Abstract: BACKGROUND: To achieve high participation rates and a representative sample, active parent consent procedures require a significant investment of study resources. The purpose of this article is to describe processes and outcomes of utilizing active parent consent procedures with sixth-grade students from urban, ethnically diverse, economically disadvantaged K-8 public schools involved in an evaluation of a middle school service-learning program. METHODS: As part of the evaluation of the Lead Peace-Plus service-learning program, active parent consent was obtained for participation in school-based health surveys conducted with sixth graders in 3 schools. To achieve acceptable rates of parent permission, we employed multiple procedures including regular communication with school staff, incentives for involved schools and teachers, a multipronged approach for reaching parents, and direct encouragement of students to return forms through repeated classroom visits, individual and classroom incentives. We used Fisher's exact tests to compare selected characteristics among students whose parents weren't reached, those whose parents refused, and those whose parents consented to survey participation. RESULTS: We achieved a parent response rate of 94.6% among sixth-grade students. No significant differences in student gender, race/ethnicity, school, or free/reduced lunch status were identified across parent consent status groups. Rates of absenteeism were significantly higher (p = .03) among students whose parents weren't reached compared to other groups. CONCLUSIONS: Employing a multifaceted active parent consent campaign can result in high rates of parental response with limited sampling bias among an urban, ethnically diverse and economically disadvantaged group of middle school students.
Abstract: Background/Aims: Our objective was to assess associations between passive smoke exposure in various venues and serum carotenoid concentrations. Methods: CARDIA is an ongoing longitudinal study of the risk factors for subclinical and clinical cardiovascular disease. At baseline in 1985/1986, serum carotenoids were assayed and passive smoke exposure inside and outside of the home and diet were assessed by self-report. Our analytic sample consisted of 2,633 black and white non-smoking adults aged 18-30 years. Results: Greater total passive smoke exposure was associated with lower levels of the sum of the three provitamin A carotenoids, alpha-carotene, beta-carotene, and beta-cryptoxanthin (-0.048 nmol/l per hour of passive smoke exposure, p = 0.001), unassociated with lutein/zeaxanthin, and associated with higher levels of lycopene (0.027 nmol/l per hour of passive smoke exposure, p = 0.010) after adjustment for demographics, diet, lipid profile, and supplement use. Exposure in both home and non-home spaces was also associated with lower levels of the provitamin A carotenoid index. Conclusion: Cross-sectionally, in 1985/86, passive smoke exposure in various venues was associated with reduced levels of provitamin A serum carotenoids.
Abstract: This article describes a study of the effectiveness of communication strategies used to influence policy makers to support local smoke-free laws in the Minneapolis-St. Paul metropolitan region. Twenty-seven of 41 members of three city councils and two county boards of commissioners were individually interviewed as were seven advocates who campaigned for the bans. Officials valued public health and economic data, public opinion polls, personally written e-mails, and dialogue with constituents. Phone banking messages indicated public support but were a nuisance. Officials felt that media ads were a waste of money and leafleting and other personal targeting were unacceptable. Advocates tended not to critically examine their own efforts for strengths and weaknesses and seemed unconcerned by public officials' negative reception to some strategies. This case study suggests the need for reflection on the pros and cons of well-funded, highly orchestrated campaigns for public health policy, as these strategies may clash with the political process of building relationships.
Abstract: PURPOSE: We sought to examine the association of food security and metabolic syndrome in a representative sample of U.S. adults and adolescents. We hypothesized that compared with those in food-secure households, adolescents and adults living in food-insecure households would have increased odds of (MetS). METHODS: Data from the National Health and Nutrition Examination Surveys from 1999 to 2006 were combined and analyzed cross-sectionally. Logistic regression was used to compute odds ratios and 95% confidence intervals (95% CI) in the association of household food security (fully food secure, marginal, low, and very low food security) and MetS. RESULTS: Compared with those who were food secure, adults in households with marginal food security had 1.80-fold increased odds of MetS (95% CI, 1.30-2.49), and those with very low food security had a 1.65-fold increased odds of MetS (95% CI 1.12-2.42). There was no association with low food security. The association of marginal household food security and MetS was not significant in adolescents. In adults and adolescents, very low was food security not associated with increased odds of MetS compared with those who were food secure. CONCLUSIONS: Members of households with marginal and very low food security are at increased risk of MetS. A mechanism may be that foods that are inexpensive and easily accessible tend to be energy dense and nutrient poor.
Abstract: PURPOSE: We examine the process of how epidemiologic evidence regarding the harms of secondhand smoke (SHS) exposure has been translated into policy and distill lessons that could be applied to other public health areas. METHODS: We detail the history of the growth of evidence and the development of prudent policies in this area and the parallel, organized efforts led by the tobacco industry to oppose them. We also describe how opposition to these policies helped shape the emerging research agenda. RESULTS: Seven lessons emerged from our study. (i) Even after a policy goal has been achieved, the need for epidemiological evidence and inquiry remains. (ii) Dissemination and implementation research is necessary. (iii) The best and most necessary research questions do not always come from epidemiologists. (iv) There is a need for epidemiologists to work with other researchers across disciplines. (v) Epidemiologists must anticipate the opposition. (vi) Focused, well-organized advocacy is needed to translate even the strongest epidemiological evidence into policy change. (vii) Epidemiologists should be trained to engage and interact with public health advocates, practitioners, and policy makers. CONCLUSIONS: Although this case study shows that policy can be driven by science, it also demonstrates that clear scientific evidence does not automatically lead to optimal policy.
Abstract: OBJECTIVE: Nationally, 10%-15% of women report smoking during the last 3 months of pregnancy. Because the Joint Commission on Accreditation of Healthcare Organizations (now the Joint Commission) requires all U.S. hospitals to be smoke-free, and because tobacco is addictive, the maternal desire to smoke after childbirth could lead to requests for early hospital discharge for mothers and newborns. The authors hypothesized that maternal tobacco use would be associated with shorter newborn nursery hospital stays. METHODS: Birth records from 405,622 singleton, "well" newborns, >or=35 weeks gestation born from 1998 to 2002 in Pennsylvania were merged with perinatal hospital record data and analyzed from 2006 to 2008. Perinatal data from 67,145 mothers self-reporting as having smoked cigarettes on the Certificate of Live Birth and data on their infants were compared 1:2 with data from mothers reporting to be nonsmokers and their infants via chi-square tests with odds ratios, 2-sample t-tests, and multiple linear regression. RESULTS: In Pennsylvania, 16.6% of mothers smoked cigarettes during pregnancy. Tobacco-using mothers were more likely to be insured by Medicaid, unmarried, adolescent, not college educated, and have late onset of prenatal care. Their newborns were more likely to be low birth weight and be born at 35-36 weeks gestation. Nonetheless, these newborns had a significantly shorter mean length of stay (48.9 hours vs 52.4 hours; p<0.001), even after adjusting for confounders. A significant inverse relationship existed between number of cigarettes smoked per day by mothers and nursery length of stay for newborns. CONCLUSIONS: Hospital smoking bans send a strong public health message regarding the risks of tobacco and protect patients and staff from secondhand smoke exposure. However, the association between maternal tobacco use and shorter newborn hospital stays may demonstrate an unintended consequence for the vulnerable population of newborns whose mothers smoke. This association should be considered during prenatal counseling, where smoking cessation can be emphasized, and at the time of mother and infant discharge. These findings are particularly important given the health and socioeconomic disparities between smoking mother-infant pairs and their nonsmoking counterparts.
Abstract: OBJECTIVE: The purpose of this study was to explore how weight might influence the relationship between depression and smoking. METHODS: Data were obtained from a cross-sectional survey representative of women age 40-65 enrolled in Group Health Cooperative, a health plan serving members in Washington and northern Idaho (n=4640). We examined the relationships between depression and smoking in normal weight, overweight, and obese women using weighted multiple logistic regression with both minimal and full adjustment. RESULTS: Current depression was significantly associated with current smoking in obese women (adjusted odds ratio=2.48, 95% confidence interval=1.26-4.88) but not in underweight/normal or overweight women. Among ever smokers, obese women, but not other groups, were significantly less likely to have quit smoking in the past. CONCLUSIONS: In our preliminary study, the association between smoking and depression in middle-aged women appears to be limited to the obese subset and may stem from a lesser likelihood of obese ever smokers to have quit. This population represents an important target for preventive medicine efforts.
Abstract: INTRODUCTION: This study examines the presence and correlates of gender disparities in smoking cessation among lower income smokers prescribed nicotine replacement medication. METHODS: We examined quit rates (7-day abstinence point prevalence) among a cohort of smokers who filled prescriptions for nicotine replacement (N = 1,782), using Minnesota Health Care Programs' (e.g., Medicaid) pharmacy claims databases (2005-2006) and mixed-mode survey protocols. A cohort of smokers who recently filled a prescription for nicotine replacement was stratified by race, and then subjects were selected by simple random sample from each race, oversampling the nonWhite groups (N = 1,782). The primary outcome was point prevalence of 7-day abstinence, and outcomes were assessed about 8 months after the nicotine replacement therapy (NRT) index prescription fill date using a mixed-mode survey protocol. Final interaction models were constructed using backward elimination. RESULTS: Abstinence rates were 11.4% among women and 19.2% among men (p = .02) and remained marginally significant after controlling for demographics, mental and physical health, period of cigarette abstinence, social environment, religious attendance, perceived stress, and NRT prescription type (p = .08). There was a significant Gender x Employment interaction (p = .02). Among men, quit rates were higher among the employed (26%) compared with the unemployed (16%); among women, quit rates were lower among those who were employed (8%) compared with those who were unemployed (14%). DISCUSSION: Results suggest the need for research on factors specific to women's work roles or workplaces that inhibit cessation as well as cessation programs tailored to low-income, employed female smokers. On-site workplace interventions and flexible counseling programs may be especially beneficial.
Abstract: OBJECTIVES: We explored differences in adolescents' eating habits, perceptions, and dietary intakes by food security status. METHODS: As part of Project EAT (Eating Among Teens), we surveyed 4746 multiethnic middle and high school students in 31 primarily urban schools in the Minneapolis-St. Paul, Minnesota, area during the 1998-1999 academic year. Participants completed in-class surveys. We used multiple regression analysis to characterize associations between behaviors, perceptions, nutritional intake, and food security status. RESULTS: Compared with food-secure youths, food-insecure youths were more likely to perceive that eating healthfully was inconvenient and that healthy food did not taste good. Additionally, food-insecure youths reported eating more fast food but fewer family meals and breakfasts per week than did youths who were food secure. Food-insecure and food-secure youths perceived similar benefits from eating healthfully (P = .75). Compared with those who were food secure, food-insecure youths had higher fat intakes (P < .01). Food-insecure youths were more likely to have a body mass index above the 95th percentile. CONCLUSIONS: The eating patterns of food-insecure adolescents differ in important ways from the eating patterns of those who are food secure. Policies and interventions focusing on improving the foods that these youths eat deserve further examination.
Abstract: PURPOSE: The objectives of this study were to construct measures of adolescent neighborhood connection and test the association of these measures with violence-related behaviors. METHODS: This study uses data from the baseline Lead Peace-Plus evaluation survey completed by sixth-grade students (n = 118). The survey was conducted in Fall 2006 in four urban community schools with similar ethnically diverse and economically disadvantaged student bodies. The survey instrument, tailored for adolescents, included questions about violence involvement in the past year, as well as youth perceptions of and interactions with others in their neighborhood. Exploratory factor analysis was employed to construct neighborhood connectedness scales. Mixed-model logistic regression was used to examine relationships of these scales with students' violent behaviors, adjusting for age, gender and ethnicity. RESULTS: Exploratory factor analysis yielded two factors. The first factor, intention to contribute, was composed of five items (alpha = .86) that indicated whether adolescents value and intend to work to improve their neighborhoods. The factor, neighborhood social resources, was composed of eight items (alpha = .76) that reflected adolescents' familiarity with neighbors and perceptions that their neighbors could provide support. Students with lower levels of both neighborhood connection measures were more likely to report violent behaviors in the past year. However, the trends were statistically significant only for relationships between intention to contribute and violence indicators. CONCLUSIONS: Neighborhood connection can be measured with reliability in middle school students. Cultivating young adolescents' intentions to contribute to their neighborhoods may be an effective strategy for reducing youth violence.
Abstract: PURPOSE: To identify distinct smoking trajectories during adolescence and assess how smoking-related factors relate to trajectory membership. METHODS: The sample includes 3637 youth from across the state of Minnesota. Measures include tobacco use, smoking behaviors of parents and friends, youth smoking-related attitudes and beliefs, and home smoking policies. A cohort-sequential design was used to identify smoking trajectories, including five cohorts of youth (ages 12-16) followed for 3 years. RESULTS: Six distinct trajectories of tobacco use were found: nonsmokers (54%), triers (17%), occasional users (10%), early established (7%), late established (8%), and decliners (4%). Several factors were associated with increased likelihood of being in a smoking trajectory group (vs. the nonsmoking group): parental smoking, friend smoking, greater perceptions of the number of adults and teenagers who smoke, and higher functional meaning of tobacco use. In contrast, higher perceived difficulty smoking in public places, negative perceptions of the tobacco industry, and home smoking policies were associated with less likelihood of being in one of the smoking trajectories (vs. the nonsmoking trajectory). CONCLUSIONS: Adolescents exhibit diverse patterns of smoking during adolescence and tobacco-related influences were strong predictors of trajectory membership.
Abstract: OBJECTIVES: To measure community-level changes in the methods youth use to obtain cigarettes over time and to relate these methods to the progression of smoking. METHODS: We analyzed 2000-2003 data from the Minnesota Adolescent Community Cohort study, where youth (beginning at age 12), who were living in Minnesota at baseline, were surveyed every 6 months via telephone. We conducted mixed model repeated measures logistic regression to obtain probabilities of cigarette access methods among past 30-day smokers (n=340 at baseline). RESULTS: The probability of obtaining cigarettes from a commercial source in the past month declined from 0.36 at baseline to 0.22 at the sixth survey point while the probability of obtaining cigarettes from a social source during the previous month increased from 0.54 to 0.76 (p for both trends=0.0001). At the community level, the likelihood of adolescents obtaining cigarettes from social sources was inversely related to the likelihood of progressing to heavy smoking (p<0.001). CONCLUSIONS: During this time, youth shifted to greater reliance on social sources and less on commercial sources. A trend toward less commercial access to cigarettes accompanied by an increase in social access may translate to youth being less likely to progress to heavier smoking.
Abstract: Tobacco-policy interventions are designed to change the environment with the ultimate goal of preventing young people from beginning to smoke or reducing the likelihood that they will accelerate and solidify their smoking patterns. Several studies show that smoking bans in the home, at school, at work, and in the community are associated with less progression to smoking, less consolidation of experimental into regular smoking, and more quitting among adolescents and young adults. Randomized community trials and cohort studies support an association between enforcement of youth access laws against businesses and lower adolescent smoking rates. Several decades of studies provide evidence that increasing cigarette price through excise taxes reduces smoking among adolescents and young adults, who are particularly price-sensitive. Ongoing surveillance of tobacco-use behaviors in adolescents and young adults is essential for monitoring smoking patterns and evaluating tobacco policies.
Abstract: OBJECTIVE: There has been reduced active smoking, decreased societal acceptance for smoking indoors, and changing smoking policy since the mid-1980s. We quantified passive smoke exposure trends and their relationship with workplace policy. METHOD: We studied 2504 CARDIA participants (Blacks and Whites, 18-30 years old when recruited in 1985-86 from four US cities, reexamination 2, 5, 7, 10, and 15 years later) who never reported current smoking and attended examinations at 10 or 15 years. RESULTS.: In non-smokers with a college degree (n=1581), total passive smoke exposure declined from 16.3 h/week in 1985/86 to 2.3 h/week in 2000/01. Less education tended to be associated with more exposure at all timepoints, for example, in high school or less (n=292) 22.2 h/week in 1985/86 to 8.5 h/week in 2000/01. Those who experienced an increase in the restrictiveness of self-reported workplace smoking policy from 1995/96 to 2000/01 were exposed to almost 3 h per week less passive smoke than those whose workplace policies became less restrictive in this time period. CONCLUSIONS: The increasing presence of restrictive workplace policies seemed to be a component of the substantial decline in self-reported passive smoke exposure since 1985.
Abstract: State youth access laws often include restrictions for minor possession, use, or purchase of tobacco (PUP). The Minnesota PUP law allows cited youth to attend a tobacco diversion program in lieu of fines. We surveyed county attorneys in all counties (N = 87), tobacco diversion program coordinators (N = 47), and adolescents (N = 3,377) to assess PUP enforcement level, tobacco diversion program quality, and youth awareness of and experience with PUP laws and penalties. Although almost all county attorneys reported enforcement of the law, mean citation rates were low (9.3/1,000 youth) but somewhat higher in counties with tobacco diversion programs than in counties without such programs. Program coordinators also reported low attendance (Mdn = 30 adolescents per year per program). Almost 70% of classes were 2 h or less, and just 21.3% included multiple sessions; little variation in program approach or materials was observed, nor did programs meet criteria recommended for effective smoking cessation programs in this population. Overall, 59% of adolescents (79% among smokers) reported having heard of adolescents being caught by police or at school for smoking. Smoking prevalence was lower in counties with tobacco diversion programs than in counties without such programs (11.6% vs. 14.6%; adjusted OR = 0.8, 95% CI = 0.6-1.1). Receipt of a citation and attendance in a special class were more commonly reported among past-month smokers who lived in counties with tobacco diversion programs; the association for class attendance reached statistical significance. Our adolescent data provide some support for PUP laws as a potential tobacco control strategy, yet low citation rates and attendance in diversion programs of limited scope reduce the likelihood of detecting any benefit associated with this approach.
Abstract: BACKGROUND: Evidence that demonstrates the harmful effect of cigarette smoking during young adulthood is limited. Therefore, we assessed associations between cigarette smoking and several self-reported illnesses in a prospective cohort study in healthy young adults. METHODS: Data were derived from 4472 adults aged 18 to 30 years at baseline participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study and reexamined at least once after 7, 10, or 15 years. RESULTS: Cigarette smoking in 1985-86 was related to self-reported smoking-related cancers, circulatory disease, and peptic ulcer. Incidence of these diseases was 9.3/1000 person years among current smokers vs. 4.5/1000 person years among never smokers with no exposure to passive smoke, relative risk (adjusted for race, sex, education, and center) 1.96 (1.42-2.70). Assuming causal relationships, 32% of these premature incidents were attributable to smoking. The relative risks of liver disease, migraine headache, depression, being ill the day before the examination, and chronic cough and phlegm production were also higher in smokers. CONCLUSIONS: Smokers aged 18-30 followed for 7 to 15 years reported an excess of both major and minor ailments related to earlier and current smoking. Thus, prevention, cessation, and avoiding passive smoking should remain strong goals among young people.
Abstract: BACKGROUND: Indoor tanning is a common adolescent risk behavior that has been hypothesized to be motivated and maintained by the mood-altering effects of ultraviolet light. OBJECTIVE: Our purpose was to explore heretofore anecdotal reports that indoor tanning leads to dependency. METHODS: A telephone interview was conducted among 1275 adolescents, ages 14 to 17 years. Self-reported difficulty in quitting indoor tanning was assessed among 267 adolescents (20.9% of total) who tanned indoors more than once in the previous year in relation to age of initiation, frequency of use, and positive or negative consequences of the practice. RESULTS: Difficulty in quitting was more likely with younger age at initiation (age 13 years or younger vs ages 16 to 17; odds ratio = 4.3, 95% confidence interval 1.3-14.7) and higher frequency of use (P = .009), even after accounting for positive or negative consequences of indoor tanning and other demographic characteristics. LIMITATIONS: This was a cross-sectional study design with a limited outcome measure. CONCLUSION: Although preliminary, our findings for age at initiation and frequency of use in relation to difficulty in quitting indoor tanning are consistent with other potentially addictive behaviors taken up during adolescence.
