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Biomedical subjects

M E Wewers

Publications and source records attributed to M E Wewers.

At least 19 recordsLinked to original sources
PubMed2000

Tobacco interventions by oncology nurses in clinical practice: report from a national survey.

BACKGROUND: Tobacco use is an important risk factor in cancer, cancer recurrence, and increased treatment morbidity, but limited information is available about interventions for tobacco cessation used in oncology clinical practice. In 1996, the Agency for Health Care Policy Research (AHCPR) published the first evidence-based smoking cessation guideline for use by health professionals. Using the AHCPR guideline as a framework, the authors describe the frequency of tobacco interventions provided by oncology nurses. METHODS: A questionnaire was mailed to 4000 randomly selected members of the Oncology Nursing Society in winter of 1998. Of those who were mailed questionnaires, 1508 respondents (38%) were available for analysis. RESULTS: The typical respondent was female, 44 years of age, and had practiced as an oncology nurse for 12 years. Seven percent were current smokers, and 30% were former smokers. Most (86%) encountered smokers on a weekly basis, but only 10% had heard of the AHCPR guideline. The majority (64%) assessed and documented tobacco status, 38% assessed readiness to quit. Few went on to provide interventions: 36% provided counseling, 32% provided cessation advice, 24% recommended nicotine replacement, and 16% taught skills to prevent relapse. Common barriers included perceived lack of patient motivation (74%) and the nurse's lack of time (52%) and skills (53%). The majority stated that they wanted to help patients stop smoking (88%) but needed additional training (92%). CONCLUSIONS: Documentation of tobacco status alone is not adequate in assisting patients with smoking cessation. Greater efforts are needed to educate oncology nurses about the range of tobacco interventions available and to facilitate their use in clinical settings.

Adult↗
PubMed2000

Smoking behavior, dysphoric states and the menstrual cycle: results from single smoking sessions and the natural environment.

A 2-way factorial repeated measures design examined the effects of menstrual cycle phase and smoking on: 1) smoking behavior, 2) mood state, 3) nicotine withdrawal symptomatology, and 4) menstrual symptomatology. Female smokers, aged 20-39, were followed for two consecutive menstrual cycles with two data collection sessions per cycle, which were conducted in the University's General Clinical Research Center (GCRC). Participants were randomly assigned to order of smoking condition, which included: 1) smoking ad libitum, and 2) 24-hour abstinence prior to data collection. Data were collected in the mid-to-late follicular (MLF) phase (between days 6 through to 11) and the four days prior to menses in late luteal (LL) phase. Participants completed the Profile of Mood States and Menstrual Symptom Severity List and recorded daily cigarette smoking rate in the natural environment during MLF and LL phases. Nicotine boost and carbon monoxide (CO) boost were measured and the Shiffman-Jarvick Tobacco Withdrawal Questionnaire was administered during GCRC data collection sessions. Results indicated that subjects smoked more cigarettes per day during the LL phase and CO boost was greater during MLF. No difference was noted in nicotine boost by condition or phase. No difference in mood state was noted by either condition or phase. Withdrawal symptomatology and craving for cigarettes were increased after 24 hours of abstinence. No difference was noted in menstrual symptoms by condition or phase. Further investigations are still needed to characterize the importance of cycle phase in the design of smoking cessation interventions for women of reproductive age.

Adult↗
PubMed2000

Tobacco use characteristics among rural Ohio Appalachians.

Appalachians remain at high risk for cancer, heart and lung disease, in part because of their high prevalence of tobacco use; yet, information about their tobacco consumption patterns is limited. The purpose of this study was to describe tobacco consumption variables among rural adult Appalachian tobacco users. Subjects, aged 18 and older (N = 249), participated in a face-to-face interview about tobacco consumption variables and knowledge regarding the health effects of tobacco at fairs in two rural Ohio Appalachian counties. The majority of participants were categorized as precontemplators, although 21 percent were classified in preparation stage of change. Mean age of initiation was 16.6 years and number of cigarettes smoked per day (cpd) was significantly higher for men, as compared to women. One-third of males reported the use of smokeless tobacco. The majority had not tried to quit for more than a year and the average number of previous quit attempts was low. One-half of the sample had been advised in the past to quit by their physician. Few had used nicotine replacement with past quit attempts but greater than half would consider this approach with future attempts. Knowledge about the health effects of smoking indicated that most were aware of the relationship between smoking and cancer but less than one-half recognized its association with heart disease. Those with less education were less informed about the health effects to self and non-smokers. While a sizeable portion expressed interest in quitting, knowledge about the health effects of smoking is lacking, especially with regard to heart disease and among those with less education.

Adolescent↗
PubMed2000

Cotinine levels in Southeast Asian smokers.

Understanding the contribution of race to factors associated with cigarette smoking and nicotine metabolism is essential for the characterization of patterns of tobacco use, nicotine dependence and incidence of tobacco-related diseases. This paper reports an investigation of cotinine levels among Southeast Asian smokers in two separate studies. Study 1 included 327 male and female smokers who participated in community-based interviews where smoking history information was obtained and a saliva continine sample was collected. Results indicated that subjects smoked an average of 11.2 cigarettes/day, with men reporting significantly higher consumption rates as compared to women (p < 0.0001). Subjects' mean cotinine level was 65 ng/ml with an average cotinine/cigarette ratio of 8.2. In Study 2, plasma and saliva cotinine in six Southeast Asian adult smokers were measured during 2 days of smoking followed by 6 days of abstinence. On day 1, mean plasma and saliva continine levels were 268 and 235 ng/ml, respectively. After 6 days of abstinence, mean levels had dropped to 12 ng/ml for plasma and 8 ng/ml in saliva. On average, it required at least 4.7 days for saliva continine levels to reach < 14 ng/ml. Mean cotinine concentrations during smoking differed in these two separate studies. Implications of these findings are discussed and future research recommendations are presented.

Adult↗
PubMed2000

Implementing the Agency for Health Care Policy and Research's Smoking Cessation Guideline in a lung cancer surgery clinic.

PURPOSE/OBJECTIVES: To determine the effectiveness of a nurse-managed smoking cessation intervention based on the Agency for Health Care Policy and Research's (AHCPR's) Smoking Cessation Guideline in a lung cancer surgery clinic. DESIGN: Quasi-experimental. SETTING: Urban, Midwest, academic, and tertiary care. SAMPLE: 25 adult male and female smokers with a confirmed diagnosis of lung cancer that had been surgically managed. Subjects were assigned to an intervention group (n = 14) or a usual-care group (n = 11). METHODS: Participants in the intervention group received a nurse-delivered, AHCPR-based smoking cessation intervention that included face-to-face and phone follow-up contact beginning with the first preoperative clinic consultation. Usual-care participants received routine care provided at the institution. MAIN RESEARCH VARIABLES: Self-reported smoking status with expired air carbon monoxide confirmation six months postsurgery. FINDINGS: Seventy-one percent of the intervention group was biochemically confirmed to be abstinent by expired air carbon monoxide, as compared to 55% in the usual-care group. CONCLUSIONS: Smokers diagnosed with lung cancer desired to quit smoking and may benefit from an intensive smoking cessation intervention at time of diagnosis. IMPLICATIONS FOR NURSING PRACTICE: Further research should include continuing evaluation of an intensive smoking cessation intervention with this population, and all clinicians should be trained to implement AHCPR's Smoking Cessation Guideline in practice.

Adult↗
PubMed1999

The effect of chronic administration of nicotine on antinociception, opioid receptor binding and met-enkelphalin levels in rats.

The effect of chronic nicotine administration on (1) antinociception; (2) opioid receptor binding; and (3) met-enkelphalin levels in discrete brain regions in rats was investigated. Male and female Sprague-Dawley rats were treated with nicotine 0.3 mg/kg, 0.1 mg/kg, or saline three times a day subcutaneously during a 14-day protocol. Antinociception was measured by hotplate (HP) test on days 1, 2, 7, 10 and 14. After completion of the protocol, mu-opioid receptors were analyzed by [3H]-DAMGO binding studies and met-enkelphalin levels were determined by radioimmunoassay. Results indicated that hot-plate latency increased during the first 2 days of nicotine administration for male and female rats who were treated with 0.3 mg/kg nicotine. There was an up-regulation of mu-receptors (increased Bmax) in the striatum of rats treated with 0.3 mg/kg nicotine, compared to 0. 1 mg/kg nicotine and saline groups. An interaction effect of group by gender was noted. After 14 days of chronic nicotine administration, met-enkelphalin levels were significantly lower in striatum and midbrain of animals treated with 0.3 mg/kg nicotine, as compared to controls. These results suggest that chronic nicotine administration, in doses representative of human smoking, produces antinociception initially, and is accompanied by an upregulation of micro-opioid receptors in the striatum of rats. In addition, nicotine-induced tolerance to antinociception may be associated with a decrease in met-enkelphalin level over a period of time.

Analgesics, Opioid↗
PubMed1998

Naltrexone administration affects ad libitum smoking behavior.

Endogenous opioid peptides have been implicated in the reinforcement of smoking and opioid antagonists have been examined to determine their role in smoking behavior. To date, the relationship between smoking behavior and chronic opiate antagonist administration during ad libitum smoking has not been investigated. The purpose of this study was to examine the relationships between naltrexone, an opiate antagonist administered orally, and smoking behavior and mood states during ad libitum smoking. A repeated measures experimental design was used. Normal adult male and female volunteers, admitted to the Clinical Research Center, were randomly assigned to naltrexone-treated (n = 22) or placebo-control (n = 21) groups in a double-blind manner. Day 1 was considered acclimation to the unit and day 2 was baseline, or pre-drug administration. On days 3, 4, and 5, subjects received 50 mg naltrexone or a placebo at 0700 and 1600 hours. Plasma nicotine and expired air carbon monoxide levels were measured daily at 1900 hours. Number of cigarettes smoked, mood states, withdrawal symptomatology and self-reported satisfaction with smoking were also quantified daily. Results indicated that plasma nicotine levels (P = 0.005), number of cigarettes smoked daily (P = 0.003) and self-reported satisfaction with smoking (P = 0.043) were significantly lower among those treated with naltrexone, compared to the placebo-control group. Expired air carbon monoxide levels did not differ between the two groups. In addition, mood states and withdrawal symptoms did not differ between groups. These findings suggest that endogenous opioid peptides influence specific smoking behavior variables.

Adult↗
PubMed1998

Cigarette smoking in HIV infection induces a suppressive inflammatory environment in the lung.

Lung lymphocyte numbers are frequently increased in human immunodeficiency virus (HIV)-infected individuals in the absence of lung infection, and may play a critical role in viral surveillance and protection against new infections. In this context, cigarette smoking by HIV-infected individuals has been associated with a relative increase in the peripheral blood CD4(+) T-lymphocyte count as compared with that of nonsmokers. Because lung defense is local, the aim of the present study was to determine whether cigarette smoking had a significant impact on local lung defenses in HIV-infected individuals. The numbers and subtypes of bronchoalveolar lymphocytes and the ability of lung lavage cells to produce proinflammatory cytokines were compared in 58 smokers and 34 nonsmokers. In contrast to a trend toward an increase in peripheral blood CD4(+) cell counts among nonsmokers, smokers had significant depressions in both the percentage and absolute numbers of CD4(+) and CD8(+) cells in their bronchoalveolar lavage fluid (BALF). A decrease in CD4(+)/CD8(+) cell ratios was also seen with smoking. In addition, production of both interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) was suppressed with cigarette smoking. These observations show that cigarette smoking is associated with suppression in localized lung defenses, and suggest that smoking cessation may have a positive impact on lung defenses in HIV-infected smokers.

AIDS-Related Opportunistic Infections↗
PubMed1998

Smoking cessation interventions in nursing practice.

Smoking cessation treatment by nurses in clinical practice significantly increases the number of smokers who are able to successfully quit the behavior. Nurse-managed cessation interventions have been shown to be effective with smokers, yet many nurses lack the knowledge to identify smokers easily, to identify those treatments that are most efficacious, and to deliver appropriate interventions. This article highlights recent developments in smoking cessation treatment that can be integrated into nursing practice. Attention is given to cessation techniques in special populations, including youth.

Female↗
PubMed1998

The effectiveness of a nurse-managed minimal smoking-cessation intervention among hospitalized patients with cancer.

PURPOSE/OBJECTIVES: To determine the effectiveness of a nurse-managed minimal smoking-cessation intervention among hospitalized patients with cancer. DESIGN: Prospective, two-group, randomized clinical trial. SETTING: Urban, academic, tertiary-care setting. SAMPLE: 28 adult male and female smokers with a diagnosis of cancer who are hospitalized for a surgical procedure. METHODS: During hospitalization, subjects were assigned to a minimal smoking-cessation intervention group (n = 14) or a usual care group (n = 14). Verification of smoking status was performed at a clinic visit six weeks postintervention. Nonsmoking status was defined as self-report of zero cigarettes/day during the prior week and confirmed by saliva cotinine analysis. MAIN RESEARCH VARIABLES: One-time, Inpatient, nurse-managed, minimal smoking-cessation intervention, self-reported smoking status, and saliva cotinine level of < or = 14 ng/ml. FINDINGS: Upon hospital admission, 64% of the intervention group and 71% of the usual care group reported their intention to quit smoking. At six weeks postintervention, only 21% and 14% of the intervention and usual care group, respectively, were classified as abstinent from smoking. More than 90% of the intervention group members who resumed smoking did so within first week of discharge. IMPLICATIONS FOR NURSING PRACTICE: A more intensive intervention may be necessary to assist hospitalized surgical patients in achieving smoking cessation. Additional contact prior to discharge or within the first few days postdischarge may be necessary to reinforce strategies for remaining abstinent.

Adult↗
PubMed1997

A nurse-managed smoking cessation intervention during diagnostic testing for lung cancer.

PURPOSE/OBJECTIVES: To determine the effectiveness of a nurse-managed smoking cessation intervention. DESIGN: Prospective, descriptive, one-group, pretest/post-test. SETTING: Urban, academic, tertiary-care setting. SAMPLE: Fifteen adult male and female smokers with a suspected diagnosis of lung cancer who were admitted to an inpatient thoracic surgery unit for diagnostic testing. METHODS: Subjects received a nurse-managed smoking cessation intervention during hospitalization with subsequent verification of smoking status at a clinic visit six weeks postintervention. MAIN RESEARCH VARIABLES: Self-reported smoking status and saliva cotinine levels at six weeks postintervention. FINDINGS: Eighty-seven percent of subjects reported an intent to quit smoking within the month. At six weeks postintervention, 93% of the subjects reported at least one cessation attempt, and 40% were confirmed, via saliva cotinine analysis, as abstinent from smoking during the prior week. CONCLUSIONS: A nurse-managed smoking cessation intervention was successful in achieving short-term cessation. IMPLICATIONS FOR NURSING PRACTICE: Hospitalization for diagnostic testing associated with lung cancer may represent an opportunity for nurses to deliver a smoking-cessation intervention.

Adult↗
PubMed1995

Misclassification of smoking status among Southeast Asian adult immigrants.

A total of 1,403 Southeast Asian adult immigrant males (n = 783) and females (n = 620) from Cambodia, Laos, and Vietnam who currently resided in Central Ohio were interviewed to determine the self-reported smoking prevalence among them, and underwent biochemical confirmation of their smoking status. Variables having to do with the subjects' sociodemography, acculturation, and smoking history that were related to the misclassification of smoking status were also investigated. Self-reported current smoking rates were 40.9% and 5.6% for males and females, respectively. After verification of the subjects' smoking status by saliva cotinine assay (smoker status > or = 14 ng/ml), the rates of smoking were found to be greater, at 43.7% for males and 14.8% for females. Years of education, self-reported smoking status, country of origin, and method of healthcare payment were significant predictors of misclassification. These findings suggest that the prevalence of smoking is higher among Southeast Asian adult females than has been previously reported. Variables that predict misclassification with regard to smoking status are presented, and their implications for clinicians and researchers are discussed.

Acculturation↗
PubMed1994

Plasma nicotine, plasma beta-endorphin and mood states during periods of chronic smoking, abstinence and nicotine replacement.

Nicotine is known to release neuroendocrine substances which may subsequently reinforce smoking behavior by improving mood states. The purpose of this study was to examine changes in plasma beta-endorphin and mood states during periods of chronic smoking, abstinence from smoking, and abstinence while chewing nicotine gum. A modified A-B-A-C design was used. Normal male volunteers were randomly assigned to an experimental or control group. Over a 12-day protocol, experimental subjects smoked ad libitum for 2 days, were abstinent for 4 days, resumed smoking for 2 days, and then chewed nicotine gum for the final 4 days. Control subjects smoked ad libitum throughout the entire protocol. Results indicated that changes in plasma beta-endorphin levels were not related to changes in the four smoking conditions. Plasma nicotine and mood states were related, such that dysphoric moods increased during abstinence from smoking in comparison to the control group. To investigate further the relationships between nicotine, beta-endorphin and reinforcement for smoking, it may be necessary to characterize endogenous opioid peptide release in the central nervous system during smoking.

Adult↗
PubMed1994

Patterns of cigarette consumption and cotinine levels among African American women smokers.

Cigarette smoking intensifies a number of serious health problems, including lung cancer, hypertension, low birth weight, and infant mortality, that disproportionately affect black Americans. Cotinine, a major nicotine metabolite, is one indicator of smoke exposure. It has been reported that black women have higher mean cotinine levels than white women. This divergence may be attributed to biologic factors or to inaccuracy in reporting cigarette use. The purpose of this study was to characterize nicotine dependence and the relationship between self-reported cigarette use and cotinine levels among black women smokers. The sample consisted of 142 black women cigarette smokers recruited individually at urban health centers and worksites. A cotinine/cigarette ratio was determined for light, moderate, and heavy smokers. Underreporting of cigarette consumption, previously defined as cotinine value > 25 ng/ml/cigarette, ranged from 86% among light smokers to 70% among moderate smokers and 21% among heavy smokers. There were significant differences in cotinine/cigarette and nicotine dependence scores across levels of smoking. Average cotinine/cigarette values were higher in black women compared with previous reports for Mexican American women smokers. No comparable values are available for white women. Additional study is needed to begin to explain variations in levels of cotinine, as well as perceived nicotine dependence among black women.

Adolescent↗
PubMed1994

A smoking cessation intervention with hospitalized surgical cancer patients: a pilot study.

The purpose of this pilot study was to examine the effect of a structured smoking cessation intervention during hospitalization on short-term smoking abstinence. Hospitalized surgical oncology patients who smoked (n = 26) and were diagnosed with cancer were randomly assigned to either an experimental or control group. Experimental group subjects (n = 12) received a structured smoking cessation intervention during hospitalization followed by five weekly phone calls after discharge. Control group subjects (n = 14) received usual care from their health-care providers during hospitalization. Abstinence from smoking, as determined by saliva cotinine, the primary metabolite of nicotine, was measured at first postdischarge visit. Subjects with a saliva cotinine level of < 10 ng/ml were classified as abstinent. At first postdischarge visit, 75% of experimental group subjects were abstinent compared with 42.9% in the usual care group, a 32% difference. These preliminary findings will assist in the design and further evaluation of cancer rehabilitation strategies promoting cessation in hospitalized postoperative cancer patients who continue to smoke.

Adult↗