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Biomedical subjects

Mary Ellen Wewers

Publications and source records attributed to Mary Ellen Wewers.

At least 19 recordsLinked to original sources
PubMed2007

Key informants' perspectives prior to beginning a cervical cancer study in Ohio Appalachia.

Higher-than-average cervical cancer incidence and mortality rates occur in Ohio Appalachia. Little is known, however, about societal norms and social determinants that affect these rates. To examine county-level sociocultural environments to plan a cervical cancer prevention program, the authors interviewed key informants from 17 of 29 Ohio Appalachia counties. Findings include the perceived offensiveness of the term Appalachia, the importance of long-standing family ties, urban and rural areas within counties, use and acceptability of tobacco, the view that cancer is a death sentence, and the stigmatization of people with cancer. Barriers to screening included cost, lack of insurance, transportation problems, fear, embarrassment, and privacy issues. These findings highlight the important role of geography, social environment, and culture on health behaviors and health outcomes. The interviews provided information about the unique characteristics of this population that are important when developing effective strategies to address cancer-related health behaviors in this medically underserved population.

Community Health Services↗
PubMed2006

Risky behaviors among Ohio Appalachian adults.

This article describes the prevalence of risky behaviors known to be associated with increased cancer morbidity and mortality among Ohio Appalachian adults. These behaviors, or risk factors, include: 1) tobacco use; 2) energy imbalance (involving poor diet, obesity, and physical inactivity); and 3) sexual behaviors. We report current estimates of the prevalence of these behaviors among Ohio Appalachian adult residents and review social, psychological, and biological variables associated with these risky behaviors. We also present recent empirical studies that have been completed or are in progress in Ohio Appalachia. Finally, we discuss how these studies help bridge well-documented gaps in the literature.

Adult↗
PubMed2006

Are physicians asking about tobacco use and assisting with cessation? Results from the 2001-2004 national ambulatory medical care survey (NAMCS).

OBJECTIVE: The objective of this study was to determine if providers asked patients about tobacco and assisted tobacco users with cessation. METHODS: The data source is the 2001-2004 National Ambulatory Medical Care Survey, which is an annual survey of outpatient visits. The prevalence of "asking" about tobacco use, providing "assistance" with tobacco cessation, and prescription of pharmacotherapy for cessation were estimated. A logistic regression model was fit to the data to determine if any variables were related to "asking" about tobacco use and providing "assistance" with cessation. RESULTS: Overall, 32% of patient charts did not include information about tobacco use, 81% of smokers did not receive assistance and less than 2% received a prescription for pharmacotherapy. Asking about tobacco use varied with presence of chronic disease, cardiovascular disease counseling, geographical region, whether the physician was the patient's primary provider, time spent with physician, age, and gender. Providing assistance with cessation varied with the presence of chronic diseases, cardiovascular disease counseling, region of the country, provider type, insurance type, and time spent with the physician. CONCLUSIONS: Methods for improving adherence to the Clinical Practice Guideline for cessation, such as medical school curricula or educational programs for practicing providers, should be examined.

Adult↗
PubMed2005

Nurses, smoking, and the workplace.

The purpose of this study was to examine attitudes and experiences of nurses regarding smoking and smoking cessation in the workplace. Eight focus groups were conducted with current or former smokers (n = 60). A questionnaire provided information about smoking history. Content analysis revealed six themes: taking breaks, stress and smoking, social support from colleagues, hiding smoking from patients and their families, impact of workplace smoking restrictions, and challenges to smoking cessation in the workplace. Nurses who smoke were perceived as taking more breaks and spending less time with patients than those who do not smoke. These findings document the impact of smoking among nurses in the workplace. Strategies are needed to support smoking cessation efforts of nurses as an important occupational health issue.

Adult↗
PubMed2005

Process evaluation of a nurse-delivered smoking relapse prevention program for new mothers.

The objective of this study(1) is to evaluate the feasibility, recall, and acceptability of an evidence-based intervention using home-health nurses to provide smoking relapse prevention skills to new mothers. The design of this study is process evaluation. Setting and participants include women who had delivered a normal newborn at a university hospital, who quit smoking during pregnancy, were smoke free for 7 days, and had saliva cotinine of less than or equal to 14 nanogram/ml. The intervention is a multicomponent cognitive-behavioral intervention, including inpatient contact, a home-health visit, and 2 follow-up phone calls. Results are as follows: 121 participants enrolled, and the intervention was implemented in 78 home visits. Nurses discussed tobacco issues for an average of 12.0 min. Almost all participants recalled the home visit; nearly two thirds recalled discussing tobacco use. Only 4% reported negative feelings toward discussing tobacco issues. In 87% of home visits, nurses implemented all 5 intervention components with self-reported nonsmokers. The conclusion is as follows: A nurse-delivered smoking relapse prevention intervention for new mothers was feasible and acceptable.

Attitude of Health Personnel↗
PubMed2004

Smoking cessation interventions among Chinese Americans: the role of families, physicians, and the media.

This article describes the results from two studies of Chinese Americans. In one study, a convenience sample of patients completed face-to-face interviews to assess smoking patterns in the home, knowledge of tobacco, and ways in which health interventions could be communicated to the community. The other study involved two focus group discussions with the primary purpose of learning how spouses, health care workers, and the media can participate in smoking cessation interventions. A convenience sample of 795 patients at the Charles B. Wang Community Health Center in New York City's Chinatown was interviewed using face-to-face interviews. The focus group discussions were conducted using 15 volunteers. One discussion was conducted in Mandarin and the other in Cantonese. Although 92.7% of the respondents prefer people not smoke in the home, only 21% ban smoking with few exceptions. The focus group participants indicated that often the smoker is the oldest male and he also is the person who establishes the rules. Nearly half of the respondents receive most of their health-related information from their physician, and the focus group participants stated that physicians are highly regarded in their culture. Finally, the majority of respondents receive health-related information from Chinese language media. These results will assist in the planning of a smoking cessation intervention targeting Chinese Americans. The physician represents a key player in any intervention, and public health antismoking messages may be communicated effectively through Chinese language media.

Adult↗
PubMed2004

Smoke constituent exposure and smoking topography of adolescent daily cigarette smokers.

Adolescent smoking prevalence is a major health concern, with 24.4% reporting smoking in the past 30 days and 15.8% considered daily smokers. The purpose of this study was to characterize biobehavioral nicotine dependence, smoke constituent exposure and smoking topography in adolescent daily smokers. Relationships among biological markers of nicotine dependence (nicotine boost, carbon monoxide [CO] boost and cotinine levels) with existing self-report measures (modified Fagerström Tolerance Questionnaire [mFTQ] and the motivations for smoking scale) were examined. Gender differences were characterized. Fifty adolescents 13-18 years old were recruited for the study, 50% female. CO, plasma nicotine levels pre- and postcigarette, cotinine, and smoking topography were measured during a smoking bout with participant's usual cigarette. Average CO boost, pre- to postcigarette was 7.2 + 3.6 ppm, baseline cotinine level averaged 224.0 +/- 169.6 ng/ml and nicotine boost averaged 23.4 +/- 21.7 ng/ml. Mean puffs per cigarette was 14.2 +/- 6.3. Males had significantly higher total puff volumes, but similar smoke constituent exposure to females, and higher handling of cigarettes as smoking motive. In regression analysis, 35% of variance in tobacco use, as indicated by baseline cotinine concentration, was explained by maximum puff duration, postcigarette CO level, and nicotine dependence, as measured by the mFTQ. Results indicated adolescents had considerable smoke constituent exposure and nicotine dependence suggesting the importance of appropriate smoking cessation treatment.

Adolescent↗
PubMed2004

Use of community health workers in research with ethnic minority women.

PURPOSE: To explore roles and effectiveness of community health workers in research with ethnic minority women in the United States (US). METHODS: Medline (1966-2002) and CINAHL (Cumulative Index to Nursing and Allied Health Literature; 1982-2002) databases were used to locate published research studies on the use of community health workers with ethnic minority women in the US. Key words for searches were community health workers, community health aides, health promoters, and community workers. RESULTS: An integrative analysis of 24 studies showed that, despite varying roles and functions, evidence indicates that community health workers are effective in increasing access to health services, increasing knowledge, and promoting behavior change among ethnic minority women. Other advantages of using community health workers are to provide social support and culturally competent, cost-effective care. Recommendations for future directions of research with community health workers and ethnic minority women include improved conceptualization of the community health worker role, theoretical frameworks for research designs, enhanced methods for evaluating effectiveness, and increased community involvement.

Clinical Competence↗
PubMed2003

Distribution of daily smokers by stage of change: Current Population Survey results.

BACKGROUND: Population-based national estimates of stage of change among daily smokers are unknown. This study described the proportion of U.S. daily smokers, 18 and older, by stage of change. Selected sociodemographic characteristics were delineated. METHODS: Cross-sectional data were collected via telephone or face-to-face interview in daily smokers who responded to the Current Population Survey in 1992-1993 (n = 39,706), 1995-1996 (n = 34,865), or 1998-1999 (n = 30,153). Main outcomes included stage of change: (1) Precontemplation-not interested in quitting smoking in next 6 months; (2) Contemplation-interested in quitting smoking in next 6 months but not next 30 days; (3) Preparation-interested in quitting smoking in next 30 days and stopped at least 1 day during past year. RESULTS: During 1992-1993, 59.1% of respondents were precontemplators, 33.2% contemplators, and 7.7% in preparation stage. This distribution was similar in subsequent surveys (1995-1996; 1998-1999). Gender differences were not apparent. Whites were more likely to be precontemplators. As education and income increased, the percentage in precontemplation decreased. Rural residents were more likely in precontemplation and less frequently in preparation. CONCLUSIONS: Among daily smokers, little movement in stage of change was apparent in the United States during the 1990s. Tobacco control efforts must receive high priority to address these static patterns.

Adolescent↗
PubMed2003

Beliefs about tobacco among Appalachian current and former users.

Higher risks of tobacco-related morbidity and mortality in Appalachians provided the impetus for this qualitative study. The purpose was to describe beliefs about tobacco use and cessation among current and former tobacco users in rural Appalachia using focus groups. Findings included themes of nicotine addiction and pros and cons of tobacco use. The importance of family and personal independence in relation to tobacco were evident. Participants identified helpful tobacco treatment strategies. Similarities to treatment needs of tobacco users in general underscore the point that rural Appalachians require best practice tobacco treatment integrating unique cultural aspects of family and personal independence.

Adult↗
PubMed2003

Smoking cessation and cancer.

OBJECTIVES: To provide an overview of scientifically based smoking cessation interventions for delivery to all tobacco-dependent users. DATA SOURCES: Research studies, published articles, and government reports. CONCLUSION: Smoking cessation interventions for patients with cancer remain poorly described with only a few studies investigating the efficacy of smoking cessation among this population. However, data suggest that quitting smoking after the diagnosis of cancer improves survival and quality of life. IMPLICATIONS FOR NURSING PRACTICE: Nurses serve a critical role in tobacco-dependence treatment. Innovative interventions for cessation, such as quit lines, telephone counseling, web-based information, and computerized cessation materials are now available.

Health Education↗
PubMed2003

Views of African-American nurses about tobacco cessation and prevention.

African-Americans experience a disproportionate share of tobacco-related diseases and death and have not received equal access to tobacco cessation and prevention services. The purpose of this study was to describe views of African-American nurses about tobacco control. This was a survey of a convenience sample of attendees of the 2002 annual meeting of the National Black Nurses Association. One hundred and sixty three (N=163) nurses participated in the survey. Eighty-one percent (81%) of these nurses reported that they should be involved in tobacco control efforts; 92% indicated nurses should help patients stop smoking; 63% encountered patients who smoked at least every week, but only 11% of these nurses actually provided counseling for smoking cessation. The majority (89%) of these respondents also noted that nurses needed additional training in tobacco control. African-American nurses can address the significant tobacco-induced health disparities experienced by African-Americans by helping to prevent tobacco use and helping patients stop smoking. The findings of this study support the critical need for nursing education in tobacco control.

Adult↗
PubMed1993

Lessons Learned and Baseline Data from Initiating Smoking Cessation Research with Southeast Asian Adults.

PURPOSES OF THE PAPER: The purposes of this paper are as follows: (1) discuss seven design considerations and their respective lessons learned or resolutions in initiating the National Institutes of Health's only funded smoking cessation grant targeting Asian Americans; (2) present empirical findings that resulted from the design considerations alluded to previously; and (3) delineate unresolved challenges on conducting smoking cessation research particularly for adult Southeast Asians. SUMMARY OF METHODS UTILIZED: The authors base this paper on their empirical data collected as part of the "Lay-led Smoking Cessation Approach for S.E. Asian men" study. Data collected include baseline data from 1553 adult Southeast Asians (721 women and 832 men) in Ohio as well as subsequent data collected on selected individuals. The investigators faced seven major, conceptual issues in initiating smoking cessation research focusing on Southeast Asian adults. These seven considerations related to: language, culture, nicotine addiction characteristics, verification of smoking exposure and smoking status, knowledge of the health consequences of smoking, social environmental factors, and criteria for evaluating effectiveness of the proposed intervention. Smoking cessation interventions must be conducted in the appropriate Asian language because current smokers are the least likely to understand spoken English. Culturally speaking, Cambodian and Laotian male smokers are significantly more likely to have traditional Southeast Asian values than their never smoker counterparts. As a measure of addiction to nicotine, the median time until the first cigarette was 30 minutes for both Cambodians and Vietnamese suggesting that these men are highly addicted. Cotinine levels were negatively correlated with time to the first cigarette and positively correlated with numbers of cigarettes. Knowledge of the health consequences of smoking is lower than mainstream populations. Almost 100 per cent of Southeast Asian male smokers have at least one "best" friend who smokes. Verification of smoking status through saliva cotinine testing suggest that actual smoking rates among Southeast Asians are higher than self­report rates. The largest proportion of Cambodian and Vietnamese smokers are in the precontemplation stage while Laotian smokers are proportionally more likely to be in the contemplation stage. CONCLUSIONS: Design considerations discussed represent considerations beyond those that are normally considered in community­based research for majority populations. The quality and quantity of empirical data collected with due attention to these conceptual considerations appear to substantiate the validity of these considerations. Authors delineated challenges for initiating smoking cessation research among Southeast Asians. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: This paper is particularly relevant for increasing the data base on adult Cambodians, Laotians, and Vietnamese. KEY WORDS: Asian Americans, Cambodians, Laotians, Vietnamese, culture, language, tobacco, smoking cessation, nicotine

Journal Article↗
PubMedDate not supplied

Tobacco control curricula content in baccalaureate nursing programs in four Asian nations.

In Asia there is widespread smoking among men; smoking among women and youth is increasing, and quitting tobacco use is rare. The involvement of nurses, as the largest group of healthcare professionals, in tobacco control efforts is essential. The findings of this survey of 282 (69% response rate) baccalaureate nursing programs in 4 countries in Asia (China, Japan, Korea, and the Philippines) revealed that the majority included content on health risks of smoking (92%), but almost half (49%) did not provide smoking cessation content, and 94% did not cover it in-depth. Only 11% of programs included supervised cessation practice with patients. Fewer than 10% reported in-depth coverage of cessation interventions and few reported opportunities for clinical practice of cessation skills. Most schools surveyed delivered < 1 hour of instruction each year on tobacco control. Further educational efforts are needed to prepare future nurses to assist smokers with smoking cessation. Tobacco use is one of the leading causes of death worldwide, and tobacco-induced deaths in Asia continue to rise. The Western Pacific accounts for one-third of the cigarettes smoked in the world (25% in China alone) and 20% of the 5 million annual deaths from tobacco. China is expected to lead the world in tobacco-related deaths by 2025. Countries in Asia have widespread smoking, especially among men. There is a disturbing increase in smoking among women and youth, quitting tobacco use is rare, and exposure to second-hand smoke is common. Considering the immensity of the problem, all health care professionals throughout the world need to be actively engaged in tobacco control measures, including prevention, cessation, and reduction of exposure to second-hand smoke. Training health care professional students about these issues can have a profound impact on public health. In recognition of the importance of involvement of health care professionals, the World Health Organization (WHO) highlighted their role in tobacco control during "World No Tobacco Day" on May 31, 2005. The involvement of nurses, as the largest group of health care professionals, could boost these efforts. Thus, education of nurses regarding the multiple aspects of tobacco control has strategic implications in controlling global tobacco use and promoting health.

Adolescent↗
PubMedDate not supplied

Passive smoking and vascular disease.

Passive smoking, or environmental tobacco smoke, is a causative factor in cardiovascular disease. A 30-minute passive smoking exposure was found to affect coronary flow velocity reserve in nonsmokers, indicating endothelial dysfunction in coronary circulation. This article summarizes empirical work on passive smoking and heart disease. Clinically relevant findings include a dose-response relationship between passive smoking exposure and heart disease and partial reversibility of physical effects after eliminating passive smoking exposure. Appropriate assessment of passive smoking exposure in a variety of settings is warranted, as well as recommendations to avoid such exposure. Policy-based public health initiatives to eliminate passive smoking in the workplace and other public areas are needed.

Animals↗
PubMedDate not supplied

Nurses' perspectives of smoking initiation, addiction, and cessation.

BACKGROUND: It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement. OBJECTIVES: To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses' attitudes toward smoking and quitting, and to explore nurses' preferences for smoking cessation interventions. METHODS: Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes. RESULTS: Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups. CONCLUSIONS: Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.

Adaptation, Psychological↗
PubMedDate not supplied

Nursing research and treatment of tobacco dependence: state of the science.

Tobacco use is considered to be the single most preventable cause of premature morbidity and mortality among men and women. It is well documented that tobacco cessation reduces the burden of disease significantly and is cost effective. Efficacious therapy for tobacco dependence exists, and nurses have been shown to be effective tobacco cessation interventionists. Given the large number of nurses in the United States, nurses can influence national health objectives of reduced tobacco use significantly and help to decrease the number of adults at risk for tobacco-attributable disease and death. The objectives of this presentation are to (a) describe the scientific evidence for tobacco cessation interventions, based on the U.S. clinical practice guideline Treating Tobacco Use and Dependence; (b) present the meta-analytic findings of the efficacy of nursing interventions for smoking cessation; (c) discuss barriers to nursing research and tobacco interventions; and (d) provide future directions for nursing intervention research.

Evidence-Based Medicine↗