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Huang AK, Hoatson T, Chakraborty P, McKetta S, Soled KRS, Reynolds CA, Boehmer U, Miranda AR, Streed CG, Maingi S, Haneuse S, Young JG, Kang JH, Austin SB, Eliassen AH, Charlton BM. Disparities in cancer incidence by sexual orientation. Cancer 2024. [PMID: 38733613 DOI: 10.1002/cncr.35356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/24/2024] [Accepted: 04/03/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Cancer risk factors are more common among sexual minority populations (e.g., lesbian, bisexual) than their heterosexual peers, yet little is known about cancer incidence across sexual orientation groups. METHODS The 1989-2017 data from the Nurses' Health Study II, a longitudinal cohort of female nurses across the United States, were analyzed (N = 101,543). Sexual orientation-related cancer disparities were quantified by comparing any cancer incidence among four sexual minority groups based on self-disclosure-(1) heterosexual with past same-sex attractions/partners/identity; (2) mostly heterosexual; (3) bisexual; and (4) lesbian women-to completely heterosexual women using age-adjusted incidence rate ratios (aIRR) calculated by the Mantel-Haenszel method. Additionally, subanalyses at 21 cancer disease sites (e.g., breast, colon/rectum) were conducted. RESULTS For all-cancer analyses, there were no statistically significant differences in cancer incidence at the 5% type I error cutoff among sexual minority groups when compared to completely heterosexual women; the aIRR was 1.17 (95% CI,0.99-1.38) among lesbian women and 0.80 (0.58-1.10) among bisexual women. For the site-specific analyses, incidences at multiple sites were significantly higher among lesbian women compared to completely heterosexual women: thyroid cancer (aIRR, 1.87 [1.03-3.41]), basal cell carcinoma (aIRR, 1.85 [1.09-3.14]), and non-Hodgkin lymphoma (aIRR, 2.13 [1.10-4.12]). CONCLUSION Lesbian women may be disproportionately burdened by cancer relative to their heterosexual peers. Sexual minority populations must be explicitly included in cancer prevention efforts. Comprehensive and standardized sexual orientation data must be systematically collected so nuanced sexual orientation-related cancer disparities can be accurately assessed for both common and rare cancers.
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Affiliation(s)
- Aimee K Huang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tabor Hoatson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah McKetta
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Kodiak R S Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Colleen A Reynolds
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alexis R Miranda
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Carl G Streed
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- GenderCare Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Shail Maingi
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessica G Young
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent and Young Adult Medicine Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Adolescent and Young Adult Medicine Research, Boston Children's Hospital, Boston, Massachusetts, USA
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Williams KM, Challa PK, Lopes EW, Burke KE, Ananthakrishnan AN, Richter JM, Chan AT, Khalili H. Periodontal disease is not associated with risk of inflammatory bowel disease: Results from two prospective cohort studies in the US. Aliment Pharmacol Ther 2023; 58:1052-1061. [PMID: 37781885 DOI: 10.1111/apt.17732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/19/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
AIM To examine the relationship between periodontal disease and tooth loss and risk of inflammatory bowel disease (IBD). METHODS We conducted a prospective cohort study of 86,602 women from the Nurses' Health Study (1992-2016) and 50,349 men from the Health Professionals Follow-up Study (1986-2016) with available data on periodontal disease and tooth loss. Cases of IBD were initially reported by participants and then confirmed by medical record review. We used Cox proportional hazards modelling to estimate multivariable-adjusted hazard ratios (aHRs) and 95% CIs. RESULTS Through the end of follow-up, we documented 175 cases of Crohn's disease (CD) and 209 cases of ulcerative colitis (UC). After adjustment for potential risk factors, there was no association between periodontal disease and risk of CD (pooled aHR: 0.99, 95% CI: 0.65-1.52, p = 0.970) or UC (aHR: 0.99, 95% CI: 0.68-1.45, p = 0.971). Similarly, we did not observe an association between tooth loss and risk of CD (aHR: 0.72, 95% CI: 0.43-1.21, p = 0.218) or UC (aHR: 0.89, 95% CI: 0.58-1.36, p = 0.581) in the pooled analysis. The associations were not modified by sex, age, body mass index (BMI), smoking status or NSAID use (all pinteraction > 0.87). CONCLUSION In two large prospective cohort studies, we did not observe an association between periodontal disease and tooth loss and risk of CD or UC.
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Affiliation(s)
- Katherine M Williams
- Division of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Prasanna K Challa
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily W Lopes
- Division of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kristin E Burke
- Division of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James M Richter
- Division of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew T Chan
- Division of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Channing Laboratory, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Hamed Khalili
- Division of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
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Hua X, Lopes EW, Burke KE, Ananthakrishnan AN, Richter JM, Lo CH, Lochhead P, Chan AT, Khalili H. Smoking Behaviour Changes After Diagnosis of Inflammatory Bowel Disease and Risk of All-cause Mortality. J Crohns Colitis 2022; 16:1030-1038. [PMID: 35102373 PMCID: PMC9351977 DOI: 10.1093/ecco-jcc/jjac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/30/2021] [Accepted: 01/25/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS We examined smoking behaviour changes after diagnoses of Crohn's disease [CD] and ulcerative colitis [UC] and evaluated their impact on mortality. METHODS Study population included incident CD or UC cases from three cohorts of the Nurses' Health Study [NHS], NHSII, and Health Professionals Follow-up Study. Smoking and other risk factors were prospectively assessed. Smoking behaviour changes were categorised as never, former [i.e., quit smoking before diagnosis], quitters [i.e., quit smoking after diagnosis], and current [i.e., continue smoking after diagnosis]. Follow-up for date and cause of death was completed through linkage to the National Death Index. Cox proportional hazard regression was used to estimate hazard ratios [HRs] and 95% confidence intervals [CIs]. RESULTS Among 909 eligible CD and UC cases, 45% were never smokers, 38% were past smokers, and 16% were active smokers at the time of diagnosis. Among active smokers, 70% of patients with CD and 44% of patients with UC continued to smoke after diagnosis. In patients with CD, compared with current smokers, the multivariable-adjusted HRs [95% CI] of death were 0.19 [0.10 to 0.38] for never smokers, 0.31 [0.16 to 0.57] for former smokers, and 0.41 [0.18 to 0.93] for quitters. Similarly for UC, compared with current smokers, we observed a reduced risk of mortality for never smokers [HR = 0.23, 95% CI 0.10 to 0.51], former smokers [HR = 0.23, 95% CI 0.11 to 0.48], and quitters [HR = 0.28, 95% CI 0.11 to 0.72]. CONCLUSIONS In three cohorts of health professionals, a substantial proportion of patients with new diagnosis of CD and UC and history of smoking continued to smoke after diagnosis. Smoking cessation around the time of diagnosis was associated with a significant reduction in mortality.
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Affiliation(s)
- Xinwei Hua
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Emily W Lopes
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kristin E Burke
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - James M Richter
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chun-Han Lo
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paul Lochhead
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Clinical and Translation Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Hamed Khalili
- Corresponding author: Hamed Khalili, MD, MPH, Digestive Healthcare Center, Crohn’s and Colitis Center, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA. Tel.: 617 726 7933; fax: 617 726 3080;
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Titan AL, He H, Lui N, Liou D, Berry M, Shrager JB, Backhus LM. The influence of hormone replacement therapy on lung cancer incidence and mortality. J Thorac Cardiovasc Surg 2019; 159:1546-1556.e4. [PMID: 31866083 DOI: 10.1016/j.jtcvs.2019.10.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Data regarding the effects of hormone replacement therapy (HRT) on non-small cell lung cancer (NSCLC) are mixed. We hypothesized HRT would have a protective benefit with reduced NSCLC incidence among women in a large, prospective cohort. METHODS We used data from the multicenter randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (1993-2001). Participants were women aged 50 to 74 years followed prospectively for up to 13 years for cancer screening. The influence of HRT on the primary outcome of NSCLC incidence and secondary outcomes of all-cause and disease-specific mortality were assessed with Kaplan-Meier analysis and Cox proportional hazard models adjusting for covariates. RESULTS In the overall cohort of 75,587 women, 1147 women developed NSCLC after a median follow-up of 11.5 years. HRT use was characterized as 49.4% current users, 17.0% former users, and 33.6% never users. Increased age, smoking, comorbidities, and family history were associated with increased risk of NSCLC. On multivariable analysis, current HRT use was associated with reduced risk of NSCLC compared with never users (hazard ratio, 0.80; 95% confidence interval, 0.70-0.93; P = .009). HRT or oral contraception use was not associated with significant differences in all-cause mortality or disease-specific mortality. CONCLUSIONS These data represent among the largest prospective cohorts suggesting HRT use may have a protective effect on the development of NSCLC among women; the physiological basis of this effect merits further study; however, the results may influence discussion surrounding HRT use in women.
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Affiliation(s)
- Ashley L Titan
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Hao He
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Natalie Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Douglas Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Mark Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
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Nilan K, McKeever TM, McNeill A, Raw M, Murray RL. Prevalence of tobacco use in healthcare workers: A systematic review and meta-analysis. PLoS One 2019; 14:e0220168. [PMID: 31344083 PMCID: PMC6657871 DOI: 10.1371/journal.pone.0220168] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/10/2019] [Indexed: 12/25/2022] Open
Abstract
Objectives To estimate tobacco use prevalence in healthcare workers (HCW) by country income level, occupation and sex, and compare the estimates with the prevalence in the general population. Methods We systematically searched five databases; Medline, EMBASE, CINHAL Plus, CAB Abstracts, and LILACS for original studies published between 2000 and March 2016 without language restriction. All primary studies that reported tobacco use in any category of HCW were included. Study extraction and quality assessment were conducted independently by three reviewers, using a standardised data extraction and quality appraisal form. We performed random effect meta-analyses to obtain prevalence estimates by World Bank (WB) country income level, sex, and occupation. Data on prevalence of tobacco use in the general population were obtained from the World Health Organisation (WHO) Global Health Observatory website. The review protocol registration number on PROSPERO is CRD42016041231. Results 229 studies met our inclusion criteria, representing 457,415 HCW and 63 countries: 29 high-income countries (HIC), 21 upper-middle-income countries (UMIC), and 13 lower-middle-and-low-income countries (LMLIC). The overall pooled prevalence of tobacco use in HCW was 21%, 31% in males and 17% in females. Highest estimates were in male doctors in UMIC and LMLIC, 35% and 45%, and female nurses in HIC and UMIC, 21% and 25%. Heterogeneity was high (I2 > 90%). Country level comparison suggest that in HIC male HCW tend to have lower prevalence compared with males in the general population while in females the estimates were similar. Male and female HCW in UMIC and LMLIC tend to have similar or higher prevalence rates relative to their counterparts in the general population. Conclusions HCW continue to use tobacco at high rates. Tackling HCW tobacco use requires urgent action as they are at the front line for tackling tobacco use in their patients.
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Affiliation(s)
- Kapka Nilan
- UK Centre for Tobacco and Alcohol Studies, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom
- * E-mail: (KN); (RLM)
| | - Tricia M. McKeever
- UK Centre for Tobacco and Alcohol Studies, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, United Kingdom
| | - Martin Raw
- NYU College of Global Public Health, New York University, New York, New York, United States of America
- NYU Medical School, New York University, New York, New York, United States of America
| | - Rachael L. Murray
- UK Centre for Tobacco and Alcohol Studies, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom
- * E-mail: (KN); (RLM)
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Abstract
INTRODUCTION Diverticulitis is a significant cause of morbidity among older women, and little attention has been paid to understanding its etiology. We have shown that menopausal hormone therapy (MHT) is associated with the risk of inflammatory bowel disease. In this study, we prospectively examined the association between MHT and the risk of incident diverticulitis. METHODS We studied 65,367 postmenopausal women enrolled in the Nurses' Health Study who provided detailed information on hormone use and other medical and lifestyle factors biennially, and on diet every 4 years. Between 2008 and 2014, participants reported any episodes of diverticulitis that required antibiotics and the date of occurrence. We used Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Over 24 years encompassing 1,297,165 person-years of follow-up, we documented 5,425 incident cases of diverticulitis. We observed an increased risk of diverticulitis among both current (HR 1.28; 95% CI 1.18-1.39) and past (HR 1.35; 95% CI 1.25-1.45) MHT users compared to never users. The increased risk was observed among participants using estrogen only (HR 1.30; 95% CI 1.20-1.41) and those using combined estrogen and progesterone (HR 1.31; 95% CI 1.21-1.42) compared to nonusers. The risk did not increase with longer duration of use (P-trend = 0.76). The association between MHT and diverticulitis was not modified by age, body mass index, past oral contraceptive use, or fiber intake (all P-interaction >0.11). CONCLUSIONS Menopausal hormone therapy was associated with an increased risk of diverticulitis. Further studies are needed to understand the potential mechanisms that may underlie this association.
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Staller K, Song M, Grodstein F, Whitehead WE, Matthews CA, Kuo B, Chan AT. Increased Long-term Dietary Fiber Intake Is Associated With a Decreased Risk of Fecal Incontinence in Older Women. Gastroenterology 2018; 155:661-667.e1. [PMID: 29758215 DOI: 10.1053/j.gastro.2018.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/01/2018] [Accepted: 05/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Fiber supplements are frequently used as treatment for fecal incontinence (FI), but little is known about the role of dietary fiber in the prevention of FI. METHODS We performed a prospective study to examine the association between long-term dietary fiber intake and risk of FI in 58,330 older women (mean age, 73 years) in the Nurses' Health Study who were free of FI in 2008. Energy-adjusted long-term dietary fiber intake was determined using food frequency questionnaires starting in 1984 and updated through 2006. We defined incident FI as at least 1 liquid or solid FI episode per month during the past year during 4 years of follow-up using self-administered biennial questionnaires. We used Cox proportional hazards models to calculate multivariable-adjusted hazard ratios and 95% CIs for FI according to fiber intake, adjusting for potential confounding factors. RESULTS During 193,655 person-years of follow-up, we documented 7,056 incident cases of FI. Compared with women in the lowest quintile of fiber intake (13.5 g/day), women in the highest quintile (25 g/day) had an 18% decrease in risk of FI (multivariable hazard ratio, 0.82; 95% CI, 0.76-0.89). This decrease appeared to be greatest for risk of liquid stool FI, which was 31% lower in women with the highest intake of fiber compared with women with the lowest intake (multivariable hazard ratio, 0.69; 95% CI, 0.62-0.75). Risk of FI was not significantly associated with fiber source. CONCLUSIONS In an analysis of data from almost 60,000 older women in the Nurses' Health Study, we found higher long-term intake of dietary fiber was associated with decreased risk of FI. Further studies are needed to determine the mechanisms that mediate this association.
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Affiliation(s)
- Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts; Center for Neurointestinal Health, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mingyang Song
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Francine Grodstein
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - William E Whitehead
- Center for Functional Gastrointestinal and Motility Disorders and Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Catherine A Matthews
- Department of Urology and Obstetrics and Gynecology, Wake Forest University Medical Center, Winston-Salem, North Carolina
| | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts; Center for Neurointestinal Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts
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Panczyk M, Woynarowska-Sołdan M, Żmuda-Trzebiatowska H, Gotlib J. Health-enhancing behaviours of nurses in Poland and their association with shift work and age. Collegian 2018. [DOI: 10.1016/j.colegn.2017.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Burke KE, Ananthakrishnan AN, Lochhead P, Olen O, Ludvigsson JF, Richter JM, Chan AT, Khalili H. Smoking is Associated with an Increased Risk of Microscopic Colitis: Results From Two Large Prospective Cohort Studies of US Women. J Crohns Colitis 2018; 12:559-567. [PMID: 29370359 PMCID: PMC6018687 DOI: 10.1093/ecco-jcc/jjy005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/15/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Long-term data on the influence of smoking on risk of microscopic colitis are limited. We therefore sought to examine and characterize the association between smoking and risk of incident microscopic colitis in two large prospective cohorts of women. METHODS We conducted a prospective study of 231015 women enrolled in the Nurses' Health Study [NHS] and NHSII. Information regarding smoking, other lifestyle factors and medications were collected biennially from 1976 to 2012 in NHS and from 1989 to 2013 in NHSII. Incident cases of microscopic colitis were confirmed through physician medical record review. We used Cox proportional hazards modelling to examine the association between smoking and risk of microscopic colitis. RESULTS We documented 166 incident cases of microscopic colitis over 6122779 person-years of follow up. Compared to non-smokers, the multivariable-adjusted hazard ratio [HR] for microscopic colitis was 2.52 (95% confidence interval [CI] 1.59-4.00) amongst current smokers and 1.54 [95% CI 1.09-2.17] amongst past smokers. The risk increased with higher pack-years of smoking [p trend = 0.001] and diminished following smoking cessation [p trend = 0.017]. Current smoking appeared to be more strongly associated with risk of collagenous colitis [HR 3.68; 95% CI 1.94-6.97] than lymphocytic colitis [HR 1.71; 95% CI 0.83-3.53]. CONCLUSION In two large prospective cohort studies, we observed an association between current smoking and risk of microscopic colitis. Risk of microscopic colitis appeared to increase with higher pack-years and diminish following smoking cessation. Future studies focused on characterizing the biological mechanisms underlying these associations are warranted.
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Affiliation(s)
- Kristin E Burke
- Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Ashwin N Ananthakrishnan
- Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Paul Lochhead
- Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Ola Olen
- Pediatric Gastroenterology and Nutrition Unit, Sachs’ Children’s Hospital, Stockholm, Sweden,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - James M Richter
- Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Andrew T Chan
- Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Hamed Khalili
- Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Karolinska Clinical Epidemiology Unit, Karolinska Institutet, Solna, Sweden,Corresponding author: Hamed Khalili, MD, Massachusetts General Hospital, Gastroenterology Unit, Crohn’s and Colitis Center, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA. Tel: 617-726-4951; fax: 978-882-6710;
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10
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Woynarowska-Sołdan M, Panczyk M, Iwanow L, Zarzeka A, Gotlib J. Validation of the positive health behaviours scale: a nationwide survey of nurses in Poland. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2018; 25:76-85. [DOI: 10.1080/10803548.2018.1436124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Mariusz Panczyk
- Faculty of Health Science, Medical University of Warsaw, Poland
| | - Lucyna Iwanow
- Faculty of Health Science, Medical University of Warsaw, Poland
| | | | - Joanna Gotlib
- Faculty of Health Science, Medical University of Warsaw, Poland
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11
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Lifestyles and Health-Related Outcomes of U.S. Hospital Nurses: A Systematic Review. Nurs Outlook 2018; 66:66-76. [DOI: 10.1016/j.outlook.2017.08.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/21/2017] [Accepted: 08/27/2017] [Indexed: 11/18/2022]
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12
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Staller K, Townsend MK, Khalili H, Mehta R, Grodstein F, Whitehead WE, Matthews CA, Kuo B, Chan AT. Menopausal Hormone Therapy Is Associated With Increased Risk of Fecal Incontinence in Women After Menopause. Gastroenterology 2017; 152:1915-1921.e1. [PMID: 28209529 PMCID: PMC5447480 DOI: 10.1053/j.gastro.2017.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/18/2017] [Accepted: 02/07/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Low estrogen levels can contribute to development of fecal incontinence (FI) in women after menopause by altering neuromuscular continence mechanisms. However, studies have produced conflicting results on the association between menopausal hormone therapy (MHT) and risk of FI. METHODS We studied the association between MHT and risk of FI among 55,828 postmenopausal women (mean age, 73 years) who participated in the Nurses' Health Study, were enrolled since 2008, and with no report of FI. We defined incident FI as a report of at least 1 liquid or solid FI episode per month during 4 years of follow-up from self-administered, biennial questionnaires administered in 2010 and 2012. We used Cox proportional hazard models to calculate multivariate-adjusted hazard ratios and 95% confidence intervals (CIs) for FI risk in women receiving MHT, adjusting for potential confounding factors. RESULTS During more than 185,000 person-years of follow-up, there were 6834 cases of incident FI. Compared with women who never used MHT, the multivariate hazard ratio for FI was 1.26 (95% CI, 1.18-1.34) for past users of MHT and 1.32 (95% CI, 1.20-1.45) for current users. The risk of FI increased with longer duration of MHT use (P trend ≤ .0001) and decreased with time since discontinuation. There was an increased risk of FI among women receiving MHT that contained a combination of estrogen and progestin (hazard ratio, 1.37; 95% CI, 1.10-1.70) compared with estrogen monotherapy. CONCLUSIONS Current or past use of MHT was associated with a modestly increased risk of FI among postmenopausal women in the Nurses' Health Study. These results support a potential role for exogenous estrogens in the impairment of the fecal continence mechanism.
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Affiliation(s)
- Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts; Center for Neurointestinal Health, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mary K Townsend
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Raaj Mehta
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Francine Grodstein
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - William E Whitehead
- Center for Functional Gastrointestinal and Motility Disorders and Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Catherine A Matthews
- Department of Urology and Obstetrics and Gynecology, Wake Forest University Medical Center, Winston-Salem, North Carolina
| | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts; Center for Neurointestinal Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts
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Stampfer M, Grodstein F, Willett W, Eliassen H. Stampfer et al. Respond. Am J Public Health 2017; 107:e3. [DOI: 10.2105/ajph.2016.303610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Meir Stampfer
- Meir Stampfer and Walter Willett are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA. Meir Stampfer, Fran Grodstein, and Heather Eliassen are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston. Fran Grodstein and Heather Eliassen are also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health
| | - Fran Grodstein
- Meir Stampfer and Walter Willett are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA. Meir Stampfer, Fran Grodstein, and Heather Eliassen are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston. Fran Grodstein and Heather Eliassen are also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health
| | - Walter Willett
- Meir Stampfer and Walter Willett are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA. Meir Stampfer, Fran Grodstein, and Heather Eliassen are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston. Fran Grodstein and Heather Eliassen are also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health
| | - Heather Eliassen
- Meir Stampfer and Walter Willett are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA. Meir Stampfer, Fran Grodstein, and Heather Eliassen are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston. Fran Grodstein and Heather Eliassen are also with the Department of Epidemiology, Harvard T. H. Chan School of Public Health
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14
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Birkhead SF. The Nurses' Health Study and Nurses: Beyond Specimens and Questionnaires. Am J Public Health 2017; 107:e3. [DOI: 10.2105/ajph.2016.303609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Susan F. Birkhead
- Susan F. Birkhead is with the Samaritan Hospital School of Nursing, Troy, NY
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15
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The Impact of Perceived Stress and Coping Adequacy on the Health of Nurses: A Pilot Investigation. Nurs Res Pract 2016; 2016:5843256. [PMID: 27882246 PMCID: PMC5108847 DOI: 10.1155/2016/5843256] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/27/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
Stress and coping abilities influence the health and work performance of nurses. However, little is known about the combined influence of stress perception and perceived coping adequacy and its impact on the health of nurses. This study examined the relationship between stress, coping, and the combined influences of perceived stress and coping abilities on health and work performance. A valid and reliable questionnaire was completed by 120 nurses in a Midwestern hospital in the USA. In general, the nurses were not healthy: 92% had moderate-to-very high stress levels; 78% slept less than 8 hours of sleep per night; 69% did not exercise regularly; 63% consumed less than 5 servings of fruits and vegetables per day; and 22% were classified as binge drinkers. When confronted with workplace stress, 70% of nurses reported that they consumed more junk food and 63% reported that they consumed more food than usual as a way of coping. Nurses in the "high stress/poor coping" group had the poorest health outcomes and highest health risk behaviors compared to those in other groups. The combined variables of perceived stress and perceived coping adequacy influenced the health of nurses. Therefore, worksite health promotion programs for nurses should focus equally on stress reduction, stress management, and the development of healthy coping skills.
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Sarna L, Bialous SA, Zou XN, Wang W, Hong J, Wells M, Brook J. Evaluation of a web-based educational programme on changes in frequency of nurses' interventions to help smokers quit and reduce second-hand smoke exposure in China. J Adv Nurs 2015; 72:118-26. [PMID: 26428712 DOI: 10.1111/jan.12816] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate a web-based educational smoking cessation programme on changes in the frequency of hospital-based nurses' self-reported interventions to help smokers quit using the 5 As (i.e. Ask, Advise, Assess, Assist, Arrange), to reduce exposure to second-hand smoke and to change attitudes about nurses' involvement in tobacco control. BACKGROUND Few nurses in China support smokers' quit attempts using evidence-based smoking cessation interventions based on the 5 As. Limited knowledge is a barrier to intervention. Web-based tobacco cessation programs have the potential to reach a large population of nurses. DESIGN A prospective single-group design with pre-, 3- and 6-month follow-up after the educational programme evaluated the feasibility of conducting web-based educational programs in two cities in China in 2012-2013. METHODS Frequency of interventions was assessed using a valid and reliable web-based survey with a convenience sample of nurses from eight hospitals in Beijing and Hefei, China. Generalized linear models, adjusting for age, clinical setting, education and site were used to determine changes in the consistent (usually/always) use of the 5 As from baseline to 3 and to 6 months. RESULTS Nurses (N = 1386) had baseline and/or 3- and 6-month data. At 6 months, nurses were significantly more likely to Assess, Assist and Arrange for smoking cessation and recommend smoke-free home environments. There was significant improvement in attitudes about tobacco control. CONCLUSIONS Nurses receiving web-based smoking cessation education significantly increased self-reports of frequency of providing interventions to patients who smoke, including recommending smoke-free home environments to support quit attempts.
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Affiliation(s)
- Linda Sarna
- School of Nursing, University of California, Los Angeles, California, USA
| | | | - Xiao Nong Zou
- Office of Tobacco Control, National Office for Cancer Prevention and Cancer Control, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Weili Wang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Jingfang Hong
- School of Nursing, Anhui Medical University, Hefei, China
| | - Marjorie Wells
- School of Nursing, University of California, Los Angeles, California, USA
| | - Jenny Brook
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Rahimi A, Vazini H, Alhani F, Anoosheh M. Relationship Between Low Back Pain With Quality of Life, Depression, Anxiety and Stress Among Emergency Medical Technicians. Trauma Mon 2015; 20:e18686. [PMID: 26290857 PMCID: PMC4538730 DOI: 10.5812/traumamon.18686] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/04/2014] [Accepted: 05/10/2014] [Indexed: 11/24/2022] Open
Abstract
Background: Musculoskeletal disorders have become increasingly common among healthcare providers. They have become the most common cause of work-related disabilities among nurses. Objectives: The current cross-sectional study aimed to measure the prevalence of back pains among emergency medical technicians (EMTs), and association of back pain with quality of life, depression, anxiety and stress. Materials and Methods: One hundred and eighty registered nurses working as EMTs at the Hamadan Emergency Medical Center were selected by consensus. Data collection tools were Demographic, Perceived Quality-of-Life, Short Form Health Survey (SF-36), and Depression Anxiety Stress Scales (DAS21) and pain scale measurements. Results: Data showed that while 50.7% of the participants had an average awareness of the basic principles of back care, the majority (71.8%) had at least one type of back pain. There were associations between the prevalence of pain and depression (P = 0.049), pain and awareness (P = 0.035), and stress and job satisfaction (P = 0.024). Conclusions: A large number (about two-thirds) of EMTs had some sort of back pain; it is highly recommended to promote the attitude and motivation of the individuals to take care to prevent back injury and inform them of the principles of back care. Implications for primary prevention and care practice include encouraging EMTs to apply accurate principles of back care.
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Affiliation(s)
- Abolfazl Rahimi
- Behavioral Sciences Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hossein Vazini
- Department of Nursing, Hamedan Branch, Islamic Azad University, Hamawdan, IR Iran
| | - Fatemeh Alhani
- Department of Nursing, Hamedan Branch, Islamic Azad University, Hamawdan, IR Iran
- Corresponding author: Fatemeh Alhani, Department of Nursing, Medical Science Faculty, Tarbiat Modares University, Tehran, IR Iran. Tel/ Fax: +98-2182883898, E-mail:
| | - Monireh Anoosheh
- Department of Nursing, Hamedan Branch, Islamic Azad University, Hamawdan, IR Iran
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Perry L, Lamont S, Brunero S, Gallagher R, Duffield C. The mental health of nurses in acute teaching hospital settings: a cross-sectional survey. BMC Nurs 2015; 14:15. [PMID: 25904820 PMCID: PMC4405850 DOI: 10.1186/s12912-015-0068-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/17/2015] [Indexed: 12/01/2022] Open
Abstract
Background Nursing is an emotionally demanding profession and deficiencies in nurses’ mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses’ health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. Methods A cross sectional survey design was used. The Registered and Enrolled Nurse workforce, employed on any form of contract, at two teaching hospitals in Sydney Australia were invited to participate. The survey tool was compiled of validated tools and questions. Family and medical history and health risk-related characteristics, current psycho-active medications, smoking status, alcohol intake, eating disorders, self-perceived general health, mental health and vitality, demographic, social and occupational details were collected. Results A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n = 49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12 month. Nurses had better mental health if they had better general health, lived with a spouse/ partner rather than alone, had fewer symptoms, sleep problems or disordered eating behaviours, were not an informal carer and did not work nights. Nurses had greater vitality if they were male, had better general health, fewer sleep problems or symptoms generally and lived with a spouse/ partner rather than alone; less vitality if they were an informal carer or had disordered eating. Conclusion Nurses and their managers should strive to create workplaces where working practices promote nurses’ health and wellbeing, or at least are configured to minimise deleterious effects; where both nurses and their managers are aware of the potential for negative effects on the mental health of the workforce; where cultures are such that this can be discussed openly without fear of stigma or denigration.
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Affiliation(s)
- Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007 Australia
| | - Scott Lamont
- Mental Health Liaison, Prince of Wales Hospital and Community Health Services, Randwick, NSW 2031 Australia
| | - Scott Brunero
- Mental Health Liaison, Prince of Wales Hospital and Community Health Services, Randwick, NSW 2031 Australia
| | - Robyn Gallagher
- Charles Perkins Centre and Sydney Nursing School, University of Sydney, Sydney, NSW 2006 Australia
| | - Christine Duffield
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007 Australia ; Edith Cowan University, Perth, WA Australia
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Khalili H, Ananthakrishnan AN, Konijeti GG, Higuchi LM, Fuchs CS, Richter JM, Chan AT. Measures of obesity and risk of Crohn's disease and ulcerative colitis. Inflamm Bowel Dis 2015; 21:361-8. [PMID: 25563694 PMCID: PMC4308549 DOI: 10.1097/mib.0000000000000283] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity is associated with intestinal-specific inflammation. Nonetheless, a specific role of obesity in the etiology of inflammatory bowel disease is unclear. METHODS We conducted a prospective cohort study of U.S. women enrolled in 1989 in the Nurses' Health Study II. At baseline, we collected information on height, weight, waist and hip circumference, weight at age 18, and body shape at age 20. We used Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals (CIs). RESULTS Among 111,498 women (median age, 35 yr), we documented 153 cases of Crohn's disease (CD) and 229 cases of ulcerative colitis (UC) more than 18 years of follow-up, encompassing 2,028,769 person-years. Compared with women with normal BMI, the multivariate-adjusted hazard ratios of CD were 2.33 (95% CI, 1.15-4.69) for obese women at age 18 and 1.58 (95% CI, 1.01-2.47) for obese women at baseline. Increasing weight gain between age 18 and baseline was associated with increased risk of CD (Ptrend = 0.04). Adolescent body habitus was also associated with risk of CD with a multivariate-adjusted hazard ratio of CD of 1.63 (95% CI, 1.07-2.50) for women with overweight/obese body shape compared with women with a thin/slender body shape. We did not observe a significant association between any of these anthropometric measures and risk of UC. CONCLUSIONS In a large prospective cohort of U.S. women, measures of adiposity were associated with an increased risk of CD but not UC. Additional studies are needed to elucidate the biological mechanisms by which excess adiposity may increase the risk of CD.
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Affiliation(s)
- Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - Ashwin N. Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - Gauree G. Konijeti
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - Leslie M. Higuchi
- Division of Gastroenterology and Nutrition, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115
| | - Charles S. Fuchs
- Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA 02115
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - James M. Richter
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - Andrew T. Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Shahbazi S, Arif AA, Portwood SG, Thompson ME. Risk factors of smoking among health care professionals. J Prim Care Community Health 2014; 5:228-33. [PMID: 24695770 DOI: 10.1177/2150131914527618] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Health care professionals (HCPs) play a vital role at various levels of smoking cessation programs to reduce tobacco use in general populations. However, their smoking habits may limit their ability to intervene with their patients who smoke. AIMS To determine prevalence rates of current smoking and examine sociodemographic and work-related factors associated with current smoking among HCPs. METHODS A statewide survey was conducted in a representative sample of 4 groups of HCPs, physicians, nurses, respiratory therapists, and occupational therapists, with active licenses in Texas in 2003. Weighted prevalence estimates of current smoking rates were computed. Survey logistic regression analysis was used to investigate associations between individual characteristics and current smoking. RESULTS There were 3600 HCPs included in the analysis. The overall prevalence of current smoking was 9% with the highest prevalence (16%) recorded among respiratory therapists and the lowest prevalence (3%) recorded among physicians. In the multivariable logistic regression analysis non-Hispanic white HCPs were almost 4 times as likely to be current smokers (adjusted odds ratio= 3.95, 95% confidence interval = 1.24-12.59) and those working for 50 hours or more per week were twice as likely to be current smokers (adjusted odds ratio = 2.07, 95% CI = 1.20-3.57). Compared with physicians, all other HCP groups had significantly greater odds of currently smoking. HCPs who were female and resided or worked in rural settings had higher smoking rates in univariable analysis only (P < .05). CONCLUSIONS Smoking is prevalent among certain HCP groups. Working long hours was identified as an important occupational factor associated with current smoking.
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Affiliation(s)
- Sara Shahbazi
- University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Ahmed A Arif
- University of North Carolina at Charlotte, Charlotte, NC, USA
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Lee PN, Fry JS, Forey BA. Estimating the decline in excess risk of chronic obstructive pulmonary disease following quitting smoking - a systematic review based on the negative exponential model. Regul Toxicol Pharmacol 2013; 68:231-9. [PMID: 24361344 DOI: 10.1016/j.yrtph.2013.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/11/2013] [Accepted: 12/12/2013] [Indexed: 12/11/2022]
Abstract
We quantified the decline in COPD risk following quitting using the negative exponential model, as previously carried out for other smoking-related diseases. We identified 14 blocks of RRs (from 11 studies) comparing current smokers, former smokers (by time quit) and never smokers, some studies providing sex-specific blocks. Corresponding pseudo-numbers of cases and controls/at risk formed the data for model-fitting. We estimated the half-life (H, time since quit when the excess risk becomes half that for a continuing smoker) for each block, except for one where no decline with quitting was evident, and H was not estimable. For the remaining 13 blocks, goodness-of-fit to the model was generally adequate, the combined estimate of H being 13.32 (95% CI 11.86-14.96) years. There was no heterogeneity in H, overall or by various studied sources. Sensitivity analyses allowing for reverse causation or different assumed times for the final quitting period little affected the results. The model summarizes quitting data well. The estimate of 13.32years is substantially larger than recent estimates of 4.40years for ischaemic heart disease and 4.78years for stroke, and also larger than the 9.93years for lung cancer. Heterogeneity was unimportant for COPD, unlike for the other three diseases.
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Affiliation(s)
- Peter N Lee
- P.N. Lee Statistics and Computing Ltd, Sutton, Surrey, United Kingdom.
| | - John S Fry
- P.N. Lee Statistics and Computing Ltd, Sutton, Surrey, United Kingdom
| | - Barbara A Forey
- P.N. Lee Statistics and Computing Ltd, Sutton, Surrey, United Kingdom
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Khalili H, Ananthakrishnan AN, Konijeti GG, Liao X, Higuchi LM, Fuchs CS, Spiegelman D, Richter JM, Korzenik JR, Chan AT. Physical activity and risk of inflammatory bowel disease: prospective study from the Nurses' Health Study cohorts. BMJ 2013; 347:f6633. [PMID: 24231178 PMCID: PMC3935281 DOI: 10.1136/bmj.f6633] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the association between physical activity and risk of ulcerative colitis and Crohn's disease. DESIGN Prospective cohort study. SETTING Nurses' Health Study and Nurses' Health Study II. PARTICIPANTS 194,711 women enrolled in the Nurses' Health Study and Nurses' Health Study II who provided data on physical activity and other risk factors every two to four years since 1984 in the Nurses' Health Study and 1989 in the Nurses' Health Study II and followed up through 2010. MAIN OUTCOME MEASURE Incident ulcerative colitis and Crohn's disease. RESULTS During 3,421,972 person years of follow-up, we documented 284 cases of Crohn's disease and 363 cases of ulcerative colitis. The risk of Crohn's disease was inversely associated with physical activity (P for trend 0.02). Compared with women in the lowest fifth of physical activity, the multivariate adjusted hazard ratio of Crohn's disease among women in the highest fifth of physical activity was 0.64 (95% confidence interval 0.44 to 0.94). Active women with at least 27 metabolic equivalent task (MET) hours per week of physical activity had a 44% reduction (hazard ratio 0.56, 95% confidence interval 0.37 to 0.84) in risk of developing Crohn's disease compared with sedentary women with <3 MET h/wk. Physical activity was not associated with risk of ulcerative colitis (P for trend 0.46). The absolute risk of ulcerative colitis and Crohn's disease among women in the highest fifth of physical activity was 8 and 6 events per 100,000 person years compared with 11 and 16 events per 100,000 person years among women in the lowest fifth of physical activity, respectively. Age, smoking, body mass index, and cohort did not significantly modify the association between physical activity and risk of ulcerative colitis or Crohn's disease (all P for interaction >0.35). CONCLUSION In two large prospective cohorts of US women, physical activity was inversely associated with risk of Crohn's disease but not of ulcerative colitis.
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Affiliation(s)
- Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114, USA
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Miyazaki Y, Hayashi K, Mizunuma H, Lee JS, Katanoda K, Imazeki S, Suzuki S. Smoking habits in relation to reproductive events among Japanese women: findings of the Japanese Nurses' Health Study. Prev Med 2013; 57:729-31. [PMID: 23933225 DOI: 10.1016/j.ypmed.2013.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/26/2013] [Accepted: 08/03/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purposes of this study were to examine smoking habits in relation to the reproductive events of pregnancy and menopause and clarify the reasons for smoking cessation among ex-smokers. METHOD This is a cross-sectional study based on a baseline survey of a prospective cohort study. From 2001 to 2007, a self-administered questionnaire survey was conducted on 49,927 female nurses from all 47 prefectures in Japan. Logistic regression models were used to estimate age-adjusted odds ratios. RESULTS Of the respondents, 17.2% were current smokers, 11.6% were ex-smokers and 69.8% had never smoked. The prevalence of smoking during pregnancy was 7.8%. Among ex-smokers, 30.3% gave "reproductive events" as their reason for smoking cessation. Current smoking and the number of cigarettes smoked per day before menopause were significantly related to onset of menopause. CONCLUSION Women's smoking habits have mutual relationships with reproductive events such as pregnancy and menopause. Although "reproductive events" were an important reason for smoking cessation among women, 7.8% of women still smoked during pregnancy. Smoking was correlated with onset of menopause. Support for smoking cessation is an important healthcare issue throughout women's lifetimes.
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Affiliation(s)
- Y Miyazaki
- Faculty of Health Care, Takasaki University of Health and Welfare, Gunma, 501,Nakaorui-Machi, Takasaki, Japan.
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Khalili H, Higuchi LM, Ananthakrishnan AN, Richter JM, Feskanich D, Fuchs CC, Chan AT. Oral contraceptives, reproductive factors and risk of inflammatory bowel disease. Gut 2013; 62:1153-9. [PMID: 22619368 PMCID: PMC3465475 DOI: 10.1136/gutjnl-2012-302362] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oral contraceptive use has been associated with risk of Crohn's disease (CD) and ulcerative colitis (UC). OBJECTIVE To determine whether this association is confounded or modified by other important lifestyle and reproductive factors. DESIGN A prospective cohort study was carried out of 117,375 US women enrolled since 1976 in the Nurses Health Study I (NHS I) and 115,077 women enrolled since 1989 in the Nurses' Health Study II (NHS II) with no prior history of UC or CD. These women had provided information every 2 years, on age at menarche, oral contraceptive use, parity, menopause status and other risk factors. Diagnoses of CD and UC were confirmed by review of medical records. Cox proportional hazards models were used to calculate HRs and 95% CIs. RESULTS Among 232,452 women with over 5,030,196 person-years of follow-up, 315 cases of CD and 392 cases of UC were recorded through 2007 in NHS II and 2008 in NHS I. Compared with never users of oral contraceptives, the multivariate-adjusted HRs for CD were 2.82 (95% CI 1.65 to 4.82) among current users and 1.39 (95% CI 1.05 to 1.85) among past users. The association between oral contraceptives and UC differed according to smoking history (pheterogeneity=0.04). Age at menarche, age at first birth and parity were not associated with risk of UC or CD. CONCLUSION In two large prospective cohorts of US women, oral contraceptive use was associated with risk of CD. The association between oral contraceptive use and UC was limited to women with a history of smoking.
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Affiliation(s)
- Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Leslie M Higuchi
- Division of Gastroenterology and Nutrition, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James M Richter
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Diane Feskanich
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Charles C Fuchs
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Abstract
BACKGROUND Early life factors have been postulated to play a role in development of immune tolerance and intestinal microbiome, which in turn may influence the risk of inflammatory bowel disease. METHODS We conducted a prospective cohort study of 60,186 U.S. women enrolled since 1976 in the Nurses Health Study (NHS) I and 86,495 women enrolled since 1989 in the NHS II with no history of ulcerative colitis (UC) or Crohn's disease (CD). Information about breastfeeding, birth weight, and preterm birth were collected in 1992 in NHS I and 1991 in NHS II. Diagnoses of CD and UC were confirmed through review of medical records. We used Cox proportional hazards models to calculate hazard ratios and 95% confidence intervals. RESULTS Among 146,681 women over 3,373,726 person-years of follow-up, we documented 248 cases of CD and 304 cases of UC through 2007 in NHS II and 2008 in NHS I. The median age of diagnosis was 51 for CD and 49 for UC. Compared with women who were not breastfed, women who were breastfed had multivariate-adjusted hazard ratios of 0.99 (95% confidence interval, 0.76-1.30) for CD and 1.03 (95% confidence interval, 0.81-1.32) for UC. Similarly, low or high birth weight and preterm birth were not significantly associated with risk of UC or CD. CONCLUSIONS In 2 large prospective cohorts of U.S. women, we did not observe a significant association between early life factors including having been breastfed, birth weight, preterm birth, and risk of adult-onset UC and CD.
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Making a difference: Nursing scholarship and leadership in tobacco control. Nurs Outlook 2013; 61:31-42. [DOI: 10.1016/j.outlook.2012.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 04/30/2012] [Accepted: 05/29/2012] [Indexed: 11/18/2022]
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Khalili H, Huang ES, Ananthakrishnan AN, Higuchi L, Richter JM, Fuchs CS, Chan AT. Geographical variation and incidence of inflammatory bowel disease among US women. Gut 2012; 61:1686-92. [PMID: 22241842 PMCID: PMC3418414 DOI: 10.1136/gutjnl-2011-301574] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Geographical variation in the incidence of Crohn's disease (CD) and ulcerative colitis (UC) according to the latitude of residence has been reported in Europe. However, there are no comparable data in the USA. The incidence of CD and UC in relation to latitude was assessed in a geographically diverse population of women enrolled in two large prospective studies in the USA. DESIGN A prospective study was undertaken of women enrolled in the Nurses' Health Study I (NHS) in 1976 and in the NHS II in 1989. Information on state of residence at the time of birth, at age 15 years and age 30 years was collected in 1992 in NHS I and in 1993 in NHS II. Reported diagnoses of incident CD or UC to the end of 2003 were confirmed by medical record review. Cox proportional hazards models were used to calculate HRs and 95% CIs for risk of CD and UC. RESULTS In both cohorts, among 175,912 women reporting their residence in 1992, 257 cases of CD and 313 cases of UC were documented over 3,428,376 person-years of follow-up. The incidence of CD and UC increased significantly with increasing latitude (p(trend)<0.01), with residence at age 30 years more strongly associated with risk. Compared with women residing in northern latitudes at age 30, the multivariate-adjusted HR for women residing in southern latitudes was 0.48 (95% CI 0.30 to 0.77) for CD and 0.62 (95% CI 0.42 to 0.90) for UC. The effect of latitude of residence on risk of CD and UC did not vary according to smoking history (p(interaction)=0.26 for CD and 0.99 for UC). CONCLUSION In a population of US women, increasing latitude of residence was associated with a higher incidence of CD and UC.
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Affiliation(s)
- Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward S Huang
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leslie Higuchi
- Division of Gastroenterology, Children’s Hospital, Boston, Massachusetts, USA
| | - James M Richter
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles S Fuchs
- Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA,Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Khalili H, Huang ES, Ananthakrishnan AN, Higuchi L, Richter JM, Fuchs CS, Chan AT. Geographical variation and incidence of inflammatory bowel disease among US women. Gut 2012. [PMID: 22241842 DOI: 10.1136/gutjnl-2011-301-574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Geographical variation in the incidence of Crohn's disease (CD) and ulcerative colitis (UC) according to the latitude of residence has been reported in Europe. However, there are no comparable data in the USA. The incidence of CD and UC in relation to latitude was assessed in a geographically diverse population of women enrolled in two large prospective studies in the USA. DESIGN A prospective study was undertaken of women enrolled in the Nurses' Health Study I (NHS) in 1976 and in the NHS II in 1989. Information on state of residence at the time of birth, at age 15 years and age 30 years was collected in 1992 in NHS I and in 1993 in NHS II. Reported diagnoses of incident CD or UC to the end of 2003 were confirmed by medical record review. Cox proportional hazards models were used to calculate HRs and 95% CIs for risk of CD and UC. RESULTS In both cohorts, among 175,912 women reporting their residence in 1992, 257 cases of CD and 313 cases of UC were documented over 3,428,376 person-years of follow-up. The incidence of CD and UC increased significantly with increasing latitude (p(trend)<0.01), with residence at age 30 years more strongly associated with risk. Compared with women residing in northern latitudes at age 30, the multivariate-adjusted HR for women residing in southern latitudes was 0.48 (95% CI 0.30 to 0.77) for CD and 0.62 (95% CI 0.42 to 0.90) for UC. The effect of latitude of residence on risk of CD and UC did not vary according to smoking history (p(interaction)=0.26 for CD and 0.99 for UC). CONCLUSION In a population of US women, increasing latitude of residence was associated with a higher incidence of CD and UC.
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Affiliation(s)
- Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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Molina AJ, Fernández T, Fernández D, Delgado M, de Abajo S, Martín V. Knowledge, attitudes and beliefs about tobacco use after an educative intervention in health sciences' students. NURSE EDUCATION TODAY 2012; 32:862-867. [PMID: 22153056 DOI: 10.1016/j.nedt.2011.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 10/14/2011] [Accepted: 11/09/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE To examine the effectiveness of a tobacco control course on the improvement of knowledge, attitudes and beliefs about smoking among health sciences' students. METHODS This was a quasi-experimental study of community intervention carried out during the years 2005-2008, at 2 university health science centres in northwest Spain. A total of 290 students on the intervention and 256 on the control campus took part in the study. The intervention consisted of a course on the prevention and control of tobacco use offered only on the intervention campus. Data were collected before the intervention and 6 months afterwards. RESULTS After the course, significant differences between groups were observed in the improvement of knowledge, attitudes and perceived ability to act in tobacco control. CONCLUSIONS The introduction of training concerning smoking through active methodologies had a positive impact on the knowledge, attitudes and beliefs about tobacco of students.
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Affiliation(s)
- Antonio J Molina
- Area of Preventive Medicine and Public Health, Institute of Biomedicine, University of León, León, Spain.
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Khalili H, Higuchi LM, Ananthakrishnan AN, Manson JE, Feskanich D, Richter JM, Fuchs CS, Chan AT. Hormone therapy increases risk of ulcerative colitis but not Crohn's disease. Gastroenterology 2012; 143:1199-1206. [PMID: 22841783 PMCID: PMC3480540 DOI: 10.1053/j.gastro.2012.07.096] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 07/09/2012] [Accepted: 07/17/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Estrogen has been proposed to modulate gut inflammation through an effect on estrogen receptors found on gastrointestinal epithelial and immune cells. The role of postmenopausal hormone therapy on risk of Crohn's disease (CD) and ulcerative colitis (UC) is unclear. METHODS We conducted a prospective cohort study of 108,844 postmenopausal US women (median age, 54 years) enrolled in 1976 in the Nurses' Health Study without a prior history of CD or UC. Every 2 years, we have updated information on menopause status, postmenopausal hormone use, and other risk factors. Self-reported diagnoses of CD and UC were confirmed through medical record review by 2 gastroenterologists who were blinded to exposure information. We used Cox proportional hazards models to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Through 2008, with more than 1.8 million person-years of follow-up, we documented 138 incident cases of CD and 138 cases of UC. Compared with women who never used hormones, the multivariate-adjusted HR for UC was 1.71 (95% CI, 1.07-2.74) among women who currently used hormones and 1.65 (95% CI, 1.03-2.66) among past users. The risk of UC appeared to increase with longer duration of hormone use (P(trend) = .04) and decreased with time since discontinuation. There was no difference in risk according to the type of hormone therapy used (estrogen vs estrogen plus progestin). In contrast, we did not observe an association between current use of hormones and risk of CD (multivariate-adjusted HR, 1.19; 95% CI, 0.78-1.82). The effect of hormones on risk of UC and CD was not modified by age, body mass index, or smoking. CONCLUSIONS In a large prospective cohort of women, postmenopausal hormone therapy was associated with an increased risk of UC but not CD. These findings indicate that pathways related to estrogens might mediate the pathogenesis of UC.
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Affiliation(s)
- Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - Leslie M. Higuchi
- Division of Gastroenterology and Nutrition, Children’s Hospital Boston and Harvard Medical School, Boston, MA 02115
| | - Ashwin N. Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Diane Feskanich
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - James M. Richter
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - Charles S. Fuchs
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
,Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA 02115
| | - Andrew T. Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
,Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Sarna L, Bialous SA. A review of images of nurses and smoking on the World Wide Web. Nurs Outlook 2012; 60:S36-46. [PMID: 23036793 DOI: 10.1016/j.outlook.2012.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 06/04/2012] [Accepted: 06/11/2012] [Indexed: 11/16/2022]
Abstract
With the advent of the World Wide Web, historic images previously having limited distributions are now widely available. As tobacco use has evolved, so have images of nurses related to smoking. Using a systematic search, the purpose of this article is to describe types of images of nurses and smoking available on the World Wide Web. Approximately 10,000 images of nurses and smoking published over the past century were identified through search engines and digital archives. Seven major themes were identified: nurses smoking, cigarette advertisements, helping patients smoke, "naughty" nurse, teaching women to smoke, smoking in and outside of health care facilities, and antitobacco images. The use of nursing images to market cigarettes was known but the extent of the use of these images has not been reported previously. Digital archives can be used to explore the past, provide a perspective for understanding the present, and suggest directions for the future in confronting negative images of nursing.
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Affiliation(s)
- Linda Sarna
- School of Nursing, University of California, Los Angeles, CA 90095, USA.
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Smoking prevalence, attitudes, and confidence about tobacco roles among Australian nursing students. J Addict Nurs 2012; 23:181-90. [PMID: 24335735 DOI: 10.1097/jan.0b013e31826f4b83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study identified major challenges to be addressed before student nurses can achieve their full potential in providing effective and comprehensive smoking cessation interventions. Smoking behaviors were assessed among undergraduate nursing students. In addition, students' attitudes, confidence levels, and support for extra training in tobacco control were examined. A nonprobability sample of 381 students at an Australian university was surveyed. The consent rate was 81%. Prevalence of current smoking was 21%. In the regression analysis, age group was the only statistically significant predictor of smoking status. Over one third (36%) did not endorse the nonsmoking exemplar role of their future profession. Most (60%) did not support the concept of routine smoking cessation intervention. Students who were smokers had significantly higher tobacco control confidence levels than nonsmokers. Smoking-related variables did not differ between students in different years of the course. Improved tobacco control training is needed at undergraduate level.
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Abstract
OBJECTIVES Long-term data on the influence of cigarette smoking, especially cessation, on the risk of Crohn's disease (CD) and ulcerative colitis (UC) are limited. METHODS We conducted a prospective study of 229,111 women in the Nurses' Health Study (NHS) and Nurses' Health Study II (NHS II). Biennially, we collected updated data on cigarette smoking, other risk factors, and diagnoses of CD or UC confirmed by medical record review. RESULTS Over 32 years in NHS and 18 years in NHS II, we documented 336 incident cases of CD and 400 incident cases of UC. Compared with never smokers, the multivariate hazard ratio (HR) of CD was 1.90 (95% confidence interval (CI), 1.42-2.53) among current smokers and 1.35 (95% CI, 1.05-1.73) among former smokers. Increasing pack-years was associated with increasing risk of CD (Ptrend < 0.0001), whereas smoking cessation was associated with an attenuation of risk. By contrast, the multivariate HR of UC was 0.86 (95% CI, 0.61-1.20) among current smokers and 1.56 (95% CI, 1.26-1.93) among former smokers. The risk of UC was significantly increased within 2-5 years of smoking cessation (HR, 3.06; 95% CI, 2.00-4.67) and remained persistently elevated over 20 years. CONCLUSIONS Current smoking is associated with an increased risk of CD, but not UC. By contrast, former smoking is associated with an increased risk of UC, with risk persisting over two decades after cessation.
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Chan CW, Perry L. Lifestyle health promotion interventions for the nursing workforce: a systematic review. J Clin Nurs 2012; 21:2247-61. [DOI: 10.1111/j.1365-2702.2012.04213.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Filion KB, Steffen LM, Duval S, Jacobs DR, Blackburn H, Luepker RV. Trends in smoking among adults from 1980 to 2009: the Minnesota heart survey. Am J Public Health 2012; 102:705-13. [PMID: 21852651 PMCID: PMC3489364 DOI: 10.2105/ajph.2011.300162] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined population-based smoking trends in Minnesota between 1980 and 2009. METHODS The Minnesota Heart Survey (MHS) is a population-based, serial, cross-sectional study of cardiovascular risk factor trends among Minneapolis-Saint Paul metropolitan residents. The MHS recently completed its sixth survey (1980-1982 [n = 3799], 1985-1987 [n = 4641], 1990-1992 [n = 5159], 1995-1997 [n = 6690], 2000-2002 [n = 3281], and 2007-2009 [n = 3179]). We used MHS data to examine smoking trends among adults aged 25 to 74 years by means of age-adjusted generalized linear mixed models. RESULTS Between 1980 and 2009, the prevalence of current smoking decreased from 32.8% to 15.5% for men and from 32.7% to 12.2% for women (P < .001 for each). Greater decreases occurred among those with higher income and those with more education. Among currently smoking men, the number of cigarettes smoked per day decreased from 26.0 in the 1980-1982 survey to 16.0 in the 2007-2009 survey (P < .001). Similar trends were observed among women. CONCLUSIONS Although the prevalence of smoking and cigarette consumption decreased from the 1980-1982 period to the 2007-2009 period, interventions specifically designed for those of lower socioeconomic status are needed.
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Affiliation(s)
- Kristian B Filion
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis 55454, USA
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Sarna L, Bialous SA, Nandy K, Yang Q. Are quit attempts among U.S. female nurses who smoke different from female smokers in the general population? An analysis of the 2006/2007 tobacco use supplement to the current population survey. BMC WOMENS HEALTH 2012; 12:4. [PMID: 22429917 PMCID: PMC3328253 DOI: 10.1186/1472-6874-12-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 03/19/2012] [Indexed: 11/23/2022]
Abstract
Background Smoking is a significant women's health issue. Examining smoking behaviors among occupational groups with a high prevalence of women may reveal the culture of smoking behavior and quit efforts of female smokers. The purpose of this study was to examine how smoking and quitting characteristics (i.e., ever and recent quit attempts) among females in the occupation of nursing are similar or different to those of women in the general population. Methods Cross-sectional data from the Tobacco Use Supplement of the Current Population Survey 2006/2007 were used to compare smoking behaviors of nurses (n = 2, 566) to those of non-healthcare professional women (n = 93, 717). Smoking characteristics included years of smoking, number of cigarettes, and time to first cigarette with smoking within the first 30 minutes as an indicator of nicotine dependence. Logistic regression models using replicate weights were used to determine correlates of ever and previous 12 months quit attempts. Results Nurses had a lower smoking prevalence than other women (12.1% vs 16.6%, p < 0.0001); were more likely to have ever made a quit attempt (77% vs 68%, p = 0.0002); but not in the previous 12 months (42% vs 43%, p = 0.77). Among those who ever made a quit attempt, nurses who smoked within 30 minutes of waking, were more likely to have made a quit attempt compared to other women (OR = 3.1, 95% CI: 1.9, 5.1). When considering quit attempts within the last 12 months, nurses whose first cigarette was after 30 minutes of waking were less likely to have made a quit attempt compared to other females (OR = 0.69, 95% CI: 0.49, 0.98). There were no other significant differences in ever/recent quitting. Conclusions Smoking prevalence among female nurses was lower than among women who were not in healthcare occupations, as expected. The lack of difference in recent quit efforts among female nurses as compared to other female smokers has not been previously reported. The link between lower level of nicotine dependence, as reflected by the longer time to first cigarette, and lower quit attempts among nurses needs further exploration.
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Affiliation(s)
- Linda Sarna
- School of Nursing, University of California, Los Angeles, 700 Tiverton Ave, Los Angeles, CA 90095, USA.
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Abstract
UNLABELLED The cornerstone of cardiovascular disease prevention is the promotion of a healthy lifestyle and the identification and reduction of cardiovascular risk factors. Cardiology nurses play a major role in counseling patients about lifestyle and cardiovascular risk factors. We used an e-mail survey to elicit self-reported prevalence of cardiovascular risk factors and healthy lifestyles among the Preventive Cardiovascular Nurses Association (PCNA) members and compared their risk profiles with published data for American cardiologists, the Nurses' Health Study 2, and the Behavioral Risk Factor Surveillance Survey data for women. RESULTS A total of 1,345 complete surveys were collected. The respondents were mostly women (96%), with mean (SD) age of 47.4 (8.7) years. More than 95% were not cigarette smokers, more than 50% had a healthy body mass index (<25), and more than 56% achieved the recommended levels of physical activity. Nevertheless, obesity (body mass index ≥ 30) was a health risk in one-fifth of PCNA respondents. The rates of hypertension (17%) and dyslipidemia (15%) were lower than rates reported in other national samples; however, the rate for family history of premature heart disease (20%) was similar to those reported in national samples. Since family history of premature heart disease may be a more significant risk factor in women, PCNA respondents with such a family history may require targeted interventions to further reduce their risk and improve their lifestyle behaviors. CONCLUSION PCNA nurses have more favorable lifestyle profiles compared with national samples. It can be expected that nurses who know their risk factors and who follow healthy lifestyle behaviors will be more effective in these counseling roles.
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Berkelmans A, Burton D, Page K, Worrall-Carter L. Registered Nurses’ smoking behaviours and their attitudes to personal cessation. J Adv Nurs 2011; 67:1580-90. [DOI: 10.1111/j.1365-2648.2010.05592.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Teschke K, Abanto Z, Arbour L, Beking K, Chow Y, Gallagher RP, Jong B, Le ND, Ratner PA, Spinelli JJ, Dimich-Ward H. Exposure to anesthetic gases and congenital anomalies in offspring of female registered nurses. Am J Ind Med 2011; 54:118-27. [PMID: 20607734 DOI: 10.1002/ajim.20875] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies of offspring of mothers exposed to anesthetic gases have shown associations with congenital anomalies reported by the mothers, but rarely in studies with objectively ascertained outcomes. We conducted a retrospective cohort study to examine associations between registry-ascertained congenital anomalies in offspring and anesthetic gas exposure of mothers employed as nurses. METHODS A cohort of registered nurses in British Columbia, Canada, was linked to records of births and congenital anomalies from 1990 to 2000. Exposures were assessed via a survey of anesthetic gas use in all hospitals in the province and records of nurses' jobs, departments, and hospitals. RESULTS Departments most frequently reporting anesthetic gas use were operating rooms, post-anesthetic recovery rooms, and maternity units. In the cohort of 15,317 live-borne children of 9,433 mothers, 1,079 had congenital anomalies. Anomalies were associated with ever and probable maternal exposure to halogenated gases (ORs: 1.49, 95% CI: 1.04-2.13; and 2.61, 95% CI: 1.31-5.18, respectively) and to nitrous oxide (ORs: 1.42, 95% CI: 1.05-1.94; and 1.82, 95% CI: 1.11-2.99). Anomalies most frequently associated with exposure were those of the heart (OR, halogenated gases: 2.31, 95% CI: 1.07-4.97) and integument (OR, halogenated gases: 3.56, 95% CI: 1.53-8.32; OR, nitrous oxide: 3.02, 95% CI: 1.37-6.64). Gases most frequently associated with anomalies were halothane (predominantly used early in the study period), isoflurane, and sevoflurane (predominantly used later in the period). CONCLUSIONS In this study, where both exposures and outcomes were assessed objectively, certain congenital anomalies were associated with estimated anesthetic gas exposure.
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Affiliation(s)
- Kay Teschke
- University of British Columbia, Vancouver, Canada.
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Ford ES, Li C, Zhao G, Pearson WS, Tsai J, Greenlund KJ. Trends in low-risk lifestyle factors among adults in the United States: findings from the Behavioral Risk Factor Surveillance System 1996-2007. Prev Med 2010; 51:403-7. [PMID: 20708637 DOI: 10.1016/j.ypmed.2010.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/29/2010] [Accepted: 08/03/2010] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Our objective was to examine recent trends in low-risk lifestyle factors for chronic diseases (not currently smoking, any exercise during the past 30 days, consuming fruits and vegetables ≥5 times per day, and body mass index <25kg/m(2)) among U.S. adults. METHODS We used data from 1,580,220 adults aged ≥18 years who participated in one of seven Behavioral Risk Factor Surveillance System surveys conducted from 1996 to 2007. RESULTS The age-adjusted percentage of adults meeting all four low-risk lifestyle factors was 8.5% in 1996 and 7.7% in 2007 (p for linear trend <0.001). Significant decreasing trends were noted for men, women, whites, Hispanics, and most age groups. The percentages of participants who were not currently smoking, who had done any exercise during the past 30 days, who reported consuming fruits and vegetables ≥5 times per day, and who had a body mass index <25kg/m(2) were 70.9%, 76.2%, 47.9% and 24.3%, respectively, in 1996 and 77.1%, 80.0%, 37.8%, and 24.5%, respectively, in 2007. Women and whites were more likely than their counterparts to meet all four criteria. CONCLUSIONS From 1996 to 2007, the percentage of U.S. adults meeting all four low-risk lifestyle factors decreased slightly.
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Affiliation(s)
- Earl S Ford
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Sarna L, Bialous SA, Sinha K, Yang Q, Wewers ME. Are Health care Providers Still Smoking? Data From the 2003 and 2006/2007 Tobacco Use Supplement-Current Population Surveys. Nicotine Tob Res 2010; 12:1167-71. [PMID: 20937670 DOI: 10.1093/ntr/ntq161] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Linda Sarna
- School of Nursing, University of California, 700 Tiverton Ave, Box 956918, Los Angeles, CA 90095-6918, USA.
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Ratner PA, Spinelli JJ, Beking K, Lorenzi M, Chow Y, Teschke K, Le ND, Gallagher RP, Dimich-Ward H. Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs. BMC Nurs 2010; 9:15. [PMID: 20846432 PMCID: PMC2949748 DOI: 10.1186/1472-6955-9-15] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 09/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the relationships of potential occupational exposure to antineoplastic drugs with cancer incidence and adverse pregnancy outcomes in a historical prospective cohort study of female registered nurses (RNs) from British Columbia, Canada (BC). METHODS Female RNs registered with a professional regulatory body for at least one year between 1974 and 2000 formed the cohort (n = 56,213). The identifier file was linked to Canadian cancer registries. An RN offspring cohort from 1986 was created by linkages with the BC Birth and Health Status Registries. Exposure was assessed by work history in oncology or cancer agencies (method 1) and by estimating weighted duration of exposure developed from a survey of pharmacists and nursing unit administrators of all provincial hospitals and treatment centers and the work history of the nurses (method 2). Relative risks (RR) were calculated using Poisson regression for cancer incidence and odds ratios (OR) were calculated for congenital anomaly, stillbirth, low birth weight, and prematurity incidence, with 95% confidence intervals. RESULTS In comparison with other female RNs, method 1 revealed that RNs who ever worked in a cancer center or in an oncology nursing unit had an increased risk of breast cancer (RR = 1.83; 95% CI = 1.03 - 3.23, 12 cases) and their offspring were at risk for congenital anomalies of the eye (OR = 3.46, 95% CI = 1.08 - 11.14, 3 cases). Method 2 revealed that RNs classified as having the highest weighted durations of exposure to antineoplastic drugs had an excess risk of cancer of the rectum (RR = 1.87, 95% CI = 1.07 - 3.29, 14 cases). No statistically significant increased risks of leukemia, other cancers, stillbirth, low birth weight, prematurity, or other congenital anomalies in the RNs' offspring were noted. CONCLUSIONS Female RNs having had potential exposure to antineoplastic drugs were not found to have an excess risk of leukemia, stillbirth, or congenital anomalies in their offspring, with the exception of congenital anomalies of the eye, based on only three cases; however, elevated risks of breast and rectal cancer were observed.
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Affiliation(s)
- Pamela A Ratner
- School of Nursing, University of British Columbia, 302-6190 Agronomy Road, Vancouver, V6T 1Z3, Canada.
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Val Palumbo M, Rambur B, McIntosh B, Naud S. Registered nurses' perceptions of health and safety related to their intention to leave. ACTA ACUST UNITED AC 2010; 58:95-103. [PMID: 20210261 DOI: 10.3928/08910162-20100216-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined perceptions of general and emotional health among a statewide sample of nurses, and their assessment of employers' workplace health and safety initiatives. These variables and demographic data were then used to model predictors of intention to leave their work positions. A survey was mailed to all registered nurses in one state. Fifty-three percent responded (n = 3,955). Findings suggested marked differences in perception of emotional health by age, with younger nurses reporting less positive perceptions of their emotional health. Perceptions of employers' safety and health initiatives varied by age, setting, and work role. Predictors of intention to leave included lower perceived emotional health among younger nurses and employer safety initiatives for both age groups. This exploratory study suggests a relationship among employer health and safety practices, nurses' emotional health, and intention to leave. Implications for occupational health nurses are detailed.
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Palumbo MV, Rambur B, McIntosh B, Naud S. Registered Nurses' Perceptions of Health and Safety Related to Their Intention to Leave. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/216507991005800303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined perceptions of general and emotional health among a statewide sample of nurses, and their assessment of employers' workplace health and safety initiatives. These variables and demographic data were then used to model predictors of intention to leave their work positions. A survey was mailed to all registered nurses in one state. Fifty-three percent responded ( n = 3,955). Findings suggested marked differences in perception of emotional health by age, with younger nurses reporting less positive perceptions of their emotional health. Perceptions of employers' safety and health initiatives varied by age, setting, and work role. Predictors of intention to leave included lower perceived emotional health among younger nurses and employer safety initiatives for both age groups. This exploratory study suggests a relationship among employer health and safety practices, nurses' emotional health, and intention to leave. Implications for occupational health nurses are detailed.
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Ruiz-Canela M, Martínez-González M, Burgo CLD, De Irala J, Beunza J, Bes-Rastrollo M. Are Smoking Habits Changing among Spanish Health Professionals? Results from the SUN Cohort 1999–2008. Tob Use Insights 2009. [DOI: 10.4137/tui.s3001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Smoking by health professionals is a very negative habit not only for their own health, but also because it diminishes their capacity to influence their smoker patients to quit their habits. Objective The aim of this study was to assess the trend of the smoking prevalence, as well as the impact of the 2005 Spanish Smoking Act, among healthcare professionals. Methods Participants were asked about their smoking consumption in the baseline and the follow-up questionnaires in a Spanish dynamic prospective cohort of university graduates (the SUN Project) from 1999 to 2008. Non-conditional logistic regression models were fit to assess the relationship between type of profession and prevalence of smoking. Results The proportion of current smokers at the entrance into the cohort was 16.4% for physicians, 20.8% for pharmacists, 23.4% for nurses and 24% for other university graduates. The risk of being current smoker (adjusted OR [95% CI]) was lower in physicians (0.68 [0.61–0.76]) but not in pharmacists (0.94 [0.84–1.06]) or nurses (0.94 [0.84–1.05]) compared to other university graduates. All professional groups presented a statistically significant decline of smoking prevalence from 1999 to 2008. This decline might be at least partly due to the impact of the Spanish legislation on their smoking habits. Conclusion This study shows a decline in smoking prevalence among Spanish physicians. This decline has reached lower levels than what is current among other professionals and the general population. However, there is still a high number of smokers among health professionals, thus more efforts are needed to achieve lower levels of tobacco consumption.
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Affiliation(s)
- M. Ruiz-Canela
- Department of Biomedical Humanities, School of Medicine, University of Navarra, Pamplona, Spain
| | - M.A. Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - C. López-del Burgo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - J. De Irala
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - J.J. Beunza
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - M. Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
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Sarna L, Bialous S, Wewers ME, Froelicher ES, Wells MJ, Kotlerman J, Elashoff D. Nurses trying to quit smoking using the Internet. Nurs Outlook 2009; 57:246-56. [PMID: 19789002 DOI: 10.1016/j.outlook.2009.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Indexed: 11/17/2022]
Abstract
Nurses QuitNet, an Internet-based smoking cessation program, was created to support nurses' quit attempts. The purposes of this study were to evaluate quit attempts at 3, 6, and 12 months after the use of the program and to determine differences in demographic, professional, and smoking characteristics by smoking status. Differences in the use of quit methods, barriers, and facilitators to quitting also were assessed. Data among 246 smokers who responded to at least 1 follow-up email at 3, 6, or 12 months after registration were analyzed. Quit rates among respondents were 43% (3 months), 45% (6 months), and 53% (12 months). Total time on the website was significantly higher for those who quit. Barriers to quitting included lack of support from colleagues, stress, lack of cessation services, and fear of not getting a work-break. Facilitators included working in a smoke-free facility, support from colleagues, and workplace cessation services. The use of Nurses QuitNet demonstrated promise in supporting quit attempts. Quitting was influenced by workplace factors.
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Affiliation(s)
- Linda Sarna
- University of California, School of Nursing, 700 Tiverton Ave, Box 956918, Los Angeles, CA 90095, USA.
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Abstract
Lung cancer is the leading cause of cancer mortality in women worldwide. Although the rise and growing epidemic status of lung cancer are overwhelmingly attributed to tobacco use, its rank in nonsmokers as the seventh most common cause of cancer worldwide suggests that other factors contribute to this disease. The majority of lung cancers among nonsmokers occur in women. Aside from geographic, cultural, and genetic differences, hormonal and possibly infectious factors also may play etiologic roles. This review aims to discuss the epidemiology of lung cancer in women, as well as the incidence of second primaries, and presents current opinions on the myriad of causes.
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Affiliation(s)
- Brian L. Egleston
- Department of Biostatistics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Sibele I. Meireles
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Douglas B. Flieder
- Department of Pathology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Margie L. Clapper
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
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