To test effects of parent/child training designed to increase calcium intake, bone-loading physical activity (PA), and bone density.
Two-group randomized controlled trial.
Family-based intervention delivered at research center.
117 healthy children aged 10-13 years (58.1% female, 42.7% Hispanic, 40.2% White). Ninety-seven percent of participants had at least one parent graduate from high school and 37.2% had at least one parent graduate from a 4-year university.
Children and parents were randomly assigned to diet and exercise (experimental) or injury prevention (control) interventions. Children were taught in eight weekly classes how to engage in bone-loading PA and eat calcium-rich foods or avoid injuries. Parents were taught behavior management techniques to modify children’s behaviors.
Measures at baseline, three, nine and twelve months included 24-hour diet and PA recalls, and bone mineral density (BMD) by DXA.
ANOVA and Generalized Estimating Equations assessed group by time differences. Comparisons were conducted separately for boys and girls.
For boys, cross-sectional differences between experimental versus control group were achieved for 3 and 9-month calcium intake (1352 vs. 1052mg/day, 1298 vs. 970mg/day, p<0.05). For girls, marginal cross-sectional differences were achieved for high-impact PA at 12 months (p<0.10). For calcium intake, a significant group by time interaction was observed from pre to post test for the full sample (p=.008) and for girls (p=.006) but not for boys. No significant group by time differences in calcium were observed across the follow-up period. No group by time differences were observed for high impact physical activity. Among boys, longitudinal group by time differences reached significance for total hip BMD (p=.045) and femoral neck BMD (p=.033), even after adjusting for skeletal growth. Similar differential increases were observed among boys for BMC at the hip (p=.068) and total body (p=.054) regions. No significant group by time interaction effects were observed for girls at any bone site for BMD. For BMC, control girls showed a significant increase (p=.03) in spine BMC compared to intervention girls
This study demonstrated that parent/preteen training can increase calcium intake and attenuate the decline in high-impact PA. Results suggest that more powerful interventions are needed to increase activity levels and maximize bone mineral accrual during pre-adolescent years.
Calcium; diet; parent education; physical activity; preteens; Osteoporosis prevention; Manuscript format: research; Research purpose: intervention testing/ program evaluation; Study design: randomized trial; Outcome measure: behavioral, biometric; Setting: family; Health focus: fitness/physical activity, nutrition; Strategy: education, skill building/behavior change; Target population age: youth; Target population circumstances: geographic location
This paper reviews methodological and theoretical fidelity of secondhand smoking (SHS) intervention studies (n=29) that target protection of children in their home. In 2005, interventions were evaluated in terms of treatment fidelity according to guidelines provided by Borrelli et al. of the National Institutes of Health Behavior Change Consortium. The degree of fidelity was evaluated based on the percentage of criteria met; the inter-rater reliability based on percent agreement across independent raters was 0.78. Analysis indicated that studies with higher treatment fidelity were more likely to obtain statistically significant results (p=.003) with the average fidelity rating of 0.74 for statistically significant studies vs. 0.50 for statistically non-significant studies. Higher treatment fidelity was also significantly associated with being a more recent investigation (year 2000 or later), an efficacy as compared to effectiveness trial, more intensive as compared to less intensive intervention, a trial in the U.S. as compared to foreign nations, and having a theoretical basis. After taking all other variables into account, only treatment fidelity was significantly related to study outcome (p=.052). Ratings of treatment fidelity were ranked and compared to previous rankings based on 342 behavioral change interventions; the rank-ordered correlation between previous and current ratings was 0.84, although median fidelity ratings were 0.10 points lower in the previous than in the present study (0.52 vs. 0.62; intraclass correlation=0.79). Improvements to the treatment fidelity evaluation guidelines were suggested, including the consideration of theoretical fidelity. Enhancing methodological and theoretical fidelity will speed identification of valid theoretical precepts that will, in turn, guide effective public health prevention programs.
To test and compare 2 predictive models of weapon carrying in youth (n=308) recruited from 4 drop-in centers in San Diego and Imperial counties.
Both models were based on the Behavioral Ecological Model (BEM).
The first and second models significantly explained 39% and 53% of the variance in weapon carrying, respectively, and both full models shared the significant predictors of being black(−), being Hispanic (−), peer modeling of weapon carrying/jail time(+), and school suspensions(+).
Results suggest that the BEM offers a generalizable conceptual model that may inform prevention strategies for youth at greatest risk of weapon carrying.
weapon carrying; risk factors; protective factors; adolescents; drop-in centers
The Arkansas Method (AM) for Isoniazid (INH) metabolite detection is a relatively inexpensive, simple, objective measure of adherence. The purpose of the study was to explore whether variations in urine sample handling and storage will produce accurate assay outcomes. Participants were a convenience sample of 28 adults and adolescents prescribed INH for Latent Tuberculosis Infection (LTBI). Participants provided one sample to test effects of: mixing processes; durations at room temperature, in a refrigerator, or frozen; and effects of freeze/thaw cycles on AM outcomes. No manipulations had a discernible impact on outcomes with concordant positive rates from 85–100%. Concordance rates of manipulated samples didn’t appear to differ from rates of norm samples. Results suggest that urine samples can withstand a variety of manipulations in both handling and storage without affecting the accuracy of AM assay results. These findings have important implications for providers of treatment and researchers, and provide the impetus for both to examine the potential of using the AM of INH metabolite testing as a measure of medication adherence.
Arkansas Method; Tuberculosis; LTBI; Adherence; Isoniazid
Secondhand smoke exposure (SHSe) threatens fragile infants discharged from a neonatal intensive care unit (NICU). Smoking practices were examined in families with a high respiratory risk infant (born at very low birth weight; ventilated > 12 hr) in a Houston, Texas, NICU. Socioeconomic status, race, and mental health status were hypothesized to be related to SHSe and household smoking bans.
Data were collected as part of The Baby's Breath Project, a hospital-based SHSe intervention trial targeting parents with a high-risk infant in the NICU who reported a smoker in the household (N = 99). Measures of sociodemographics, smoking, home and car smoking bans, and depression were collected.
Overall, 26% of all families with a high-risk infant in the NICU reported a household smoker. Almost half of the families with a smoker reported an annual income of less than $25,000. 46.2% of families reported having a total smoking ban in place in both their homes and cars. Only 27.8% families earning less than $25,000 reported having a total smoking ban in place relative to almost 60% of families earning more (p < .01). African American and Caucasian families were less likely to have a smoking ban compared with Hispanics (p < .05). Mothers who reported no smoking ban were more depressed than those who had a household smoking ban (p < .02).
The most disadvantaged families were least likely to have protective health behaviors in place to reduce SHSe and, consequently, are most at-risk for tobacco exposure and subsequent tobacco-related health disparities. Innovative SHSe interventions for this vulnerable population are sorely needed.
Susceptibility to cigarette smoking in tobacco-naive youth is a strong predictor of smoking initiation. Identifying mechanisms that contribute to smoking susceptibility provide information about early targets for smoking prevention. This study investigated whether sensitivity to secondhand smoke exposure (SHSe) contributes to smoking susceptibility.
PARTICIPANTS AND METHODS:
Subjects were high-risk, ethnically diverse 8- to 13-year-old subjects who never smoked and who lived with at least 1 smoker and who participated in a longitudinal SHSe reduction intervention trial. Reactions (eg, feeling dizzy) to SHSe were assessed at baseline, and smoking susceptibility was assessed at baseline and 3 follow-up measurements over 12 months. We examined the SHSe reaction factor structure, association with demographic characteristics, and prediction of longitudinal smoking susceptibility status.
Factor analysis identified “physically unpleasant” and “pleasant” reaction factors. Reported SHSe reactions did not differ across gender or family smoking history. More black preteens reported feeling relaxed and calm, and fewer reported feeling a head rush or buzz compared with non-Hispanic white and Hispanic white counterparts. Longitudinally, 8.5% of subjects tracked along the trajectory for high (versus low) smoking susceptibility. Reporting SHSe as “unpleasant or gross” predicted a 78% reduction in the probability of being assigned to the high–smoking susceptibility trajectory (odds ratio: 0.22 [95% confidence interval: 0.05–0.95]), after covariate adjustment.
Assessment of SHSe sensitivity is a novel approach to the study of cigarette initiation etiology and informs prevention interventions.
secondhand smoke; sensitivity; smoking susceptibility; trajectories; preteens
The latest amendment to the ban on smoking in public places in Israel was implemented in 2007, adding pubs and bars (P&B) to the list of public places in which smoking is prohibited. However, smoking in most P&B continued. The aim of the study was to identify the theoretically plausible reasons for the partial success of a public ban on smoking in P&B settings. Explanations provided by P&B owners were interpreted as probable causal factors based on the Behavioral Ecological Model (BEM).
Qualitative interviews were performed with 36 P&B owners in Tel-Aviv and 18 Israeli towns and cities of various population size.
P&B owners reported a variety of situational factors (i.e., contingencies) and reinforcers as likely explanations of the partial failure of the legislated ban on smoking in public places, particularly P&B. The major reinforcers for non-adherence with the law were no or low frequency of inspections and low penalties from authorities. P&B owners also feared loss of customers and revenue if bans were enforced in their own establishment but not in competing establishments. Finally, owners reported social norms prevailing among some Israeli patrons supporting smoking in P&B settings, in part to express opposition to the new law.
Qualitative assessment can uncover probable social situations that operate to prevent greater adherence to smoking bans. The results warrant confirmation by quantitative analyses. Policies with mandated inspections and penalty requirements that are implemented in all bars without prejudice could lead to greater adherence to smoking bans. Positive reinforcing consequences that encourage adherence (such as publicity and support from non-smokers) would be more likely to generate both greater adherence to the policy and good will toward the government. Principles of behavior outlined in the BEM offer guidance for designing quantitative confirmation analyses of future bans.
Smoking ban; Bars; Pubs; Behavioral ecological model; Israel
Given the considerable variability in drinking practices among Asian American groups, the generalizations that suggest an increase in their alcohol use associated with acculturation need to be questioned. Also, the experience of children of immigrants growing up in the United States may be much more complex than a focus on acculturation can capture. Informed by the theory of segmented assimilation, this study addresses two research questions: 1) Is acculturation associated with alcohol use of Korean American adolescents? and 2) What other social, economic, and cultural forces influence their alcohol use? Survey data collected from 202 adolescents of Korean descent in Southern California were used. Multivariate regression analyses revealed that acculturation was not a significant predictor of most measures of alcohol use, while peer influence, scholastic achievement/aspirations, and current smoking were predictive. Gender and social class were unrelated to drinking. Findings suggest focusing research on an integrative approach to understanding drinking in complex social, economic, and social contexts may be useful.
Home and car smoking bans implemented by caregivers are important approaches to reducing children’s secondhand smoke (SHS) exposure and attendant health risks. Such private smoking bans are usually informal and are subject to individuals’ interpretation, observation, and recall. Relying on a single reporter may lead to misclassification of bans in families.
To determine (1) proportion of families with discordant reports of bans; (2) association between parent–child report agreement and SHS exposure; and (3) whether including a second reporter of bans improves prediction of child SHS exposure.
In each of 386 participating families a preteen and a parent reported separately on their home and car smoking bans, and agreement was determined. ANOVA, chi-square, and multiple regression were used to determine relationships between SHS exposure (measured by urine cotinine and reported exposure) and home/car smoking bans reported by preteens and parents.
In 19% of families, reports disagreed for home smoking bans; 30% for car smoking bans. Families who agreed on the presence of a ban had the lowest exposure, families who agreed on the absence of a ban had the highest exposure, and intermediate exposure for those who disagreed. Parent and child reports of bans each explained significant, unique variance in child SHS exposure.
Due to relatively high prevalence of discordant reporting, a more accurate classification of home/car bans may result from including multiple reporters.
To investigate the sensitivity to secondhand smoke exposure (SHSe) in preteens age 8 to 13 who have never smoked, and to determine whether SHSe sensitivity predicts smoking susceptibility.
We assessed sensitivity to SHSe using reactions commonly used for assessment of sensitivity to the first smoked cigarette (e.g., feeling dizzy), and investigated the factor structure of these reactions for the purpose of data reduction. We examined the association of each reaction measure and summary score with demographic characteristics and with smoking susceptibility, using logistic regression and ordinal logistic regression.
One factor was identified that captured physical/unpleasant reactions. Older preteens and preteens with more highly educated parents reported fewer reactions to SHSe. More African American preteens reported feeling relaxed or calm compared to all other racial/ethnic groups. Experiencing physical/unpleasant reactions to SHSe predicted lower risk for smoking susceptibility.
This was the first study to extend analytical methodology for sensitivity to active smoking to sensitivity to SHSe in youth who have never smoked. Results suggest a desensitization process with age and lower sensitivity to some reactions in preteens from more highly educated households. Preteens who have more aversive experience s with SHSe tend to be less susceptible to smoking than those who experience fewer aversive reactions. Assessment of sensitivity to SHSe is a novel approach to the study of cigarette use etiology and may contribute to better prediction of smoking initiation.
preteens; secondhand smoke; reactions; sensitivity; smoking susceptibility
The South Korean (SK) government monopolizes the tobacco industry and is accused of pushing smoking on captive military personnel. However, estimating the association between military service and smoking is difficult, since military service is required for all SK men and the few civilian waivers are usually based on smoking determinants, e.g., social status.
Materials and Methods
Using a quasi-experimental design we validly estimate the association between military service and smoking. Military service was assigned by immigration patterns to the United States, instead of an experimenter, by comparing Korean Americans who happened to immigrate before or after the age(s) of mandated service. Smoking promotion in the military was also described among SK veterans, to identify the probable mechanisms for veterans' smoking tendencies.
Veterans were 15% [95% confidence interval (CI), 4 to 27] more likely to ever-puff and 10% (95% CI, 0 to 23) more likely to ever-smoke cigarettes, compared to a similar group of civilians. Among veterans, 92% (95% CI, 89 to 95) recalled cigarettes were free, 30% (95% CI, 25 to 35) recalled smokers were given more work breaks and 38% (95% CI, 32 to 43) felt explicit "social pressure" to smoke. Free cigarettes was the strongest mechanism for veterans' smoking tendencies, e.g., veterans recalling free cigarette distribution were 16% (95% CI, 1 to 37) more likely to ever-smoke than veterans not recalling.
These patterns suggest military service is strongly associated with smoking, and differences between veterans and civilians smoking may carry over long after military service. Given military service remains entirely in government purview, actively changing military smoking policies may prove most efficacious. This highlights the importance of recent bans on military cigarette distribution, but policies eliminating other smoking encouragements described by veterans are necessary and could effectively reduce the smoking prevalence by as much as 10% in SK.
South Koreans' health; smoking; military; tobacco control
Immigration involves challenges and distress, which affect health and well-being of immigrants. Koreans are a recent, fast growing, but understudied group of immigrants in the US, and no study has established or evaluated any immigration stress measure among this population. This study explores the psychometric properties of Korean-translated Demands of Immigration (DI) Scale among first-generation female Korean immigrants in California. Analyses included evaluation of factor structure, reliability, validity, and descriptive statistics of subscales.
A surname driven sampling strategy was applied to randomly select a representative sample of adult female Korean immigrants in California. Telephone interviews were conducted by trained bilingual interviewers. Study sample included 555 first-generation female Korean immigrants who were interviewed in Korean language. The 22-item DI scale was used to assess immigration stress in the study sample.
Exploratory Factor Analysis suggested six correlated factors existed in the DI scale: language barriers, sense of loss, not feeling at home, perceived discrimination, novelty, and occupation. Confirmatory Factor Analysis validated the factor structure. Language barriers accounted for the most variance of the DI Scale (29.11%). The DI scale demonstrated good internal consistency reliability and construct validity.
Evidence has been offered that the Korean-translated DI scale is a reliable and valid measurement tool to examine immigration stress among Korean immigrants. The Korean-translated DI scale has replicated factor structure obtained in other ethnicities, but addition of cultural-specific items is suggested for Korean immigrants. High levels of language and occupation related stress warrant attention from researchers, social workers and policy makers. Findings from this study will inform future interventions to alleviate stress due to demands of immigration.
Immigration; immigrant; stress; distress; Korean; Demand of Immigration; Exploratory Factor Analysis; Confirmatory Factor Analysis
Secondhand smoke (SHS) is hazardous to children’s health. Designing interventions to reduce exposure requires understanding children’s behavior in the presence of smokers, yet little is known about this behavior.
To determine whether children’s avoidance of SHS is associated with lower exposure and to explore predictors of avoidance based on a behavioral ecological model.
Preteens aged 8–13 (N=358) living with a smoker identified their primary source of SHS exposure, and reported whether they left (avoided exposure) or stayed the last time they were exposed to that person’s smoke. The SHS avoidance measure was validated by examining associations with SHS exposure. Multivariable Logistic Regression was used to determine predictors of SHS avoidance.
Based on urine cotinine and reported exposure, preteens who left the presence of SHS had lower exposure than those who stayed. Preteens were more likely to leave SHS if they were less physically mature, had not tried smoking, had a firm commitment not to smoke, did not assist family smoking, had family/friends who discouraged breathing SHS, or had friends who disliked smoking.
Most SHS exposure reduction interventions have targeted changes in smokers’ behavior. Reductions can also be achieved by changing exposed nonsmokers’ behavior, such as avoiding the exposure. Future studies should measure young people’s SHS avoidance and test interventions to increase their avoidance practices.
Secondhand smoke (SHS); Avoidance; Children; Youth; Ecological model
This study, informed by ecological frameworks, compared the prevalence, predictors, and association of home smoking restrictions with secondhand smoke exposure (SHSe) between Koreans in Seoul, South Korea, and Korean Americans in California, United States.
A cross-sectional survey was drawn from telephone interviews with Korean adults in Seoul (N = 500) and California (N = 2,830) during 2001–02. Multivariable regressions were used for analyses.
Koreans, compared with Korean Americans, had significantly fewer complete home smoking bans, 19% (95% CI: 16–23) versus 66% (95% CI: 64–68), and were more likely to not have a home smoking restriction, 64% (95% CI: 60–69) versus 5% (95% CI: 4–6). Home smoking restrictions were associated with lower home SHSe; however, the impact was consistently larger among Korean Americans. Households with more SHSe sources were less likely to have the strongest home smoking restrictions, where the difference in complete bans among Korean Americans versus Koreans was largely among those at low risk of SHSe, 82% (95% CI: 76–86) versus 36% (95% CI: 17–57), while high-risk Korean American and Koreans had similar low probabilities, 10% (95% CI: 7–13) versus 7% (95% CI: 3–13).
Consistent with ecological frameworks, exposure to California’s antismoking policy and culture was associated with stronger home smoking restrictions and improved effectiveness. Interventions tailored to Korean and Korean American SHSe profiles are needed. Behavioral interventions specifically for high-risk Korean Americans and stronger policy controls for Koreans may be effective at rapidly expanding home smoking restrictions.
To evaluate the sensitivity and specificity of Community Health Survey (CHS), we analyzed data from 11,217 participants aged ≥ 19 yr, in 13 cities and counties in 2008. Three healthcare utilization indices (admission, outpatient visits, dental visits) as comparative variables and the insurance benefit claim data of the Health Insurance Review & Assessment Service as the gold-standard were used. The sensitivities of admission, outpatient visits, and dental visits in CHS were 54.8%, 52.1%, and 61.0%, respectively. The specificities were 96.4%, 85.6%, and 82.7%, respectively. This is the first study to evaluate the validity of nationwide health statistics resulting from questionnaire surveys and shows that CHS needs a lot of efforts to reflect the true health status, health behavior, and healthcare utilization of the population.
Validity; Self-Reported; Healthcare Utilization; Community Health Survey
Despite decades of research surrounding determinants of alcohol and tobacco (A&T) use among adolescents, built environment influences have only recently been explored. This study used ordinal regression on 205 Latino adolescents to explore the influence of the built environment (proximity to A&T retailers) on A&T use, while controlling for recognized social predictors. The sample was 45% foreign-born. A&T use was associated with distance from respondents’ home to the nearest A&T retailer (−), acculturation (+), parents’ consistent use of contingency management (−), peer use of A&T (+), skipping school (+), attending school in immediate proximity to the US/Mexico border (+), and the interaction between the distance to the nearest retailer and parents’ consistent use of contingency management (+). The association between decreasing distance to the nearest A&T retailer and increased A&T use in Latino adolescents reveals an additional risk behavior determinant in the US–Mexico border region.
GIS; Alcohol use; Tobacco use; Built environment; Latinos; Adolescents
Identifying adults' physical activity patterns across multiple life domains could inform the design of interventions and policies.
Cluster analysis was conducted with adults in two US regions (Baltimore-Washington DC, n = 702; Seattle-King County, n = 987) to identify different physical activity patterns based on adults' reported physical activity across four life domains: leisure, occupation, transport, and home. Objectively measured physical activity, and psychosocial and built (physical) environment characteristics of activity patterns were examined.
Main Outcome Measures
Accelerometer-measured activity, reported domain-specific activity, psychosocial characteristics, built environment, body mass index (BMI).
Three clusters replicated (kappa = .90-.93) across both regions: Low Activity, Active Leisure, and Active Job. The Low Activity and Active Leisure adults were demographically similar, but Active Leisure adults had the highest psychosocial and built environment support for activity, highest accelerometer-measured activity, and lowest BMI. Compared to the other clusters, the Active Job cluster had lower socioeconomic status and intermediate accelerometer-measured activity.
Adults can be clustered into groups based on their patterns of accumulating physical activity across life domains. Differences in psychosocial and built environment support between the identified clusters suggest that tailored interventions for different subgroups may be beneficial.
cluster analysis; exercise; built environment; social environment; accelerometer
Background: There is broad consensus regarding the health impact of tobacco use and secondhand smoke exposure, yet considerable ambiguity exists about the nature and consequences of thirdhand smoke (THS).
Objectives: We introduce definitions of THS and THS exposure and review recent findings about constituents, indoor sorption–desorption dynamics, and transformations of THS; distribution and persistence of THS in residential settings; implications for pathways of exposure; potential clinical significance and health effects; and behavioral and policy issues that affect and are affected by THS.
Discussion: Physical and chemical transformations of tobacco smoke pollutants take place over time scales ranging from seconds to months and include the creation of secondary pollutants that in some cases are more toxic (e.g., tobacco-specific nitrosamines). THS persists in real-world residential settings in the air, dust, and surfaces and is associated with elevated levels of nicotine on hands and cotinine in urine of nonsmokers residing in homes previously occupied by smokers. Much still needs to be learned about the chemistry, exposure, toxicology, health risks, and policy implications of THS.
Conclusion: The existing evidence on THS provides strong support for pursuing a programmatic research agenda to close gaps in our current understanding of the chemistry, exposure, toxicology, and health effects of THS, as well as its behavioral, economic, and sociocultural considerations and consequences. Such a research agenda is necessary to illuminate the role of THS in existing and future tobacco control efforts to decrease smoking initiation and smoking levels, to increase cessation attempts and sustained cessation, and to reduce the cumulative effects of tobacco use on morbidity and mortality.
aggregate exposures; biomarkers; cumulative exposure; exposure; housing; nicotine; policy; secondhand smoke; tobacco smoke
This study examined the validity of child-reported exposure to secondhand smoke (SHS) and investigated factors, such as child's age, that might affect accuracy of recall.
Study Design and Setting
Participants were drawn from a nonprobability sample of 380 families who completed baseline assessment as part of a randomized trial of a SHS reduction intervention conducted in an urban setting in Southern California. Parents and children (aged 8-13 years) retrospectively reported child's exposure to SHS using timeline follow-back methodology; reports were compared to child's urine cotinine.
Validity coefficients for parents and children were comparable (r = 0.58 vs. r = 0.53) but parents recalled three times more exposure than children (2.2 vs. 0.8 cigarettes per day; p < 0.001). Regression models predicting cotinine indicated that including child in addition to parent reports resulted in better prediction than either alone.
When there is a choice, parent reports are preferable over child reports due to decreased underreporting. However, child-reported SHS exposure had adequate validity (r > 0.50) and might be appropriate in some situations. Researchers might consider collecting both parent and child reports, since each made a unique contribution to the prediction of cotinine.
Bias; Cotinine; Passive smoking; Psychometrics; Questionnaires; Validity of results
Tobacco smoke exposure (TSE) is a serious threat to child health. Roughly 40% of children worldwide are exposed to tobacco smoke, and the very young are often "captive smokers" in homes in which others smoke.
The goal of this research project is to develop and evaluate an intervention to reduce young child tobacco smoke exposure. The objective of this paper is to document our approach to building the intervention, to describe the planned intervention, and to explore the conceptual issues regarding the intervention and its evaluation.
This project is being developed using an iterative approach. We are currently in the middle of Stage 1. In this first stage, Intervention Development, we have already conducted a comprehensive search of the professional literature and internet resources, consulted with experts in the field, and conducted several Design Workshops. The planned intervention consists of parental group support therapy, a website to allow use of an "online/offline" approach, involvement of pediatricians, use of a video simulation game ("Dr. Cruz") to teach parents about child TSE, and personalized biochemical feedback on exposure levels. As part of this stage we will draw on a social marketing approach. We plan to use in-depth interviews and focus groups in order to identify barriers for behavior change, and to test the acceptability of program components.
In Stage II, we plan to pilot the planned intervention with 5-10 groups of 10 parents each.
In Stage III, we plan to implement and evaluate the intervention using a cluster randomized controlled trial with an estimated 540 participants.
The major challenges in this research are twofold: building an effective intervention and measuring the effects of the intervention. Creation of an effective intervention to protect children from TSE is a challenging but sorely needed public health endeavor. We hope that our approach will contribute to building a stronger evidence base for control of child exposure to tobacco smoke.
ClinicalTrials.gov Identifier: NCT01335178
Tobacco smoke exposure (TSE); Secondhand smoke (SHS); tobacco control; children; health promotion; development of intervention; cluster randomized controlled trial
This study assesses the association of immediate social and legal reprimand and current smoking status among Californians of Korean descent.
Data were drawn from a population-based probability sample using a telephone survey conducted by bilingual, professional interviewers (N=2085). About 85.0% of eligible respondents completed interviews and 86.3% of participants preferred to be interviewed in Korean.
Main Outcome Measure
Smoking status was measured using CDC criteria, ever smoked 100 cigarettes and currently smoke every day or some days.
Results and Conclusion
Reports of immediate criticism by others in several settings was associated with non-smoking, but likelihood of immediate legal penalties was unrelated. Participants were far less likely to expect legal than social sanction. Results were replicated after controlling for reinforcers of smoking and ecologically relevant variables including models of smoking, primary group social support for smoking, acculturation, gender, acculturation by gender (male) interaction, age, and education. It may be efficacious to target public health interventions encouraging appropriate social sanctions of smoking in public among persons of Korean descent, and to encourage strict enforcement of legal penalties for smoking in public places.
smoking; reprimand; citation; Korean; Asian; social; legal
Modernisation and urbanisation have led to lifestyle changes and increasing risks for chronic diseases in China. Physical activity and sedentary behaviours among rural populations need to be better understood, as the rural areas are undergoing rapid transitions. This study assessed levels of physical activity and sedentary behaviours of farming and non-farming adults in rural Suixi, described activity differences between farming and non-farming seasons, and examined correlates of leisure-time physical activity (LTPA) and TV viewing.
A random sample of rural adults (n = 287) in Suixi County, Guangdong, China were surveyed in 2009 by trained interviewers. Questionnaires assessed multiple physical activities and sedentary behaviours, and their correlates. Analysis of covariance compared activity patterns across occupations, and multiple logistic regressions assessed correlates of LTPA and TV viewing. Quantitative data analyses were followed by community consultation for validation and interpretation of findings.
Activity patterns differed by occupation. Farmers were more active through their work than other occupations, but were less active and more sedentary during the non-farming season than the farming season. Rural adults in Suixi generally had a low level of LTPA and a high level of TV viewing. Marital status, household size, social modelling for LTPA and owning sports equipment were significantly associated with LTPA but not with TV time. Most findings were validated through community consultation.
For chronic disease prevention, attention should be paid to the currently decreasing occupational physical activity and increasing sedentary behaviours in rural China. Community and socially-based initiatives provide opportunities to promote LTPA and prevent further increase in sedentary behaviours.
Although Korean American women show high levels of involvement in religious practices and high prevalence of alcohol consumption, no studies have assessed the association between religious denomination and alcohol intake among this group of women. This cross-sectional study examined the associations of religious denomination and religious commitment to alcohol consumption among Korean American women in California. Polychotomous regression models were used to provide estimates of the associations between religious denomination and religious commitment to alcohol consumption. Catholic Korean American women (OR 5.61 P < 0.01) and Independent Christian women (OR 4.87 P < 0.01) showed stronger associations to heavy alcohol consumption when compared to Conservative Christian Korean American women. Path analysis suggested that specific denominations had both direct and indirect effects on the outcome of interest, and that religious commitment and drinking models served as moderators for this phenomenon.
Religious denomination; Korean American women; Alcohol consumption; Polychotomous regression; Drinking models; Path analysis
This research examines the influence of messages from religious leaders and congregants on whether Korean women are overweight or obese. Data were drawn from telephone interviews with a probability sample (N=591) of women of Korean descent living in California. Overweight or obese prevalence was measured using World Health Organization standards for Asians (BMI>23). Respondents reported the frequency of messages discouraging “excessive eating” or encouraging “exercise” from religious leaders and congregants during a typical month. When conditioned on leaders’ messages, the frequency of congregants’ messages was associated with a significantly lower probability of being overweight or obese, although messages from either in the absence of the other were unassociated with being overweight or obese. At least for Korean women, religion may help prevent obesity via religious-based social mechanisms.
We tested a combined intervention to reduce children's secondhand smoke exposure (SHSe) and help parents quit smoking.
After baseline, mothers who exposed their children younger than 4 years to 10 or more cigarettes/week were randomized to the intervention (n = 76) or usual care control condition (n = 74). Outcomes were assessed at 3, 6, 12, and 18 months. Intervention families were offered 10 in-person at home and 4 telephone counseling sessions over 6 months, and additional pre- and postquit telephone sessions. Counseling procedures included behavioral contracting, self-monitoring, and problem solving.
Parents’ reports of their smoking and children's exposure showed moderate and significant correlations with children's urine cotinine levels and home air nicotine (r = .40–.78). Thirteen (17.1%) intervention group mothers and 4 (5.4%) controls reported that they quit smoking for 7 days prior to 1 or more study measurements, without biochemical contradiction (p = .024). Results of generalized estimating equations showed significantly greater decrease in reported SHSe and mothers’ smoking in the counseled group compared with controls. Reported indoor smoking and children's urine cotinine decreased, yet group differences for changes were not significant.
Nicotine contamination of the home and resulting thirdhand exposure may have contributed to the failure to obtain a differential decrease in cotinine concentration. Partial exposure to counseling due to dropouts and lack of full participation from all family members and measurement reactivity in both conditions may have constrained intervention effects. Secondhand smoke exposure counseling may have been less powerful when combined with smoking cessation.