Practical implications of recall bias

Smoking among pregnant women in small towns in Poland

Objectives

The aim of the work was to assess among pregnant women from small towns and villages in Poland: the prevalence of smoking, credibility of smoking, and influence of socioeconomic factors on smoking status.

Methods

The data came from 4512 interviews with women in different trimesters of pregnancy. The interviews were collected in 2007 and 2008 year in towns up to 8000 citizens in 12 voivodeships.

Results

Prevalence of smoking in the beginning of pregnancy was confirmed by 34.6 % of women. During the pregnancy 14.7 % of women declared quitting smoking and 19.9 % continued smoking. Cigarette smoking was most frequent in those with a primary education, unemployed, very low incomes in household, and having both smoking parents. In multifactorial analysis, risk of smoking was highest (95 % CI 1.74–6.06) for women that were divorced or not living with a partner compared with married.

Conclusions

Rates of active smoking among a population of pregnant women living in small towns in Poland are very high. Since the correlates of smoking during pregnancy are a low education level and a low economic status of the pregnant woman, these socioeconomic groups should be first priority targets.

Relationship between gender and psychotic symptoms in cocaine-dependent and methamphetamine-dependent participants

BACKGROUND

It has been well documented that cocaine and methamphetamine use can lead to the onset of psychotic symptoms similar to schizophrenia. However, the research and literature on gender differences and stimulant-induced psychosis have been mixed.

OBJECTIVE

The primary aim of this study was to investigate gender differences in the reporting of psychotic symptoms in cocaine- versus methamphetamine-dependent individuals.

METHODS

Participants were recruited from the Los Angeles, California, community via radio and newspaper advertisements. All met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for cocaine or methamphetamine dependence, and all reported either methamphetamine or cocaine as their primary drug of abuse. During a screening interview, participants answered questions from the Psychotic Symptom Assessment Scale, which characterizes various types of psychotic symptoms during drug use ("while high") or during periods of nonuse ("while abstinent").

RESULTS

Participants included 42 cocaine-dependent individuals (27 men, 15 women) and 43 methamphetamine-dependent individuals (25 men, 18 women). Among cocaine users, there were no significant differences between men and women with regard to ethnicity, years of use, route of administration, and amount used in the past week, though they differed significantly with regard to age (P = 0.029). In the "while abstinent" condition, women were significantly more likely than men to report experiencing auditory hallucinations (13% vs 0%, respectively; P = 0.050) and tactile hallucinations (20% vs 0%; P = 0.016), whereas men were more likely to report delusions of grandeur (48% vs 6%; P = 0.006). During the "while high" condition, women were significantly more likely than men to report delusions of grandeur (13% vs 0%, respectively; P = 0.050), tactile hallucinations (33% vs 0%; P = 0.001), and olfactory hallucinations (13% vs 0%; P = 0.050). Among methamphetamine users, there were no significant differences between men and women with regard to age, ethnicity, years of use, route of administration, or amount used in the past week. In the "while abstinent" condition, women were significantly more likely than men to report feeling that something was wrong with the way a part of their body looked (72% vs 32%, respectively; P = 0.009), olfactory hallucinations (39% vs 8%; P = 0.010) and dressing inappropriately (22% vs 0%; P = 0.010). During the "while high" condition, women were more likely than men to report delusions of grandeur (33% vs 16%, respectively; P = 0.030), paranoia (50% vs 16%; P = 0.017), and tactile hallucinations (61% vs 32%; P = 0.050).

CONCLUSIONS

The findings of the present study revealed that cocaine- and methamphetamine-dependent women were more likely than their male counterparts to report experiencing various psychotic symptoms. This information may be useful for clinicians and mental health professionals, who should take these symptoms into account as potential barriers that may impede effective treatment.

Provision of smoking care in NSW hospitals: opportunities for further enhancement

The provision of smoking care, including the management of nicotine withdrawal and assistance with a quitting attempt, is identified as an important part of the overall care of hospitalised patients. Levels of smoking care delivery in hospitals have been less than optimal. Increasing this care across multiple facilities and units within NSW Health represents a significant challenge. This article examines levels of smoking care delivery in NSW hospitals, and research evidence and best practice recommendations to inform potential strategies to increase such care. It also reviews statewide initiatives implemented by NSW Health to enhance the delivery of smoking care and suggests further strategies that could facilitate this.

Distributing questionnaires about smoking to patients: impact on general practitioners' recording of smoking advice

BACKGROUND

Little is known about the impact of questionnaire-based data collection methods on the consulting behaviour of general practitioners (family physicians) who participate in research. Here data collected during a research project which involved questionnaires on smoking being distributed to patients before and after appointments with general practitioners (GPs) is analyzed to investigate the impact of this data collection method on doctors' documenting of smoking advice in medical records.

METHODS

Researchers distributed questionnaires on smoking behaviour to 6775 patients who attended consultations during surgery sessions with 32 GPs based in Leicestershire, UK. We obtained the medical records for patients who had attended these surgery sessions and also for a comparator group, during which no researcher had been present. We compared the documenting of advice against smoking in patient's medical records for consultations within GPs' surgery sessions where questionnaires had been distributed with those which occurred when no questionnaires had been given out.

RESULTS

We obtained records for 77.9% (5276/6775) of all adult patients who attended GPs' surgery sessions, with 51.9% (2739) being from sessions during which researchers distributed questionnaires. Discussion of smoking was recorded in 8.0% (220/2739) of medical records when questionnaires were distributed versus 4.6% (116/2537) where these were not. After controlling for relevant potential confounders including patients' age, gender, the odds ratio for recording of information in the presence of questionnaire distribution (versus none) was 1.78 (95% CI, 1.36 to 2.34).

CONCLUSION

Distributing questionnaires about smoking to patients before and after they consult with doctors significantly increases GPs' recording of discussions about smoking medical records. This has implications for the design of some types of research into addictive behaviours and further research into how data collection methods may affect patients' and doctors' behaviours is warranted.

Is making smoking status a vital sign sufficient to increase cessation support actions in clinical practice?

BACKGROUND

There is widespread belief that adding smoking status to the list of vital signs in medical practice will lead to an increased likelihood that physicians will offer more cessation support for smokers during office visits. This article evaluates the impact of introducing routine use of smoking status as a vital sign on clinician cessation support in a primary care setting.

METHODS

A total of 429 adult health plan members who were smokers and recent quitters from 2 primary care clinics in Minneapolis, Minn, were administered a 28-item questionnaire by telephone. The instrument included questions about patient health status, smoking status, advice about smoking, clinic actions during the most recent visit, satisfaction with clinic actions, and intention to change smoking. Comparisons were made with a cohort of smoking patients before and after smoking status was used as a vital sign, using 2-tailed t tests for continuous variables and chi-square analysis for categorical variables.

RESULTS

Patient self-report of receiving advice about smoking in the past year (about 66%) was unchanged after smoking status was implemented as a vital sign. Medical chart documentation of tobacco use increased from 38.0% to 78.4% of all encounters, whereas documentation of advice about smoking decreased from 33.5% to 18.8%. Except for identification of tobacco use before implementation of the guideline, none of the specific activities recommended in the guideline occurred at very high levels.

CONCLUSION

Implementing smoking status as a vital sign appears to have increased the documentation of tobacco use but had little effect on specific implementation actions. Overall, the findings suggest that more consistent identification of tobacco use alone will not lead to guideline-recommended changes in cessation support actions by clinicians. Greater environmental changes will be needed if tobacco guideline goals are to be achieved.

Aids to quitting tobacco use: how important are they outside controlled trials?

BACKGROUND

Although there is good evidence that several pharmacotherapies and counseling can effectively facilitate smoking cessation, there is little information about the use or effectiveness of these or any other quit aids outside of controlled trials.

METHODS

A mailed survey with phone follow-up documented the use of various quit aids among 3,122 health plan members who smoke. A multilevel statistical modeling technique controlled for potentially confounding variables.

RESULTS

Nearly half (1,513) of these smokers reported a quit attempt during the preceding 6 months. Although 1,036 (33.2%) reported using some type of aid to quitting, primarily nicotine products or bupropion, 10-26% of these "users" did not report an actual quit attempt. Ninety percent of the medication users had a personal cost, averaging $53-$87. Fully 26.9% of those reporting a quit without any type of aid quit for at least 7 days. This rate equals that of users of all types of aids except for nicotine patches and bupropion, both of which had associated 7 or more day quit rates of about 46% (95% CI 39.3-52.2).

CONCLUSIONS

Pharmacotherapeutic quit aids are being widely used, even in the absence of significant insurance coverage.