An exploration of the influence of family on cigarette smoking among American Indian adolescents.

American Indians have the highest smoking rate of all major racial/ethnic groups in the US, despite significant variation across tribes and regions of the country. Yet, little research has been conducted on smoking initiation among American Indian adolescents. In an effort to identify the mechanisms through which families influence teen smoking, both positively and negatively, 20 focus groups were conducted with 144 non-reservation American Indian teens in Oklahoma. Findings indicated that most of the antismoking messages from family members were given by parents and grandparents, and focused on the long-term health consequences of smoking and addiction. Parental responses to teen smoking varied widely, with some responses sending mixed messages to the teens. Many teens discussed obtaining their first cigarette in a family setting and the teens felt that having smokers in their families influenced them to try smoking. Teens were able to discuss the traditional role of tobacco in their culture and were aware of its presence at Indian events, but felt ceremonial and traditional use was distinct from recreational use. Additional research is necessary to assess whether these results are generalizable to other tribes and regions, and to other racial/ethnic groups.

Quality assurance and iron deficiency in Egypt.

OBJECTIVE: To develop an intervention in rural Egypt to address the problem of iron deficiency anemia and to demonstrate the effectiveness of applying quality assurance (QA) methods in combating this. DESIGN: Assessment of an intervention study utilizing QA methods. SETTING: Rural primary care clinics in Egypt. STUDY PARTICIPANTS: One hundred and eighty pregnant mothers (and their 180 children) were randomly selected at two clinic sites from all those who were diagnosed as having an iron deficiency disorder. INTERVENTION: Multi-disciplinary teams were formed to develop and deliver health promotional approaches related to iron deficiency to the study participants. By using QA techniques the teams were able to strengthen local capacity and participant compliance to the educational messages. MAIN OUTCOME MEASURES: Pre- and post-measurements of client satisfaction, results of hemoglobin lab tests, and the extent of retention of nutritional messages by the participants. RESULTS: Eighty percent of the study population demonstrated satisfactory knowledge of the nutritional messages. There was a 75% improvement of client satisfaction with the clinic and an effective follow-up system of care was designed and implemented successfully for each clinic. On average, the number of children aged less than 5 years diagnosed with an iron deficiency disorder decreased from 37% to 5%. Similar success was achieved with the pregnant mothers: the prevalence of iron deficiency anemia was reduced from 100% to only 14%. CONCLUSIONS: The use of QA process improvement techniques was extremely effective in reducing iron deficiency anemia among the target population. There is an increasing need to include quality methods in micronutrient intervention techniques.