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Biomedical subjects

R H Secker-Walker

Publications and source records attributed to R H Secker-Walker.

At least 19 recordsLinked to original sources
PubMed1992

Training obstetric and family practice residents to give smoking cessation advice during prenatal care.

OBJECTIVE: Our objective was to determine the effectiveness of training obstetric and family practice residents to provide smoking cessation advice. STUDY DESIGN: The effectiveness of the trained residents' advice was assessed from exit interviews of pregnant smokers taking part in a randomized, controlled trial of smoking cessation advice. Exit interview responses were compared by chi 2 analysis. RESULTS: Training resulted in significant changes in the advice provided by the residents, with greater emphasis on gaining a commitment to smoking behavior change, but not in the average time providing the advice, approximately 3 minutes. Adherence to the protocol was maintained at 80%. Significantly more women who received the brief structured advice agreed to stop smoking (54%) or cut down their cigarette consumption (28%) compared with women in the control group (14% and 6%, respectively), p = 0.0001. CONCLUSION: The structured advice consistently provided by the trained residents was effective in gaining commitments from pregnant smokers to change their smoking behavior.

Family Practice↗
PubMed1992

Prevention of cigarette smoking through mass media intervention and school programs.

OBJECTIVES: In this study we tested the ability of mass media interventions to enhance the efficacy of school cigarette smoking prevention programs. METHODS: For 4 years, students in one pair of communities received media interventions and school programs that had common educational objectives. Students in a matched pair of communities received only the school programs. The combined cohort of 5458 students was surveyed at baseline in grades 4, 5, and 6 and was followed up annually for 4 years. RESULTS: Significant reductions in reported smoking, along with consistent effects on targeted mediating variables, were observed for the media-and-school group. For cigarettes per week the reduction was 41% (2.6 vs 4.4); for smoking cigarettes yesterday the reduction was 34% (8.6% vs 13.1%); and for smoking in the past week the reduction was 35% (12.8% vs 19.8%). No effects were observed for substance use behaviors not targeted by the interventions. CONCLUSIONS: These results provide evidence that mass media interventions are effective in preventing cigarette smoking when they are carefully targeted at high-risk youths and share educational objectives with school programs.

Adolescent↗
PubMed1991

Family physicians' attitudes about dietary advice.

Family physicians in Vermont were surveyed to assess their attitudes and practices concerning the provision of dietary and nutritional advice to their patients. The response rate was 82%. Ninety-six percent of respondents considered that nutrition counseling was their responsibility, and the attitudes and beliefs of most of them concurred with the presently accepted relationships between diet and coronary artery disease. Sixty-five percent of respondents reported making dietary recommendations to less than 40% of their nondiabetic patients under the age of 40. Only 27% of respondents routinely took a dietary history, but those who did were significantly more likely to counsel a larger proportion of their patients than those who did not. Serum cholesterol was reported as being measured in about 35% of adults, and the average level of serum cholesterol at which dietary advice would be given was 237 +/- 15 mg/dL. Most reasons for not giving dietary advice were related to the physician's perception that the patient was not at risk for a diet-related disease. Perceived patient lack of interest and lack of compliance were also important reasons, but lacking time or not being reimbursed were much less frequently cited, although adequate financial reimbursement for giving such advice was considered a moderate or major problem by 45% of family physicians.

Adolescent↗
PubMed1990

Predictors of smoking behavior change 6 and 18 months after individual counseling during periodic health examinations.

Predictors of smoking behavior change were examined in a randomized controlled trial of individualized smoking cessation counseling delivered by a smoking cessation counselor during periodic health examination. Self-reports of not smoking at 6 and 18 months and attempts to quit were greater, but not significantly so, in the intervention group compared with the usual care group. There was no difference between the intervention group and the usual care group in reported continuous abstinence. Multivariate analysis showed that longer periods of abstinence in the past and having smoking identified as the main problem were important predictors of subsequent quitting. Having fewer other smokers in the household, stronger intentions to stop smoking in the next month, and being in the intervention group were also significant predictors of abstinence at 6 months, but not at 18 months. Those who had tried to quit by 6 months and 18 months were more likely to be in the intervention group, to have greater motivation to stop smoking, and to have more problems of daily living. Supplementing physician's advice with individualized smoking cessation counseling during health maintenance examinations was associated with a greater short-term quit rate and more quit attempts over 18 months than physician advice alone, but did not influence continuous abstinence from cigarettes over this time.

Attitude to Health↗
PubMed1989

Advising parents to stop smoking. Opportunities and barriers in pediatric practice.

All pediatricians in Maine were surveyed by mail to assess their beliefs and attitudes about parental smoking and their current activities concerning advice on smoking cessation. The response rate to three mailings was 86%. Most pediatricians (91%) reported advising parents who smoke to quit and estimated spending an average of almost 5 minutes giving advice on how to quit smoking. Almost all pediatricians (94%) felt moderately or very confident in addressing passive smoking issues. However, only 46% felt moderately or very confident in advising parents how to stop smoking. Important barriers to providing advice on smoking cessation to parents included negative parental expectations and not having enough time. Only 6% of the pediatricians noted lack of reimbursement as a barrier. The majority of respondents (84%) were moderately or very willing to learn brief methods of giving advice on how to stop smoking to parents.

Female↗
PubMed1989

A statewide survey of dentists' smoking cessation advice.

The general practitioners of the Vermont State Dental Society (251) were surveyed in 1986 to determine their smoking cessation activities. Seventy-eight percent of the dentists completed the survey and 87% reported that they discussed concerns about smoking with their patients who smoke. They estimated spending an average of 2.4 minutes addressing cigarette smoking issues. Among those dentists who discussed smoking issues, the majority (60%) provided some advice on ways to change smoking behavior. The remaining 40% provided no guidance regarding smoking behavior change. The larger the proportion of smokers advised about smoking, the greater the dentists' interest in using incentives to help smokers make an attempt to quit.

Counseling↗
PubMed1989

Smoking cessation counseling during periodic health examinations.

Periodic health examinations are an excellent opportunity to counsel smokers to quit. The impact of a specialized smoking cessation counselor on the smoking behavior of patients having periodic health examinations was studied in a general internal medicine practice. One hundred fifty-five smokers having periodic health examinations were randomly assigned to a control group who received usual physician advice or an intervention group who received usual physician advice and two counseling sessions with a smoking cessation counselor. The two groups were similar in all demographic variables, smoking-related baseline variables, and baseline levels of motivation and intention to quit smoking. The smoking status of 97% of the subjects was assessed 6 months later. In the intervention group, 46% made quit attempts and 19% quit, compared with 34% and 12%, respectively, in the control group. Intervention-group smokers made more quit attempts (mean +/- SD, 5.0 +/- 2.5 vs 1.8 +/- 0.2) and had a greater reduction in daily cigarette use (8.4 +/- 1.5 vs 3.5 +/- 1.3). Of the 74% of smokers with higher levels of motivation to quit smoking, more intervention-group smokers attempted to quit (70.8% vs 45.5%) and succeeded in quitting at the 6-month follow-up (27.1% vs 10.9%). Periodic health examinations are an excellent opportunity to counsel smokers to quit, especially those smokers with higher levels of motivation to quit smoking.

Adult↗
PubMed1988

Development of a smoking prevention mass media program using diagnostic and formative research.

The process of developing a mass media campaign to prevent smoking among adolescents is described in detail. This campaign supplements a school smoking prevention program and shares educational objectives with the school program but is otherwise independent. It comprises various television and radio 30- and 60-sec "spot" messages. The campaign development process includes identifying educational objectives and strategies for appealing to young people; conducting diagnostic surveys and focus groups to determine target audience interests and perceptions about smoking and media content; suggesting approaches to producers to create preliminary television and radio messages for testing; conducting formative pretests with target groups to select optimal messages and suggest improvements to those messages; producing final messages for media presentation; and developing a media exposure plan to place messages in local media at optimal times for reception by target audiences. The media campaign is being evaluated in a 5-year project with 5,500 adolescents in four communities to determine the additional effect of mass media over a school program alone in preventing smoking.

Adolescent↗
PubMed1987

Smoking cessation practices in dental offices.

We have surveyed the health promotion efforts of dentists and dental hygienists in general dental practice in Chittenden County, Vermont, in relation to smoking. The response rate was 61 percent. Smoking issues were addressed by 76 percent of dentists and 81 percent of dental hygienists in approximately one quarter of their smoking patients. Although the majority of both dentists and dental hygienists advised their patients to change their smoking behavior, their advice was usually to cut down rather than to quit. Most of the respondents--78 percent of dentists and 93 percent of dental hygienists--considered it appropriate to give advice about smoking during visits for routine dental care and 68 percent and 89 percent, respectively, were willing to learn brief methods of advising their patients about smoking. Experience with giving advice about smoking and agreement that it was appropriate to give such advice were both strongly related to willingness to learn brief methods of giving such advice. In individual dental practices, there were virtually no correlations between the dentist's and the dental hygienist's behaviors as far as the proportion of patients from whom a smoking history was taken, the proportion of smokers advised about smoking, the content of the advice, or the nature of the advice. Only nine percent of dentists and 11 percent of dental hygienists were current smokers.

Dental Hygienists↗
PubMed1979

Helium-oxygen flow volume curves in young healthy adults.

Helium-oxygen (HeO2) flow volume curves were done in young, healthy, nonsmoking adults. This paper discusses the theoretical design of the test, the nomenclature, and the results in this population. Our study shows that HeO2 and air curves crossed around 15% of vital capacity; one point of identical flow occurs more frequently than has been appreciated; and fully developed laminar flow occurs infrequently at low lung volumes in young adults.

Adult↗
PubMed1979

Observations on regional ventilation and perfusion in kyphoscoliosis.

Studies of regional ventilation and perfusion have been made in 10 patients with kyphoscoliosis. In 7 of the 10 patients ventilation was more severely impaired in the region of the maximum convexity than in the opposite lung. Perfusion was not impaired to the same degree. The resulting locally diminished ventilation-perfusion ratios may account for the hypoxemia and increased PA-aO2 gradient seen in patients with kyphoscoliosis. It is suggested that the local distortion of the chest wall, with the splayed out ribs, may account for the local change in lung mechanics.

Adolescent↗
PubMed1976

Estimating relative renal function.

Radionuclide measurements of relative renal function have been made using conventional dual-probe renography, computer assisted triple-probe renography, rectilinear kidney scanning and computer assisted gamma camera renography and kidney scanning. The relative area of each kidney from the excretory urogram also has been used to measure relative function. The best correlation between renography and kidney scanning was obtained with the gamma camera computer system. The relative function of each kidney was obtained by outlining regions of interest that corresponded closely to the renal images and subtracting the blood and tissue background activity, using a special background region. Triple-probe renography, using computer assisted blood background subtraction, provides another reliable indicator of relative function, which is considerably more accurate than conventional dual-probe renography. Relative renal function also may be determined, but with less precision, from the relative counts in a rectilinear kidney scan, from the relative scan areas and from the relative areas found on excretory urography. Both relative area methods are less reliable in the presence of outflow tract obstruction, renal tumors and renal cysts.

Aged↗
PubMed1975

Regional ventilation-perfusion relationships.

Regional ventilation-perfusion ratios have been determined in 12 healthy subjects, 16 patients with pulmonary embolism, and 22 patients with chronic obstructive lung disease. The ventilation-perfusion ratios were determined from xenon-133 ventilation studies and 99-tc-m-labeled particle perfusion scans, using either the fractional exchange of air or the relative distribution of tidal volume per unit volume as the numerator of the ratio. A comparison of these two methods showed comparable distributions of regional ventilation-perfusion relationships in the healthy subjects and patients with pulmonary embolism. However, in the patients with chronic obstructive pulmonary disease, the fractional exchange method clearly separated this group of patients from the others.

Chemotherapy, Cancer, Regional Perfusion↗
PubMed1975

The measurement of regional ventilation during tidal breathing: a comparison of two methods in healthy subjects, and patients with chronic obstructive lung disease.

Regional ventilation has been measured in 17 healthy volunteers, and 24 patients with chronic obstructive lung disease during tidal breathing using 133-Xe. The wash-in and wash-out of 133-Xe were recorded by a gamma camera interfaced to a small digital computer. Regional ventilation was calculated as the distribution of tidal volume per unit lung volume-a measure of relative ventilation--and from the wash-out curves as the fractional exchange of air per second. Determination of the regional fractional exchange of air showed a significant difference between the patients with chronic obstructive lung disease and normal subjects for all regions. The distribution of tidal volume per unit lung volume did not effect such a clear separation. Significant correlations were found between the whole-lung fractional exchange of air in the patients with chronic obstructive lung disease and their FEV1 r equal 0-70, MMFR r equal 0-70, FVC r equal 0-56 and FEV1/FVC r equal 0-57. It is suggested that measurement of regional ventilation as the fractional exchange of air is more realistic than methods that determine relative ventilation or only make use of the early part of the wash-out 133-Xe.

Adult↗