To identify factors associated with cigarette smoking in the 6th-grade through 10th-grade youth population of Sarasota County, Florida.
A closed-ended, quantitative survey was completed by 2004 youth and used to extract population-specific data on the correlates of cigarette use.
A range of factors influence cigarette use including self-efficacy to refuse offers of cigarettes, perceived emotional benefits, and perceived maternal disapproval of smoking.
Results underscore the need for multiple-component interventions. This study is unique in that it represents population-specific research in which community partners are using the findings to develop community-specific prevention marketing interventions.
To obtain and discuss in-depth information on health care use in Asian Americans (AAs).
Nineteen focus groups were conducted in 174 adults from 13 AA communities in Montgomery County, Maryland. MAX QDA software was used to analyze qualitative data.
Financial, physical, communication, and cultural attitudes were 4 major barriers to accessing health care. Underrepresented communities reported unique additional barriers, such as lack of screening opportunities and interpretation services due to lack of resources in the communities.
Future studies, public health policy, and funding resources should consider including underrepresented AA subgroups and reflect their needs.
To examine adolescent tobacco use among members of the South-Eastern Europe (SEE) Health Network using data from the Global Youth Tobacco Survey (GYTS).
Nationally representative samples were drawn from students in grades associated with youth aged 13 to 15 in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, the Former Yugoslavian Republic of Macedonia, Montenegro, Republic of Moldova, Romania, and Serbia.
Current cigarette smoking rates among students ranged from 5.6% to 33.1%. Current use of tobacco products other than cigarettes ranged from 3.6% to 10.2%.
If effective programs are not developed, implemented, and enforced, morbidity and mortality attributed to tobacco use will surely increase.
To identify factors associated with successful neighborhood mobilization to prevent teen pregnancy using a positive youth development approach.
A multiple case study was conducted on 5 neighborhood partnerships using in-person interviews with key informants, observation of meetings, and review of existing documents.
Competent staff, strong sense of community, support of key organizations, shared leadership, effective group process, and a perceived need for the initiative influenced level of mobilization.
Organizing neighborhoods around teen pregnancy prevention, even using a youth development approach, is challenging but can be accomplished when the right constellation of factors is in place.
To examine whether theories and/or models are used in interventions geared towards improving health-related outcomes for individuals with limited literacy skills.
Intervention studies (n=52) published between 1980 and 2009 that met inclusion criteria were reviewed to assess the topic addressed, type of theory and/or model used, and the extent of theory use.
Twenty-one (40.4%) interventions were based on a theory or model. Most of those 21 interventions were either "informed by" (n=15, 71.4%) or "applied" (n=4, 19.1%) theory whereas 2 (9.5%) "tested" theory.
Most low-literacy intervention research is not based on any educational, behavioral, or social science theory or model.
To understand changes in cigarette-brand choice by adolescents in the context of demographic differences and advertising.
Data from 3 nationally representative cross-sectional surveys of adolescents were analyzed.
Marlboro, Camel, and Newport brand cigarettes accounted for over 80% of the cigarettes usually bought by adolescents in 1989, 1993, and 1996. Between 1989 and 1996, Marlboro and Camel market shares changed little, whereas preference for Newport doubled among white and Hispanic adolescents.
Brand preference among adolescents has been steadily concentrated among 3 brands. More attention may need to be focused on mentholated brands given the increase in Newport's market share.
To examine the prevalence and trend of inhalant use among Indiana public school students.
The Alcohol, Tobacco, and Other Drug Use among Indiana Children and Adolescents surveys conducted annually between 1991 and 2004 were reanalyzed using 2-way moving average, Poisson regression, and ANOVA tests.
The prevalence had increased during 1991- 1997, decreased during 1997- 2002, and increased again since 2003. Poisson model estimated an average annual decrease rate of 5.6%. The intensity of inhalant use had also decreased. More males and Hispanics use inhalants.
Inhalant use needs to be addressed in drug prevention programs.
To examine the feasibility of using a composite index of smoking behaviors to analyze adolescent smoking.
A secondary analysis of data from 10 annual surveys (1991-2000), from 566,467 Indiana students in grades 6 through 12. A composite index was calculated, and differences between index scores were analyzed using 1-way ANOVA, Tukey's post hoc tests, and 2-way moving averages.
Index scores increased before 1997 and decreased after 1976, with greater change among 7th through 10th graders.
The 2-way moving average comparison of a composite index, used with prevalence-based trend analyses, provides a more complete picture of changes in adolescent cigarette smoking.
To determine trends and sexual risk behaviors associated with anal intercourse among college women over an 8-year period.
A sexual activity questionnaire was used to collect data from 813 students enrolled in a women's health course.
Thirty-two percent of the women had engaged in anal intercourse, and this measure was consistent across time. Women who had engaged in anal intercourse were significantly younger at first intercourse and had a greater lifetime number of partners and more reported STIs.
This study underscores the importance of expanding our understanding of sexual behaviors of college women and openly addressing anal intercourse as a part of the sexual repertoire of college women.
To determine the extent of coverage of tobacco topics, as compared to coverage of health and nonhealth topics, in "general interest" and "health" magazines.
Lead articles and fillers published from 1996 through 1999 in 9 widely circulated magazines were studied.
Less than 1% of all articles and fillers on health topics focused on tobacco topics. A smaller proportion of tobacco articles and fillers, as compared to other health topics, was published in health magazines than in general interest magazines.
Tobacco is covered less, compared to other health topics, especially in health magazines, than its importance warrants as a threat to health.
To examine the current-period cost of treating 4 major smoking-related diseases: lung cancer, chronic obstructive pulmonary disease, ischemic heart disease, and cerebrovascular disease.
Analyses are based on the MarketScan database, a medical claims database from large employers.
We found that total expenditures to treat ischemic heart disease were highest, followed by those to treat chronic obstructive pulmonary disease (COPD). When median expenditures per claim and disease severity were considered, lung cancer was the most expensive condition to treat and ischemic heart disease the least expensive. Median treatment expenditures increased as the severity of disease increased.
Treating smoking-related diseases is costly in the current-period and over a lifetime.
To determine the magnitude and causes of unintentional burn injuries attributed to hot objects or substances among children aged birth to 4 years in the United States.
Data were obtained from the National Hospital Ambulatory Medical Care System.
Annually, 78,000 infants and toddlers were treated in ambulatory care settings for injuries due to contact with a hot object or substance. Hot foods, curling irons, or clothing irons were the main causes of burns.
Due to the varied causes of burns, a combination of health education and product design interventions are likely necessary to prevent these injuries.
To evaluate the accountability of osteoporosis information available in selected mass-circulating women's magazines (n=8) and a sample of newspapers (n=2).
Osteoporosis articles (n=132) were assessed for sources of information used, incidence/prevalence statistics, risks factors, and prevention measures.
Expert sources were highlighted in the majority of articles, whereas incidence/ prevalence statistics were described in less than half of the articles. Risk factors and prevention measures were outlined in most articles; however, much of the information presented was ambiguous and incomplete.
It appears that the reporting of osteoporosis in women's magazines and newspapers is not entirely balanced; thus, future coverage should provide greater detail when reporting risks and preventive measures.
To investigate the association of current smoking with body mass index (BMI) and perceived body weight among high school students in the United States.
We analyzed data from the 1999-2005 Youth Risk Behavior Survey.
Perceived body weight and BMI were associated with adolescents' current smoking. Adjusted odds ratios of current smoking for overweight and at-risk-of-overweight BMI groups continued to increase over the entire survey years. The more recent the cohort, the stronger the link of current smoking with BMI and perceived body weight.
The relationship between body weight and current smoking strengthened over time.
To examine dental visits among smoking and nonsmoking adults in a nationally representative sample.
Logistic regression analysis was performed, using a sample of 15,250 US adults from the Medical Expenditure Panel Survey Household Component 2000.
Current smokers were less likely to report dental visits (32.9%) than were nonsmokers (45.0%) during 2000. Differences were statistically significant even after accounting for other predictors of dental care use.
Efforts to optimize the oral health of smokers and reduce serious oral diseases may benefit from addressing this lower use of dental services among smokers.
To examine associations between menthol cigarette smoking and nicotine dependence, quit attempts, and physical and mental health.
Data were drawn from the 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS) and a follow-up survey among current smokers (N = 3396). Univariate and multivariate logistic regression analyses were conducted.
In multivariate analyses, menthol cigarette smoking was associated with women, African American and Hispanic race/ethnicity, and greater mental distress.
Women, racial/ethnic minorities, and individuals reporting a greater frequency of mental distress are more likely to smoke menthol versus nonmenthol cigarettes. Implications for public health policy and cessation interventions are discussed.
To explore the relationship between health-related quality of life (HRQOL) and nicotine dependence in a representative sample of 3560 Florida smokers.
Data from the 2007 Behavioral Risk Factor Surveillance System-Florida Tobacco Callback Survey were used. Logistic regression models were conducted to identify factors independently associated with HRQOL measures.
Greater nicotine dependence was associated with poor/fair self-rated health, 1-29 days of poor physical health, and poor mental health, and inactivity in the past 30 days.
The consequences of long-term smoking, and thus nicotine dependence, may not be confined to traditional morbidity measures but may include poor perceived health and overall well-being.
To understand vendor perspectives regarding changes made in 2009 to the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) food package.
Fifty-two in-depth, qualitative interviews with owners or managers of small stores in 8 urban areas across 7 states conducted 6-12 months after the changes.
Store owners experienced implementation challenges, but felt the changes increased the number of customers, sales, and profits.
This research provides vendor perspectives on the 2009 WIC policy changes and may enhance policy implementation directed at increasing healthy food availability, particularly in urban communities.
To examine the relationships of religious involvement and affiliation with health behavior and conditions.
A survey (n = 3014) conducted for the Nashville REACH 2010 project included questions about religious affiliation and practice as well as health behaviors and conditions.
Bivariate analyses indicated negative associations between religious involvement and health, along with differences between religious affiliations/groups. This relationship changed, however, after controlling for demographic differences and individual differences in religious involvement.
Religious groups share not only beliefs, but also socioeconomic, ethnic, and cultural similarities that must be taken into account in research examining religion and health.
To investigate the psychometric properties of the BMSLSS among 522 college students.
Internal consistency reliability explored scale reliability, factor analysis explored construct validity, known-groups validity was assessed by use of items from the National College Youth Risk Behavior Survey and Harvard National Survey of Alcohol Use, and criterion-related validity was explored through analyses with the CDC's Health-Related Quality of Life Scale.
Acceptable internal consistency reliability, construct, known-groups, and criterion-related validity were established.
These findings offer preliminary support for the BMSLSS; it could serve as part of comprehensive evaluations of subjective QOL for program evaluation and/or policy purposes among college students.
To describe relationships between teachers' amenability to implement antitobacco programs and features of implementation settings.
A telephone random survey was administered to middle school and high school teachers in Florida. Data were analyzed via cluster analysis and other multivariate techniques.
Teachers were classified by their amenability to implement tobacco-use-prevention education (TUPE). Cluster membership was associated with key contextual variables. Hierarchical multiple regression identified significant predictors of teachers' perceptions of program success.
After controlling for other school and community factors, classroom activities remained significant predictors of program effectiveness. Findings may have implications for the design of secondary interventions to promote teacher efficacy related to delivery of antitobacco programs.
This state of the Academy address was presented at the opening ceremonies of the fourth annual scientific meeting of the American Academy of Health Behavior by the outgoing president of the Academy, February 29, 2004.
To examine demographics and beliefs about influenza disease and vaccine that may be associated with influenza vaccination among 50- to 64-year-olds.
A national sample of adults aged 50-64 years surveyed by telephone.
Variables associated with receiving influenza vaccination included age, education level, recent doctor visit, and beliefs about vaccine effectiveness and vaccine safety. Beliefs about influenza vaccination varied by race/ethnicity, age, education, and gender.
The finding of demographic differences in beliefs suggests that segmented communication messages designed for specific demographic subgroups may help to increase influenza vaccination coverage.
To examine sex-specific disparities in total and abdominal obesity prevalence across 6 ethnic-immigrant groups and explore whether the observed differences were attributable to diet and physical activity (PA).
Data were from 4331 respondents age 18-64 from the 2003-2006 National Health and Nutrition Examination Survey. Sex-specific multiple logistic regression analyses were performed.
Regardless of race-ethnicity, immigrants exhibited lower prevalence of total and abdomi - nal obesity than natives. Among the US-born, Whites had the lowest total obesity prevalence followed by Hispanics and then Blacks; but racial-ethnic disparities for immigrants were different. In abdominal obesity, US-born white men had the highest prevalence. PA helped explain some ethnic-immigrant disparities.
Complex interactions of sex by race-ethnicity and nativity exist for obesity prevalence.
To explore prevalence of aberrant medication-taking behaviors (AMTB) among headache patients and treating physician's awareness of such behaviors.
Fifty patientphysician dyads were surveyed on patients' AMTB.
The most frequently endorsed behaviors by patients and physicians, respectively, were going to the ER for pain medication (n = 19) and continuing to take pain medication despite minimal relief (n = 23). For the majority of AMTB, phi coefficients indicating level of patient-physician agreement were equal to chance.
Headache patients perform a wide range of AMTB. Low rates of patient-physician agreement indicate that physicians possess limited knowledge of patients' AMTB.
To examine factors influencing time from screening to final diagnosis among multicultural women with abnormal mammograms using the precede-proceed model.
Staff of 58 clinics and a sample of 436 women served by these clinics were interviewed and their medical records examined.
Longer duration from screening to diagnosis was associated with speaking Spanish and having clinic staff make appointments. Ease of access to health care, provision of early morning screening services and higher levels of patient anxiety shortened the time to diagnosis.
The precede-proceed model is useful in delineating personal and structural factors that affect timely diagnosis.
To assess the relationship between body mass index, as categorized by the recently released guidelines of the NHLBI, and health care costs and absenteeism in a sample of municipal workers.
A cross-sectional study was employed that compared the obesity-related health care costs and absences of normal and overweight/obese city workers.
While accounting for age, gender, race, smoking behavior, and educational attainment, BMI predicted both average annual health-care costs and work absence hours.
The NHLBI guidelines for overweight and obesity effectively predicted absences and health care costs.
To examine whether health locus of control mediated relations of self-reported neighborhood vigilance and biochemically verified, continuous short-term smoking abstinence among 200 smokers enrolled in a cohort study.
A nonparametric bootstrapping procedure was used to assess mediation.
Health locus of control-chance mediated relations between neighborhood vigilance and smoking abstinence in analyses adjusted for sociodemographics and tobacco dependence (p < .05). Greater vigilance was associated with greater attributions that health was affected by chance, which was associated with a lower likelihood of smoking abstinence.
Results suggest that neighborhood perceptions influence residents' attributions for health outcomes, which can affect smoking abstinence.
To identify distinct subgroups of treatment responders and nonresponders to aid in the development of tailored smoking-cessation interventions for long-term maintenance using signal detection analysis (SDA).
The secondary analyses (n = 301) are based on data obtained in our randomized clinical trial designed to assess the efficacy of extended cognitive behavior therapy for cigarette smoking cessation. Model 1 included only pretreatment factors, demographic characteristics, and treatment assignment. Model 2 included all Model 1 variables, as well as clinical data measured during treatment.
SDA was successfully able to identify smokers with varying probabilities of maintaining abstinence from end-of-treatment to 52-week follow-up; however, the inclusion of clinical data obtained over the course of treatment in Model 2 yielded very different partitioning parameters.
The findings from this study may enable researchers to target underlying factors that may interact to promote maintenance of long-term smoking behavior change.
To determine if community subjective social status (SSS) predicted smoking abstinence through 26 weeks postrandomization among 755 African American light smokers of low SES (socioeconomic status).
Participants were enrolled in a double-blind, placebo-controlled, randomized clinical trial, which examined the efficacy of nicotine gum and counseling for smoking cessation.
Results indicated that SSS predicted smoking abstinence over time [P=.046; odds ratio (OR) =1.075 (1.001-1.155)] after adjusting for covariates.
Further research is needed to understand the effects of community SSS on smoking cessation among heavy smokers and other ethnic groups.
To evaluate the impact of an abstinence education program on sexual intercourse initiation and on possible cognitive mediators of sexual initiation for virgin seventh graders in suburban Virginia.
Measures of sexual behavior and 6 mediating variables were compared at 3 time periods for program participants and a matched comparison group (n=550), controlling for pretest differences.
At posttest, program students scored significantly better on 4 of the 6 mediators. After one year, program students had a substantially lower risk of sexual initiation than did comparison students (RR=.457, P=.008).
The program achieved a significant reduction in teen sexual initiation, and the role of the cognitive mediators was supported.
To examine the effects of an abstinence education curriculum series on student outcomes.
The series was taught at upper elementary, junior high, and high school levels. A questionnaire was administered to all intervention and comparison students before and after implementation of the curriculum.
At the upper elementary level, the curriculum group had better outcomes on knowledge, self-efficacy, and a more hopeful outlook; at the middle school level no differences; at the high school level, findings favored the curriculum group on attitude, behavioral intent, and sexual behavior variables.
Results are encouraging and should be considered by those interested in helping young people postpone sexual involvement.
To determine whether longer durations of voucher-based reinforcement therapy (VBRT) increase long-term abstinence compared to standard durations.
Cocaine-abusing or dependent methadone-maintenance patients (N = 130) were randomized to receive either Standard (12-week; n = 62) or Extended (36-week; n = 68) VBRT. Participants provided 3 urine samples weekly during VBRT, and each cocaine-negative sample produced a voucher exchangeable for goods and services.
Extended VBRT produced longer durations of self-reported continuous abstinence during study Year 1 (M = 74 vs. 46 days; F(1,128) = 5.23, P = 0.024), but not during Year 2. However, each week of abstinence during Year 1 was associated with an increase of 9.19 days of abstinence during Year 2, regardless of study condition (t(1) = 4.92, P < 0.001).
Longer-duration VBRT can increase abstinence during VBRT, but may not maintain it afterwards. However, longer during-treatment abstinence begets later abstinence suggesting that further research regarding this relationship is needed.
To use youth and parent demographic factors, youth assets (strengths), and community constructs to develop age-group-specific profiles for youth who abstain from sexual activity.
Data were collected using in-person interviews of youth (N = 1253) residing in randomly selected, inner-city neighborhood households. Data were analyzed to create classification trees.
Results indicated that assets typically were the most important factors related to abstinence and that the profiles differed for each age group.
When sexual abstinence is considered, the influence of youth and parent demographics, youth assets, and community factors appears to vary across adolescent developmental age periods.
To investigate predictors of tobacco abstinence among smokeless tobacco (ST) users.
Logistic regression analyses assessed characteristics associated with tobacco abstinence among ST users receiving bupropion SR.
Older age was associated with increased tobacco abstinence in both placebo and bupropion SR groups at end of treatment and one year. Abstinence was lower at one year for subjects with a history of major depression. At end-of-treatment, a 2-way interaction was detected suggesting bupropion SR may be efficacious for subjects with other household tobacco users.
Younger ST users and those with a history of depression are less likely to quit ST use.
To examine effectiveness of abstinence-until-marriage curriculum on knowledge, beliefs, efficacy, intentions, and behavior.
Nonrandomized control trial involving 2069 middle school students with a 5-month follow-up.
Intervention students reported increases in knowledge and abstinence beliefs, but decreases in intentions to have sex and to use condoms. Intervention did not influence sexual initiation or condom use; however, intervention students who had sex during the evaluation period reported fewer sexual episodes and fewer partners than did controls.
Abstinence-until-marriage interventions can influence knowledge, beliefs, and intentions, and among sexually experienced students, may reduce the prevalence of casual sex. Reduction in condom use intentions merits further study to determine long-term implications.
To provide a review of the evidence from 3 experimental trials of Project Towards No Drug Abuse (TND), a senior-high-school-based drug abuse prevention program.
Theoretical concepts, subjects, designs, hypotheses, findings, and conclusions of these trials are presented. A total of 2,468 high school youth from 42 schools in southern California were surveyed.
The Project TND curriculum shows reductions in the use of cigarettes, alcohol, marijuana, hard drugs, weapon carrying, and victimization. Most of these results were replicated across the 3 trials.
Project TND is an effective drug and violence prevention program for older teens, at least for one-year follow-up.
To research effective drug prevention strategies for school-aged populations from drug prevention programs funded by the USDHHS Center for Substance Abuse Prevention (CSAP).
Nine directors and staff members from model CSAP-funded programs were interviewed.
Fifteen strategies that focus on building trusted relationships, selecting well-qualified staff using existing communication networks, and providing timely evaluation feedback are discussed, with examples from the agencies cited.
Formulating effective partnerships that support both the goals of the outside agency with drug prevention resources and the mission of a school can contribute toward effective school-based drug prevention programs.
To test the impact of a school-based substance-abuse-prevention program, Project Towards No Drug Abuse (TND), on risk for violence.
Logistic regression analyses tested whether victimization, perpetration, or weapon carrying differed for intervention students relative to control students within a sample of 850 continuation high school students followed over 12 months.
We observed a higher risk for victimization (OR=1.57) among male control students. No intervention effect was observed for female students or for perpetration among males.
The findings provide limited support for a generalization of TND's preventive effect.
To assess perceived implementation of 2 substance-abuse prevention programs: a standard one and a peer-led interactive one.
Data from 16 health educators were collected after 504 classroom sessions, 63 of which were observed by 24 monitors.
In the interactive program, health educators (HEs) followed the curriculum less closely, reported less favorable classroom processes and less off-task talking than in the standard one.
These data indicate that an interactive substance-abuse prevention program does not necessarily entail more off-task discussion but also does not necessarily guarantee more favorable program implementation.
To explore caregiver correlates of adolescent inhalant abuse.
Youth were surveyed about inhalant use. Caregivers were surveyed about demographics, behaviors, family environment, perceptions of parent/ adolescent interaction, coping strategies, caregiver monitoring of youth and self-reported substance use. Multiple logistic regression with backward elimination was used.
Of the 218 dyads recruited, 94% of the youth inhalant and inhalant non-users were correctly classified using a model constructed from independent variables.
We believe that parent-based educational training services should be studied that provide information about inhalant abuse and encourage open communication, adaptive coping, and adequate monitoring skills.
To describe how a community academic partnership (CAP) created a cardiovascular disease (CVD) prevention program for firefighters.
Principles of community based participatory research (CBPR) were integrated with intervention mapping (IM) to guide the development of a physical activity program.
Key elements of the CAP program include instituting annual CVD screenings; creating a department-wide program and a pilot intervention for high-risk firefighters; training firefighters to become peer health mentors; improving access to physical activity equipment; instituting policy to promote physical activity, and validating instrumentation for assessing cardiorespiratory fitness.
Integrating CBPR with IM was an efficacious approach for engaging firefighters in research for developing an ecological approach to cardiovascular health in firefighters.
To examine the association between health behavior indicators, school contentment, and academic achievement.
Structural equation modeling with 5810 adolescents.
Our model explained 36% of the variance in academic achievement and 24% in school contentment. BMI and sedentary lifestyle were negatively related to school contentment and academic achievement, but physical activity was positively related to school contentment and academic achievement (P < .01). School contentment was strongly related to academic achievement but only a weak mediator of the health behavior indicators.
Findings may inform the efforts to improve academic achievement and the general health status of youth.
To investigate weight perception and related psychological factors in Chinese adolescents.
A questionnaire on weight perception, academic performance, stress, hostility, and depression was completed by 6863 middle and high school students. Weight and height were measured.
Overweight perception was related to school-related stress and depression in both girls and boys (P<0.01) and to hostility in boys (P<0.01). Perceived over-weight was related to lower GPA in girls only (P<0.05).
Distorted weight perception has a detrimental psychological impact on Chinese adolescents. These findings may contribute to the obesity research and to the development of future effective intervention programs in China.