Post-discharge tobacco cessation rates among hospitalized US veterans with and without diabetes.

AIMS: Smoking is a major risk factor for cardiovascular complications among patients with diabetes. Hospitalization has been shown to enhance cessation rates. The purpose of this study was to compare 6-month post-hospitalization tobacco cessation rates among US veterans with and without diabetes. METHODS: This was a longitudinal study among inpatient veterans who used tobacco in the past month (n = 496). Patients were recruited and surveyed from three Midwestern Department of Veterans Affairs hospitals during an acute-care hospitalization. They were also asked to complete a follow-up survey 6 months post-discharge. Bivariate- and multivariable-adjusted analyses were conducted to determine differences in tobacco cessation rates between patients with and without a diagnosis of diabetes. RESULTS: The mean age of patients was 55.2 years and 62% were white. Twenty-nine per cent had co-morbid diabetes. A total of 18.8% of patients with diabetes reported tobacco cessation at 6 months compared with 10.9% of those without diabetes (P = 0.02). Cotinine-verified cessation rates were 12.5 vs. 7.4% in the groups with and without diabetes, respectively (P = 0.07). Controlling for psychiatric co-morbidities, depressive symptoms, age, self-rated health and nicotine dependence, the multivariable-adjusted logistic regression showed that patients with diabetes had three times higher odds of 6-month cotinine-verified tobacco cessation as compared with those without diabetes (odds ratio 3.17, P = 0.005). CONCLUSIONS: Post-hospitalization rates of smoking cessation are high among those with diabetes. Intensive tobacco cessation programmes may increase these cessation rates further.

Ethnicity predicts perceptions of smoking and smoking cessation among veterans.

The objective of this study was to determine if race/ethnicity predicts motivation to quit smoking and preferences for cessation services among smokers serviced by a primarily psychiatric Veterans Affairs hospital. A self-administered survey was given to a convenience sample of smokers (n=146) at the Battle Creek Veterans Affairs Medical Center. Univariate, bivariate and multivariate regression analyses were calculated to determine the association between race/ethnicity and motivation to quit smoking. Forty-two per cent of the sample was non-white. Non-white patients smoked significantly less cigarettes per day as compared with white patients (P=0.002). In the multivariate analyses, compared with whites, non-whites had 3.5 times greater odds of thinking that quitting smoking was extremely/very important to health (P= 0.01), 4.0 times greater odds of thinking of quitting using tobacco products in the next 30 days (P=0.004) and 3.4 times greater odds of being interested in receiving smoking cessation services (P=0.007). Yet, non-white patients were less likely to be interested in intensive nurse counselling and cessation medications. As the number of non-whites continues to increase in the military, novel strategies may be needed to capitalize on the high motivation to quit smoking and preference for non-traditional interventions among non-white smokers treated in Veterans Affairs hospitals.

Integrating text and pictorial information: eye movements when looking at print advertisements.

Viewers looked at print advertisements as their eye movements were recorded. Half of them were told to pay special attention to car ads, and the other half were told to pay special attention to skin-care ads. Viewers tended to spend more time looking at the text than the picture part of the ad, though they did spend more time looking at the type of ad they were instructed to pay attention to. Fixation durations and saccade lengths were both longer on the picture part of the ad than the text, but more fixations were made on the text regions. Viewers did not alternate fixations between the text and picture part of the ad, but they tended to read the large print, then the smaller print, and then they looked at the picture (although some viewers did an initial cursory scan of the picture). Implications for (a) how viewers integrate pictorial and textual information and (b) applied research and advertisement development are discussed.

Global context effects on processing lexically ambiguous words: evidence from eye fixations.

Readers' eye movements were monitored as they read biased ambiguous target words in the context of a short paragraph. Two aspects of context were manipulated. The global context was presented in the topic sentence of the paragraph and instantiated either the dominant or the subordinate meaning of biased ambiguous target words (those with highly dominant meanings). Local contextual information either preceded or followed the target word and was always consistent with the subordinate interpretation. Consistent with prior research, we obtained a subordinate bias effect wherein readers looked longer at the ambiguous words than control words when the preceding context instantiated the subordinate meaning. More importantly, the magnitude of the subordinate bias effect was the same when global context alone, local context alone, or local and global context combined were consistent with the subordinate meaning of the ambiguous word. The results of this study indicate that global contextual information (1) has an immediate impact on lexical ambiguity resolution when no local disambiguating information is available, (2) has no additional effect when it is consistent with local information, but (3) does have a slightly delayed effect when inconsistent with local information.

Sentence and text comprehension: roles of linguistic structure.

Readers and listeners use linguistic structure in comprehending sentences and texts. We review research, mostly published in the past five years, that addresses the question of how they use it. We consider effects of syntactic, lexical, prosodic, morphological, semantic, and discourse structure, as well as reviewing research on how discourse context and frequency of experience, the contents of long-term memory, and the mental models being constructed by a reader or listener affect sentence and text comprehension. We point out areas of theoretical debate including depth-first versus breadth-first models of parsing and memory-based versus constructionist models of discourse comprehension, attempt to show how the empirical effects we review bear on such theoretical questions, and discuss how new lines of research, including research on languages other than English, may enrich the discussion of these questions.

Cartoon characters as tobacco warning labels.

BACKGROUND: Multiple studies have indicated that the Joe Camel advertising campaign has been successful in marketing tobacco to children and adolescents, whereas other studies have reported that current tobacco warning messages are ineffective. OBJECTIVE: To determine the importance and believability of familiar and novel tobacco warning messages with and without cartoons that were modeled after Joe Camel. DESIGN: Children and adolescents (N = 580) in Chicago, Ill, public schools were surveyed to determine the believability and importance of 3 cartoon tobacco warnings modeled after Joe Camel developed with the messages "Smoking Causes Lung Cancer, Heart Disease, Emphysema, and May Complicate Pregnancy" or "Smoking Kills" and the same 2 messages without cartoons. RESULTS: Respondents rated all 3 cartoons significantly more believable than the plain condition regardless of the message (P<.05). Furthermore, respondents rated the "Smoking Causes Lung Cancer, Heart Disease, Emphysema, and May Complicate Pregnancy" warning significantly more believable and important than the "Smoking Kills" message across all 4 cartoon conditions (walrus, penguin, bear, and no cartoon) (P<.01). Selected demographic groups found particular cartoon and warning messages more believable and/or important than others. CONCLUSIONS: The finding that cartoon tobacco warnings are more believable than plain warnings suggests that it may be desirable to include cartoons in future tobacco warning labels. The lower ratings of believability and importance of the "Smoking Kills" warning is a concern because similar warnings have recently been implemented in at least 2 countries (Australia and Canada) and have been considered for implementation in the United States. Arch Pediatr Adolesc Med. 2000;154:1230-1236.

The effect of clause wrap-up on eye movements during reading.

The effect of clause wrap-up on eye movements in reading was examined. Readers read passages in which a target category noun referred to either a high typical or a low typical antecedent. In addition, the category noun was either clause final or non-clause final. There were four primary results: (1) Readers looked longer at a category noun when its antecedent was a low typical member of the category than when it was a high typical member; (2) readers looked longer at the category noun and at the post-category region when they were clause final than when they were not clause final; (3) readers regressed from a category noun or post-category region more frequently when it was clause final than when it was not clause final; and (4) readers made longer initial saccades when their eyes left the category noun or post-category region when this word was in clause final position than when it was not clause final. The last result suggests that sometimes higher order processes that are related to making a decision about when to move the eyes impinge on lower level decisions that are typically associated with deciding where to move the eyes.

Racial variations in end-of-life care.

OBJECTIVES: To identify differences in advanced care planning and end-of-life decision-making between whites and blacks aged 70 and older. DESIGN: The Asset and Health Dynamics Among the Oldest Old (AHEAD) study is a nationally representative survey of adults who were aged 70 and older in 1993. Relatives (proxy respondents) for 540 persons who died between the first (1993) and second (1995) waves of the study were surveyed about advanced care planning and end-of-life decisions that were made for their family member who died. SETTING: Respondents were interviewed at home by telephone (n = 444) or in person (n = 95). PARTICIPANTS: The 540 proxy respondents included 454 whites and 86 blacks. MEASUREMENTS: Questions were asked about advance care planning and end-of-life decisions. RESULTS: Whites were significantly more likely than blacks to discuss treatment preferences before death (P = .002), to complete a living will (P = .001), and to designate a Durable Power of Attorney for Health Care (DPAHC) (P = .032). The treatment decisions for whites were more likely to involve limiting care in certain situations (P = .007) and withholding treatment before death (P = .034). In contrast, the treatment decisions for blacks were more likely to be based on the desire to provide all care possible in order to prolong life (P = .013). Logistic regression models revealed that race continued to be a significant predictor of advance care planning and treatment decisions even after controlling for sociodemographic factors. CONCLUSIONS: These findings suggest that there are important differences between blacks and whites regarding advanced care planning and end-of-life decision-making. Health professionals need to understand the diverse array of end-of-life preferences among various racial and ethnic groups and to develop greater awareness and sensitivity to these preferences when helping patients with end-of-life decision-making.

The framing of drivers' route choices when travel time information is provided under varying degrees of cognitive load.

In two experiments, participants chose between staying on a main route with a certain travel time and diverting to an alternative route that could take a range of travel times. In the first experiment, travel time information was displayed on a sheet of paper to participants seated at a desk. In the second experiment, the same information was displayed in a virtual environment through which participants drove. Overall, participants were risk-averse when the average travel time along the alternative route was shorter than the certain travel time of the main route but risk-seeking when the average travel time of the alternative route was longer than the certain travel time along the main route. In the second experiment, in which cognitive load was higher, participants simplified their decision-making strategies. A simple probabilistic model describes the risk-taking behavior and the load effects. Actual or potential applications of this research include the development of efficient travel time information systems for drivers.

Contextual strength and the subordinate bias effect: comment on Martin, Vu, Kellas, and Metcalf.

Martin, Vu, Kellas, and Metcalf (this issue) claim to have demonstrated that the subordinate bias effect (when preceding context instantiates the subordinate meaning of an ambiguous word that has a highly dominant meaning, reading time on that word is lengthened) can be eliminated by strong context. They argue that this provides evidence critical to discriminating between competing models of lexical ambiguity resolution: the reordered access model (in which access of meanings for an ambiguous word is exhaustive but in which the order of access is influenced by prior disambiguating context) and the context-sensitive model (in which access is selective in the presence of prior disambiguating information). We argue that there are methodological problems with their demonstration, but even if there were not, it is unclear that the subordinate bias effect is appropriate for discriminating between competing models of lexical ambiguity resolution (the reordered access model and the context-sensitive model). The effect is an empirical finding and not a fundamental tenet of the reordered access model.

Influences on parent perceptions of inclusive practices for their children with mental retardation.

Influences on parent perceptions regarding the practice of integrating students with significant cognitive disabilities into general education classrooms were examined. Findings confirmed that perceptions were significantly influenced by characteristics of the parent and the child as well as by factors associated with the child's placement history. Further, factors influencing these perceptions differed according to varying dimensions of inclusion being considered. We argue that the efficacy of any specific type of educational model cannot be determined without a consideration of the complex dynamics involved in the interplay between individual child characteristics, parent and family values, and the perceived role of the school.

Measuring problem behaviors in children with mental retardation: dimensions and predictors.

Scores from the Child Behavior Checklist (CBCL; Achenbach, 1991a) and the Client Development Evaluation Report (CDER; California Department of Developmental Services, 1980) for 67 children and adolescents with mental retardation were examined to evaluate the factorial validity of the instruments. Four factor analyses were conducted. The initial factor analysis of CBCL data failed to confirm the presence of the five first-order factors previously reported for the CBCL standardization sample (Achenbach, 1991b). Second, the higher-order factors of Externalizing and Internalizing behaviors, similar to the structure reported for the CBCL standardization sample (Achenbach, 1991b), were confirmed on the present sample. Third, the two CDER factors of Personal Maladaption and Social Maladaption, previously identified by Widaman, Gibbs, and Geary (1987), were also confirmed. Finally, a higher-order factor analysis of the two factor scores from the CBCL and two factor scores from the CDER was conducted to study the congruence between the CBCL Externalizing and CDER Social Maladaption dimensions, and between the CBCL Internalizing and CDER Personal Maladaption factors. Moderate levels of congruence were found. Next, child characteristics, including level of mental retardation, age, and four dimensions of adaptive behavior, were used as predictors of problem behavior. No child characteristics were significantly related to the CBCL Externalizing dimension, but child age and level of mental retardation were significant predictors of the CBCL Internalizing dimension. CDER Cognitive Competence predicted CDER Social Maladaption, and child age predicted CDER Personal Maladaption. The findings are discussed in relation to previous studies of problem behaviors of children and adolescents with mental retardation.

Epidemiology and prevalence of psychopathology in people with mental retardation.

There is a general consensus that, for several reasons, people with mental retardation are at an increased risk of developing emotional disorders. Numerous research studies have examined the prevalence of psychiatric disorders among people with mental retardation, and a wide range of rates have been reported. Reasons for the variability in these results are discussed, including definitional and identification issues, and sampling issues. A summary of representative studies is presented and discussed in light of the above-mentioned issues. The need for updated epidemiological studies in this area is emphasized.

Community baby shower as a transcultural nursing intervention.

A community assessment was conducted by nursing students to determine the educational needs of Native American women whose infants were at risk for infant mortality. As a result, a culturally based community baby shower was provided for the women and their infants which incorporated health education. Games, prizes, and lunch were provided for the mothers upon completion of educational newborn care, immunizations, and infant safety learning activities. The intervention project based upon maintaining a Native American cultural theme was used with cake, favors, prizes, invitations, and advertisements. In addition, a recognized Native American spiritual leader was invited to begin the shower with a traditional blessing. Multiple community resources such as businesses, stores (including drug), churches, hospitals, a local nursing home, and several private individuals also contributed time, money, and baby care items for the shower. From the advertising, many women expressed interest in attending the baby shower than could be accommodated. Press releases provided exposure for the school of nursing, contributors, participants, and many members of the Native American community. A pre- and post-test survey indicated that by the end of the baby shower, all 10 key native American women participants were able to demonstrate the use of the information taught by the nursing students. The baby shower enhanced the Native American mothers' self confidence and provided them with culturally sensitive care. The welcoming atmosphere created by the students for the Native Americans was also important to the success of the project.

Construct validity of dimensions of adaptive behavior: a multitrait-multimethod evaluation.

The construct validity of four dimensions of adaptive and maladaptive behavior was investigated using the multitrait-multimethod matrix procedure of Campbell and Fiske (1959). Measures of four traits--cognitive competence, social competence, social maladaption, and personal maladaption--were obtained on a sample of 157 persons with moderate, severe, or profound mental retardation using each of three methods of measurement--standardized assessment instrument, day shift staff ratings, and evening shift staff ratings. Applying the Campbell and Fiske rules of thumb and recently proposed structural equation modeling techniques to the data demonstrated strong convergent validity, clear discriminant validity, and only moderate levels of method variance in the observed measures. Implications of the results for the assessment of adaptive behavior and its dimensional structure were discussed.

The association between psychiatric diagnoses and severe behavior problems in mental retardation.

To investigate the relationship between psychiatric disorders and severe behavior problems in mental retardation, statewide client databases from developmental disabilities services in California (N = 89,419) and New York (N = 45,683) were analyzed and juxtaposed. The study focussed on nine major DSM-III-R psychiatric categories (or their equivalents), and severe forms of aggressive behavior, property destruction, self-injurious behavior, and stereotyped behavior in individuals 45 years old and younger with mental retardation of all levels of severity. In California, 3.9% had at least one psychiatric diagnosis; in New York, 5.4%. The rate of specific psychiatric diagnoses was variable across states, suggesting local preferences in diagnostic practices. Severe behavior problems occurred in 22.1% in California and in 41.4% in New York. This difference in rates can be attributed in part to different recording criteria for behavior problems. With regard to the association between psychiatric diagnoses and problem behaviors the results were consistent across databases: No compelling correlations were found. This means that neither aggression, self-injury, destruction, nor stereotypies determine whether a person receives a psychiatric diagnosis or not.

Comprehension of synthetic speech produced by rule: a review and theoretical interpretation.

In this paper, we review research on the perception and comprehension of synthetic speech produced by rule. We discuss the difficulties that synthetic speech causes for the listener and the evidence that the immediate result of those difficulties is a delay in the point at which words are recognized. We then argue that this delay in processing affects not only lexical access but also comprehension processes. We consider the mechanisms by which the comprehension system adjusts to this delay, the resulting costs to higher level comprehension processes, and the changes that occur in the language processing system as its familiarity with synthetic speech increases. Based on the framework we have developed, we suggest several directions for future research on the comprehension of synthetic speech.