Although a few studies have suggested the use of smokeless tobacco to be less harmful than smoking, all forms of smokeless tobacco are recognized carcinogens and dangerous for health. It is not sufficient to simply ask patients about smoking behaviors. Primary care providers, especially nurse practitioners, have the unique opportunity to assess use of smokeless tobacco and to offer treatment and counsel to help patients to stop the behavior.

Water companies in the UK are required to operate their disinfection processes to keep the concentration of disinfection by-products (DBPs) in drinking water as low as possible. At present, this is can be achieved largely by maintaining trihalomethane (THM) and haloacetic acid (HAA) levels below regulated or guideline values. However, several hundred DBPs have been identified and the increasing emphasis on a risk-based approach to water quality is likely to make consideration of these a priority. Routine monitoring and analysis for the wide range of known DBPs would be impractical, if not impossible. However, knowledge of the factors that lead to their formation and mitigation would allow other DBPs to be considered in a risk-based approach. This paper outlines raw water characteristics and water treatment processes that promote the formation of different categories of DBPs. Indicative concentrations and toxicological properties for the different categories of DBPs are combined to yield a prioritisation factor that indicates the potential for the formation of DBPs under different water treatment scenarios. This risk-based approach has been encapsulated in a spreadsheet-based tool developed for assessing the potential formation of DBPs at water treatment works.

No abstract

Smokeless tobacco use among women living in rural areas is poorly understood and largely ignored. This qualitative study explored the use of smokeless tobacco with 10 participants living in rural areas in Alabama, with the women telling their own stories of use. Themes emerging from interviews included the initiation of use, secrecy, health-risk beliefs, daily-use patterns, and thoughts about quitting. The study results could assist community health nurses in awareness of risks, case finding, and development of community-based prevention strategies. Additional research would help better understanding of the epidemiology of the problem, cultural implications, and practice interventions.

No abstract

No abstract

This poem was extracted from a larger study exploring the experience of serenity in persons recovering from alcohol/drug addiction in 12-step programs. The piece was shaped using the search for serenity through the eyes of a person in recovery. It maintains the storytelling tradition of 12-step programs while retaining the unique experience of the storyteller through her own eyes. It reflects her struggle toward sobriety from the self-loathing of a person in the throes of addiction—the person in the mirror that she was ashamed of—to the acceptance of herself as reflected in growth, self-respect, and self-love.

No abstract