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Karen Suchanek Hudmon

Publications and source records attributed to Karen Suchanek Hudmon.

At least 19 recordsLinked to original sources
PubMed2006

Psychometric analysis of a scale assessing self-efficacy for cultural competence in patient counseling.

BACKGROUND: The Accreditation Council for Pharmacy Education adopted revised accreditation standards and guidelines for the PharmD degree program in January 2006. The revised standards mandate the inclusion of cultural competence in pharmacy curricula. Assessment tools to evaluate the impact of training are needed. OBJECTIVE: To examine the psychometric properties of a 12 item scale designed to estimate the impact of cultural competence training on pharmacy students' self-efficacy in providing culturally appropriate patient care. METHODS: A 12 item scale to assess the impact of an elective course on pharmacy students' (N = 175; 173 analyzable) perceived self-efficacy in providing culturally competent patient care was used before and after students completed the training. Principal components analysis was conducted to examine the underlying structure of the scale, and the Cronbach alpha statistic was computed as an estimate of internal consistency. Pre-versus posttraining responses for each item and for the total scale scores were compared as an indicator of concurrent validity. RESULTS: The principal components analysis yielded a one-component solution, "self-efficacy for cultural competence," which included all 12 contributing items and accounted for 46% of the total variance. Item communalities ranged from 0.25 to 0.58. Component loadings ranged from 0.50 to 0.76. Overall, the scale exhibited a Cronbach alpha estimate of internal consistency of 0.89. Posttraining scores were significantly higher than pretraining scores for both the total scale scores (posttest and pretest mean +/- SD score = 47.96 +/- 5.15 and 34.21 +/- 6.19, respectively; p < 0.001) and for each item (p values < 0.001). These comparisons provide evidence of concurrent validity. CONCLUSIONS: Our results suggest that our 12 item scale exhibits acceptable psychometric properties and is a useful tool for estimating the impact of cultural competence training on pharmacy students' perceived self-efficacy for providing culturally competent care and services.

Cultural Diversity↗
PubMed2006

Pharmacy students' perceptions of tobacco sales in pharmacies and suggested strategies for promoting tobacco-free experiential sites.

OBJECTIVE: The objectives of this report were to estimate the extent to which pharmacy student perceptions are aligned with the 2003 resolution of the American Association of Colleges of Pharmacy (AACP) addressing the use of experiential sites that sell cigarettes and other tobacco products. METHODS: Pharmacy students participating in a national tobacco cessation training program completed posttraining survey instruments and indicated their opinion about tobacco sales in pharmacies. Responses were examined with respect to students' sex and tobacco use status. RESULTS: Of 3,064 students, 3.5% were in favor of tobacco sales in pharmacies. Opinions varied by students' sex (p < 0.001) and tobacco use status (p < 0.001); in logistic regression analyses, males (OR = 2.62; 95% CI, 1.77, 3.89) and current tobacco users (OR = 2.31; 95% CI, 1.41, 3.76) were most likely to be in favor of tobacco sales. CONCLUSION: Few pharmacy students are in favor of tobacco sales in pharmacies. Given the overall lack of support, and acting in accordance with the 2003 AACP resolution, pharmacy schools are encouraged to use only experiential sites that do not sell tobacco products. Suggested strategies for moving toward this goal are presented.

Female↗
PubMed2006

The epidemiology of tobacco use and dependence.

Tobacco use continues to be a public health issue of great importance. Acute and critical care nurses in particular have a unique opportunity to become a cornerstone for the nation's tobacco control efforts through integration of prevention and cessation interventions as part of patient care. This article provides readers with a working knowledge of tobacco use and dependence as background reading for the subsequent articles presented in this special issue addressing tobacco cessation in acute and critical care settings.

Adolescent↗
PubMed2006

Pharmacologic interventions for smoking cessation.

According to the US Public Health Service, all patients attempting to quit smoking should be encouraged to use one or more effective pharmacotherapy agents for cessation except in the presence of special circumstances. This article provides an overview of the pharmacologic agents for acute and critical care nurses to consider when intervening with tobacco-dependent patients. Medications addressed in this article include (1) first-line agents (nicotine replacement therapy, sustained-release bupropion) that have proven efficacy and are approved by the Food and Drug Administration (FDA) for smoking cessation, (2) second-line agents (nortriptyline, clonidine) that have proven efficacy but no FDA indication for smoking cessation, (3) approaches that use of combination or high-dose therapy, (4) herbal therapies, and (5) emerging therapies that are currently under investigation.

Administration, Cutaneous↗
PubMed2006

Tobacco cessation counseling: pharmacists' opinions and practices.

OBJECTIVE: As a key interface between patients and the health-care community, pharmacists are uniquely positioned to promote tobacco cessation. The objectives of this study were to: (a) characterize pharmacists' past training and current activities in provision of tobacco interventions, attitudes toward assisting patients with quitting, and interest in receiving specialized training for tobacco cessation counseling; and (b) identify predictors of pharmacists' counseling for tobacco cessation. METHODS: A 10-page survey was mailed to all licensed pharmacists in four California counties. RESULTS: Returned surveys (n = 1,168; 54.2% response) indicated that fewer than 8% of pharmacists have received formal training for tobacco cessation counseling, and current levels of counseling are low. Key predictors of cessation counseling include practice setting, pharmacists' race/ethnicity, perceived pros of counseling, and self-efficacy for counseling. Of 715 pharmacists who have direct patient contact, 93% indicated that receiving specialized tobacco cessation counseling training would increase their counseling quality, and 70% indicated that it would increase the number of patients counselled. Eighty-eight percent reported interest in receiving specialized training to obtain these skills. CONCLUSION: Although few pharmacists have received formal training in tobacco cessation and counseling activities currently are low, there is substantial professional interest in further developing this role. PRACTICE IMPLICATIONS: Provision of comprehensive training that focuses on promoting self-efficacy for counseling likely will increase pharmacists' tobacco cessation counseling activities.

Adult↗
PubMed2005

Validity of retrospective assessments of nicotine dependence: a preliminary report.

Information about levels of nicotine dependence in ex-smokers when they smoked, or in current smokers at an earlier date, is useful for clinical and research purposes. To estimate the accuracy of retrospective reports of dependence, 28 individuals who completed either the Fagerström Tolerance Questionnaire (FTQ) or Fagerström Test for Nicotine Dependence (FTND) in smoking cessation trials conducted 5 to 12 years earlier were asked to respond again to the same questions, thinking back to their smoking behavior just prior to their on-study quit attempt. Concordance and Kappa values for the items ranged from 50.0% to 95.0% and 0.00 to 0.92, respectively. The mean difference between the baseline and follow-up total scale scores was 0.05 for the FTQ and 0.38 for the FTND, and the correlation between these assessments was 0.62 for the FTQ (p<0.005) and 0.72 for the FTND (p<0.05). These preliminary results suggest that retrospectively assessed FTQ/FTND scale scores have acceptable reliability.

Adult↗
PubMed2005

Statewide evaluation of a tobacco cessation curriculum for pharmacy students.

BACKGROUND: Previous studies suggest that healthcare professionals are inadequately trained to treat tobacco use and dependence. Because even brief interventions from clinicians improve patient quit rates, widespread implementation of effective tobacco cessation training programs for health professional students is needed. METHODS: Pharmacy students received 7-8 h of comprehensive tobacco cessation training. Participants completed pre- and post-program surveys assessing perceived overall abilities for cessation counseling, skills for key facets of cessation counseling (Ask, Advise, Assess, Assist, Arrange), and self-efficacy for counseling. RESULTS: A total of 493 students (82.3%) completed linkable pre- and post-training evaluations. Self-reported abilities, measured on a five-point scale, increased significantly from 1.89 +/- 0.89 to 3.53 +/- 0.72 (P < 0.001). Twenty-two percent of students rated their overall counseling abilities as good, very good, or excellent before the training versus 94% of students after the training. Eighty-seven percent of students indicated the training will increase the number of patients that they counsel; 97% believed it will increase the quality of their cessation counseling. CONCLUSIONS: Comprehensive training significantly improved pharmacy students' perceived confidence and ability to provide tobacco cessation counseling. The curriculum is applicable to other health professional training programs and currently is being used to train pharmacy, medical, nursing, and dental students.

Adult↗
PubMed2005

Tobacco education in U.S. schools of pharmacy.

This study is the first to characterize tobacco-related content in pharmacy school curricula in the United States. A national survey mailed to 83 U.S. schools of pharmacy assessed the extent to which tobacco is addressed in required coursework, educational methods of instruction, perceived importance of addressing tobacco in the doctor of pharmacy degree program, perceived adequacy of current levels of tobacco education in curricula, and perceived barriers to enhancing the tobacco-related content. A total of 82 surveys (98.8% response) revealed a median of 170 min of tobacco education throughout the doctor of pharmacy program. The most heavily emphasized topics are aids for cessation, assisting patients with quitting, nicotine pharmacology and principles of addiction, and drug interactions with smoking, yet more than 40% of respondents believed that each of these topics was covered inadequately. Key barriers to enhancing tobacco training are lack of curriculum time and lack of clinical clerkship sites focusing on tobacco interventions. Pharmacy faculty members perceive tobacco cessation training to be important, yet a mismatch exists between the perceived importance and the perceived adequacy of current levels of training in pharmacy school curricula. The results of this study will serve as a baseline measure against which future, parallel assessments will be compared as faculty at schools of pharmacy across the United States work together toward enhancing the tobacco cessation training of student pharmacists.

Curriculum↗
PubMed2005

"Withdrawal symptoms" in adolescents: a comparison of former smokers and never-smokers.

Since the early 1980s, investigators have been reporting that adolescent smokers felt "dependent" on cigarettes and that adolescents trying to quit smoking experienced the same withdrawal symptoms observed in adult quitters, including restlessness, insomnia, increased appetite and weight gain, irritability or anger, depression, craving for cigarettes, and trouble concentrating. We hypothesized that most of these symptoms might be attributed to adolescence itself. To investigate this hypothesis, we examined the prevalence of these seven "adult" withdrawal symptoms in a population of adolescent former smokers and never-smokers. Participants were high school students in Houston, Texas, participating in a nested, group-randomized control group study designed to estimate the impact of a CD-ROM intervention for smoking prevention and cessation. We measured differences in symptoms frequency between never-smokers and former smokers, matched in a 2:1 ratio on sex and race/ethnicity, and differences in symptoms among former smokers as a function of time since final quit attempt and prior level of smoking. Only former heavy smokers have shown significantly higher prevalence of withdrawal symptoms compared with never-smokers. Of the seven symptoms assessed, only craving incrementally increased with the intensity of smoking. Overall the individual withdrawal symptoms did not effectively differentiate between 112 never-smokers and 34 former lighter smokers (persons who used to smoke less than "a few cigarettes on most days"). Withdrawal symptoms can reliably differentiate former heavy smokers from light smokers and never-smokers, among adolescents. Because most adolescents tend to be lighter smokers, future tobacco use and cessation studies should interpret adult withdrawal symptoms among adolescents with caution.

Adolescent↗
PubMed2004

Implementation and evaluation of cultural competency training for pharmacy students.

BACKGROUND: The demographic composition of the US population is rapidly changing. As a result, pharmacists increasingly face the need to interact effectively with and provide care for patients whose ethnic or cultural background may differ from their own. While schools implement curricula to provide pharmacy students with cultural awareness, knowledge, and communication skills they will need in practice, few assessment tools exist to evaluate the impact or effectiveness of such training. OBJECTIVE: To implement and assess the impact of a cultural competency training course designed specifically for pharmacy students. METHODS: An 8-hour elective course offering basic cultural competency training was provided to 60 first-through fourth-year pharmacy students in 2003. A 12-item survey assessing students' perceived awareness, knowledge, and communication skills in the areas of cultural competence and cross-cultural communication skills was administered immediately prior to and upon completion of the course. Surveys were linked, enabling estimation of within-student change as a result of exposure to the program. RESULTS: Fifty-six paired surveys (96.6% of participants) were analyzable. Responses to all survey items (p < 0.05) and total scores (t55 = 16.27; p < 0.001) increased significantly from pre- to posttraining. The mean +/- SD 12-item pretraining scale score was 33.35 +/- 5.48 (range 21-44), and the mean posttraining scale score was 47.88 +/- 4.90 (range 36-59). CONCLUSIONS: Survey results suggest that the course successfully raised student awareness of diversity and provided basic knowledge and skills pertaining to cultural competence and cross-cultural communication.

Adult↗
PubMed2004

Training future pharmacists at a minority educational institution: evaluation of the Rx for change tobacco cessation training program.

OBJECTIVES: To estimate the impact of Rx for Change, an 8-h tobacco cessation training program on pharmacy students' perceived counseling skills, confidence for counseling, and future counseling of patients for tobacco cessation. METHODS: Unlinked, pre- and post-training surveys were administered to 142 pharmacy students enrolled at Texas Southern University, a primarily minority and historically black educational institution. RESULTS: Post-training counseling abilities were significantly improved over pretraining values for each of the five key components of tobacco cessation counseling (Ask, Advise, Assess, Assist, and Arrange), overall counseling abilities, and confidence for counseling (P < 0.001). Racial/ethnic differences in self-reported overall counseling was observed (P = 0.01). Ninety-one percent of participants believed that the training would increase the number of patients whom they counsel for cessation, and 95% believed that it would improve the quality of counseling that they provide. At least 95% of participants believed that the pharmacy profession should be more active in preventing patients from starting smoking and helping patients to stop smoking. CONCLUSIONS: The Rx for Change program had a positive impact on perceived abilities and confidence for providing tobacco cessation counseling to patients. While it is important that all current and future health care providers receive specialized tobacco cessation training, it is particularly important for clinicians of racial/ethnic minority backgrounds, who are more likely to practice in geographic areas with a high density of population subgroups at an elevated risk for tobacco-related mortality. In particular, pharmacists, who are uniquely positioned within the community to provide care to all patients, including the medically underserved, must be equipped with the necessary skills to assist patients with quitting.

Adult↗
PubMed2003

Predictors of susceptibility to smoking and ever smoking: a longitudinal study in a triethnic sample of adolescents.

This report describes a longitudinal study of the natural course of smoking initiation in a school-based, ethnically diverse (42% White, 37% African American, 20% Hispanic) sample of adolescents in grades 5, 8, and 12 who were followed prospectively for 1 year. A cohort of 659 students was identified who were never smokers at baseline and who completed questionnaires both at baseline and at 1-year follow-up. From this cohort, predictor variables were used to identify ethnic-specific risk factors for (a) "susceptibility to smoking" among the 509 students who were nonsusceptible, never smokers at baseline and (b) "ever smoking" among all 659 students who were never smokers at baseline (both susceptible and nonsusceptible). Logistic regression analyses revealed that parental and household influences (parental education, marital status, household smoking) were important predictors of ever smoking, but not of susceptibility to smoking, for African Americans. Hispanic adolescents were significantly influenced by environmental influences, namely smoking by other household members (ever smoking) and by peers (susceptibility and ever smoking), although peer pro-tobacco influences (friends who smoke or friends' approval of smoking) were important predictors of susceptibility to smoking or ever smoking for all three ethnic groups. Exposure to tobacco-related advertising was a risk factor for White (susceptibility and ever smoking) and African American (susceptibility only) adolescents but not for Hispanic adolescents. Inclusion of the susceptibility to smoking variable in the model predicting ever smoking substantially reduced the importance of other predictors in the model, suggesting that susceptibility to smoking was not an independent risk factor for ever smoking but rather a potential mediating variable. The results of this study offer important insights for designing ethnic-specific strategies for preventing smoking during adolescence.

Adolescent↗
PubMed2003

Self-reported health status, health vulnerability, and smoking behavior in college students: implications for intervention.

Health-related factors, including prevalence of respiratory symptoms and perceived health status, were analyzed by smoking status and by stages of change for quitting to evaluate their potential use as motivators for tobacco cessation. Data were obtained from a survey of 1,283 Houston-area community college students. Respiratory symptoms were most frequent among current smokers and least frequent among never smokers. A higher prevalence of reported respiratory symptoms was associated with being in later stages of readiness to change. An "optimism bias" regarding smoking-related health was evident among smokers; over half of the current smokers believed that their health was better than the average same-age smoker's health, and 19% believed that their health was better than that of the same-age nonsmoker. Furthermore, virtually all of the smokers perceived that their health was either not at all or only slightly affected by smoking, and almost half of smokers thought that quitting would bring either no benefit or only minor benefit to their health. Of the smokers, 45% believed that continuing to smoke would have only minor or no impact on their health. Differences in perceived health vulnerability were observed across the various stages of readiness to quit; precontemplators reported the lowest perceptions of health vulnerability related to smoking, and those in the preparation stage reported the highest perceptions of vulnerability. Smoking cessation counselors should consider measuring and demonstrating the early tobacco-attributable health problems to young smokers to possibly enhance motivation to quit.

Adolescent↗
PubMed2003

A multidimensional model for characterizing tobacco dependence.

The standard tool for assessing tobacco dependence is the Fagerström Tolerance Questionnaire (FTQ) or its more recent variant, the Fagerström Test for Nicotine Dependence (FTND). Although both of these scales reportedly assess physiological dependence on nicotine, they might not tap some facets of dependence, particularly psychosocial factors. To determine whether tobacco dependence exhibits multidimensional properties, we examined two existing, independent data sets, one from SRI International (n=443) and another from the University of Michigan (n=445). Based on our knowledge from existing literature, standard psychometric statistical analyses, and results from exploratory factor analysis using SRI's data set, we identified two competing models for dependence representing a hybrid of the FTQ/FTND and the Smoking Motives Questionnaire. We then examined these models using confirmatory factor analysis with data from the University of Michigan. We characterized the final model by five first-order factors, each consisting of two to four items, and one higher-order factor. The first-order factors were termed stimulation, automaticity, sedation, psychosocial motives, and morning smoking; the higher-order factor, tobacco dependence, underlay each of the first-order factors. The ranges of interitem correlations and Cronbach's alpha estimates of internal consistency for the first-order factors were .34 - .68 and .64 - .81, respectively. Results of these analyses support the hypothesis that tobacco dependence is multidimensional.

Adult↗
PubMed2003

An exploratory study of control of smoking in the home to reduce infant exposure to environmental tobacco smoke.

This study examined control of environmental tobacco smoke (ETS) exposure in the home by new mothers and identified factors related to the establishment of home smoking control rules. Pregnant women who, at 28 weeks gestation, reported they had not smoked in the past 28 days were enrolled in a randomized smoking cessation study. Telephone interviews were conducted at 6 weeks, 3 months, 6 months, and 12 months postpartum. A Home Smoking Control Index, composed of four items (whether the mother smokes in the home, the partner smokes in the home, other household smokers are asked to smoke outside, and visitors who smoke are asked to smoke outside), was used to classify homes as having a home smoking policy in effect, no policy or an incomplete policy, or no policy needed. Sociodemographic variables and maternal self-efficacy were examined in relation to the index data among 325 women who had need to exercise control of smoking in the home: 63% had a home smoking policy in effect at 3 months, 60% at 6 months, and 64% at 12 months postpartum. Predictors of policy at 6 and 12 months included (a) having a policy in effect at the previous assessment, (b) confidence in limiting infant ETS exposure in the home, and (c) perceived difficulty in preventing exposure. Early establishment of a policy appears to be important for ensuring sustained infant ETS avoidance over time. The index measures key actions that influence infant exposure and warrants further testing for use in intervention trials.

Adolescent↗
PubMed2003

Adolescent smoking: epidemiology and approaches for achieving cessation.

The initiation of smoking typically occurs during adolescence. To date, most adolescent smoking control efforts have focused on prevention; attempting to identify and influence factors that contribute to experimentation and initiation. However, given the large number of adolescent smokers, it is important that effort also be directed toward facilitating cessation. Many adolescents are addicted to cigarettes and report withdrawal symptoms that are similar to those experienced by adults. Relapse rates are high; few adolescents who try to quit on their own are successful. Clinician-delivered smoking cessation interventions have a positive impact in adults and should be applied to adolescents to promote and sustain abstinence. Although pharmaceutical aids for cessation have been shown to be well tolerated and effective in adults, less is known about their use in adolescents. As such, clinicians are encouraged to explore whether pharmaceutical aids have been approved for use in adolescents in their country and to use discretion when considering their use in patients <18 years of age. Because pediatricians are in a unique position to facilitate tobacco cessation counseling, they should routinely ask their patients whether they use tobacco, advise users to quit, assess readiness to quit, assist with quitting, and arrange follow-up counseling. Tobacco cessation efforts can be enhanced by teaming with other health professionals (e.g. nurses, dentists, pharmacists, social workers) or worksite and community-based organizations that provide health promotion services.

Adolescent↗
PubMed2003

Environmental and genetic determinants of tobacco use: methodology for a multidisciplinary, longitudinal family-based investigation.

This article describes the ongoing collaborative effort of six research teams to operationalize and execute an integrative approach to the study of gene x environment interactions in the development of tobacco dependence. At the core of the project is a longitudinal investigation of social and behavioral risk factors for tobacco use in individuals who were, on average, 13 years of age at intake and for whom smoking outcomes extending from early adolescence to young adulthood have been characterized previously (current average age of the cohort is 29 years). The conceptual framework for the integrative approach and the longitudinal investigation on which the study is based is presented. A description is also provided of the methods used to: (a) recruit participants and families to provide DNA samples and information on tobacco use; (b) assess participants for relevant tobacco-related phenotypes including smoking history, current use of tobacco, and nicotine metabolism; (c) assess the quality of the DNA samples collected from participants for genome-wide scanning and candidate gene analysis; (d) examine several research questions concerning the role of genetic and environmental factors in the onset and maintenance of tobacco use; and (e) ensure adherence to local and federal guidelines for ethical and legal investigations of genotypic associations with tobacco-related phenotypes in families. This investigation is unique among ongoing studies of the genetics of tobacco dependence in the extent to which equal importance has been assigned to both phenotypic and genotypic measurements.

Adolescent↗