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Biomedical subjects

R H Secker-Walker

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

At least 37 records · Page 2Linked to original sources
PubMed1994

Mass media and school interventions for cigarette smoking prevention: effects 2 years after completion.

The long-term cigarette smoking prevention effects of mass media and school interventions were assessed. Adolescents in two communities received both mass media and school interventions; those in two matching communities received only school interventions. Surveys of 5458 students were conducted at baseline in grades 4 through 6 and 2 years after the 4-year interventions were completed, when students were in grades 10 through 12. Students exposed to the media-plus-school interventions were found to be at lower risk for weekly smoking (odds ratio = 0.62, 95% confidence interval = 0.49, 0.78) than those receiving school interventions only, indicating that the effects of the combined interventions persisted 2 years after the interventions' completion.

Adolescent↗
PubMed1993

Advising parents to stop smoking: pediatricians' and parents' attitudes.

Pediatricians are in a unique position to address the issues of smoking cessation with parents. Vermont pediatricians and parents of their patients were surveyed to assess attitudes about giving and receiving smoking cessation advice. A questionnaire was mailed to all pediatricians in Vermont, and 72 valid responses were received, for a response rate of 91%. Forty percent of pediatricians routinely took a smoking history from parents and 11% recorded this information in the child's chart. Most pediatricians (94%) reported advising at least 60% of smoking parents to quit, and they spent an average of 4.4 minutes doing this. Barriers to giving advice were lack of time (42%), feeling that parents did not expect advice (25%), and feeling ill at ease giving the advice (25%). Only 8.5% of pediatricians had received training in how to give smoking cessation advice, but 87% were willing to learn methods to give advice briefly. Six hundred seventy-six parents from randomly selected pediatric practices were interviewed. The average parental age was 32, and 84% were women; 49% had never smoked, 30% were former smokers, and 21% were current smokers. Current smokers were less likely to agree with statements about the adverse effects of passive smoke on children. Most parents (56%) felt that pediatricians should give quit-smoking advice to parents, and 52% of smoking parents reported that they would welcome advice. Only 30% of current smokers said advice would bother them somewhat, and 15% had more negative reactions. Parents and pediatricians agreed on the best opportunities to give quit-smoking advice.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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↗
PubMed1984

Locating community residents with chronic airway obstruction. A comparison of four strategies.

In the course of establishing and evaluating a patient education program, we compared 4 strategies for locating patients with chronic obstructive airway disease (COAD): (1) search of hospital discharge records (HOSP), (2) referral by physicians (MD), (3) an advertising campaign (AD), and (4) a respiratory symptom questionnaire mailed to households (QUEST). Of 1,834 persons assessed, 923 (50%) had airway obstruction; 43% of the confirmed cases (396 of 923) reported no previous diagnosis of COAD. The HOSP strategy accounted for 75 assessments (4%) and 63 confirmed cases (7%), MD produced 352 assessments (19%) and 247 cases (27%), AD generated 475 assessments (26%) and 204 cases (22%), and QUEST resulted in 932 assessments (51%) and 409 cases (44%); MD was the least expensive strategy ($17.00/case). The mailed questionnaire located the largest number of cases not previously diagnosed.

Advertising↗
PubMed1982

Regional lung function in asbestos workers: observations and speculations.

The clinical findings, occupational exposure, smoking history, pulmonary function, chest radiograph and ventilation-perfusion studies have been examined in 12 men exposed to asbestos fibers in the course of their work. Minor abnormalities of regional ventilation, consistent with early small airway dysfunction, were found in the fibrotic zones of most of the nonsmokers or mild cigarette smokers. The whole-lung washout times, estimated by visual inspection of serial washout images, were strongly correlated with measurements of airflow obstruction, but not with pack-years of smoking. There was a close correspondence between radiographic extent of pulmonary fibrosis and the abnormalities in pulmonary blood flow in these regions. The severity of the abnormalities in regional pulmonary blood flow was significantly correlated with the years of asbestos exposure (r = + 0.73, p less than 0.01). It is suggested that the magnitude of the disturbance in pulmonary blood flow in the fibrotic zones could be used to estimate the proportion of pulmonary dysfunction due to asbestos exposure.

Aged↗
PubMed1981

Patterns of regional ventilation in patients with cardiomegaly or left heart failure.

Patterns of regional ventilation have been examined in 42 patients, the majority of whom had clinical evidence of left-ventricular or left-atrial dysfunction. Regional ventilation was studied with xenon-133 and regional perfusion with Tc-99m human albumin microspheres. The presence of a cardiac defect, seen in 54.8% of the washin images, was related to the depth of lung between the posterior heart border and the posterior lung border, but not to cardiac size. Washout patterns were fairly uniform in those patients (43%) who cleared their lungs within 3 min, but were remarkably variable in those with longer washout times. The presence of râles or clinical signs of a pleural effusion, and radiographic evidence of vascular redistribution or pleural effusion, were significantly associated with prolonged washout times. These observations suggest that the prolonged washout is due to edema in the walls of the smaller bronchioles, leading to airflow obstruction.

Adult↗
PubMed1980

Observations and speculations on perfusion patterns in apparently normal lung scans.

The patterns of pulmonary blood flow have been studied in 21 apparently normal perfusion scans. Two patterns were identified, a predominantly lower lobar distribution and a more even pattern. The predominantly lower lobar distribution is probably the more normal pattern, which suggests that in addition to the relationships between alveolar pressure, pulmonary vascular pressures and gravity, the anatomical structure of the lung also influences the regional distribution of blood flow. West's zone I was identified in 20 of the patients and occupied, on average, 16% of the vertical height of the lung. It is suggested that recognition of this zone may enable mean pulmonary arterial pressure to be measured from a combination of ventilation-perfusion imaging and the chest radiograph.

Blood Pressure↗