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Background: Quitting smoking remains a challenge for almost one-third of the military veteran population. Alternatives to pharmacological therapies such as acupuncture, acupressure, and electrical stimulation have received minimal attention in research but have been widely reported to be popular and safe interventions for smoking cessation.Methods: This randomized, double-blind, placebo-controlled clinical trial of 125 veterans was conducted to determine whether aural electrical stimulation (auriculotherapy) once a week for 5 consecutive weeks is associated with a higher rate of smoking abstinence are than observed with sham stimulation.Results: Auriculotherapy was found to be safe and largely free from significant side effects. However, there was no difference in the rate of smoking cessation between those participants who received true auriculotherapy and those who received sham auriculotherapy. The auriculotherapy group achieved a rate of 20.9% abstinence versus 17.9% for the placebo arm after 6 weeks. Conclusion:The results of this randomized, controlled clinical trial do not support the use of auriculotherapy to assist with smoking cessation. It is possible that a longer treatment duration, more frequent sessions, or other modifications of the intervention protocol used in this study may result in a different outcome. However, based on the results of this study, there is no evidence that auriculotherapy is superior to placebo when offered once a week for 5 weeks, as described in previous uncontrolled studies. ( Smoking is a major health hazard. Although the risk of smoking-related diseases and death decline sharply when smokers quit, 19% of Americans currently smoke.1 Rates of smoking are even higher among US military veterans, with about 1 in 3 current smokers.2 In keeping with the 2008 clinical guidelines for smoking cessation, veterans are asked about their smoking status annually and are offered group or individual counseling and either bupropion or nicotine replacement therapy to help them achieve smoking abstinence. 3,4 Both bupropion and nicotine replacement therapy have been found to be more effective than placebo or no treatment, 5,6 but they are ineffective in many cases. In fact, a meta-analysis of clinical trials found that bupropion and a nicotine patch result in abstinence in only 20% and 13% of participants, respectively.7 At the Veterans Affairs Medical Center (VAMC), varencline, a second-line medication with a reported 25% abstinence rate, is considered only after bupropion or nicotine replacement therapy or a combination of the two have failed, and then only after appropriate psychiatric and cardiovascular screening. [7][8][9][10][11][12] Alternatives to pharmacological therapies such as acupuncture, acupressure, and electrical stimulation have received minimal attention in the re- search but are used widely, and proponents of their use believe them to be effective and safe interventions for smoking. 13 However, a recent Cochrane review found little evidence from randomized controlled tria...

School nurses who work with adolescents are in an ideal position to promote smoking cessation. This opportunity is important because research suggests teens who smoke are likely to become habitual smokers. This study characterizes adolescents' patterns and levels of smoking, describes adolescents' perceptions toward smoking, and delineates quit strategies that may prove helpful for adolescents who attempt smoking cessation. Results suggest adolescent smokers have highly variable patterns and levels of smoking. They fail to consider their future health and continue to be unaware of the harmful effects of smoking and the addictive nature of tobacco. Among adolescent smokers, there are few gender differences in perception of smoking. Therefore, gender specific cessation programs may not be necessary. The most effective quit strategy was the acquisition of information on contents of cigarettes and the health effects of smoking. Armed with these strategies, school nurses can provide leadership in the design and implementation of school based smoking cessation programs.

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Constipation remains a challenging problem for patients and caregivers in home healthcare. Part 1 of this two-part series discussed the scope, physiology, and evidence-based practice for nonpharmacological interventions for constipation. This second article will focus on evidence-based pharmacological prevention and management of constipation, medication cost, and implications for palliative care.