Des Jarlais DC. Comparison of injecting drug users who obtain syringes from pharmacies and syringe exchange programs in Tallinn, Estonia. Harm Reduction Journal 6(3), 2009. (42 refs.)

Background: Both syringe exchange programs (SEPs) and pharmacy sales of syringes are available in Estonia, though the current high incidence and high prevalence of HIV among injection drug users (IDUs) in Tallinn, Estonia requires large-scale implementation of additional harm reduction programs as a matter of great urgency. The aims of this report were to compare risk behavior and HIV infection and to assess the prevention needs among IDUs who primarily use pharmacies as their source of sterile syringes with IDUs who primarily use SEPs in Tallinn. Methods: A cross-sectional study using respondent-driven sampling was used to recruit 350 IDUs for an interviewer-administered survey and HIV testing. IDUs were categorized into two groups based on their self-reported main source for syringes within the last six months. Odds ratios with 95% CI were used to compare characteristics and risk factors between the groups. Results: The main sources of sterile needles for injection drug users were SEP/SEP outreach (59%) and pharmacies (41%). There were no differences in age, age at injection drug use initiation, the main drug used or experiencing overdoses. Those IDUs using pharmacies as a main source of sterile needles had lower odds for being infected with either HIV (AOR 0.54 95% CI 0.33-0.87) or HCV (AOR 0.10 95% CI 0.02-0.50), had close to twice the odds of reporting more than one sexual partner within the previous 12 months (AOR 1.88 95% CI 1.17-3.04) and engaging in casual sexual relationships (AOR 2.09 95% CI 1.24-3.53) in the last six months. Conclusion: The data suggest that the pharmacy users were at a less "advanced" stage of their injection career and had lower HIV prevalence than SEP users. This suggests that pharmacies could be utilized as a site for providing additional HIV prevention messages, services for IDUs and in linking IDUs with existing harm reduction services.

Walker SL; Saltman DL; Colucci R; Martin L. Awareness of risk factors among persons at risk for lung cancer, chronic obstructive pulmonary disease and sleep apnea: A Canadian population-based study. Canadian Respiratory Journal 17(6): 287-294, 2010. (33 refs.)

OBJECTIVE: To assess awareness among persons at risk for lung cancer, chronic obstructive pulmonary disease (COPD) and sleep apnea regarding symptoms and risk factors of the disease, and their attitudes regarding the disease and toward those who are affected. METHODS: A quantitative hybrid telephone and Internet survey of a representative population of Canadian adults at risk for at least one of the three diseases was conducted. To measure the awareness and attitudes of First Nations, Inuit and Metis people to these diseases, a proportionate number were also surveyed. RESULTS: A total of 3626 individuals were contacted. Of these, 3036 (84%) were eligible to participate. Of those at risk for lung cancer and COPD, 65% and 69%, respectively, were due to tobacco smoke exposure. Among those at risk, 72% believed that they were informed about lung cancer compared with 36% for COPD and 56% for sleep apnea. Most respondents were knowledgeable about the common symptoms of lung cancer, COPD and sleep apnea, but were less aware of the impact lifestyle choices could have on the development of these disorders and the availability of treatment. Most of the participants (77%) believed that smoking was an addiction rather than a habit (19%). There were no significant differences in the awareness of risk factors, symptoms and attitudes toward all three lung diseases between First Nations, Inuit and Metis people and the general population. CONCLUSIONS: Canadians are reasonably aware of risk factors and symptoms for lung cancer and sleep apnea. However, there is poor awareness of COPD as a disease entity. There is a lack of appreciation for the impact lifestyle choices and changes can have on lung diseases.

Wang TC; Kyriacou DN; Wolf MS. Effects of an intervention brochure on emergency department patients' safe alcohol use and knowledge. Journal of Emergency Medicine 39(5): 561-568, 2010. (32 refs.)

Alcohol abuse is a leading cause of morbidity and mortality in the United States, contributing to over 100,000 deaths and costing society over 185 billion dollars each year. The objective of this study was to evaluate the effects of the American College of Emergency Physician's brief alcohol use intervention brochure on patients' hazardous drinking behavior and knowledge of safe alcohol use. We conducted a controlled trial comparing Emergency Department (ED) subjects receiving the alcohol use intervention brochure vs. receiving no brochure. One-month outcome measures included the following: 1) change in days of hazardous drinking; 2) change in knowledge of safe alcohol use: and 3) movement along a readiness-to-change continuum for excessive alcohol use. Of 277 subjects, 252 (91.0%) agreed to participate, and 188 of these (74.6%) were successfully contacted for 1-month follow-up assessment. We did not find any significant decreases in days of hazardous drinking or increases in knowledge of safe drinking limits for either the intervention or comparison groups. However, among the subgroup of excessive alcohol users (n = 100), we found that significantly more intervention subjects had advanced along the readiness-to-change continuum than comparison subjects (p < 0.01). This effect was even greater among the intervention group subjects who stated that they read the brochure (p < 0.001). A brief alcohol use intervention brochure does not affect ED patients' hazardous drinking behavior or knowledge of safe alcohol use. The brochure, however, may affect certain patients' motivation to change their drinking behavior. Changing drinking behavior requires more than simply handing out a brochure in the ED; referral to community resources for those motivated to change is likely an important component to successful management of this problem.

Webb MS. Culturally specific interventions for African American smokers: An efficacy experiment. Journal of The National Medical Association 101(9): 927-935, 2009. (48 refs.)

This pilot study sought to dismantle the efficacy of culturally specific print materials for smoking cessation. Two-hundred sixty-one African American smokers were randomized into I of 2 conditions: standard booklet or culturally specific booklet. The content and length of the interventions were identical yet varied in their degree of cultural specificity. Three-month follow-up assessments were completed by 70% (N = 183) of participants. Dependent variables included content evaluation, readiness to quit smoking, and actual behavior change. Evidence suggested that the culturally specific material was more effective at capturing attention, providing encouragement and gaining interest compared to standard materials; however, greater credibility was found for standard materials. In addition, greater readiness to quit and more 24-hour quit attempts were found in the standard condition. No differences were found in abstinence rates. In conclusion, culturally specific interventions may be preferred over standard approaches among African American smokers. Culturally specific approaches, however, may not result in greater behavior change. Implications for written interventions and cultural specificity ore discussed.

Wilkinson SA; Miller YD; Watson B. The effects of a woman-focused, woman-held resource on preventive health behaviors during pregnancy: The Pregnancy Pocketbook. Women & Health (4): 342-358, 2010. (64 refs.)

We evaluated the effectiveness of a woman-held pregnancy record ('The Pregnancy Pocketbook') on improving health behaviors important for maternal and infant health. The Pregnancy Pocketbook was developed as a woman-focused preventive approach to pregnancy health based on antenatal management guidelines, behavior-change evidence, and formative research with the target population and health service providers. The Pregnancy Pocketbook was evaluated using a quasi-experimental, two-group design; one clinic cohort received the Pregnancy Pocketbook (n = 163); the other received Usual Care (n = 141). Smoking, fruit and vegetable intake, and physical activity were assessed at baseline (service-entry) and 12-weeks. Approximately two-thirds of women in the Pregnancy Pocketbook clinic recalled receiving the resource. A small, but significantly greater proportion of women at the Pregnancy Pocketbook site (7.6%) than the UC site (2.1%) quit smoking. No significant effect was observed of the Pregnancy Pocketbook on fruit and vegetable intake or physical activity. Few women completed sections that required health professional assistance. The Pregnancy Pocketbook produced small, but significant effects on smoking cessation, despite findings that indicate minimal interaction about the resource between health staff and the women in their care. A refocus of antenatal care toward primary prevention is required to provide essential health information and behavior change tools more consistently for improved maternal and infant health outcomes.

Winstock AR; Lea T; Fettell A. Pilot evaluation of an educational DVD for people with opioid dependence. Drugs: Education, Prevention and Policy 16(2): 182-192, 2009. (22 refs.)

Aims: There are currently 39,000 people on methadone or buprenorphine treatment in Australia, representing approximately one third of the opioid-dependent population. An educational DVD, entitled Access All Areas, was developed to inform, attract and engage opioid-dependent drug users into treatment, with a view to increasing users' understanding of the benefits and risks of treatment and factors impacting the way treatment is delivered. Methods: A pilot evaluation of the draft DVD was conducted with 99 opioid users recruited from two public opioid treatment clinics and four Needle Syringe Programs (NSP). Participants viewed a 1-hour segment of the DVD and completed a pre- and post-test knowledge questionnaire, and an evaluation questionnaire. Findings: After viewing the DVD, the majority of participants had a 'better understanding of the benefits of treatment' (95%), and were 'more likely to ask about hepatitis C treatment' (69%). Among participants not on opioid treatment, 37% were 'more interested in the idea of treatment' after viewing the DVD. The mean number of correct responses to knowledge questions increased marginally after viewing the DVD (14/28 vs. 15/28; p .05). However, there were considerable increases in the proportion of participants who responded correctly to questions regarding pregnancy and opioids, the dental effects of methadone, and hepatitis. Conclusions: This study provides preliminary evidence of the benefits of this educational resource to people with opioid dependence. Future research is planned evaluating the DVD in a controlled trial exploring treatment engagement, retention, and other outcomes.

Wood TE; Englander-Golden P; Golden DE; Pillai VK. Improving addictions treatment outcomes by empowering self and others18. International Journal of Mental Health Nursing 19(5): 363-368, 2010. (18 refs.)

The present research tested the effectiveness of adding an interpersonal, interactive, experiential training programme to addictions treatment that enhances motivation, cognitive-behavioural coping skills, social support, and group cohesiveness. The research was conducted in a co-educational, long-term residential treatment facility for addictive disorders (alcohol and other substances, sexual addiction, eating disorders, compulsive shopping, and gambling) and concomitant psychiatric diagnoses. The added training is co-created by participants. They choose challenging situations important in their lives that are played out as 'movies' in which they play and experience all the parts. Motivation for change, skills to implement positive changes, self-efficacy, empathy, positive support, and group cohesiveness are rooted in their own experiences and the feedback they receive from others, as they behave in empowering and disempowering ways. The training resulted in significant increases in empowering communication, self-esteem and quality of group life in the treatment group and in the family. Many of these results have large effect sizes and are consistent with the findings from prior studies. The results obtained in this study suggest that Say It Straight training can be an effective addition to the treatment of addictions in residential treatment. Future research is needed to determine the long-term effects of this training on relapse.

Woods SS; Jaen CR. Increasing consumer demand for tobacco treatments. Ten design recommendations for clinicians and healthcare systems. American Journal of Preventive Medicine 38(3, Supplement 3): S385-S392, 2010. (50 refs.)

Health professionals play an important role in addressing patient tobacco use in clinical settings. While there is clear evidence that identifying tobacco use and assisting smokers in quitting affects outcomes, challenges to improve routine, clinician-delivered tobacco intervention persist. The Consumer Demand Initiative has identified simple design principles to increase consumers' use of proven tobacco treatments. Applying these design strategies to activities across the healthcare system, we articulate ten recommendations that can be implemented in the context of most clinical systems where most clinicians work. The recommendations are: (1) reframe the definition of success, (2) portray proven treatments as the best care, (3) redesign the 5A's of tobacco intervention, (4) be ready to deliver the right treatment at the right time, (5) move tobacco from the social history to the problem list, (6) use words as therapy and language that makes sense, (7) fit tobacco treatment into clinical team workflows, (8) embed tobacco treatment into health information technology, (9) make every encounter an opportunity to intervene, and (10) end social disparities for tobacco users. Clinical systems need to change to improve tobacco treatment implementation. The consumer- and clinician-centered recommendations provide a roadmap that focuses on increasing clinician performance through greater understanding of the clinician's role in helping tobacco users, highlighting the value of evidence-based tobacco treatments, employing shared decision-making skills, and integrating routine tobacco treatment into clinical system routines.