Family & Community Medicine

Secondhand smoke exposure (SHSe) has been identified as a distinct risk factor for adverse obstetric and gynecological outcomes. This study examined the prevalence of SHSe reduction practices (i.e., home and car smoking bans) among pregnant women in a large U.S. prenatal clinic serving low-income women. Pregnant women (N = 820) attending a university-based, urban prenatal clinic in Houston, Texas, completed a prenatal questionnaire assessing bans on household and car smoking and a qualitative urine cotinine test as part of usual care. Data were collected from April 2011 to August 2012. Nearly one-third (n = 257) of the sample reported at least 1 smoker living in the home. About a quarter of the women in the full sample did not have a total smoking ban in their home and car. Within smoking households, 44% of the pregnant women reported smoking, 56% reported smoking by another household member, and in 26% of smoking households both the pregnant woman and at least one other person were smoking. Only 43% of women with a household smoker reported a total ban on smoking, with higher rates among Hispanic women. Smoking bans were less common when the pregnant women smoked, when more than 1 smoker resided in the home, and when pregnant with her first child. SHSe among low-income pregnant women is high, and interventions to raise awareness and increase the establishment of smoking bans in homes and cars are warranted.

While agonist replacement therapies are effective for managing opioid dependence, community treatment programs are increasingly choosing detoxification. Unfortunately, success rates for opioid detoxification are very low, in part, due to physical and psychological symptoms associated with opioid withdrawal. Few behavior therapies specifically address the distressing experiences specific to opioid withdrawal. A novel behavioral treatment, acceptance and commitment therapy (ACT), works from the premise that the avoidance of unpleasant private experiences (thoughts, feelings, bodily sensations) is ubiquitous yet may be pathogenic, resulting in treatment drop-out and further drug use. Methods: This Stage I pilot study developed and tested an ACT-based opioid detoxification behavioral therapy. Opioid dependent patients (N = 56) who were attending a licensed methadone clinic were randomized to receive either 24 individual therapy sessions of ACT or drug counseling (DC) in the context of a 6-month methadone dose reduction program. Results: While no difference was found on opioid use during treatment, 37% of participants in the ACT condition were successfully detoxified at the end of treatment compared to 19% of those who received DC. Fear of detoxification was also reduced across time in the ACT condition relative to DC. Conclusion: This first study of ACT to assist opioid detoxification indicates promise. Research is needed to refine specific treatment strategies for this population to further strengthen effects.

Animal experiments and cell biology studies have provided evidence that both estrogens and androgens can play a protective role against Alzheimer's disease (AD) related neurodegeneration. Males who become hypogonadal in later life often report problems with their memory. Lower than normal testosterone levels have also been detected in patients prior to the onset of AD, as well as in younger late-onset male AD patients, when compared to appropriate controls. The results of some small clinical trials suggest that testosterone can improve cognitive function in andropause. Although such improvement in cognitive function is subtle, patients on testosterone replacement therapy have reported memory improvements in both declarative and procedural domains. In contrast, there is no clinical evidence to date which suggest that the hormone dihydroepiandrosterone (DHEA) can improve cognitive function. Rises in the levels of the gonadotropins, follicle stimulating hormone (FSH) and luteinizing hormone (LH), have been associated with AD, but the clinical effects of reducing their levels remain to be determined. We hypothesize that androgens, gonadotropin modulators, or perhaps selective androgen receptor modulators may be useful components of therapy aimed at preventing the onset or delaying the progression of AD in male patients.

There has been some controversy about whether males undergo an andropause (male equivalent of a menopause). This study seeks to describe how older males perceive and understand this entity and whether there is an association between the age of onset of andropause and risk factors such as ethnic origin, smoking, alcohol, hypertension, and cerebrovascular disease. A nonexperimental, cross-sectional study was conducted at the outpatient clinic at a Veterans Affairs Medical Center. Subjects were interviewed by a single investigator and administered a questionnaire consisting of 22 items, including information on patient demographics, patient understanding of the andropause, patient understanding of possible interventions with hormonal therapy, medical, and drug history, and social habits such as smoking and drinking. Altogether 302 male patients were recruited, 71% of which were above the age of 60 years, and 87% were white, 6% were Hispanic, and 5% were black. The knowledge of patients toward the entity of andropause was lacking, though the majority (70%) expressed an interest in getting further knowledge. The most frequent age of onset of symptoms related to andropause was 51-60 years, and patients reported symptoms such as impotence, weakness, and memory loss. The next most common age reported to he associated with age of onset was 61-70 years. Multivariate regression analysis reveals that smoking more than 10 cigarettes a day was independently associated with an earlier onset of symptoms of andropause, bringing down the age of onset to below 50 years (p = .01, OR = 2.5, CI = 1.2-5.3). We found no association with risk factors such as ethnicity and alcohol. Andropause is experienced by many older males but knowledge of the entity is nonuniform. Older males are at risk for an earlier onset of andropause if they were smokers. This is the first study looking at risk factors for andropause and the results are consistent with studies in females on smoking and menopause.