Page 509 - Encyclopedia of Nursing Research

476 n SmOKIng CeSSATIOn

7-day point prevalence is also recommended Froelicher, Doolan, yerger, mcgruder,
as a secondary measure. Failure, defined and malone (2010) examined a smoking ces-
S as seven consecutive days of tobacco use or sation intervention randomized clinical trial
using at least 1 day of two consecutive weeks implemented as a community participatory
includes any type of tobacco. nontobacco nic- research project among African Americans
otine use (i.e., nicotine replacement therapy) in an urban low-income neighborhood. A
is excluded (hughes et al., 2003). trained community health nurse delivered
Outcome measures also include bio- a 5-week smoking cessation program, based
chemical verification of tobacco abstinence. on established guidelines, to both the control
A limitation in smoking cessation interven- and intervention groups. The intervention
tion research is the lack of biochemical veri- group also received a community code-
fication to confirm smoking status. Cotinine, veloped industry and media intervention.
the major metabolite of nicotine, has excellent Smoking cessation reported at 6 months was
specificity for tobacco use except in persons 11.5% (control) and 13.6% (intervention) and
using nicotine replacement therapy. Cotinine at 12 months was 5.3% (control) and 15.8%
can be measured in plasma, saliva, and urine. (intervention). Salivary cotinine confirmed
Carbon monoxide (CO), a by-product of ciga- quit status. The findings were not signifi-
rette smoke, can be measured in expired air. cant because of the small sample sizes. The
Unfortunately, CO has a shorter half-life of 2 authors note failure to recruit and enroll a
to 4 hours and is rapidly eliminated, whereas sufficient number of participants resulted
cotinine may be detected for several days in statistical insignificance. lessons learned
after tobacco use. however, CO assessments were discussed to help future investiga-
are often used to confirm abstinence in stud- tors and community workers interested in
ies where nicotine replacement therapy is community based participatory approaches
ongoing. Recommendations include bio- (Froelicher et al., 2010).
chemical verification be used in most or all Smith and Burgess (2009) examined the
studies of smoking cessation among special efficacy of a minimal versus intensive inter-
populations, including adolescents, pregnant vention for smoking cessation delivered by a
women, and medical patients with smoking- research nurse for patients hospitalized for
attributable disease. Biochemical verification either coronary artery bypass graft or acute
provides added precision to participant’s myocardial infarction. The minimal inter-
self-reports (Society for Research on nicotine vention included personalized quit advice
and Tobacco Subcommittee on Biochemical from the nurse and physicians as well as
Verification, 2002). two pamphlets. The intensive intervention
Wells and Sarna (2006) published a list- also included 45 to 60 minutes of bedside
ing of literature focusing on nursing research counseling, take-home materials, and seven
in smoking cessation since 1996, when the nurse-initiated counseling calls, focusing on
guidelines were first published. They iden- relapse prevention, for 2 months after dis-
tified 175 databased articles focused on charge. Stratified randomization was used
smoking cessation and involved nurses. for the intervention assignment (n = 276).
publications steadily increased each year, Self-reported abstinence was higher in the
with more than 40 published in 2005. The intensive intervention than the minimal
minority (35%) were published in nurs- intervention at 3 months (76%, p = 0.009), 6
ing journals, with the Journal of the Academy months (67%, p = 0.003), and 12 months (62%,
of Nurse Practitioners having the most (>4). p = 0.007). Abstinence was confirmed via
Research included experimental (38%), quasi- proxy confirmation at 12 months. Continuous
experimental (24%), and descriptive [quanti- 12-month abstinence was 57% in the inten-
tative (25%), qualitative (8%)], among others. sive group versus 39% in the minimal group