Aims

The average US adolescent is exposed to 34 references to alcohol in popular music daily. Although brand recognition is an independent, potent risk factor for alcohol outcomes among adolescents, alcohol brand appearances in popular music have not been systematically assessed. We aimed to determine the prevalence of and contextual elements associated with alcohol brand appearances in U.S. popular music.

Design

Qualitative content analysis.

Setting

We used Billboard Magazine to identify songs to which US adolescents were most exposed in 2005-2007. For each of the 793 songs, two trained coders independently analyzed the lyrics of each song for references to alcohol and alcohol brand appearances. Subsequent in-depth assessments utilised Atlas.ti to determine contextual factors associated with each of the alcohol brand appearances.

Measurements

Our final code book contained 27 relevant codes representing 6 categories: alcohol types, consequences, emotional states, activities, status, and objects.

Findings

Average inter-rater reliability was high (κ=0.80), and all differences were easily adjudicated. Of the 793 songs in our sample, 169 (21.3%) explicitly referred to alcohol, and of those, 41 (24.3%) contained an alcohol brand appearance. Consequences associated with alcohol were more often positive than negative (41.5% vs. 17.1%, P<.001). Alcohol brand appearances were commonly associated with wealth (63.4%), sex (58.5%), luxury objects (51.2%), partying (48.8%), other drugs (43.9%), and vehicles (39.0%).

Conclusions

One-in-five songs sampled from U.S. popular music had explicit references to alcohol, and one quarter of these mentioned a specific alcohol brand. These alcohol brand appearances are commonly associated with a luxury lifestyle characterised by wealth, sex, partying, and other drugs.

BACKGROUND

Although processes of care are common proxies for health care quality, their associations with medical outcomes remain uncertain.

METHODS

For 2076 patients hospitalized with pneumonia from 32 emergency departments, we used multilevel logistic regression modeling to assess independent associations between patient outcomes and the performance of 4 individual processes of care (assessment of oxygenation, blood cultures, and rapid initiation [<4 hours] and appropriate selection of antibiotic therapy) and the cumulative number of processes of care performed.

RESULTS

Overall, 141 patients (6.8%) died. Mortality was 0.3% to 1.7% lower for patients who had each of the individual processes of care performed (P ≥ .13 for each comparison); mortality was 7.5% for patients who had 0 to 2 processes of care, 7.2% for those with 3 processes of care, and 5.8% for those with all 4 processes of care performed (P = .39). Mortality was not significantly associated with either individual or cumulative process measures in multivariable models.

CONCLUSION

Neither the individual processes of care nor the cumulative number performed is associated with short-term mortality for pneumonia.

Setting

While waterpipe and cigarette smoking are well studied in Syria and Lebanon, data from Jordan are sparse.

Objectives

To characterize the relative prevalence of waterpipe tobacco and cigarette smoking among university students in Jordan, and to compare the demographic and environmental factors associated with each form of tobacco use.

Design

We surveyed 1845 students randomly recruited from four universities in Jordan. We used multivariable logistic regression controlling for clustering of individuals within universities to determine associations between demographic and environmental covariates and waterpipe tobacco and cigarette use.

Results

Waterpipe tobacco smoking rates were 30% in the past 30 days and 56% ever, and cigarette smoking rates were 29% in the past 30 days and 57% ever. Past 30-day waterpipe tobacco smoking rates were 59% for males and 13% for females. Compared with males, females had substantially lower odds of being current waterpipe (OR=0.12, 95% CI=0.10–0.15) or cigarette (OR=0.08, 95% CI=0.05–0.14) smokers. Compared with waterpipe tobacco smoking, current cigarette smoking was more significantly associated with markers of high socioeconomic status.

Conclusion

Waterpipe tobacco smoking is as common as cigarette smoking among Jordanian university students. While cigarette smoking is consistently associated with high socioeconomic status, waterpipe tobacco smoking is more evenly distributed across various populations.

Background

Establishments dedicated to hookah tobacco smoking have recently proliferated and helped introduce hookah use to U.S. communities.

Purpose

To conduct a comprehensive, qualitative assessment of websites promoting these establishments.

Methods

In June 2009, a systematic search process was initiated to access the universe of websites representing major hookah tobacco smoking establishments. In 2009–2010, codebook development followed an iterative paradigm involving three researchers and resulted in a final codebook consisting of 36 codes within eight categories. After two independent coders had nearly perfect agreement (Cohen’s κ=0.93) on double-coding the data in the first 20% of sites, the coders divided the remaining sites and coded them independently. A thematic approach to the synthesis of findings and selection of exemplary quotations was used.

Results

The search yielded a sample of 144 websites originating from states in all U.S. regions. Among the hookah establishments promoted on the websites, 79% served food and 41% served alcohol. Of the websites, none required age verification, <1% included a tobacco-related warning on the first page, and 4% included a warning on any page. Although mention of the word tobacco was relatively uncommon (appearing on the first page of only 26% sites and on any page of 58% of sites), the promotion of flavorings, pleasure, relaxation, product quality, and cultural and social aspects of hookah smoking was common.

Conclusions

Websites may play a role in enhancing or propagating misinformation related to hookah tobacco smoking. Health education and policy measures may be valuable in countering this misinformation.

With today’s focus on the translation of basic science discoveries into clinical practice, the demand for physician-scientists is growing. Yet, physicians have always found it challenging to juggle the demands of clinical care with the time required to perform research. The Research on Careers Workgroup of the Institute for Clinical Research Education at the University of Pittsburgh developed a comprehensive model for career success that would address, and allow for the evaluation of, the personal factors, organizational factors, and their interplay that contribute to career success. With this model, leaders of training programs could identify early opportunities for intervening with potential physician-scientists to ensure career success. Through an iterative process described in this article, the authors identified and examined potential models for career success from the literature, added other elements determined to be significant, and developed a comprehensive model to assess factors associated with career success for physician-scientists. The authors also present examples of ways in which this model can be adapted and applied to specific situations to assess the effects of different factors on career success.

Communities are being encouraged to develop locally-based interventions to address environmental risk factors for obesity. Online public directories represent an affordable and easily accessible mechanism for mapping community food environments, but may have limited utility in rural areas. The primary aim of this study was to evaluate the efficacy of public directories versus rigorous onsite field verification to characterize the community food environment in 32 geographically-dispersed towns from two rural states, covering 1237.6 square miles. Eight types of food outlets were assessed in 2007, including food markets and eating establishments, first using two publically available online directories followed by onsite field verification by trained coders. Chi-square and univariate binomial regression were used to determine whether the proportion of outlets accurately listed varied by food outlet type or town population. Among 1340 identified outlets, only 36.9% were accurately listed through public directories; 29.6% were not listed but were located during field observation. Accuracy varied by outlet type, being most accurate for big box stores and least accurate for farm/produce stands. Overall, public directories accurately identified less than half of the food outlets. Accuracy was significantly lower for rural and small towns compared to mid-size and urban towns. In this geographic sample, public directories seriously misrepresented the actual distribution of food outlets, particularly for rural and small towns. To inform local obesity-prevention efforts, communities should strongly consider utilizing field verification to characterize the food environment in low population areas.

Introduction:

Exposure to smoking in movies is strongly associated with smoking uptake and maintenance among adolescents. However, little is known about what features of movies (e.g., the context for smoking or motives for a character smoking) moderate the association between exposure to movie smoking and adolescent smoking. This laboratory study examined whether exposure to movie smoking that is portrayed as having a clear motive is associated with the desire to smoke differently than smoking that is portrayed as having no clear motive.

Methods:

A sample of 77 middle school students (mean age of 12.8 years, 62% male, 60% Caucasian) viewed movie clips that portrayed smoking as helping to facilitate social interaction, to relax, to appear rebellious, or as having no clear motive. After exposure to each clip, participants rated their desire to smoke.

Results:

Exposure to clips where smoking was portrayed as helping characters to relax was associated with a significantly stronger desire to smoke compared with clips where the motive for smoking was unclear. Desire to smoke was similar for clips where no motive was clear, social smoking clips, and rebellious smoking clips.

Discussion:

These results suggest that the way that smoking is portrayed in movies is important in determining its effect on adolescent smoking.

Background

Burnout is a pervasive problem among clinicians. However, little is known about burnout among early-career clinical investigators, who must balance clinical responsibilities with challenges related to research. We aimed to determine the prevalence of and demographic associations with burnout in a cohort of early-career clinical investigators.

Methods

A cross-sectional questionnaire was administered to 179 trainees at the University of Pittsburgh Institute for Clinical Research Education in 2007-2008. We used chi-square analyses and Fisher’s exact test to determine whether associations between demographic characteristics and burnout were significant.

Results

Of the participants, 29 (16%) reported feeling burned out. Burnout was more prevalent among those over 35 years of age relative to their younger counterparts (29% vs. 13%, p=.01) and among females relative to males (22% vs. 10%, p=.03). With regard to race and ethnicity, burnout was most common among underrepresented minorities (30%) followed by Caucasians (18%) and Asians (3%); these differences were significant (p=.02).

Discussion

Considering the early-career status of these research trainees, rates of burnout were concerning. Certain demographic subgroups—including older trainees, females, and underrepresented minorities—had particularly high rates of burnout and may benefit from interventions that provide them with skills needed to sustain successful clinical research careers.

Background

K2 or "spice" has emerged as a popular legal alternative to marijuana among adolescents and young adults. However, no data has been published assessing prevalence of and associations with ever K2 use in any population. This study's aims were to examine prevalence of ever K2 use among a sample of college students, to determine characteristics of persons who use K2, and to access the association between K2 and other drug use.

Findings

Ever use of K2 was reported by 69 (8%) of the sample of 852 college students. Response rate was 36%. Bivariate and multivariate analyses assessed whether sociodemographic characteristics and other drug use were associated with ever use of K2. Ever use of K2 was reported by 69 (8%) of the sample. Among these 69 individuals, 61 (88%) had used a cigarette and 25 (36%) had used a hookah to smoke K2. In multivariate analyses, K2 use was more common in males (vs. females, adjusted Odds Ratio (aOR) = 2.0, 95% Confidence Interval (CI) = 1.2-3.5, p = 0.01) and 1st or 2nd year college students (vs. 3rd year or above, aOR = 2.4, 95% CI = 1.2-5.0, p = 0.02).

Conclusions

Ever use of K2 in this sample was higher than ever use of many other drugs of abuse that are commonly monitored in adolescents and young adults. Although DEA had banned five synthetic cannabinoids recently, clinicians and public health officials concerned with substance abuse in youth should be aware of and monitor the use of this drug in college students over time.

Introduction:

Although water pipe tobacco smoking is common in Lebanon and Syria, prevalence in neighboring Jordan is uncertain. The purposes of this study were (a) to assess the prevalence of water pipe tobacco smoking among university students in Jordan and (b) to determine associations between sociodemographic variables and water pipe tobacco smoking in this population.

Methods:

A trained interviewer administered a questionnaire among randomly selected students at four prominent universities in Jordan. The questionnaire assessed sociodemographic data, personal history of water pipe tobacco use, and attitudes regarding water pipe tobacco smoking. We used logistic regression to determine independent associations between sociodemographic and attitudinal factors and each of two dependent variables: ever use of water pipe and use at least monthly.

Results:

Of the 548 participants, 51.8% were male and mean age was 21.7 years. More than half (61.1%) had ever smoked tobacco from a water pipe, and use at least monthly was reported by 42.7%. Multivariable analyses controlling for all relevant factors demonstrated significant associations between ever use and only two sociodemographic factors: (a) gender (for women compared with men, odds ratio [OR] = 0.11, 95% CI = 0.07–0.17) and (b) income (for those earning 500–999 Jordanian dinar (JD) monthly vs. <250 JD monthly, OR = 2.37, 95% CI = 1.31–4.31). There were also significant associations between perception of harm and addictiveness and each outcome.

Discussion:

Water pipe tobacco smoking is highly prevalent in Jordan. Although use is associated with male gender and upper middle income levels, use is widespread across other sociodemographic variables. Continued surveillance and educational interventions emphasizing the harm and addictiveness of water pipe tobacco smoking may be valuable in Jordan.

Background

The Ragins and McFarlin Mentor Role Instrument (RMMRI) was originally developed to measure perceptions of mentoring relationships in research and development organizations. The current study was designed to evaluate the RMMRI’s reliability and validity when the instrument was administered to clinical and translational science trainees at an academic medical center.

Methods

The 33-item RMMRI was administered prospectively to a cohort of 141 trainees at the University of Pittsburgh in 2007-2008. Likert-scale items focused on perceptions of 5 mentoring roles in the career dimension (sponsor, coach, protector, challenger, and promoter) and 6 mentoring roles in the psychosocial dimension (friend, social associate, parent, role model, counselor, and acceptor). Outcome items included overall perceptions of mentoring satisfaction and effectiveness.

Results

Of 141 trainees, 53% were male, 66% were white, 22% were Asian, and 59% were medical doctors. Mean age was 32 years. Analyses showed strong within-factor inter-item correlations (Pearson coefficients of 0.57-0.93); strong internal consistency (Cronbach alphas of 0.82-0.97); confirmatory factorial validity, as demonstrated by confirmatory factor analysis of the 2 mentoring dimensions, 11 mentoring roles, and 33 RMMRI items; and concurrent validity, as demonstrated by strong correlations (Pearson coefficients of 0.56-0.71) between mentoring dimensions, satisfaction, and effectiveness.

Conclusions

The RMMRI shows reliability and validity in capturing the multidimensional nature of mentoring when administered to clinical and translational science trainees in the academic setting.

Media literacy has the potential to alter outcomes in various fields, including education, communication, and public health. However, measurement of media literacy remains a critical challenge in advancing this field of inquiry. In this manuscript, we describe the development and testing of a pilot measure of media literacy. Items were formed based on a composite conceptual model and administered to college communications students (n = 34). Each of three media literacy subscales had good internal consistency reliability (α1 = 0.74, α2 = 0.79, α3 = 0.75). Principal components analysis revealed a five-factor structure that corresponded closely with the underlying conceptual model. As was expected, the media literacy scale was significantly correlated with a composite critical thinking measure (r = 0.32, P = .03). This scale may be valuable for the measurement of media literacy and the assessment of media literacy interventions.

Objective

To use ecological momentary assessment techniques to measure the association of major depressive disorder (MDD) with media use.

Design

Data were collected using an ecological momentary assessment protocol with cellular telephone–based brief interviews.

Setting

Participants received as many as 60 telephone calls from a trained staff member during 5 extended week-ends in an 8-week period.

Participants

One hundred six adolescent participants who were part of a larger neurobehavioral study of depression in Pittsburgh from January 1, 2003, through December 31, 2008.

Main Exposure

At each call, participants were asked whether they were using the following 5 types of media: television or movies, music, video games, Internet, and print media, such as magazines, newspapers, and books.

Main Outcome Measures

We developed multivariable models to determine the independent association of each type of media use with MDD, controlling for socio-demographic variables.

Results

Of the 106 participants, 46 were diagnosed as having MDD. In multivariable models controlling for age, sex, and race, each increasing quartile of audio use was associated with an 80% increase in the odds of having MDD (odds ratio, 1.8; 95% confidence interval, 1.1–2.8; P = .01 for trend). Conversely, each increasing quartile of print media use was associated with a 48% decrease in the odds of having MDD (odds ratio, 0.5; 95% confidence interval, 0.3–0.9; P = .009 for trend).

Conclusions

Major depressive disorder is positively associated with popular music exposure and negatively associated with reading print media such as books. Further research elucidating the directionality and strength of these relationships may help advance understanding of the relationships between media use and MDD.

Background

Cannabis use is frequently referenced in American popular music, yet it remains uncertain whether exposure to these references is associated with actual cannabis use. We aimed to determine if exposure to cannabis in popular music is independently associated with current cannabis use in a cohort of urban adolescents.

Methods

We surveyed all 9th grade students at three large U.S. urban high schools. We estimated participants’ exposure to lyrics referent to cannabis with overall music exposure and content analyses of their favorite artists’ songs. Outcomes included current (past 30 day) and ever use of cannabis. We used multivariable regression to assess independent associations between exposures and outcomes while controlling for important covariates.

Results

Each of the 959 participants was exposed to an estimated 40 cannabis references per day (standard deviation = 104). Twelve percent (N = 108) were current cannabis users and 32% (N=286) had ever used cannabis. Compared with those in the lowest tertile of total cannabis exposure in music, those in the highest tertile of exposure were almost twice as likely to have used cannabis in the past 30 days (odds ratio = 1.83; 95% confidence interval = 1.04, 3.22), even after adjusting for sociodemographic variables, personality characteristics, and parenting style. As expected, however, there was no significant relationship between our cannabis exposure variable and a sham outcome variable of alcohol use.

Conclusions

This study supports an independent association between exposure to cannabis in popular music and early cannabis use among urban American adolescents.

Background

Myocardial recovery after VAD is rare but appears more common in non-ischemic cardiomyopathies (NICM). We sought to evaluate left ventricular (LV) end diastolic diameter (LVEDD) for predicting recovery after ventricular assist device (VAD).

Methods and Results

NICM patients receiving long-term mechanical support 1996–2008 were reviewed. Subjects were divided into 3 groups: mild, moderate and severe dilation (Group A: LVEDD <6.0 cm [n=22]; Group B: 6.0–7.0 cm [n=32]; Group C: >7.0 cm [n=48], respectively). Overall, recovery (successful explant without transplantation) occurred in 14 of 102 subjects (14%). Of these, 2 died and 2 required transplantation within one year. Recovery was more common in patients without LV dilation (Groups A/B/C = 32%/22%/0 %, P<0.001), as was sustained recovery (alive and transplant free one year after explant; A/B/C =27%/10%/0%, P=0.001). Of the recovery patients in Group A, 6/7 (86%) had sustained recovery versus 3/6 (50%) in Group B.

Conclusions

Recovery occurred in 32% of NICM patients without significant LV dilation at time of VAD, the majority of whom experienced significant sustained recovery. Recovery was not evident in those with severe LV dilation. Routine echocardiography at the time of implant may assist in targeting patients for recovery after VAD.

Objective

To identify different components of smoking normative beliefs and determine if each component is independently associated with two clinically relevant measures of smoking in adolescents.

Design

Cross-sectional survey.

Setting

One large suburban high school.

Participants

1211 high school students aged 14–18.

Main outcome measures

Current smoking and susceptibility to smoking.

Results

Nineteen percent (N=216) of students reported current smoking, and 40% (N=379) of the non-smokers were susceptible to smoking. Factor analysis identified three normative beliefs constructs, labeled “perceived prevalence of smoking,” “perceived popularity of smoking among elite/successful elements of society,” and “disapproval of smoking by parents/peers.” On average, students felt that 56% of people in the US smoke cigarettes. Twenty-four percent (24%) believed that wealthy people smoke more than poor people. Multiple logistic regression showed that each of the three constructs was independently associated with current smoking (Adjusted OR = 1.05, 95% CI: 1.02, 1.08; Adjusted OR = 1.12, 95% CI: 1.02, 1.23; Adjusted OR = 0.66, 95% CI: 0.59, 0.75; respectively) even after controlling for covariates. Students’ perceptions of smoking among successful/elite and disapproval by parents/peers were independently associated with susceptibility to future smoking (Adjusted OR = 1.20, 95% CI: 1.11, 1.29; Adjusted OR = 0.87, 95% CI = 0.79, 0.96; respectively).

Conclusions

Adolescents’ normative beliefs about smoking are multidimensional and include at least three distinct components, each of which was independently related to smoking outcomes. These distinct components should be considered in the design and evaluation of programs related to prevention and cessation of adolescent smoking.

BACKGROUND

Using a water pipe to smoke tobacco is increasing in prevalence among US college students, and it may also be common among younger adolescents. The purpose of this study of Arizona middle and high school students was to examine the prevalence of water-pipe tobacco smoking, compare water-pipe tobacco smoking with other forms of tobacco use, and determine associations between sociodemographic variables and water-pipe tobacco smoking in this population.

METHODS

We added items assessing water-pipe tobacco smoking to Arizona’s 2005 Youth Tobacco Survey and used them to estimate statewide water-pipe tobacco smoking prevalence among various demographic groups by using survey weights. We also used multiple logistic regression to determine which demographic characteristics had independent relationships with each of 2 outcomes: ever use of water-pipe to smoke tobacco and water-pipe tobacco smoking in the previous 30 days.

RESULTS

Median age of the sample was 14. Accounting for survey weights, among middle school students, 2.1% had ever smoked water-pipe tobacco and 1.4% had done so within the previous 30 days. Among those in high school, 10.3% had ever smoked from a water pipe and 5.4% had done so in the previous 30 days, making water-pipe tobacco smoking more common than use of smokeless tobacco, pipes, bidis, and kreteks (clove cigarettes). In multivariate analyses that controlled for covariates, ever smoking of water-pipe tobacco was associated with older age, Asian race, white race, charter school attendance, and lack of plans to attend college.

CONCLUSIONS

Among Arizona youth, water pipe is the third most common source of tobacco after cigarettes and cigars. Increased national surveillance and additional research will be important for addressing this threat to public health.

We aimed to determine which media exposures are most strongly associated with marijuana and alcohol use among adolescents. In 2004, we surveyed 1,211 students at a large high school in suburban Pittsburgh regarding substance use, exposure to entertainment media, and covariates. Of the respondents, 52% were female, 8% were non-White, 27% reported smoking marijuana, and 60% reported using alcohol. They reported average exposure to 8.6 hr of media daily. In adjusted models, exposure to music was independently associated with marijuana use, but exposure to movies was independently associated with alcohol use. Implications, limitations, and suggestions for further research are discussed.

The purpose of this study was to investigate the psychometric properties of a child self efficacy scale for learning, peer interactions, and resisting pressure to use drugs, to use in an elementary school drug prevention education program based on social cognitive theory. A diverse cohort of 392 4th and 5th grade students completed the 20-item self efficacy scale and social support and social skills instruments. The results provide evidence for a valid and reliable 3-factor self efficacy scale. Subscale internal consistency reliability was good to excellent (Cronbach’s alpha = 0.75, 0.83, 0.91). Construct validity was supported by correlations between each subscale and social skills, social support, and demographic data. The scale has potential as a tool to measure self efficacy in children related to learning, peer interactions, and resisting peer pressure to use drags and to help shape drag education programs.

Organizations recommend media literacy to reduce tobacco use, and higher media literacy has been associated with lower smoking among high school students. The relationship between smoking media literacy and tobacco use, however, has not been systematically studied among college students. The purpose of this study was to determine the association between smoking and smoking media literacy among college students. We conducted the National College Health Assessment (NCHA) at a large, urban university, adding six items measuring smoking media literacy. A total of 657 students responded to this random sample e-mail survey. We used multiple logistic regression to determine independent associations between smoking media literacy items and current smoking. The media literacy scale was internally consistent (α = 0.79). Of the respondents, 21.5% reported smoking cigarettes over the past 30 days. In a fully adjusted multivariate model, participants with medium media literacy had an odds ratio (OR) for current smoking of 0.45 (95% CI = 0.29, 0.70), and those with high media literacy had an OR for current smoking of 0.38 (95% CI = 0.20, 0.70). High smoking media literacy is independently associated with lower odds of smoking. Smoking media literacy may be a valuable construct to address in college populations.

Background

Two thirds of all sexual references in music are degrading in nature, yet it remains uncertain whether these references promote earlier sexual activity. The purpose of this study was to determine if exposure to lyrics describing degrading sex in popular music is independently associated with sexual behavior in a cohort of urban adolescents.

Methods

All ninth-grade health students at three large urban high schools completed in-school surveys in 2006 and 2007. Participants’ exposure to lyrics describing degrading sex was computed with overall music exposure and content analyses of their favorite artists’ songs. Outcomes included sexual intercourse and progression along a noncoital sexual continuum. Multivariable regression was used to assess independent associations between exposure to lyrics describing degrading sex and outcomes.

Results

The 711 participants were exposed to 14.7 hours each week of songs with lyrics describing degrading sex (SD=17.0). Almost one third of participants (n=216) had previously been sexually active. Compared to those with the least exposure to lyrics describing degrading sex, those with the most exposure were more than twice as likely to have had sexual intercourse (OR=2.07; 95% CI=1.26, 3.41), even after adjusting for all covariates. Similarly, among those who had not had sexual intercourse, those in the highest tertile of exposure to lyrics describing degrading sex were nearly twice as likely to have progressed along a noncoital sexual continuum (OR=1.88; 95% CI=1.23, 2.88) compared to those in the lowest tertile. Finally, the relationships between exposure to lyrics describing nondegrading sex and sexual outcomes were not significant.

Conclusions

This study supports an association between exposure to lyrics describing degrading sex in popular music and early sexual experience among adolescents.

Purpose

To determine whether media literacy concerning tobacco use is independently associated with two clinically relevant outcome measures in adolescents: current smoking and susceptibility to smoking.

Methods

We asked high school students aged 14–18 years to complete a survey that included a validated 18-item smoking media literacy (SML) scale, items assessing current smoking and susceptibility to future smoking, and covariates shown to be related to smoking. We used logistic regression to assess independent associations between the two outcome measures and SML.

Results

Of the 1211 students who completed the survey, 19% reported current smoking. Controlling for all potential confounders of smoking, we found that an increase of one point (out of 10) in SML was independently associated with an odds ratio for smoking of .84 (95% confidence interval [CI] .71–.99). Compared with students below the median score on the SML scale, students above the median had an odds ratio for smoking of .57 (95% CI .37–.87). Of the students who were nonsmokers, 40% were classified as susceptible to future smoking. Controlling for all potential confounders of smoking, we found that an increase of one point (out of 10) was independently associated with and an odds ratio for smoking susceptibility of .68 (95% CI .58–.79). Compared with students below the median SML, students above the median SML had an odds ratio for smoking susceptibility of .49 (95% CI .35–.68).

Conclusions

In this sample of high school students, higher SML is independently associated with reduced current smoking and reduced susceptibility to future smoking. © 2006 Society for Adolescent Medicine. All rights reserved.

Objective

To examine the joint effects of movie smoking exposure and team sports participation on established smoking.

Design

Longitudinal study.

Setting

School- and telephone-based surveys in New Hampshire and Vermont between September 1999 through November 1999 and February 2006 through February 2007.

Participants

A total of 2048 youths aged 16 to 21 years at follow-up.

Main Exposures

Baseline movie smoking exposure categorized in quartiles assessed when respondents were aged 9 to 14 years and team sports participation assessed when respondents were aged 16 to 21 years.

Main Outcome Measure

Established smoking (having smoked ≥100 cigarettes in one’s lifetime) at follow-up.

Results

At follow-up, 353 respondents (17.2%) were established smokers. Exposure to the highest quartile of movie smoking compared with the lowest increased the likelihood of established smoking (odds ratio=1.63; 95% confidence interval, 1.03–2.57), and team sports nonparticipants compared with participants were twice as likely to be established smokers (odds ratio=2.01; 95% confidence interval, 1.47–2.74). The joint effects of movie smoking exposure and team sports participation revealed that at each quartile of movie smoking exposure, the odds of established smoking were greater for team sports nonparticipants than for participants. We saw a dose-response relationship of movie smoking exposure for established smoking only among team sports participants.

Conclusions

Team sports participation clearly plays a protective role against established smoking, even in the face of exposure to movie smoking. However, movie smoking exposure increases the risk of established smoking among both team sports participants and nonparticipants. Parents, teachers, coaches, and clinicians should be aware that encouraging team sports participation in tandem with minimizing early exposure to movie smoking may offer the greatest likelihood of preventing youth smoking.

Objective

It is essential to train health care providers to deliver care sensitive to the needs of diverse individuals with varying degrees of health literacy. We aimed to evaluate an innovative, theory-based, educational intervention involving social marketing and health literacy.

Methods

In 2006 at a large medical school, all first-year students were exposed to the intervention. They completed pre- and post-test anonymous surveys including demographic data, covariates, and key outcome variables. Paired t-tests and multiple linear regression were used to evaluate the intervention and to determine independent associations among the key outcome variables.

Results

Post-intervention scores were significantly higher than pre-intervention scores for social marketing (3.31 versus 1.90, p < 0.001), health literacy (3.41 versus 2.98, p < 0.001), and comfort in brochure development (3.11 versus 2.52, p < 0.001) (N = 83). After controlling for demographic and covariate data, health literacy and comfort in brochure development were independent predictors of comfort interacting with diverse populations.

Conclusion

A brief intervention involving social marketing and health literacy can improve skills that improve medical students’ comfort with patients of diverse backgrounds.

Practice implications

Health care providers can be taught educational principles and skills involved in developing effective patient education materials. These skills may improve providers’ comfort with direct patient interaction.