Barriers, control and identity in health information seeking among African American women

Qualitative research methods were used to examine the role of racial, cultural, and socio-economic group (i.e., communal) identities on perceptions of barriers and control related to traditional and internet resources for seeking health information. Eighteen lower income, African American women participated in training workshops on using the internet for health, followed by two focus groups. Transcripts were analyzed using standardized coding methods. Results demonstrated that participants perceived the internet as a tool for seeking health information, which they believed would empower them within formal healthcare settings. Participants invoked racial, cultural, and socio-economic identities when discussing barriers to seeking health information within healthcare systems and the internet. The findings indicate that the internet may be a valuable tool for accessing health information among lower income African American women if barriers are reduced. Recommendations are made that may assist health providers in improving health information seeking outcomes of African American women

Pharmacotherapy of Smoking Cessation

Tobacco use is the number one cause of preventable diseases in the United States. Smoking accounts for more than 400,000 deaths yearly and 30% of all cancer deaths. Primary care physicians have access to 70% of smokers, approximately 60% of whom are perceived to be in excellent health. Recent advances in the pharmacotherapy of nicotine addiction, including nicotine nasal spray, nicotine inhaler, bupropion hydrochloride, and over-the-counter transdermal nicotine patches, have increased the treatment options physicians can offer to smokers. Physicians, especially thosein primary care specialties, should familiarize themselves with these products to improve efforts to help their patients stop smoking. This article reviews scientific data on the efficacy of approved medications, benefits, adverse effects, and appropriate use of these products. We also discuss nicotine addiction and treatment for special populations, including women, ethnic minorities, light smokers, and patients with cardiovascular and pulmonary diseases

Volumetric analysis of carotid plaque components and cerebral microbleeds: a correlative study

PURPOSE: The purpose of this work was to explore the association between carotid plaque volume (total and the subcomponents) and cerebral microbleeds (CMBs). MATERIALS AND METHODS: Seventy-two consecutive (male 53; median age 64) patients were retrospectively analyzed. Carotid arteries were studied by using a 16-detector-row computed tomography scanner whereas brain was explored with a 1.5 Tesla system. CMBs were studied using a T2*-weighted gradient-recalled echo sequence. CMBs were classified as from absent (grade 1) to severe (grade 4). Component types of the carotid plaque were defined according to the following Hounsfield unit (HU) ranges: lipid less than 60 HU; fibrous tissue from 60 to 130 HU; calcification greater than 130 HU, and plaque volumes of each component were calculated. Each carotid artery was analyzed by 2 observers. RESULTS: The prevalence of CMBs was 35.3%. A statistically significant difference was observed between symptomatic (40%) and asymptomatic (11%) patients (P value = .001; OR = 6.07). Linear regression analysis demonstrated an association between the number of CMBs and the symptoms (P = .0018). Receiver operating characteristics curve analysis found an association between the carotid plaque subcomponents and CMBs (Az = .608, .621, and .615 for calcified, lipid, and mixed components, respectively), and Mann-Whitney test confirmed this association in particular for the lipid components (P value = .0267). CONCLUSIONS: Results of this study confirm the association between CMBs and symptoms and that there is an increased number of CMBs in symptomatic patients. Moreover, we found that an increased volume of the fatty component is associated with the presence and number of CMBs

Smoking Characteristics of a Homeless Population

When addressing tobacco control and smoking cessation measures, the homeless have been perceived as a difficult to reach population. The purpose of this study was to examine the smoking characteristics of a homeless population. Data were derived from a larger study that examined smoking among inner-city residents. Homeless smokers (n=107) were compared with non-homeless smokers (n=491) on socio-demographics, smoking characteristics, motivation to quit, and smoking cessation experiences. Results showed that homeless smokers were more likely to be white, smoke more cigarettes per day, initiate smoking at a younger age, and have a longer smoking history. Knowledge about the risks of smoking and the benefits of quitting was equally high in both groups. Homeless smokers were less likely to be preparing to quit smoking compared to non-homeless smokers. These factors place homeless smokers at increased risk of tobacco-related diseases. Programs are needed to design and test effective cessation interventions for homeless smokers

Assessing the Integrity of Motivational Interviewing Interventions: Reliability of the Motivational Interviewing Skills Code

The motivational interviewing skills code (MISC) was used to review 86 audiotaped interactions between clinicians and patients participating in a smoking cessation intervention. Intraclass correlations (ICCs) were completed for two of the MISC elements: global evaluations and behavior counts. Results indicate 75% of the global ratings yielded ICCs in the good to excellent range, while only 44% of the behavior counts yielded this level of accuracy. Adherence scores were created to form overall ratings of clinician adherence to using motivational interviewing and 80% of these competence measures yielded ICCs in the good to excellent range. Specific recommendations regarding modifications for the MISC are suggested based on the data presented

Adolescent gender differences in the determinants of tobacco smoking: a cross sectional survey among high school students in São Paulo

Background: Diverse psychosocial factors have been associated with the use of cigarettes by adolescents. We investigated gender differences in tobacco smoking, and factors correlated with smoking among boys and girls. Methods: Data was collected on recent cigarette smoking (CS) and related factors, with a focus on religious beliefs, leisure activities, family structure, relationships and parental monitoring from 2,691 private school-attending youths from 28 schools in São Paulo, Brazil, selected via probability sampling. Estimates were derived via weighted hierarchical logistic regression models. Results: There was no difference in the prevalence of recent cigarette smoking between boys and girls (14.2%). Older age (a_OR_boys = 1.71[1.33-2.21]; a_OR_girls = 1.73[1.35-2.23]), second-hand smoke exposure at home (a_OR_boys = 1.52[1.00-2.29]; a_OR_girls = 1.74[1.13-2.68]) and not having a religion (a_OR_boys = 1.99[1.41-2.81]; a_OR_girls = 1.78[1.14-2.78]) were associated with CS in boys and girls. Adolescents who went out often at night were more likely to be tobacco smokers (a_OR_boys = 8.82[3.96-19.67]; a_OR_girls = 14.20[6.64-30.37]). For girls, data suggest that CS was also associated with a lack of parental attention and care (a_OR_girls = 4.37[1.19-16.04]) and no participation in youth religious activities (a_OR_girls = 2.76[1.49-5.12]). For boys, CS was additionally associated with the loss of one or both parents (a_OR_boys = 3.75[1.78-7.85]). Conclusions: Although older age, living with smokers at home and lack of religion were common contributing factors to cigarette smoking among all adolescents, girls were influenced to a greater degree by family relationships and religiosity than boys. The study results may be materially important to the development of prevention programs that influence determinants connected to gender and the implementation of single-core models of prevention; gender differences must be considered in order to reduce adolescent CS

Ultrasound IMT measurement on a multi-ethnic and multi-institutional database: Our review and experience using four fully automated and one semi-automated methods

Automated and high performance carotid intima-media thickness (IMT) measurement is gaining increasing importance in clinical practice to assess the cardiovascular risk of patients. In this paper, we compare four fully automated IMT measurement techniques (CALEX, CAMES, CARES and CAUDLES) and one semi-automated technique (FOAM). We present our experience using these algorithms, whose lumen-intima and media-adventitia border estimation use different methods that can be: (a) edge-based; (b) training-based; (c) feature-based; or (d) directional Edge-Flow based. Our database (DB) consisted of 665 images that represented a multi-ethnic group and was acquired using four OEM scanners. The performance evaluation protocol adopted error measures, reproducibility measures, and Figure of Merit (FoM). FOAM showed the best performance, with an IMT bias equal to 0.025 ± 0.225 mm, and a FoM equal to 96.6%. Among the four automated methods, CARES showed the best results with a bias of 0.032 ± 0.279 mm, and a FoM to 95.6%, which was statistically comparable to that of FOAM performance in terms of accuracy and reproducibility. This is the first time that completely automated and user-driven techniques have been compared on a multi-ethnic dataset, acquired using multiple original equipment manufacturer (OEM) machines with different gain settings, representing normal and pathologic case

CT imaging features of carotid artery plaque vulnerability

Despite steady advances in medical care, cardiovascular disease remains one of the main causes of death and long-term morbidity worldwide. Up to 30% of strokes are associated with the presence of carotid atherosclerotic plaques. While the degree of stenosis has long been recognized as the main guiding factor in risk stratification and therapeutical decisions, recent evidence suggests that features of unstable, or 'vulnerable', plaques offer better prognostication capabilities. This paradigmatic shift has motivated researchers to explore the potentialities of non-invasive diagnostic tools to image not only the lumen, but also the vascular wall and the structural characteristics of the plaque. The present review will offer a panoramic on the imaging modalities currently available to characterize carotid atherosclerotic plaques and, in particular, it will focus on the increasingly important role covered by multidetector computed tomographic angiography

Adherence to Principles of Motivational Interviewing and Client Within-Session Behavior

The purpose of this study was to examine whether counselor adherence to Motivational Interviewing (MI) principles was associated with more productive within-session client behavior in a smoking cessation trial for African American smokers. For these analyses 89 baseline counseling sessions of the trial were audiotaped and coded using the Motivational Interviewing Skill Code (MISC). Counselor adherence indicators included a global subjective rating of MI adherence and the frequency of MI-consistent and MI-inconsistent counselor behaviors described in the MISC. Indicators of productive client behaviors included global subjective ratings of within-session client functioning and counselor-client interaction, as well as the frequency of statements by the client favorable toward changing behavior (“change talk”) and resistant regarding changing behavior (“resist-change talk”). Results provided support for the principles of MI. Counselor adherence indexed by both the global subjective rating and MI-consistent behavior frequency was significantly positively associated with global ratings of within-session client functioning and counselor-client interaction, as well as more change talk