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Objective: Examine receptivity and motivation to use/quit tobacco among college students after viewing Truth ads. Participants: Random sample of 10,000 college students invited to complete online survey February 2016 (8.5% response rate). Methods: Quasi-experimental. Participants (N = 854) watched four ads and answered survey items for each ad. Results: Students rated ad receptivity and decreased motivation to use tobacco higher for the Catmageddon ad than the others. Regardless of ad, men and current cigarette smokers reported lower receptivity. Younger age was associated with lower motivation to use tobacco for all ads. Tobacco users reported greater motivation to quit with the Catmageddon ad. Conclusions: College students were receptive to the Truth ads, and many indicated lower motivation to use tobacco. Men, older college students, and current cigarette smokers were less receptive to the ads, reinforcing the need to develop tailored campaigns to reach these subgroups.

Purpose: Rural adolescents engage in higher smoking and smokeless tobacco use rates than those from urban communities; urban adolescents are more likely to use e-cigarettes. The study investigated whether place of residence (rural vs urban) is associated with tobacco use prevalence and change in prevalence among middle and high school students over time., Methods: We analyzed data from the National Youth Tobacco Survey (2011-2016). Multiple logistic regression methods for weighted survey data assessed the relationship of place of residence with current tobacco product use over time, adjusting for demographics., Findings: There was no difference in rate of change in use of any tobacco product between rural and urban middle or high school students. Adjusting for age, sex, race/ethnicity, and survey year, both middle and high school rural students were more likely to use cigarettes and smokeless tobacco, whereas urban high school students were more likely to use hookah. Significant polynomial trends were observed for e-cigarette and hookah use patterns, whereas linear changes in use patterns were detected for cigarette and smokeless tobacco use over time., Conclusions: Rural high school students are more likely to smoke cigarettes and use smokeless tobacco than their urban counterparts, although prevalence rates have decreased over time. However, use of hookah and e-cigarettes among middle and high school students has increased over time regardless of place of residence. To stem the rapid increase in use of hookah and e-cigarettes, comprehensive tobacco control policies are needed regardless of rural or urban location., (© 2019 National Rural Health Association.)

Introduction: Tobacco smoke and radon are the leading causes of lung cancer. The FRESH intervention was a randomized controlled trial of 515 homeowners to promote stage of action to reduce radon and air nicotine levels., Methods: We studied 515 participants, 257 in a treatment group and 258 in a control group. Treatment participants received free radon and air nicotine test kits, report back, and telephone support, and those participants whose homes had high radon levels received a voucher for $600 toward mitigation. Both groups were asked to retest 15 months post intervention. We examined differences in stage of action to test for and mitigate radon and adopt a smoke-free-home policy and in observed radon and air nicotine values by study group over time., Results: Homeowners in the treatment group scored higher on stage of action to test for radon and air nicotine and to mitigate for radon during follow-up than those in the control group at 3 months and 9 months, but the effect of the intervention diminished after 9 months. We saw no difference between groups or over time in observed radon or air nicotine values. Of homeowners in the treatment group with high radon levels at baseline, 17% mitigated, and 80% of them used the voucher we provided., Conclusion: The null finding of no significant change in observed radon or air nicotine values from baseline to 15 months may reflect the low proportion of radon mitigation systems installed and the decline in stage of action to adopt a smoke-free home policy. Including a booster session at 9 months post intervention may improve the remediation rate.

This study investigated the association between sociodemographic characteristics and public attitudes toward Tobacco 21 laws. Through a random telephone survey in 2017, 1,675 Kentucky adults were asked if they favored/opposed increasing the minimum legal age to purchase tobacco products from 18 to 21 years of age. Over half (57.9%) favored raising the minimum legal age for tobacco sales to 21 (95% confidence interval: [54.5, 61.2]). Multivariable logistic regression for weighted survey data was used to determine factors associated with support. In the adjusted analysis, older age, female sex, non-White, conservative political ideology (versus moderate), and support for a statewide smoke-free policy were each significantly associated with greater support for Tobacco 21. The results suggest multiple demographic and personal factors associated with support, even in a tobacco-growing state. Health care professionals, including nurses, must understand existing public attitudes to effectively advocate for tobacco policies in states with high tobacco use.

Background: More radon-related lung cancers occur among those exposed to tobacco smoke., Objectives: To test the effects of a personalized environmental report back intervention on change in stage of action for air nicotine testing and adopting a smoke-free home and radon testing and mitigation from baseline to 3 months postintervention., Methods: The study design used a two-arm parallel groups randomized controlled trial with stratified quota sampling. The treatment group received free air nicotine and radon home test kits and a brief problem-solving phone intervention; the control group received a coupon for free test kits. A sample of 515 homeowners were enrolled; 319 completed the 3-month follow-up. Stage of action to test and remediate the home was measured consistent with the precaution adoption process model. Linear mixed modeling assessed whether the main and interaction effects of treatment and time were associated with the testing and remediation outcomes; multiple covariates were included in the models., Results: The models for the four stages of action outcomes (testing and remediating for radon and secondhand smoke) each had a significant treatment-by-time effect. The general pattern was an increase in stage of action from baseline to 3 months. The degree of change was generally larger among the treatment group participants relative to the controls, indicating that those in the treatment group were more ready to take action. For all the models, participants with higher self-efficacy for radon/air nicotine testing and radon/secondhand smoke remediation were more ready to take action to test and remediate. Synergistic risk perception was associated with stage of action for radon mitigation., Conclusions: Homeowners who were provided free radon and air nicotine test kits, given their results, and engaged in a brief telephonic problem-solving consultation tended to show a greater increase in readiness to take action to test and remediate by 3 months compared with those who received standard public health practice. Both groups showed an increase in stage of action for all four outcomes over time.

Little is known about polytobacco use in college students. One nationally representative survey indicated 51.3% of tobacco-using college students used more than one product, which may increase risk of tobacco-related disease and premature death. The purpose of this study was to examine the association of intention to quit smoking (ITQS) cigarettes with polytobacco use status, controlling for frequency of tobacco product use and cigarette smoking intensity as measured by cigarettes per day (CPD). Data are from a larger quasi-experimental study conducted at a large state university in the Southeastern United States. Analysis is based on the combined sample of current smokers from two randomly selected cohorts surveyed two months apart. Polytobacco users ( n  = 52) were as likely as cigarette-only users ( n  = 81) to intend to quit smoking. Compared to students who used tobacco products 1-9 days per month, students using 10-29 days per month or daily reported higher ITQS. Higher intensity smokers (>10 CPD) were 71% less likely to indicate ITQS, compared to lower intensity smokers (≤10 CPD) ( p  = .025). College student polytobacco users were as likely as those using only cigarettes to intend to quit smoking. Interventions are needed to target college student polytobacco users as well as cigarette smokers as both groups may intend to quit. Smokers using 10 or fewer CPD and those who use tobacco products daily or 10-29 days per month may be more motivated to quit than college students who smoke with more intensity but who use tobacco products less frequently.

Emerging tobacco product use is increasing. We evaluated factors associated with perceived risk of and intention to use waterpipe tobacco by surveying students at a large university in the southeastern U.S. (N = 667). Proportional odds modeling assessed whether demographic characteristics and social acceptability are associated with perceived risk of waterpipe tobacco use; and if these factors and perceived risk are related to intention to use waterpipe tobacco. Participants who perceived waterpipe tobacco to be more socially acceptable had lower odds of perceiving it as risky (95% confidence interval [CI] 0.50-0.68). Compared with never users, former tobacco users and current users had lower odds of perceiving waterpipe tobacco use as risky (95% CI 0.38-0.80 and 0.28-0.63, respectively). Similarly, students with greater perceived social acceptability scores had higher odds of intending to use waterpipe tobacco (95% CI 1.41-2.63), while those who perceived greater risk had lower odds of intending to use it (95% CI 0.34-0.64). Compared with never users, former users had higher odds of intending to use waterpipe tobacco (95% CI 1.42-7.21). Among those who had ever used waterpipe tobacco, 90% reported 'to socialize' as the most frequent reason for deciding to do so. Findings underscore the need for future prevention efforts., (© The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose/objectives: To examine the association of smoking in the home with lung cancer worry, perceived risk, and synergistic risk, controlling for sociodemographics, family history of lung cancer, and health-related self-concept. The hypothesis is that participants with smoking in the home would have higher scores for lung cancer worry, perceived risk, and synergistic risk.
., Design: Cross-sectional baseline survey. 
., Setting: Participants recruited from an outpatient clinic and pharmacy at University of Kentucky HealthCare, an academic medical center.
., Sample: 515 homeowners from a larger randomized, controlled trial aimed at reducing exposure to radon and secondhand smoke (SHS).
., Methods: Homeowners were selected via quota sampling so that about half would have a smoker or smokers in the home.
., Main Research Variables: Lung cancer worry and perceived risk; perception of synergistic risk of radon and SHS exposure; demographics.
., Findings: Participants with smoking in the home had higher rates of lung cancer worry and perceived risk. In addition, those with less education and a family history of lung cancer and who were current smokers had higher lung cancer worry and perceived lung cancer risk scores. Predictors of perception of synergistic risk were marital status and health-related self-concept.
., Conclusions: Homeowners with smoking in the home, less education, and a family history of lung cancer had greater lung cancer worry and perceived lung cancer risk. Lung cancer risk reduction interventions with vulnerable populations are needed. 
., Implications for Nursing: Nurses are in a unique position to target high-risk populations and identify opportunities to create teachable moments to reduce environmental risks of radon and tobacco smoke exposure.

Lung cancer is largely preventable by eliminating tobacco smoke and radon exposure. This exploratory study assessed the relationships of demographic factors, including having one or more smokers living in the household, and a) lung cancer worry and b) completion of home screening for radon and secondhand smoke (SHS) among renters. A convenience sample of renters (N = 47) received free test kits for radon and SHS as part of a larger study. Demographic factors, lung cancer worry, and completion of home testing were assessed at baseline. The sample was mostly Caucasian (68%), female (62%), and educated beyond high school (70%). The average age was 43 years (SD = 15), and roughly half lived with at least one smoker (49%). Gender, race/ethnicity, education, and whether they had smokers in the home accounted for 35% of the variability in lung cancer worry, F(4, 42) = 5.6, p = .001. Lung cancer worry was associated with lower level of education, b = 0.77; SE(b) = 0.32, and having at least one smoker living in the home, b = 0.71; SE(b) = 0.31. Renters tested their homes for radon and SHS whether they had smokers in the home or not. Constructing and delivering educational messages that target low-educated populations may promote radon testing and smoke-free homes.

Introduction: Low-cost media campaigns increase demand for smoke-free policies in underserved rural areas. The study examined the impact of loss- and gain-framed smoke-free print ads on recall and perceived effectiveness in rural communities, controlling for personal characteristics., Methods: Following 6- to 9-month print media campaigns in three rural counties, recall and perceived effectiveness of loss-framed (ie, targeting dangers of secondhand smoke [SHS]) and gain-framed (ie, highlighting positive aspects of smoke-free air) ads were assessed using random-digit-dial phone surveys. Respondents were asked if they remembered each ad, whether they liked it, whether they were prompted to contact a smoke-free coalition, whether the ad made them think, and whether it prompted emotion. Mixed modeling assessed whether personal factors predicted ad recall or perceived effectiveness., Results: Loss-framed ads were less likely to be recalled but more likely to prompt emotion. For ads of both frame types, females reported greater recall and perceived effectiveness than males. Those with less education reported higher perceived effectiveness of the ads but lower recall. Nonsmokers were more likely than smokers to perceive the ads as effective. Knowledge of SHS risk and support for smoke-free workplaces were positively associated with recall and effectiveness., Conclusions: Ad recall and perceived effectiveness were associated with framing and demographic and personal characteristics. Smoke-free efforts in rural areas may be bolstered by continuing to promote benefits of smoke-free workplace policies and educate on SHS risks. Rural areas may need to provide a combination of ad types and framing strategies to appeal to a wide audience., Implications: Rural communities are disproportionately affected by SHS and less likely to be protected by smoke-free policies. This study adds evidence-based guidance for tailoring rural smoke-free media campaigns using different framing: gain-framed messages (ie, benefits of smoke-free environments) to promote recall and loss-framed content (ie, dangers of SHS) to prompt emotion. Further, gain-framed messages that are localized to the rural community may be especially effective. Findings support designing smoke-free campaigns in rural communities with the audience in mind by tailoring messages to age, sex, and education level., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Use of more than one tobacco product among college students is increasing in popularity, leading to nicotine addiction and additional health risks. The study (1) examined polytobacco use patterns among college students who had ever used tobacco; and (2) assessed the sociodemographic and personal factors associated with current polytobacco use, compared to current single product use and former tobacco use among college students., Methods: Of 10,000 randomly selected college students from a large public university in the Southeast, a sample of 1593 students age 18 or older completed an online survey assessing tobacco use and attitudes. Ever tobacco users were included in this study (n = 662, or 41.6% of survey completers)., Results: About 15% of ever users reported current polytobacco use, and more than 70% of polytobacco users smoked cigars, little cigars, or clove cigarettes in combination with one or more products. Cigarettes were the most commonly-used product among single users, followed by hookah. Males, underclassmen, and students with greater acceptance of cigarette use were more likely to be polytobacco users. Race/ethnicity was marginally related to polyuse status, with white/non-Hispanics 28% less likely to be polytobacco users versus single product users., Conclusions: Polytobacco users were more likely than single users to consume emerging tobacco products, (ie, hookah and electronic cigarettes). Males, underclassmen, and racial/ethnic minorities were more at risk for polytobacco use. As young people are particularly prone to nicotine addiction, there is a need to further investigate polytobacco use among college students., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Tobacco media campaigns are effective, but less is known regarding the impact on college students., Purpose: The purpose was to test the effects of an on-campus Tips television campaign on frequency and believability of ads recalled and to assess demographic and personal factors associated with believability., Methods: A quasi-experimental pre-post design was used to assess the 8-week campaign with three Tips ads. Two randomly-selected cohorts of college students ( N = 1,593) from a large public university completed online surveys pre- and post-campaign. Group comparisons using chi-square tests, two-sample t-tests, and logistic regression, controlling for residence or cohort; predictors of believability using proportional odds modeling., Results: Ads were recalled by significantly more students (68%) post-campaign. Believability for one or more ads was lower for males, undergraduates, those belonging to fraternity/sorority, and current polytobacco users ( p <.05). Believability was greater for those who recalled seeing the ads more often ( p <.05)., Discussion: Sub-groups of college students, including males and undergraduates, reported less ad believability, which should be considered when designing communication strategies., Translation to Health Education Practice: Considering the potential impact and cost-effective nature of on-campus TV media campaigns, these ads need to be integrated into current campus tobacco control strategies.

Objectives: Objectives were to (1) explore perceived effectiveness of existing smoke-free print advertisements in rural communities and (2) generate message content, characteristics, and media delivery channels that resonate with residents., Design and Sample: Qualitative methods design. Thirty-nine rural adults recruited by community partners., Measures: Content analysis of findings from individuals in four focus groups who participated in general discussion and reviewed eight print ads related to secondhand smoke (SHS) and smoke-free policy., Results: Six content themes were identified: smoking/SHS dangers, worker health, analogies, economic impact, rights, and nostalgia. Seven message characteristics were recognized: short/to the point, large enough to read, graphic images, poignant stories, statistics/charts/graphs, message sender, and messages targeting different groups. Four media delivery channels were considered most effective: local media, technology, billboard messages, and print materials., Conclusions: Seeking input from key informants is essential to reaching rural residents. Use of analogies in media messaging is a distinct contribution to the literature on effective smoke-free campaigns. Other findings support previous studies of effective messaging and delivery channels. Further research is needed to examine effectiveness of themes related to message content in smoke-free ads and delivery strategies. Effective media messaging can lead to policy change in rural communities to reduce exposure to SHS., (© 2015 Wiley Periodicals, Inc.)

Promoting tobacco control policies in rural tobacco-growing communities presents unique challenges. The purpose of this study was to assess smoke-free coalition cohesiveness in rural communities and identify coalition members' perceived barriers or divisive issues that impede the development of smoke-free policies. A secondary aim was to evaluate differences in coalition cohesiveness between advocates in communities receiving stage-based, tailored policy advocacy assistance versus those without assistance. Tobacco control advocates from 40 rural Kentucky communities were interviewed by telephone during the final wave of a 5-year longitudinal study of community readiness for smoke-free policy. On average, five health advocates per county participated in the 45-min interview. Participants rated coalition cohesiveness as not at all cohesive, somewhat cohesive, or very cohesive, and answered one open-ended question about potentially divisive issues within their coalitions. The mean age of the 186 participants was 48.1 years (SD = 13.3). The sample was predominantly female (83.6%) and Caucasian (99.5%). Divisive concerns ranged from rights issues, member characteristics, type of law, and whether or not to allow certain exemptions. Three of the divisive concerns were significantly associated with their rankings of coalition cohesiveness: raising tobacco in the community, the belief that smoke-free would adversely affect the economy, and government control. Educating coalition members on the economics of smoke-free laws and the actual economic impact on tobacco-growing may promote smoke-free coalition cohesiveness. More resources are needed to support policy advocacy in rural tobacco-growing communities as well as efforts to reduce the divisive concerns reported in this study.

Introduction: Secondhand smoke (SHS) is a leading cause of childhood illness and premature death, especially in rural areas. The study examined the relationship of having a smoke-free home, strength of smoke-free law (SFL) in the county of residence, having one or more minor children in the home, rural/urban location, and demographics., Methods: An Internet-based panel survey was administered to Kentucky residents from 2007 to 2012. Sample size ranged from 400 to 513 per year; N = 2,653 total. Most were female, aged 35-54, had at least some college education, and lived in a smoke-free home. Almost half lived in a county with a comprehensive SFL; 14% lived in a county with a moderate or weak law., Results: Multivariate logistic regression revealed that the significant predictors of a smoke-free home included having education beyond high school, being a nonsmoker, living in an urban county, and having a year of participation in the survey. Controlling for smoking status and other personal characteristics, those who responded to the survey in the last 2 years of administration were more likely to have a smoke-free home compared to the reference year of 2007. Respondents living in urban counties were nearly 2 times more likely to report a smoke-free home than rural dwellers., Conclusions: Smoke-free homes in urban areas, where SFLs may be the norm, may be more typical than in rural communities. Public awareness campaigns and education about the benefits of smoke-free homes is needed, especially in rural areas, targeting smokers, those with less education, and those with children living in the home.

Objective: Tobacco use is the leading preventable cause of death, resulting in 443,000 US deaths per year. Rural adults have higher smoking prevalence and less access to tobacco dependence treatment than their urban counterparts. This study examined exposure to a culturally specific smoking cessation outreach intervention, assessing whether exposure was associated with cessation behaviors., Design and Sample: Post-test only quasi-experimental study. Targeted adult smokers (N = 251) living in a rural, economically distressed southeastern US county for at least 6 months., Measurements: Five outreach elements (brochures/pushcards, posters, print and radio advertisements, quilt made by local artisans) based on themes from focus groups with current and former smokers and paired with brief tobacco cessation counseling, and were delivered over 6 months in 2009-2010. Exposure and cessation behavior indicators were collected via cross-sectional random-digit dial survey. The total intervention exposure score was 4.8 (SD = 4.3, range 0-19)., Results: Intervention exposure was associated with having talked to a health care provider about quitting smoking in the past 6 months and planning to quit smoking in the next 6 months., Conclusions: Culturally specific outreach materials based on personal narratives are a promising population-based intervention to motivate rural smokers to consider cessation., (© 2013 Wiley Periodicals, Inc.)

Objectives: The purpose of this study was to assess attitudes and behaviors related to smoke-free policy among undergraduate student alcohol drinkers on a campus in a community with smoke-free bars., Design and Sample: This was a secondary data analysis of a study in which participants completed mailed surveys assessing demographic characteristics, attitudes and behaviors related to alcohol and tobacco use and smoke-free policy (n = 337). Opinion and behavior items were summarized descriptively; associations were examined using Kruskal Wallis tests and chi-square tests of association. Logistic regression tested for predictors of importance of smoke-free policy., Results: Respondents were predominantly female and Caucasian; mean age 20.3 years. One fourth were current smokers. Seventy-nine percent said the community smoke-free law had no effect on frequency of visiting bars. Eighty-seven percent said smoke-free policy in campus buildings was "somewhat" or "very important." Predictors of perceived importance of smoke-free policy included gender and smoking status., Conclusions: Most smokers in this sample did not experience a change in their motivation to quit smoking or in number of cigarettes smoked daily. Implementation of a community smoke-free law did not reduce the likelihood of visiting bars. Women and nonsmokers were more likely to rate smoke-free campus policy as very important., (© 2011 Wiley Periodicals, Inc.)

Little is known about the most effective strategies to motivate rural smokers to quit. This article describes the personal narratives of current and former smokers living in an economically distressed, rural area of Appalachian Kentucky. Three categories emerged: personal motivators to quit smoking, external influences, pride of place. Capturing personal narratives represents an evidence-based, data-rich strategy for development of culturally sensitive, population-based interventions for rural smokers. Such strategies may be effective in reaching rural smokers and motivating them to quit, thereby reducing tobacco-related disease and premature death in rural, economically distressed communities., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Despite a strong stance by the American College Health Association and years of prevention and control efforts on US college campuses, smoking and exposure to secondhand smoke remain a problem among college students. This article provides an overview of what is known about cigarette smoking in this population as well as existing interventions for smoking prevention, cessation, and exposure to secondhand smoke on college campuses. Strategies to reduce tobacco use are presented, many of which have been demonstrated to be effective in the short-term., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to determine the factors related to motivation to quit among smoking family members of lung cancer patients., Design and Sample: Relatives of multidisciplinary lung cancer clinic patients were recruited during family members' treatment. Participants (N=29) were primarily female and Caucasian., Measures: The items assessed included the effect of their relative's disease on motivation to quit, intent to quit in the next 6 months, stage of change, perceived risk from smoking, and attitudes about being approached about cessation., Results: Most indicated that their relative's disease had increased motivation to quit smoking (71%); 72% planned to quit within 6 months. One fourth (28%) were in precontemplation stage of change; 65% in contemplation; and 7% in preparation. The average perceived risk of developing lung cancer was 6.3. Two thirds were glad or very glad that someone had talked with them about quitting; 91% thought it was somewhat or very appropriate to talk about cessation with family members of lung cancer patients. Motivation to quit smoking was positively correlated with stage of change and perceived lung cancer risk., Conclusions: Public health nurses who interact with families of lung cancer patients may be able to promote cessation in an at-risk group that is motivated to quit smoking., (© 2010 Wiley Periodicals, Inc.)

Tobacco use is the leading cause of preventable disease and death in the United States. Nurses are effective interventionists for tobacco dependence treatment but lack the related education. This quasi-experimental study evaluated the impact of the Rx for Change: Clinician-Assisted Tobacco Cessation curriculum on baccalaureate nursing students' perceived knowledge, confidence, skills, and opinions related to tobacco dependence treatment. Cohort 1 completed a process evaluation to assess acceptability of the pretraining survey and intervention. Cohort 2 completed pretraining and posttraining surveys. A subsample received a 2-hour intervention, whereas other participants received 6 hours of training. Cohort 1 rated the pretraining survey instrument favorably. In cohort 2, the Rx for Change program had a positive impact on perceived knowledge, confidence, skills, and opinions. Outcomes did not differ based on duration of intervention or students' smoking status. Further research related to standardized content for tobacco dependence treatment is indicated.

This article describes an innovative, evidence-based approach to community healthcare: the creation of toolkits to address health problems. The exemplar used is the development of an evidence-based meningococcal disease prevention toolkit, with action plans for dissemination, implementation, and evaluation, to be used by healthcare providers in developing comprehensive programs on college campuses. Qualitative research methods were used to develop the content. Formative and summative evaluations were conducted. Anticipated outcomes of such toolkits when implemented as designed are provision of evidence-based healthcare, improved health status of individuals, populations, and communities, fewer hospitalizations, and reduction of healthcare costs.

As new nursing graduates enter the workplace, they are faced with demands that have the potential to be the most challenging they will face in their professional careers. Challenges include nursing shortages, increased patient acuity, and early patient discharges (Ellerton & Gregor, 2003). Moreover, studies indicate clinical nursing practice is extremely stressful for new graduates (Charnley, 1999; Dearmun, 1998; Delaney, 2003; Maben & Clark, 1998; Oermann & Moffitt-Wolf, 1997). Authors have documented concerns of graduating nursing students, which include being able to function as a competent professional registered nurse and worries about the work environment (McConnell & Dadich, 1997) as well as meeting the performance expectations of the workplace given new graduates' self-perceived lack of clinical experience (Heslop, McIntyre &e Ives, 2001). There is a need to examine what is known about the transition from nursing student to professional nurse. The purpose of this paper is to review the literature to identify current issues affecting the transition of newly graduated nursing students into their professional nursing roles, examine strategies designed to enhance transition, and to propose ways nurse leaders in education and service can collaborate to positively influence this process.

Leaders in nursing education are incorporating innovative educational strategies, including reflection, which will more fully develop student nurses' intellectual capacities to conceptualize knowledge to better meet patients' needs (Boud, Keough, & Walker, 1998; Duraghee, 1996; Hallett, 1997). This article examines the theoretical basis for reflective practice and explores its usefulness in the development and transmission of nursing knowledge in baccalaureate nursing education. Critical reflection can be effectively utilized by leaders in baccalaureate nursing education in classrooms, clinical settings, service learning experiences, experiential learning activities, and in the instruction of ethical decision-making.

Cardiovascular disease is the primary cause of morbidity and mortality in patients with chronic kidney disease. Anemia, a well-defined risk factor for cardiovascular disease, has been shown to contribute to the development of angina pectoris, ischemic events, and left ventricular hypertrophy. Data indicate that these cardiovascular-related disorders are often ameliorated or reversed in patients who maintain hemoglobin (Hb) levels in the 11 to 12 g/dL range recommended by NKF-K/DOQI. Conversely, Hb levels below 11 g/dL result in an increase in cardiovascular disorders and a 2.9-fold increased risk of death. Nephrology nurses should understand the interplay between Hb levels and cardiovascular disease, and how their efforts to maintain Hb levels > or = 11 g/dL can positively affect patient outcomes.