Although cigarette smoking is decreasing in the U.S., hookah tobacco smoking (HTS) is an emerging trend associated with substantial toxicant exposures. The purpose of this study was to assess how a representative sample of U.S. tobacco control policies may apply to HTS.
We examined municipal, county, and state legal texts that apply to the largest 100 cities in the U.S. We developed a summary policy variable that distinguishes cities without clean air legislation preventing cigarette or HTS in freestanding bars; with anti-smoking legislation exempting HTS by name; with anti-smoking legislation providing for a different exemption under which HTS may fall; and with anti-smoking legislation and no clear exemption governing HTS. We used multinomial logistic regression to determine associations between community-level socio-demographic variables and our policy outcome variable.
Although 73 of the 100 largest cities in the U.S. have laws that disallow cigarette smoking in bars, HTS may be allowed due to exemptions in 69 of these 73 cities. While 4 of these cities have passed legislation specifically exempting HTS, 65 may permit HTS via generic tobacco retail establishment exemptions. Compared with cities without clean air legislation, the cities in which HTS may be exempted had denser populations.
Although three-fourths of the largest cities in the U.S. disallow cigarette smoking in bars, HTS may be permitted in nearly 90% of these cities via exemptions. Closing this gap in clean air regulation may significantly reduce exposure to HTS.
YouTube is now the second most visited site on the Internet. We aimed to compare characteristics of and messages conveyed by cigarette- and hookah-related videos on YouTube.
Systematic search procedures yielded 66 cigarette-related and 61 hookah-related videos. After 3 trained qualitative researchers used an iterative approach to develop and refine definitions for the coding of variables, 2 of them independently coded each video for content including positive and negative associations with smoking and major content type.
Median view counts were 606,884 for cigarettes and 102,307 for hookahs (P<.001). However, the number of comments per 1,000 views was significantly lower for cigarette-related videos than for hookah-related videos (1.6 vs 2.5, P=.003). There was no significant difference in the number of “like” designations per 100 reactions (91 vs. 87, P=.39). Cigarette-related videos were less likely than hookah-related videos to portray tobacco use in a positive light (24% vs. 92%, P<.001). In addition, cigarette-related videos were more likely to be of high production quality (42% vs. 5%, P<.001), to mention short-term consequences (50% vs. 18%, P<.001) and long-term consequences (44% vs. 2%, P<.001) of tobacco use, to contain explicit antismoking messages (39% vs. 0%, P<.001), and to provide specific information on how to quit tobacco use (21% vs. 0%, P<.001).
Although Internet user–generated videos related to cigarette smoking often acknowledge harmful consequences and provide explicit antismoking messages, hookah-related videos do not. It may be valuable for public health programs to correct common misconceptions regarding hookah use.
waterpipe; hookah; cigarette; internet; user-generated content
Teaching of health and medical concepts in the K-12 curriculum may help improve health literacy.
The purpose of this project was to determine acceptability and preliminary efficacy of pilot implementation of a health literacy curriculum using brief clips from a popular television program.
Participants included 55 ninth-grade students in a low-income school with a high proportion of minority students. The curriculum used three brief interspersed segments from the television show ER to teach basic topics in cardiology. After the 30-minute experimental curriculum, students completed open-ended surveys which were coded qualitatively.
The most common codes described “enjoyment” (N=28), “acquisition of new knowledge” (N=28), “informative” (N=15), “interesting” (N=12), and “TV/video” (N=10). We found on average 2.9 examples of medical content per participant. Of the 26 spontaneously-generated verifiable statements, 24 (92.3%) were judged as accurate by two independent coders (κ=0.70, P=.0002).
Use of brief segments of video material contributed to the acceptability of health education curricula without detracting from students’ acquisition of accurate information.
Translation to Health Education Practice
Health education practitioners may wish to include brief clips from popular programming to motivate students and provide context for health-related lessons.
Segmentation of populations may facilitate development of targeted substance abuse prevention programs. We aimed to partition a national sample of university students according to profiles based on substance use.
We used 2008–2009 data from the National College Health Assessment from the American College Health Association. Our sample consisted of 111,245 individuals from 158 institutions.
We partitioned the sample using cluster analysis according to current substance use behaviors. We examined the association of cluster membership with individual and institutional characteristics.
Cluster analysis yielded six distinct clusters. Three individual factors—gender, year in school, and fraternity/sorority membership—were the most strongly associated with cluster membership.
In a large sample of university students, we were able to identify six distinct patterns of substance abuse. It may be valuable to target specific populations of college-aged substance users based on individual factors. However, comprehensive intervention will require a multifaceted approach.
University; tobacco; marijuana; alcohol; cluster analysis
Exposure to smoking in movies has been linked to adolescent smoking uptake. However, beyond linking amount of exposure to smoking in movies with adolescent smoking, whether the way that smoking is portrayed in movies matters for influencing adolescent smoking has not been investigated. This study experimentally examined how motivation for smoking depicted in movies affects self-reported future smoking risk (a composite measure with items that assess smoking refusal self-efficacy and smoking intentions) among early adolescents.
A randomized laboratory experiment was used. Adolescents were exposed to movie scenes depicting one of three movie smoking motives: social smoking motive (characters smoked to facilitate social interaction); relaxation smoking motive (characters smoked to relax); or no smoking motive (characters smoked with no apparent motive, i.e., in neutral contexts and/or with neutral affect). Responses to these movie scenes were contrasted (within subjects) to participants’ responses to control movie scenes in which no smoking was present; these control scenes matched to the smoking scenes with the same characters in similar situations but where no smoking was present. A total of 358 adolescents, aged 11–14 years, participated.
Compared with participants exposed to movie scenes depicting characters smoking with no clear motive, adolescents exposed to movie scenes depicting characters smoking for social motives and adolescents exposed to movie scenes depicting characters smoking for relaxation motives had significantly greater chances of having increases in their future smoking risk.
Exposure to movies that portray smoking motives places adolescents at particular risk for future smoking.
tobacco; smoking; advertising; marketing; adolescence
Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it may also be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes.
Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source), sample data (e.g., number of study participants, demographics), intervention and control details, outcomes data, and quality measures were abstracted independently by two researchers.
Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of <12 weeks, and only 11% of studies blinded researchers.
There is potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help build evidence in this emerging area.
Latin America has the highest prevalence of tobacco use by youth. Higher media literacy, defined as the ability to analyze and evaluate media messages, has been associated with lower smoking among youth in the United States. The objective of this study was to determine whether media literacy related to smoking is independently associated with current smoking and susceptibility to future smoking in a sample of mostly indigenous youth in Jujuy, Argentina.
In 2006, a self-administered survey was conducted among 10th grade students sampled from 27 randomly selected urban and rural schools in Jujuy. Survey items measured smoking behavior (ever, never, and current), susceptibility to future smoking among never-smokers (definitely not accept a cigarette from a friend or to smoke in the future), 5 items assessing smoking media literacy (SML), and risk factors for smoking.
Of the 3,470 respondents, 1,170 (34%) reported having smoked in the previous 30 days (current). Of the 1,430 students who had never smoked, 912 (64%) were susceptible to future smoking. High media literacy was present in 38%. Using multiple logistic regression, fully adjusted models showed that high media literacy was significantly associated as a protective factor of being a current smoker (odds ratio [OR] = 0.81; 95% CI = 0.67–0.97) and of being susceptible to future smoking (OR = 0.73; 95% CI = 0.58–0.92) among those who had never smoked.
Among youth in Jujuy, higher SML was significantly associated with both lower current smoking and susceptibility to future smoking. Teaching SML may be a valuable component in a prevention intervention in this population.
It is not known whether exposure to smoking depicted in movies carries greater influence during early or late adolescence. We aimed to quantify the independent relative contribution to established smoking of exposure to smoking depicted in movies during both early and late adolescence.
We prospectively assessed 2049 nonsmoking students recruited from 14 randomly selected public schools in New Hampshire and Vermont. At baseline enrollment, students aged 10–14 years completed a written survey to determine personal, family, and sociodemographic characteristics and exposure to depictions of smoking in the movies (early exposure). Seven years later, we conducted follow-up telephone interviews to ascertain follow-up exposure to movie smoking (late exposure) and smoking behavior. We used multiple regression models to assess associations between early and late exposure and development of established smoking.
One-sixth (17.3%) of the sample progressed to established smoking. In analyses that controlled for covariates and included early and late exposure in the same model, we found that students in the highest quartile for early exposure had 73% greater risk of established smoking than those in the lowest quartile for early exposure (27.8% vs 8.6%; relative risk for Q4 vs Q1 = 1.73, 95% confidence interval = 1.14 to 2.62). However, late exposure to depictions of smoking in movies was not statistically significantly associated with established smoking (22.1% vs 14.0%; relative risk for Q4 vs Q1 = 1.13, 95% confidence interval = 0.89 to 1.44). Whereas 31.6% of established smoking was attributable to early exposure, only an additional 5.3% was attributable to late exposure.
Early exposure to smoking depicted in movies is associated with established smoking among adolescents. Educational and policy-related interventions should focus on minimizing early exposure to smoking depicted in movies.
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.
Qualitative content analysis.
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.
Our final code book contained 27 relevant codes representing 6 categories: alcohol types, consequences, emotional states, activities, status, and objects.
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%).
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.
Alcohol; music; product placement; marketing; advertising; adolescent; vodka; tequila; rap music; hip-hop music; country music
Although processes of care are common proxies for health care quality, their associations with medical outcomes remain uncertain.
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.
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.
Neither the individual processes of care nor the cumulative number performed is associated with short-term mortality for pneumonia.
Pneumonia; Processes of care; Quality of care
While waterpipe and cigarette smoking are well studied in Syria and Lebanon, data from Jordan are sparse.
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.
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.
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.
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.
hookah; narghile; college; Middle East
Establishments dedicated to hookah tobacco smoking have recently proliferated and helped introduce hookah use to U.S. communities.
To conduct a comprehensive, qualitative assessment of websites promoting these establishments.
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.
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.
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.
Food outlets; rural; fast food; convenience store; field validation; obesity
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.
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.
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.
These results suggest that the way that smoking is portrayed in movies is important in determining its effect on adolescent smoking.
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.
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.
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).
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.
Burnout; clinical researchers; exhaustion; cynicism; under-represented minority; African-American; Hispanic; female; clinical research training programs
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
media literacy; measurement; critical thinking; assessment
To use ecological momentary assessment techniques to measure the association of major depressive disorder (MDD) with media use.
Data were collected using an ecological momentary assessment protocol with cellular telephone–based brief interviews.
Participants received as many as 60 telephone calls from a trained staff member during 5 extended week-ends in an 8-week period.
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.
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.
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).
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.
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.
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.
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.
This study supports an independent association between exposure to cannabis in popular music and early cannabis use among urban American adolescents.
Cannabis; adolescence; music; popular music; mass media; iPod; radio
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.
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.
Heart-assist device; Heart failure; Remodeling; Cardiomyopathy
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.
One large suburban high school.
1211 high school students aged 14–18.
Main outcome measures
Current smoking and susceptibility to smoking.
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).
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.
smoking; tobacco; adolescent; norms; normative beliefs; subjective norms; theory of reasoned action; ecological model; youth; factor analysis; principal components analysis; logistic regression; risk behavior; scale development