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The number of teens using electronic cigarettes in the United States has reached epidemic proportions. One in 20 middle school youth currently vapes regularly (Wang et al., 2020), supporting the need for e-cigarette education and prevention programs in this vulnerable population.The evidence-based youth vaping prevention program, CATCH My Breath, was implemented and evaluated in a small, private, parochial middle school using a quasi-experimental, within-subjects, longitudinal design.Students' e-cigarette knowledge significantly improved postintervention (p.001) and was sustained at 3 months follow-up. Attitudes about vaping remained stable after postintervention and at 3 months follow-up (p.05). Susceptibility toward vaping increased or remained consistent despite increased knowledge (p = .096).CATCH My Breath is an effective school-based resource to educate middle school youth about the dangers of vaping. Additional research is needed to evaluate the intervention's impact on e-cigarette attitudes and the measurement of susceptibility in teens.

OBJECTIVE The purpose of this paper was to examine changes in situational temptations to smoke among women in early to late pregnancy enrolled in a texting trial to help them quit smoking. We compared changes between (1) intervention arms, (2) those who quit, (3) those who reduced by 50% or more, and (4) those who reduced by less than 50%. We also examined cravings overtime in the intervention arm and the relationship between real-time cravings assessed via text message and situational temptations. METHODS This was a secondary analysis of the Baby Steps trial, a randomized controlled trial testing the efficacy of a text-based scheduled gradual reduction (SGR) intervention on cessation. We used t-tests to examine changes across intervention arms and repeated measured proc mixed to explore changes in situational temptations and cravings. RESULTS Among all women, situational temptations decreased from early to late pregnancy for the positive, negative, and habitual subscales, (ps

The connection between health and housing is well-established. People who are precariously housed have worse health than those who have stable housing arrangements.- Persons moving into public housing have a higher illness burden than the general population, and public housing residents engage in less healthy behaviors, which contribute to public housing residents having poorer health than persons living in other housing situations. Public housing authorities and residents can benefit from authentic and constructive relationships with academic partners; academicians and students can benefit from engaging in partnerships with housing authorities and residents to better understand the connection between housing and health. This article describes the well-established relationship between the Duke University School of Nursing (DUSON) and the Durham Housing Authority (DHA), the evolution of that relationship, our collaborative work in improving the health of DHA residents while advancing nursing education and science, and lessons learned.

Four common health risk behaviors have the greatest impact on all-cause mortality risk, but studies are needed with larger samples and the appropriate age range for cigarette smokers. We examined the impact of smoking in the context of multiple health behaviors on all-cause mortality using a nationally representative sample of adults aged 30 and older in the United States. National Health Interview Survey data from 1997 to 2005 were linked to the National Death Index with a follow-up to December 2015. The primary dependent variable was all-cause mortality, and the primary predictors were smoking, heavy drinking, physical inactivity, and unhealthy weight (underweight or obesity). The sample contained 189,087 individuals (≥ age 30; population estimate = 140.7 million). Our primary statistical analysis tool involved fitting Cox proportional hazards models. Our findings demonstrated that smoking led to the highest mortality risk among the four risk behaviors examined, but more than half of smokers engaged in at least one additional health risk behavior. Smokers who engaged in multiple health behaviors experienced higher increased mortality risks: smoking combined with one other health risk behavior increased mortality risk by 32% and by 82% when combined with two behaviors. Engaging in all four risk behaviors more than doubled the mortality risk of smokers. Smoking cessation interventions that address multiple risk behaviors-physical inactivity, heavy drinking, and unhealthy weight-will likely prevent premature death better than interventions that address only smoking.

OBJECTIVES To examine smoking behavior and social contexts related to smoking among dual-smoker couples. DESIGN Cross-sectional online survey study. SAMPLE A convenience sample of 183 dual-smoker couples. MEASUREMENTS Investigator-developed survey on smoking and related social contexts. RESULTS Participants smoked 16.0 cigarettes daily for 14.2 years; 48.4% shared more than half of their smoking time with their spouse. More than half made quit attempts in the past year individually (M = 5.3) and jointly (M = 2.5). Couples sharing more smoking time were more likely to be motivated to quit (p = .002), make quit attempts (p

Over the last two centuries nurses have been practicing, teaching, and conducting research on social factors that contribute to health and the language has evolved over this time.To explore how social factors that contribute to health are described by nurse authors and how that use has changed over time.A scoping review using the JBI Manual for Evidence Synthesis, Cochrane Handbook, and PRISMA guidelines was completed.From 1967 to 2021, nurses used the term "social factors" most commonly and there was a shift from demographic to social factors.As the language that nurses use has shifted from demographic descriptions to the social factors that may be associated with those descriptions, nurses have an opportunity to promote the use of non-deterministic language for health promotion and research.

Symptom distress places a burden on patients and their families, but it is often not captured in nursing documentation. Using a symptom management tool, such as the Condensed Memorial Symptom Assessment Scale (CMSAS), can assist in this capture and link patients to resources.The purpose of this quality improvement (QI) project was to implement the CMSAS and capture symptom burden to create a streamlined method of documentation.A QI pilot was conducted on an inpatient oncology unit implementing the CMSAS. Then, surveys were provided to the patients to complete at admission and discharge. The most distressing symptoms patients reported were added into the electronic health record nursing care plan that automatically uploaded interventions based on ONS Guidelines™.Patient (N = 73) symptom distress was quickly tracked, and there were no statistically significant changes in patient distress from admission to discharge, except for two symptoms.

INTRODUCTION: Many Latino men have multiple risk factors that predispose them to chronic disease morbidity and mortality, yet few have examined patterns in this population. We describe the co-occurrence of daily smoking, binge drinking, and intimate partner violence (IPV) behaviors among Latino expectant fathers and examine factors associated with the co-occurrence of these behaviors. METHODS: We conducted a secondary analysis of baseline data from the Parejas Trial, a randomized controlled trial testing a culturally tailored couples-based smoking cessation intervention. We used Kruskal-Wallis test statistics to explore the relationship of the co-occurring behavior and demographic and cultural factors. RESULTS: All participants smoked as was a requirement of being in the trial, but only 39% smoked daily. 43% of the participants engaged in one behavior, 32% engaged in two behaviors, and 5% engaged in three behaviors, with binge drinking being the most common co-occurring behavior. In the bivariate analysis, higher stress (p=0.01) and having more children (p=0.003) were found to be positively significantly associated with the number of behaviors. DISCUSSION AND CONCLUSIONS: Helping Latino expectant fathers manage with their stress may serve as tailoring points for future interventions to reduce risk behaviors.

IntroductionLight and intermittent smokers (LITS) represent almost 50% of all current smokers. Research is needed to understand smoking motives among adult light smokers.AimsTo explore smoking cues and motivators among a racially diverse sample of adult LITS (≤10 CPD). In addition, we explored differences between native (always smoked ≤10), and converted (former heavier) LITS.MethodsWe used purposive sampling to recruit participants who were native and converted LITS and to include equal numbers of African Americans, Whites and Latinos. We coded and analyzed transcripts using a stage approach to identify themes.ResultsFour main themes emerged that may be unique to light smokers and suggests potential strategies for intervention: (1) smoking in response to cues and control, (2) identifying as a smoker, (3) concern about health consequences, and (4) other priorities influencing smoking. There were some differences among smoking cues and motivators by race and ethnicity, and differences between native and converted LITS.ConclusionsOverall, LITS reported drivers of smoking that were unrelated to symptoms of nicotine withdrawal. Even when experiencing salient cues, our LITS cohort expressed the ability to assert control over smoking by abstaining when situational contexts made smoking inconvenient.

Introduction Smoking during pregnancy poses serious risks to baby and mother. Few disseminable programs exist to help pregnant women quit or reduce their smoking. We hypothesized that an SMS text-delivered scheduled gradual reduction (SGR) program plus support texts would outperform SMS support messages alone. Methods We recruited 314 pregnant women from 14 prenatal clinics. Half of the women received theory-based support messages throughout their pregnancy to promote cessation and prevent relapse. The other half received the support messages plus alert texts that gradually reduced their smoking more than 3–5 weeks. We conducted surveys at baseline, end of pregnancy, and 3 months postpartum. Our primary outcome was biochemically validated 7-day point prevalence abstinence at late pregnancy. Our secondary outcome was reduction in cigarettes per day. Results Adherence to the SGR was adequate with 70% responding to alert texts to smoke within 60 minutes. Women in both arms quit smoking at the same rate (9%–12%). Women also significantly reduced their smoking from baseline to the end of pregnancy from nine cigarettes to four; we found no arm differences in reduction. Conclusions Support text messages alone produced significant quit rates above naturally occurring quitting. SGR did not add significantly to helping women quit or reduce. Sending support messages can reach many women and is low-cost. More obstetric providers might consider having patients who smoke sign up for free texting programs to help them quit. Implications A disseminable texting program helped some pregnant women quit smoking. Clinical Trial Registration number: NCT01995097.

Women living in rural America experience significant disparities in cardiometabolic diseases warranting research to aid in understanding the contextual factors that underlie the rural and urban disparity and in planning effective primary prevention interventions. While research has established a general understanding of cardiometabolic risks individually, the combination or bundling of these risk behaviors is not clearly understood. The purpose of this study is to explore the association of social determinants of health on obesity and adiposity related cardiometabolic disease risk among rural women. Data were from the multi-state Rural Families Speak about Health Study. A total of 399 women were included in the analyses. Data were collected using a self-administered questionnaire on women's demographics, economic stability, education, and health and healthcare. Food insecurity, education, healthcare access and comprehension health literacy were associated with higher obesity and adiposity-related cardiometabolic risk. Health behaviors, tobacco use and physical activity were not associated with higher cardiometabolic risk in this sample of rural women. This is one of the first studies to focus on multiple social determinants of health and cardiometabolic risk in rural American women. Understanding combinations of risk behaviors can assist health care providers and community health professionals in tailoring multiple health behavior change interventions to prevent cardiometabolic disease among rural women. The findings support a focus on community and societal level factors may be more beneficial for improving the cardiometabolic health of rural women.

Background Excess gestational weight gain (EGWG) is associated with multiple pregnancy complications and health risks for birthing people and their infants. Likewise, postpartum weight retention (PPWR), or not losing all pregnancy weight, has long-term health consequences. EGWG among people who enter pregnancy with overweight or obesity have worse obstetric outcomes and increased PPWR compared to women who gain within Institute of Medicine guidelines. Methods This study protocol describes the details of a blinded, randomized clinical trial of GROWell: Goals for Reaching Optimal Wellness, a mHealth tool designed to improve diet quality among people who enter pregnancy with overweight or obese BMIs to help them achieve appropriate GWG and safe postpartum pregnancy weight loss. Individuals with overweight and obesity will be randomly assigned to an attention control or intervention arm. The intervention group will receive personalized, goal-oriented text messages regarding dietary choices, while the attention control group will receive text messages about healthy pregnancy, labor, delivery, and early infancy. Both groups will complete online surveys at baseline, follow up, 3 and 6 months postpartum. Results and discussion Currently, 162 subjects have been enrolled. Outcomes associated with GWG and pregnancy are expected in late 2023, while outcomes on postpartum weight retention GROWell adherence are expected in late 2024. The results of this trial will support the use of an evidence-based mHealth tool to be integrated into clinical practice to reduce EGWG and PPWR among pregnant people with overweight and obese BMIs, a resource that is currently lacking. Trial registration ClinicalTrials.gov identifier: NCT04449432 . Registered on June 26, 2020.

Background: Excess gestational weight gain (GWG) is associated with many pregnancy complications and health risks for mothers and infants. Likewise, postpartum weight retention (PPWR) has long-term health consequences for women. Excess GWG among women who enter pregnancy with overweight or obesity have worse obstetric outcomes and increased PPWR compared to women who gain within Institute of Medicine guidelines. Methods: This study is a blinded, randomized clinical trial of GROWell: Goals for Reaching Optimal Wellness, a mHealth tool designed to improve diet quality among women who enter pregnancy with overweight or obese BMIs in order to help them achieve appropriate GWG and safe postpartum pregnancy weight loss. Overweight and obese (BMI B25 and Discussion: This study protocol describes the details of the GROWell randomized clinical trial. The results of this trial will provide data to support the use of an evidence-based mHealth tool to be integrated into clinical practice to reduce excess GWG and PPWR among pregnant women with overweight and obese BMIs, a resource that is currently lacking.Trial registration: ClinicalTrials.gov identifier: NCT04449432. Registered on June 26, 2020.

PURPOSE: People living in rural areas experience greater health disparities than their non-rural counterparts, but little is known about the association between rural status and quality of life (QOL) in non-Hodgkin’s lymphoma (NHL) survivors. We compared self-reported quality of life and impact of cancer in rural and non-rural NHL survivors. METHODS: This study is a secondary analysis of 566 NHL cancer survivors recruited from cancer registries at 2 large academic medical centers in 1 state. Standardized measures collected information on demographics and clinical characteristics, quality of life (QOL; SF-36), and the Impact of Cancer (IOCv2). Rural residence was determined by Rural-Urban Commuting Area (RUCA) codes designated as non-metropolitan. Multiple linear regression analysis, adjusted for demographic and clinical covariates, was used to evaluate the relationship between rural residence and QOL and impact of cancer. FINDINGS: Among the 566 participants (83% response rate), rural residence was independently associated with lower SF-36 physical component summary scores and the physical function subscale (all P < .05). Rural residence was also associated with higher IOCv2 positive impact scores and the subscales of altruism/empathy and meaning of cancer scores in the adjusted models (all P < .05). CONCLUSIONS: Given documented rural cancer disparities and the lack of resources in rural communities, study findings support the continued need to provide supportive care to rural cancer survivors to improve their QOL. Consistent with previous research, rural residence status is associated with increased positive impact following cancer diagnosis.

Introduction Light smoking (smoking ≤ 10 cigarettes per day or on some days) has become increasingly prevalent in the US and increases morbidity and mortality. Many light smokers do not experience significant nicotine withdrawal but instead smoke in response to cues. Minimal evidence exists supporting interventions to help light smokers quit smoking. Methods We present results from a proof-of-concept pilot study designed to evaluate the feasibility and acceptability of a cue-based smoking cessation intervention targeted to light daily and intermittent smokers. Participants were randomized to one of two arms: Arm 1) standard smoking cessation treatment or Arm 2) standard smoking cessation treatment + enhanced cue-based treatment that included interactive texting to extend cue exposure treatment to real-world settings and cue management counseling. Outcomes included feasibility (number of participants who were recruited and who completed the intervention), acceptability (intervention ratings), and preliminary efficacy (7-day point prevalence abstinence). Results We randomized 24 English and Spanish-speaking light smokers, 13 to the treatment arm and 11 to the control arm. Across both arms, 77% attended all counseling sessions, 90% rated these sessions as very useful and 100% said that they would recommend the intervention to a friend. 15% in the treatment arm had biochemically-validated smoking abstinence compared to 0% in the standard counseling arm. Conclusions Results from this proof-of-concept study demonstrated that a cue-based intervention is feasible and acceptable among light smokers and suggests the need for a fully powered study to assess this approach. Trial registration This study is registered at www.clinicaltrials.gov NCT03416621.

Many couples tend to report steadily decreasing relationship quality following the birth of a child. However, little is known about the postpartum period for Latino couples, a rapidly growing ethnic group who are notably underserved by mental and physical health caregivers in the United States. Thus, this study investigated whether a brief couples’ intervention focused on helping couples support each other while increasing healthy behaviors might improve dyadic functioning postpartum. This study presents secondary analyses of data regarding couple functioning from a larger randomized controlled trial with 348 Latino couples to promote smoking cessation. Portions of the intervention taught the couple communication and problem-solving skills to increase healthy behavior. Couples participated in four face-to-face assessments across 1 year starting at the end of the first trimester. Latent growth curve analyses revealed that the treatment group reported an increase in relationship satisfaction and constructive communication after the intervention, which diminished by 1-year follow-up, returning couples to their baseline levels of satisfaction. Results suggest that incorporating a brief couple intervention as part of a larger health intervention for Latinos may prevent postpartum decreases in relationship satisfaction.

Purpose Research has documented that holding certain etiological beliefs about depression can determine the level of stigma experienced by individuals with depression. To date, no studies have yet examined this relationship among adolescents. Using a sample of Arab adolescents, the purpose of this study was to describe adolescents' beliefs about the etiology of depression, and examine whether these beliefs influence the type and severity of depression stigma. Methods A nationwide school survey was conducted in a representative sample of Jordanian public and private schools located in Jordan, a Middle-Eastern Arab country. A total of 2,349 adolescents aged 12-17 (59% female) completed and returned an anonymous survey that included measures on adolescents' sociodemographic and health characteristics, depression symptoms, depression stigma, and depression etiological beliefs. An exploratory factor analysis with principal components analysis (PCA) was used to examine the factor structure of the Depression Etiological Beliefs Scale. The stability of the PCA findings was tested using a cross-validation method. Regression analyses were performed to examine whether depression etiological beliefs, depression severity, or their interaction are associated with depression stigma. Results Adolescents endorsed multiple etiological beliefs about depression. The beliefs in which likely or very likely was most often reported were stressful events in one's life (72%), social factors (65%), and one's weak will (56%). On the other hand, the least reported beliefs were genetic or inherited problems (24%), chemical imbalance (30%), and punishment for wrong doings (35%). The interaction between adolescents' depression severity and depression beliefs significantly predicted personal stigma. Adolescent sex, age, and region of residence significantly affected the relationship between depression beliefs and stigma. Conclusions Nurses need to consider the beliefs and attitudes their patients have around depression, as these can influence symptom severity, comprehensive treatment plans, and adherence to provider recommendations. This study provides a better understanding of how depression beliefs affect Jordanian adolescents' attitudes toward depression, which can guide intervention programs to increase awareness about depression and promote treatment utilization.

Background The lack of research regarding the current profile of adolescent depression in the Arab countries in general, and Jordan in particular, makes it difficult to design, implement, and disseminate effective interventions to improve the prevention, diagnosis, and treatment of adolescent depression in the region. The purpose of this study was to estimate a national prevalence of depressive symptoms among adolescents in Jordan, and to identify characteristics associated with severity of depression. Methods A descriptive, cross-sectional, nationally representative school survey was utilized. A total of 2,349 Jordanian adolescents aged 12-17 completed and returned the survey packets, which included the Beck Depression Inventory-II and measures of sociodemographics and health history. Participants represented all three regions in the country, with 34% from the northern (suburban) region, 43% from the central (urban) region, and 23% from the southern (rural) region. Results The majority of the adolescents were females (59%) and 15-17 years old (67%). Almost 14% reported having at least one chronic health problem, 15% reported having a mental health problem, 25% reported having academic difficulties, 8% reported that they had received a psychiatric diagnosis, and 22% reported that they had sought psychological help at some point in the past. The mean total depression score was 16.3 (SD = 11.2, 95% CI = 15.8-16.7), with 34% of the sample reporting moderate to severe depression. Depression was significantly higher among respondents who were female, ages 14-15 years, and living in families with low monthly incomes; and who reported having a chronic health problem, mental health problem, learning difficulty, a psychiatric diagnosis and/or seeking previous psychological help. Conclusions Our findings should serve as an alarm, particularly given that rates of depression in the Arab countries are expected to increase rapidly in the context of the Arab Spring. Healthcare providers, researchers, and educators should focus attention on developing effective and culturally appropriate screening, prevention, and intervention approaches using evidence-based guidelines to promote Jordanian adolescent mental health, particularly for depression.

This study described the health behaviors and barriers and facilitators of those behaviors in elderly and/or disabled residents of public housing. A mixed-methods design was used. Residents (N = 88) completed a survey with validated measures of health behaviors. A sub-sample (N = 16) participated in three focus groups. Residents scored worse than population norms on the majority of behaviors measured. Qualitative results framed in an ecological model indicated the majority of facilitators and barriers to health behaviors were perceived as occurring at the intrapersonal and interpersonal levels. Interventions to promote health should consider the unique barriers and facilitators to health behaviors among residents.

BACKGROUND In Arab communities, the selection, utilization, and attitudes towards mental health services are substantially affected by existing mental illness stigma. However, little is known about how the stigma of depression manifests among Arab adolescents, which makes it difficult to design, implement, and disseminate effective anti-stigma interventions for this vulnerable population. Therefore, the purpose of this study was to determine levels of depression stigma among Arab adolescents. The specific aims were to (1) describe the severity of personal and perceived depression stigma among Arab adolescents and its relationship to severity of depression, and (2) determine characteristics associated with severity of depression stigma among Arab adolescents. METHODS This study was conducted in Jordan, a Middle Eastern Arab country. A nationally representative, school-based survey was utilized. A total of 2349 Jordanian adolescents aged 12–17 completed and returned the survey packets, which included measures on individual characteristics, depression severity, and depression stigma. RESULTS The majority of the adolescents (88%) reported scores indicating moderate to high depression stigma. Adolescents reported higher rates of perceived stigma than personal stigma. Depression stigma was not significantly associated with severity of depression, but with adolescent's sex, age, region of residence, parents' education, and history of mental health problem. CONCLUSIONS This is the first Arab study to isolate the influence of adolescent depression and personal characteristics on personal and perceived depression stigmas, and highlight the presence of these distinctions early in adolescence. Such distinction can inform the design and implementation of policies and interventions to reduce both personal and perceived stigma. The study provides important recommendations on when, how, and why to utilize school settings for anti-depression stigma interventions.

Most pregnant women know that smoking poses serious risks to baby and mother, yet many still smoke. We conducted a large randomized controlled trial and found that an SMS text-delivered program helped about 10% of these women quit smoking. In this paper, we describe the feasibility of disseminating a text-based intervention to pregnant women who smoke. We tested dissemination in two ways from prenatal clinics and compared recruitment rates to those found in our large randomized controlled trial. The first method involved “direct texting” where study staff identified women who smoked and sent them a text asking them to text back if they wanted to receive texts to help them quit. The second involved “nurse screening” where clinic staff from county health departments screened women for smoking and asked them to send a text to the system if they wanted to learn more about the program. Our primary outcome was feasibility assessed by the number of women who texted back their baby’s due date, which served as “enrolling” in the texting program, which we compared to the recruitment rate we found in our large trial. Over 4 months, we texted 91 women from the academic health system. Of those, 17 texted back and were counted as “enrolled.” In the health departments, across the 4 months, 12 women texted the system initially. Of those, 10 were enrolled. This rate was similar to the rate enrolled in the randomized controlled trial. Two different methods connected pregnant women who smoke to a texting program. One of these methods can be automated further and have the potential of helping many women quit smoking with minimal effort. Clinical Trial # NCT01995097

There are almost 9 million regular smokeless tobacco (ST) users in the United States. Because ST products, manufacturing methods, distribution, use patterns, regulations, and research differ by country, this chapter focuses on interventions in the United States and is limited to studies in adults. The challenges of measuring use and dependence are discussed, and tools appropriate to particular forms of ST products and conditions of use are assessed. The various behavioral and pharmacological interventions for which reliable data exist are evaluated, and recommendations for intervention methods and research are offered. In general, research has yielded good evidence and support for several methods, with some outcomes exceeding those for smoking cessation. However, refinement of existing methods and delivery systems is needed, as well as innovation in methods. Future directions in which studies and therapeutic applications might go are projected.

IntroductionSmokeless tobacco (ST) use significantly affects morbidity and mortality and remains disproportionally prevalent in rural and medically underserved communities. Few programs exist for rural smokeless tobacco users. Text-based interventions may increase the reach of cessation interventions; yet, none has tested them in ST users. We evaluated the feasibility, acceptability, and preliminary efficacy of a text-based Scheduled Gradual Reduction (SGR) intervention in rural and underserved ST users.MethodsST users were randomized in 2:1 fashion to the SGR group (N=65), a text-based reduction program plus text-based support counseling messages or text-based support messages only group (N=33). We surveyed participants at 30-days post intervention initiation to assess feasibility and acceptability and examined self-report 7-day point prevalence cessation at 30-days and 6-months post intervention initiation in the two arms.ResultsWe achieved benchmarks for feasibility and acceptability. Among the SGR participants 51% (n=48) reported that intervention was useful in helping them quit, 83% (n=48) indicated that they would recommend the intervention to a friend. Over 95% (n=39) of SGR participants said that they read all alert texts. The SGR participants had a higher quit rate at 30-days compared to support messages alone (SGR=21.5%, Control=9.1%, p=0.1627, Cohen's d equivalent=0.56, medium effect). However, the quit rate at 6-months was 21% (p=0.9703) for both groups.ConclusionsA text-based intervention was feasible and acceptable among underserved ST users. SGR helped promote short-term cessation. The text-based interventions both had long-term efficacy. Given that text-based interventions have the potential to increase reach in underserved ST users, further testing is warranted.

BACKGROUND The objective of the current study was to determine whether survivors of non-Hodgkin lymphoma are meeting select American Cancer Society (ACS) health-related guidelines for cancer survivors, as well as to examine relationships between these lifestyle factors and health-related quality of life (HRQoL) and posttraumatic stress (PTS). METHODS A cross-sectional sample of 566 survivors of NHL was identified from the tumor registries of 2 large academic medical centers. Respondents were surveyed regarding physical activity, fruit and vegetable intake, body weight, tobacco use, HRQoL using the Medical Outcomes Study Short Form-36, and PTS using the Posttraumatic Stress Disorder CheckList-Civilian form. Lifestyle cluster scores were generated based on whether individuals met health guidelines and multiple linear regression analysis was used to evaluate relationships between lifestyle behaviors and HRQoL scores and PTS scores. RESULTS Approximately 11% of participants met all 4 ACS health recommendations. Meeting all 4 healthy recommendations was related to better physical and mental QoL (standardized regression coefficient [β], .57 [P

Little is known about help-seeking for depression among Jordanian adolescents who are a vulnerable population with high rates of depressive symptoms and few mental health services. The purpose of this study was to (1) explore Jordanian adolescents’ helpseeking intentions for depression and (2) examine whether depression stigma, depression severity, or their interaction are associated with Jordanian adolescents’ willingness to seek help for depression and the type of treatment they would seek. In collaboration with the Jordanian Ministry of Education, we conducted a nationally representative, school-based survey of adolescents aged 12–17 years ( N = 2,349). One fourth of the adolescents reported they would not seek professional help for depression, and those respondents had higher average depression scores. Among those adolescents willing to seek help, the most likely sources included family member (57%), school counselor (46%), psychiatrist (43%), religious leader (39%), and general health practitioner (28%). Lower stigma scores were associated with greater likelihood to seek psychotherapy or visit a psychiatrist, while higher stigma scores were associated with increased likelihood to seek help from a school counselor or a family member. Jordanian adolescents experience significant barriers to seeking professional help for depression. However, even among adolescents with greater depression severity and depression stigma, school counselors were identified as a key resource for help. These findings suggest that school-based interventions may fill a critical service need for adolescents with depression and other mental health problems. School nurses should be leveraged along with counselors to address mental health issues in this vulnerable population.

The influence of gender and other individual and context characteristics on the prevalence and severity of depressive symptoms among Jordanian adolescents remains unclear. The aims of the current study were to: (a) characterize depressive symptoms profiles for Jordanian adolescents; and (b) examine gender differences in the type, severity, and correlates of depressive symptoms. Cross-sectional data were collected from 2,349 Jordanian adolescents ages 12 to 17 using a nationally representative school survey. The Beck Depression Inventory-II was used to assess the presence and severity of depressive symptoms. Female adolescents had significantly higher mean depression scores (17.9 [ SD = 11.6], 95% confidence interval [CI] [17.3, 18.5]) than their male counterparts (13.8 [ SD = 10.2], 95% CI [13.2, 14.5]). Approximately 41% of girls and 26% of boys reported scores indicating moderate to severe depression. Sex differences and socially constructed gender differences need to be adequately considered in the planning and delivery of mental health care for adolescent depression. If the risk for depression is gender-specific, prevention strategies cannot be gender-neutral. [ Journal of Psychosocial Nursing and Mental Health Services, 56 (2), 44–55.]

The purpose of this study was to identify variables associated with waterpipe smoking in college students using the Theory of Reasoned Action (TRA). Of the sample (N = 104), 50% had ever smoked a waterpipe, while 43% reported ever smoking a cigarette. Examined individually, intention, attitudes, and subjective norms were each significantly associated with waterpipe smoking controlling for demographics and tobacco use. When the variables were entered into the model simultaneously, the overall model was significant, with an area under the receiver operating characteristic curve (AUC) of 0.869, indicating the model has good to excellent discrimination between smokers and nonsmokers. Attitude remained significantly associated with future waterpipe smoking.

Objectives To examine demographic and substance use factors associated with exclusive smokeless tobacco use (SLT) and dual use of both cigarettes and SLT among blue-collar workers. Design and Sample This cross-sectional study used data from the United States 2009 National Survey on Drug Use and Health. The sample (n = 5,392) was restricted to respondents who were classified as blue collar workers by self-report primary job title. Measures Various demographic variables, tobacco use and other substance use variables were examined. Results Respondents in this blue collar sample were 87% male and 64% Non-Hispanic White. An estimated 9.5% (SE = 0.6) of respondents were current SLT users; 5.3% (SE = 0.4) were current exclusive SLT users, and 4.2% (SE = 0.4) were current dual users of both SLT and cigarettes. Factors related to exclusive SLT use were gender, marital status, age, race/ethnicity, type of blue-collar occupation, current binge drinking, and current marijuana use. Significant factors related to dual use were gender, marital status, age, race/ethnicity, type of blue-collar occupation, current cigar smoking, current binge drinking, and current illicit drug use. Conclusions Rates of SLT use and dual use are high among U.S. blue-collar workers, indicating a need for targeted, workplace cessation interventions. These interventions may also serve as a gateway for addressing other substance use behaviors in this population.

Text-based interventions are effective for smoking cessation, but have not been tested in rural older adults. The purpose of this study was to compare the feasibility, acceptability and preliminary efficacy of a text-based Scheduled Gradual Reduction (SGR) program to a non-SGR text messaging support condition among rural older adults. Adults over 60 years were randomized to either: (i) the SGR program (n = 20), a text-based program to reduce smoking over 4-weeks plus text-based support messages; or (ii) control (n = 20), receipt of text-based support messages only. Participants completed surveys at baseline and end of program to assess feasibility and acceptability of the intervention, and biochemically validated 7-day point prevalence cessation was assessed at end of treatment. Most participants (81%) reported reading all the messages they received. Participants found both interventions useful in quitting smoking (SGR = 57%, Control = 63%) and would recommend it to a friend (SGR = 72%, Control = 79%). Although not statically significant, the SGR group had a higher rate of biochemically validated cessation (SGR = 15%, Control = 5%, Cohen d = 0.67). Among those still smoking, the median percent reduction in cigarettes was 33.3% for both groups. Text-based cessation interventions are feasible, acceptable and can be easily disseminated to rural older adult tobacco users.

The Arab region has the largest proportion of young people in the world and many of the factors that contribute to the onset of depression. Yet, very little is known about the current situation of depression and its associated stigma in this region. The purpose of this pilot study was to obtain preliminary data examining clinically significant depressive symptoms, depression stigma, and attitudes towards seeking professional help for depression among a sample of Arab adolescents from Jordan. Cross-sectional data were collected from 88 adolescents attending public schools in Jordan using self-report questionnaires that were available in, or translated into, Arabic. Among the 88 adolescents, 22% reported scores suggesting mild depression and 19% reported scores suggesting moderate depression, while 24% reported scores suggesting severe depression. The most frequently reported depressive symptoms were changes in sleep patterns (76%), changes in appetite (63%), agitation (62%), and crying (61%). The majority (73%) had moderate depression stigma, and 43% had negative attitudes towards seeking professional help. Yet, 67% believed they would find relief in psychotherapy if they ever had a serious emotional crisis. Findings suggest that the prevalence of depressive symptoms may be high among Jordanian adolescents. Further, many of these adolescents may experience depression-related stigma that affects their attitudes and willingness to seek professional help. To determine the true scope of these issues, including the prevalence of depression among Jordanian adolescents, future research should obtain data from a nationally representative sample.

Background Research suggests that when smokers reduce their smoking, they also reduce their alcohol consumption. Purpose To examine the effects of a smoking cessation intervention and actual quitting smoking on binge drinking behavior among Latino expectant and new fathers. Methods Logistic regression models were used to examine the effect of intervention arm and quitting smoking on past 30-day binge drinking measured at 3-months and 12-months postpartum while controlling for known covariates. Results Fathers in the intervention arm were significantly more likely to decrease their binge drinking at the 12-month follow-up (OR=0.57, 95% CI=0.35–0.93). Quitting smoking, measured by both 7-day and 30-day point prevalence, was positively associated with reduced binge drinking at 3-months (OR=0.25, 95% CI=0.14–0.45; OR=0.44, 95% CI= 0.26–0.75) and 12-months (OR=0.22, 95% CI=0.11–0.42; OR=0.43, 95% CI= 0.24–0.77). Conclusions The results of this study support the positive effects of a smoking cessation intervention on decreasing binge drinking behavior among Latino fathers in the postpartum period.

Objectives To examine the demographic and health-related factors associated with risk behaviors that have been linked to cancer including smoking, high BMI, and low physical activity. Design and Sample A secondary analysis was conducted using data from Rural Families Speak about Health, a multistate, epidemiologic study of rural American women and their families (N = 444). Measures Validated measures for various demographic and health-related items including tobacco use, BMI, physical activity, and depression were used. Results Of the total sample with complete data (n = 399), the mean age was 32 years and the majority were White (64%), married (67%), had a high school education or higher (73%), and had an annual household income of less than $40,000 (90%). Regarding cancer risk behaviors, 36% of the sample were smokers, 39% reported low levels of physical activity, and 45% had a calculated BMI over 30. Thirty-five percent of participants reported engaging in two or more risk behaviors. There were significant differences in income, perceived health status, and depression depending on the number of risk behaviors reported. Conclusions Understanding combinations of risk behaviors can assist nurses and other health professionals in tailoring multiple health behavior change interventions to prevent cancer among rural women.

College waterpipe tobacco smokers who feel more ambivalence, that is, conflicted about its use, may have a stronger desire to quit. Using baseline survey data of 315 college waterpipe smokers, we examined this relationship. While frequency of feeling ambivalence was low, greater ambivalence was related with desire to quit ( r = .46, p

Purpose The purpose of this cross-sectional study was to examine waterpipe smoking and beliefs about waterpipe smoking in a sample of college students from a public university in Virginia. Data sources A web-based survey was sent to 1000 undergraduate students recruiting them to participate in the study. Measures from the investigator-developed Theory of Reasoned Action (TRA) Waterpipe Questionnaire were used to capture belief-based components of the TRA related to waterpipe use. Descriptive statistics were used to examine the prevalence of waterpipe smoking and beliefs associated with waterpipe smoking. Conclusions Of the sample (n = 223), 71% of males and 52% of females reporting ever smoking tobacco using a waterpipe and 22% of males and 5% of females reporting current waterpipe smoking. Of the sample, 28% of males and 10% of females were current cigarette smokers and 25% of males and 10% of females were current marijuana users. Common beliefs associated with waterpipe smoking are also presented. Implications for practice Nurse practitioners working with college students need to be aware of the multiple forms of tobacco that students may engage in. They also should be aware of the common beliefs about waterpipe smoking. This information is useful when targeting and counseling patients about alternative tobacco products like waterpipe smoking.

Blue collar workers are at risk for obesity. Little is known about factors associated with obesity in Operating Engineers, a group of blue collar workers. Therefore, a cross-sectional survey was conducted to determine variables related to obesity among Operating Engineers (heavy equipment operators). Operating Engineers (N=498) were recruited during their three-day safety courses to participate in the study. Bivariate and multivariate analyses were conducted to determine differences in personal and behavioral factors between obese and non-obese participants. Approximately 45% of the Operating Engineers screened positive for obesity and another 40% were overweight. Multivariate analysis revealed that younger age, male sex, higher numbers of self-reported comorbidities, not smoking, and low physical activity levels were significantly associated with obesity among Operating Engineers. Operating Engineers are significantly at risk for obesity. Workplace interventions that have been successful in other studies should be implemented to address the obesity epidemic among Operating Engineers in Michigan.

Rural adolescent females are at-risk for smoking at rates nearly equal to those of boys, and girls are at increased risk for smoking related diseases, reproductive, and pregnancy problems. The purpose of this study was to investigate protective factors related to nonsmoking in African American (AA) and Caucasian American (CA) female adolescents residing in rural tobacco-producing counties in Virginia. This qualitative study targeted rural female adolescent nonsmokers and their parents because of the importance of promoting tobacco-free, healthy lifestyles into adulthood. Participants were 18 adolescent female nonsmokers 16–17 years of age (6 AA and 12 CA) and 10 mothers (5 AA and 5 CA). Semi-structured questionnaires based on a health behavior framework and communication theory guided four in-depth group interviews of female adolescents and two group interviews of mothers. Protective factors identified by youth and parent groups were: frequent and open communication about smoking dangers and risks, mother...

Hookah smoking is a form of tobacco use that is growing in popularity in the United States (1). College-aged students, who are known to experiment with multiple forms of tobacco, are particularly v...

The objective of the current study was to determine whether survivors of non-Hodgkin lymphoma are meeting select American Cancer Society (ACS) health-related guidelines for cancer survivors, as well as to examine relationships between these lifestyle factors and health-related quality of life (HRQoL) and posttraumatic stress (PTS).A cross-sectional sample of 566 survivors of NHL was identified from the tumor registries of 2 large academic medical centers. Respondents were surveyed regarding physical activity, fruit and vegetable intake, body weight, tobacco use, HRQoL using the Medical Outcomes Study Short Form-36, and PTS using the Posttraumatic Stress Disorder CheckList-Civilian form. Lifestyle cluster scores were generated based on whether individuals met health guidelines and multiple linear regression analysis was used to evaluate relationships between lifestyle behaviors and HRQoL scores and PTS scores.Approximately 11% of participants met all 4 ACS health recommendations. Meeting all 4 healthy recommendations was related to better physical and mental QoL (standardized regression coefficient [β], .57 [P.0001] and β, .47 [P = .002]) and to lower PTS scores (β, -0.41; P = .01).Survivors of NHL who met more ACS health-related guidelines appeared to have better HRQoL and less PTS. Unfortunately, many survivors are not meeting these guidelines, which could impact their overall well-being and longevity.

BackgroundNovel interventions tailored to blue collar workers are needed to reduce the disparities in smoking rates among occupational groups. ObjectiveThe main objective of this study was to evaluate the efficacy and usage of the Web-enhanced “Tobacco Tactics” intervention targeting operating engineers (heavy equipment operators) compared to the “1-800-QUIT-NOW” telephone line. MethodsOperating engineers (N=145) attending one of 25 safety training sessions from 2010 through 2012 were randomized to either the Tobacco Tactics website with nurse counseling by phone and access to nicotine replacement therapy (NRT) or to the 1-800-QUIT-NOW telephone line, which provided an equal number of phone calls and NRT. The primary outcome was self-reported 7-day abstinence at 30-day and 6-month follow-up. The outcomes were compared using chi-square tests, t tests, generalized mixed models, and logistic regression models. ResultsThe average age was 42 years and most were male (115/145, 79.3%) and white (125/145, 86.2%). Using an intent-to-treat analysis, the Tobacco Tactics website group showed significantly higher quit rates (18/67, 27%) than the 1-800-QUIT NOW group (6/78, 8%) at 30-day follow-up (P=.003), but this difference was no longer significant at 6-month follow-up. There were significantly more positive changes in harm reduction measures (quit attempts, number of cigarettes smoked per day, and nicotine dependence) at both 30-day and 6-month follow-up in the Tobacco Tactics group compared to the 1-800-QUIT-NOW group. Compared to participants in the 1-800-QUIT NOW group, significantly more of those in the Tobacco Tactics website group participated in the interventions, received phone calls and NRT, and found the intervention helpful. ConclusionsThe Web-enhanced Tobacco Tactics website with telephone support showed higher efficacy and reach than the 1-800-QUIT-NOW intervention. Longer counseling sessions may be needed to improve 6-month cessation rates. Trial RegistrationClinicaltrials.gov NCT01124110; http://clinicaltrials.gov/ct2/show/NCT01124110 (Archived by WebCite at http://www.webcitation.org/6TfKN5iNL).

Background The objective of this study was to evaluate the effectiveness of the inpatient, nurse-administered Tobacco Tactics program for patients admitted for psychiatric conditions in two Veterans Affairs (VA) hospitals compared to a control hospital. Methods This is a subgroup analysis of data from the inpatient tobacco tactics effectiveness trial, which was a longitudinal, pre- post-nonrandomized comparison design with 6-month follow-up in the three large Veterans Integrated Service Networks (VISN) 11 hospitals. Results Six-month self-reported quit rates for patients admitted for psychiatric conditions increased from 3.5% pre-intervention to 10.2% post-intervention compared to a decrease in self-reported quit rates in the control hospital (12% pre-intervention to 1.6% post-intervention). There was significant improvement in self-reported quit rates for the pre- versus post-intervention time periods in the Detroit and Ann Arbor intervention sites compared to the Indianapolis control site (P = 0.01) and cotinine results were in the same direction. Conclusion The implementation of the Tobacco Tactics intervention has the potential to significantly decrease smoking and smoking-related morbidity and mortality among smokers admitted to VA hospitals for psychiatric disorders.

OBJECTIVE This study examined differences in perception of risk, hospitalization quit rates, and 6-month quit rates between pipe smokers, cigarettes smokers, and those who smoke both in the Department of Veterans Affairs. METHODS Before implementing the Tobacco Tactics intervention (among 811 smokers), smoking quit rates were determined (among N = 465 patients with 6-month follow-up data available) in three Midwestern hospitals during 2006-2010. RESULTS Pipe smokers were less likely to believe that they needed to quit tobacco, that quitting would be difficult, and that quitting tobacco was important to their health. Eighty-five percent of pipe smokers remained tobacco free throughout their hospital stay compared with 59% of dual smokers and 60% of cigarette smokers (p < .10). Twenty-three percent of pipe smokers remained tobacco free at 6 months compared with 19% of dual users and 7% of cigarette smokers (p < .10). CONCLUSION Although pipe smokers had higher spontaneous quit rates than dual smokers and cigarette smokers, the perception of the risk of smoking was less among pipe smokers suggesting a need to expel the myths surrounding pipe smoking and increase cessation efforts.