Background: In 2000, the American College of Obstetricians/Gynecologists (ACOG) established the 5 A's method of brief smoking cessation counseling (ask, advise, assess, assist, arrange) as a standard component of prenatal care. The purpose of this study was to describe use of the 5 A's in prenatal care in Northeast Tennessee, where pregnancy smoking rates are three times the national average, and to evaluate provider attitudes toward addressing pregnancy smoking. Method: Surveys were distributed to all obstetric practices in a 6-county area. Results: One-quarter of respondents indicated they always asked pregnant patients about smoking, with two-thirds always giving their pregnant smokers advice to quit. Over half reported always assessing willingness to quit, while one-quarter or fewer always provided quit assistance, or arranged follow up. Over half believed addressing smoking was of significant value. Secondhand smoke was infrequently addressed. Demographics, efficacy, and outcome beliefs predicted use of the 5 A's. Conclusions: Most obstetric providers in Northeast Tennessee are not following ACOG recommendations for pregnancy smoking. Efforts to address pregnancy smoking and associated adverse pregnancy outcomes in the region should include facilitation of smoking cessation interventions in prenatal care.

In the United States, cigarette smoking is the main contributor to preventable death in all populations; and, among the mentally ill, the prevalence of smoking is a clinical practice concern. Nearly half of all smokers also have a diagnosis of mental illness compared with 23% of the general population. In an effort to reduce the problem of tobacco use within mentally ill populations, this project sought to create an educational module on smoking cessation for staff in a mental health clinic. The theory of planned behavior was used to guide the project that focused on implementation of a behavior change approach to counter smoking dependence. With evidence obtained from a comprehensive literature search of medical databases and textbooks, the education module was developed for teaching staff in a 30-bed outpatient mental health facility. Staff were taught to administer the education module on smoking cessation and to evaluate the plan. Evaluation of the project effectiveness on the knowledge of clinical staff was determined through the use of questions directed toward understanding professionals' perceptions of the module development and implementation, and the evidence-based educational materials developed for the program. Post tests administered after the staff education showed an increase in knowledge. The full education program was provided to the unit and will be used for staff training and for working with patients in the future. Positive social change is expected to occur because of the increased knowledge among clinical staff who care for mentally ill individuals who smoke. The result should be a safer, healthier setting for both smoking and nonsmoking patients in mental health clinics.

Indiana University-Purdue University Indianapolis (IUPUI) / Tooth decay is a complex dieto-bacterial disease with an association of social, behavioral and biological factors. Streptococcus mutans plays a major role in tooth decay. This endogenous oral microorganism adheres to tooth surfaces and grows and develops into micro-communities that mature and form dental biofilm. Development of cariogenic biofilm is one of the major factors associated with the tooth decay process. The use of tobacco is considered a great risk factor for oral diseases. Several studies demonstrated the association of tooth decay and the use of tobacco as effects of first-hand or second- hand smoking. Nicotine has been reported to increase the biofilm growth and metabolism of S. mutans in a dose-dependent manner up to 16 mg/ml of nicotine. However, its effects on biofilm formation of S. mutans strains isolated from smokers are not known and should be investigated. Therefore, we proposed the use of an in-vitro model to better understand the effects of nicotine on biofilm formation of strains of S. mutans isolates from smokers versus non-smoking subjects. Objectives: To investigate the effects of nicotine on biofilm formation of S. mutans isolates from oral washes of smoker and non-smoker human subjects. Materials and Methods: This study was conducted using three S. mutans isolates collected from oral washes of 10 smoking subjects and 10 non-smoking subjects. The oral wash samples were stored at -80oC before S. mutans isolation. S. mutans isolates were obtained by plating on Mitis Salivarius Sucrose Bacitracin plates and species identity confirmed by carbohydrate fermentation assays. Nicotine from Sigma-Aldrich (St. Louis, MO, USA) was used. Biofilm was formed by overnight culturing of each S. mutans strain (10 μl) in 190 μl of tryptic soy broth (TSB) supplemented with 1.0-percent sucrose (TSBS) containing 0 mg/ml, 0.25 mg/ml, 0.5 mg/ml, 1.0 mg/ml, 2.0 mg/ml, 4.0 mg/ml, 8.0 mg/ml, 16.0 mg/ml, and 32.0 mg/ml of nicotine for 24 hours in 5.0-percent CO2 at 37oC in sterile (8 x 12) 96-well microtiter plates (Fisher Scientific, Newark, DE, USA). The absorbance values of biofilm were measured at 490 nm in a microplate spectrophotometer (SpectraMax 190; Molecular Devices, SunnyVale, CA, USA) after crystal violet staining. Null Hypotheses: 1) Nicotine will not increase biofilm formation in both smoker and non-smoker S. mutans isolates. 2) An increase in nicotine concentrations will not increase biofilm formation in both smoker and non-smoker S. mutans isolates in a dose-dependent manner. 3) Nicotine will not produce significant differences in biofilm formation between smoker and non-smoker S. mutans isolates. Alternative Hypotheses: 1) Nicotine increases the growth of biofilm formation in both smoker and non-smoker S. mutans isolates. 2) An increase in nicotine concentrations increase biofilm formation of both smoker and non-smoker S. mutans isolates in a dose-dependent manner. 3) However, nicotine increases biofilm formation of smoker S. mutans strains more than non-smoker S. mutans isolates. The rationale for this hypothesis is that our preliminary data indicated that S. mutans can become resistant to increased nicotine concentrations and that this resistance appears to be stable and may allow the smoker isolates to be able to respond more vigorously to higher nicotine concentrations than the non-smoker isolates. Results: There was a significant effect (p < 0.05) of both nicotine concentrations and smoking on the growth of biofilm, planktonic cells, and total absorbance, for all strains of S. mutans (p < 0.0001). Isolates from smokers had significantly more biofilm at 0 mg/ml to 16 mg/ml of nicotine compared with those from non-smokers (p-value < 0.0001). Conclusion: S. mutans smoker isolates are more affected by high nicotine concentrations than non-smoker isolates.

This investigation involved three procedural areas. The first was the development of a "Grief Work Treatment Program" designed for smokers who wanted to quit or reduce smoking. The second was the use of the program in experimental research in order to distinguish a relationship between structured grief work and cigarette-smoking reduction. The third area of investigation concerned evaluation of the program in terms of the subjects' goals for their smoking behavior. Results of the study indicated that the Grief Work Treatment Program was effective. A statistical comparison of treatment and control subjects using Analysis of Covariance, with number of cigarettes smoked daily at the beginning of the program as the covariate, produced a significant F at the 0.05 level on measures taken immediately after the treatment and four weeks later. Thus, in terms of the subjects’ respective goals, the grief work program was effective in assisting subjects to quit or reduce smoking. In addition, correlational tests concerning the treatment group indicated significant relationships existed between the variable, decrease in number of cigarettes smoked daily, and the variables: length of time a subject smoked prior to treatment; importance of cigarettes to the subject; and number of cigarettes smoked daily at the outset of the program. On comparisons of these variables, significant Spearman-Rank and Pearson Product Moment Correlational Coefficients ranged from 0.67 to 0.85.

This study investigated the impact of counselor smoking behavior upon nonsmoking clients' perceptions of therapists both during and at the conclusion of treatment. Clients' impressions when counselor smoking behavior was consistent across sessions and when counselors smoked in only the first or only the second interview were examined. In addition, the effect of therapists' smoking behavior on the outcome of counseling was assessed in two ways: changes in clients' career decisiveness and counselors' ability to influence client behavior. Eighty-two female undergraduates met with a vocational counselor for two sessions during which the counselor either smoked or refrained from smoking. Prior to the first interview, subjects completed the Behavioral Indecision Scale. Subjects then met and discussed their vocational concerns with a counselor. Following the interview, subjects completed the Counselor Rating Form and the California Occupational Preference System. The latter instrument, an interest inventory, was interpreted by the counselor during the second interview. The Counselor Rating Form and the Behavioral Indecision Scale were again administered following the conclusion of treatment. Data were analyzed by 2 (counselors) X 2 (conditions) X 2 (interviews) multivariate analyses with repeated measures on the third factor. No significant differences emerged for clients' perceptions when the counselors' indulgence in or restraining from smoking was constant from the first to the second sessions. Similarly, clients' impressions did not differ in relation to the inconsistency of counselors' smoking behavior from the first to the second interviews. In addition, subjects' compliance to a counselor initiated behavioral task and reported certainty of career choice were not differentially affected by counselors' smoking behavior. In conclusion, this study suggests that it makes no difference in nonsmoking clients' impressions of therapists and in counseling outcome if the latter smoke during treatment. Suggested variables to further explore include the effects of counselors' smoking in brief and extended psychotherapy, the impact of therapists' smoking implements other than cigarettes, and smoking clients' perceptions of smoking therapists.

Smoking combustible cigarettes is the major cause of disease and death among adults living in the United States (U.S.). In fact, smoking combustible cigarettes causes nearly half a million premature deaths among U.S. adults every year.1–4 It is estimated that over 14% (equating to 34 million persons) of U.S. adults smoke cigarettes currently.2,5 This is a substantial decrease from 1965 when it was estimated that more than 42% of U.S. adults smoked cigarettes.1 This is partly attributed to the well-established evidence that smoking cigarettes causes harm to almost every human organ system5 and is associated with an elevated risk of developing cancer6, cardiovascular disease 7, pulmonary disease and respiratory illnesses.8–10 Despite the well-established health consequences of smoking cigarettes, millions of people are still smoking, which alone suggests that nicotine (the primary constituent of cigarettes) is highly addictive.3 Thankfully, smoking cessation by means of pharmacological treatments has been shown to help smokers overcome nicotine addiction. A review of the research on the efficacy of varenicline (Chantix) and Nicotine Replacement Therapy (NRT), two of the most commonly used smoking cessation treatments, reveals that both treatments increase long-term smoking abstinence rates with odds ratios of 3.85 for varenicline and 1.74 for NRT when compared to placebo.11–14 Even more, both drugs appear to be generally well-tolerated, with no known life-threatening side effects when compared to placebo. Research shows that the most common side effects for varenicline are nausea, insomnia, gastrointestinal effects, headache and abnormal dreams.11,15 The most common side effects for NRT appear to be skin irritation, insomnia, headache, nausea/vomiting and cough.11,15 Ultimately, both varenicline and NRT appear to be strong options for achieving smoking abstinence both with respect to overall efficacy and tolerability.

published_or_final_version / Pharmacology / Doctoral / Doctor of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing