Generalizability of findings from a chewing tobacco cessation clinical trial.

This study examined selection bias by comparing characteristics of a general population sample of tobacco chewers, participants in a chewing tobacco cessation trial, and non-participants in the trial. A population-based sample of chewers (n = 155) was surveyed by telephone to assess demographics, tobacco-use patterns, and quitting history. Six months later, chewers from this same population were recruited for a cessation trial (n = 401 participants and 68 non-participants). Trial participants differed little from general population chewers on demographics, but they used more chew and were more dependent on nicotine. They were more likely to have tried to quit, received advice to quit and experienced tobacco-related health problems. Trial non-participants were virtually identical to participants on demographic and tobacco use measures. The findings suggest that clinically tested treatments are generalizable beyond the research setting, because trial participants are demographically representative of the general population of chewing tobacco users, are not biased toward light users, and are representative of those chewers most likely to seek out community-based cessation services outside the trial context.

What factors are associated with local enforcement of laws banning illegal tobacco sales to minors? A study of 182 law enforcement agencies in California.

OBJECTIVES: The aims of this study were to understand the attitudes of local law enforcement staff regarding policies to reduce youth access to tobacco, to determine what proportion of these agencies have conducted unannounced compliance checks in the past year, and to examine factors associated with conducting compliance checks. METHODS: A written questionnaire was completed by 182 law enforcement officials representing 200 cities and counties in California (some officials represented multiple jurisdictions). Logistic regression analyses were conducted to identify factors associated with conducting compliance checks. RESULTS: Only 36% of local enforcement agencies reported conducting one or more compliance checks in the previous year. Agencies were more likely to conduct compliance checks if they perceived fewer barriers to enforcement, reported more frequent collaboration with other community agencies to enforce youth access laws, and believed that youth access to tobacco is a problem in their community. CONCLUSIONS: Because active enforcement of youth access laws using unannounced compliance checks has been shown to reduce the rate of illegal tobacco sales to minors and may reduce youth smoking, efforts to increase the level of enforcement should be promoted. These study results may be used to inform efforts to encourage local agencies to enforce existing youth access laws.

Peer influences and susceptibility to smoking among California adolescents.

Using data from a diverse statewide sample of 10th-grade adolescents in California, in 1996-97, this study investigated the associations between peer influence variables and susceptibility to smoking. Peer influence variables included attitudes about the social consequences of smoking and subjective norms, as described by the Theory of Reasoned Action. Among never-smokers (N=2681) and ever-smokers (N=4248), attitudes about social consequences of smoking and subjective norms each were associated with an increased risk of susceptibility to smoking. The model explained a larger proportion of the variance in susceptibility among ever-smokers than among never-smokers. Results indicate that peer influences, including perceptions of the social consequences of smoking and perceived social norms, may make adolescents susceptible to smoking.

Opinion leaders' support for tobacco control policies and participation in tobacco control activities.

OBJECTIVES: Because opinion leaders hold positions from which they may influence tobacco control efforts, this study examined their support for tobacco control policies and their involvement in tobacco control activities. METHODS: A telephone survey was administered to 712 California opinion leaders who were randomly selected from constructed lists representing 8 types of organizations: health, education, law enforcement, media, government, business, ethnic, and youth. Hierarchical regression analysis was used to identify predictors of support for and participation in tobacco control activities. RESULTS: Approximately one half to two thirds of opinion leaders supported the tobacco control policies queried; 60% reported involvement in tobacco control-related activities during the previous year. Organizational affiliation was a strong predictor of support and involvement, with leaders from health and educational organizations reporting the highest levels and business and media leaders reporting the lowest. Tobacco issue involvement variables (e.g., having a friend or family member with a smoking-related illness) were significantly associated with the outcomes, while sociodemographics, for the most part, were not. CONCLUSIONS: Study results can be used to mobilize opinion leaders' support for tobacco control more effectively.

The relationship between home smoking bans and exposure to state tobacco control efforts and smoking behaviors.

PURPOSE: To examine the relationship between home smoking bans and adult smokers' exposure to the statewide California Tobacco Control Program (TCP) and their cigarette smoking behavior. DESIGN: Cross-sectional survey that was part of the statewide Independent Evaluation of the California Tobacco Control, Prevention and Education Program. SETTING: Random telephone interviews within 18 California counties. SUBJECTS: A representative sample of 1315 adult smokers, aged 25 years and older. MEASURES: The telephone survey included questions about smoking behavior, quitting smoking, exposure to tobacco control program components, home smoking rules, and attitudes related to tobacco use and environmental tobacco smoke (ETS). RESULTS: Smokers with a home smoking ban were twice as likely (OR = 2.29; 95% CI 1.22, 4.29) to have heard of TCP community programs and three times more likely (OR = 3.18; 95% CI 1.34, 7.57) to have seen and talked about the ETS media spot than smokers with no home smoking policy. Multivariate regression models indicated that having a home smoking ban was related to smoking fewer cigarettes per day and greater interest in quitting smoking compared with smokers with no smoking rules in the home (p < .05). CONCLUSIONS: These findings suggest that smokers reporting exposure to the California TCP were more likely to have restrictive home smoking policies and that more restrictive home smoking policies were associated with reduced smoking behavior.

Quitting chew: results from a randomized trial using nicotine patches.

The authors examined the efficacy of transdermal nicotine replacement for cessation in 410 adult nonsmoking chewing tobacco users. Participants were randomly assigned to 6 weeks of 15-mg nicotine patch plus behavioral treatment or placebo patch plus behavioral treatment. All participants received the same behavioral treatment of 2 pharmacy visits, 2 support calls, and self-help materials. At 6 months after treatment, biochemically confirmed point-prevalence rates (no chewing in the last 7 days) in the active (38%) and placebo (34%) groups were high and not significantly different. The difference in relapse (no chewing for 7 consecutive days) between the active patch group (33%) and placebo group (48%) was significant at 6 months (p = .003). Nicotine dependence and age predicted nonrelapse at 6 months. The results suggest that nicotine replacement may improve chewers' chances of abstinence.

Smoking bans in the home and car: Do those who really need them have them?

BACKGROUND: This paper addresses the question of whether individuals who are most in need of household and car smoking bans, such as individuals with children living at home or who have many friends who smoke, are the ones who have them. METHOD: A representative sample of 6985 California adults ages 18 and older participated in telephone interviews. RESULTS: Overall, 76% of adults report having home smoking bans and 66% have car smoking bans. Being a smoker or African American, not having children in the home, having more friends who smoke, and lower household income were associated with lower prevalence of both home and car smoking bans (P < 0.01). In multivariate analyses, nonsmokers were 7.9 (95% CI = 3.56, 17.31) times more likely to have a home smoking ban when none of their friends were smokers compared to when most of their friends were smokers. Among smokers, there was an interaction between having children at home and the proportion of friends who smoke. Only 27 to 55% of smokers had home smoking bans unless most of their friends were smokers, then the odds of having a ban were 6.1 (95% CI = 2.76, 13.68) times higher for smokers with children (67% with home bans) than for smokers without children at home (25% with home bans). CONCLUSIONS: Efforts to increase home and car smoking bans for nonsmokers who have friends who smoke and smokers with children living at home are needed.

Which adults do underaged youth ask for cigarettes?

OBJECTIVES: This study identified adults' demographic and smoking behavior characteristics that are related to being asked to provide tobacco to a minor. METHODS: Telephone interviews were conducted with 6352 California adults. Predictors included age, sex, household income, and smoking status. RESULTS: Only 10.1% of California adults had been asked to provide tobacco to a minor in the previous year. Fewer than 3% of individuals 55 years and older had been asked to provide tobacco, but among younger smokers 59.0% of 18- and 19-year-olds and 39.3% of 20- to 24-year-olds had been approached. CONCLUSIONS: Interventions to reduce the social availability of tobacco are needed.

Predicting achievement of a low-fat diet: a nutrition intervention for adults with low literacy skills.

BACKGROUND: This paper identifies factors that predict achievement of a low-fat diet among 242 California adults with low literacy skills, following their participation in the Stanford Nutrition Action Program (SNAP), a randomized classroom-based nutrition intervention trial (1993-1994). METHODS: The intervention classes received a newly developed curriculum that focuses on reducing dietary fat intake (SNAP); the control classes received an existing general nutrition (GN) curriculum. Data were collected at baseline and 3 months postintervention. This hypothesis-generating analysis uses a signal detection method to identify mutually exclusive groups that met the goal of a low fat diet, defined as < 30% of calories from total fat, at 3 months postintervention. RESULTS: Three mutually exclusive groups were identified. Twenty-three percent of Group 1, participants with high baseline dietary fat (> 60 g) who received either the GN or the SNAP curriculum, met the postintervention goal of < 30% of calories from total fat. Thirty-four percent of Group 2, participants with moderate baseline dietary fat (< or = 60 g) who received the GN curriculum, were successful. Sixty percent of Group 3, participants with moderate baseline dietary fat who received the SNAP curriculum, were successful. Members of Group 3 also significantly increased their intake of vegetables, grains, and fiber. CONCLUSIONS: Within this population of adults with low literacy skills, a large proportion of those with moderate baseline dietary fat who participated in the SNAP classes met the postintervention criteria for a low-fat diet. A much smaller proportion of those with high baseline dietary fat were successful, suggesting that this group may benefit from different, more intensive, or longer-term interventions.

The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults.

OBJECTIVES: This study was undertaken to test the effectiveness of the Stanford Nutrition Action Program, an experimental trial to reduce dietary fat intake among low-literacy, low-income adults. METHODS: Twenty-four paired adult education classes (351 participants, 85% women, mean age = 31 years) were randomly assigned to receive a newly developed dietary fat curriculum (the Stanford Nutrition Action Program) or an existing general nutrition curriculum. Food frequency and nutrition-related data, body mass index, and capillary blood cholesterol were collected at baseline and at two postintervention follow-ups. RESULTS: The Stanford Nutrition Action Program classes showed significantly greater net improvements in nutrition knowledge (+7.7), attitudes (/0.2), and self-efficacy (-0.2) than the general nutrition classes; they also showed significantly greater reductions in the percentage of calories from total (-2.3%) and saturated (-0.9%) fat. There were no significant differences in body mass index or blood cholesterol. All positive intervention effects were maintained for 3 months postintervention. CONCLUSIONS: The Stanford Nutrition Action Program curriculum, tailored to the cultural, economic, and learning needs of low-literacy, low-income adults, was significantly more effective in achieving fat-related nutritional changes than the general nutrition curriculum.

Hispanic/white differences in dietary fat intake among low educated adults and children.

BACKGROUND: This comparative study tests for ethnic differences in dietary fat consumption in a community-based sample of Hispanic and white adults with low educational attainment (< 12 years of schooling) and a separate sample of their children. METHODS: Data are presented for adults (age 20-64, n = 886) and youths (age 12-19, n = 170) from four California cities who participated in one of four sequential cross-sectional surveys (1981-1990). RESULTS: After adjustment for age, sex, city of residence, and time of survey, white adults were significantly (P < 0.03) more likely than Hispanic adults to have eaten high-fat foods in the last 24 hr, such as red meat (75.7% vs 68.4%), cured meats, (39.1% vs 25.8%), and cheese (41.4% vs 32.7%). Furthermore, white adults consumed significantly (P < 0.001) more fat, as measured by percentage of calories from total fat (37.7% vs 33.3%) and saturated fat (13.7% vs 11.8%), and consumed significantly less dietary carbohydrate (45.5% vs 49.7%) and fiber (17.1 g vs 26.0 g) than Hispanic adults. Ethnic differences were similar for the youth sample (except for carbohydrates), but were generally not significant. A graded relationship was found between acculturation and dietary measures, where more acculturated Hispanics (English-speaking) were intermediate between less acculturated Hispanics (Spanish-speaking) and whites in their dietary intake. CONCLUSIONS: This study illustrates the high dietary fat consumption of whites with low educational attainment, the increasing fat consumption of Hispanics at higher levels of acculturation, and the need for effective dietary interventions for low educated whites and Hispanics.

Psychological and social indicators of suicide ideation and suicide attempts in Zuni adolescents.

Suicide behavior is a significant problem for many American Indian populations, often more so than in the general population, but little tribal-specific data available. In this study, baseline data on the correlates of suicide ideation and the social and psychological differences between suicide attempters and nonattempters were collected on a sample of 84 Zuni adolescents. Results show significant correlations between a measure of suicide ideation and past suicide attempt behavior, drug use, depression, hopelessness, stress, psychological symptomatology, social support, liking for school, and interpersonal communication. Significant differences between the 30% of the students who reported having previously attempted suicide and the nonattempters were also found on these measures. Areas for education and prevention efforts are suggested.

Obstacles to and future goals of ten comprehensive community health promotion projects.

Over 100 project staff, community coalition members, and other representatives from 10 comprehensive community health promotion projects in the western United States were surveyed two years into a three year funding cycle about: (1) the problems or obstacles they judged as preventing successful completion of their current goals and objectives, and (2) future goals and objectives they envisioned for their projects. The key issues confronting respondents were diverse, although issues around the process of implementing community health promotion programs were cited more frequently than issues related to the content of health promotion. When respondents were asked to prioritize Future Goals in the second survey, consensus across communities was obtained despite broad differences in the type of community surveyed and the health problem targeted. This study identifies the common organizational and community development problems faced by newly emerging community health promotion programs and has implications for other communities involved in designing, implementing, and evaluating community-wide health promotion programs.

Responsible alcohol service: a study of server, manager, and environmental impact.

A responsible alcohol-service training program was evaluated for its impact on changing beliefs, knowledge, and behavior in 97 servers and 43 managers and on changing establishment policies that encourage safer drinking environments. The training program had a significant impact on changing the beliefs and knowledge of both servers and managers. Observation 4 to 6 weeks after training showed no effects on server behavior, but there was a tendency toward more establishment policies compared with controls.

Community impact of a localized smoking cessation contest.

The present study assessed the effectiveness of a localized community contest timed to coincide with a statewide smoking cessation contest. Follow-up interviews were conducted with 218 local contest participants and 198 participants from the statewide contest. Overall cessation impact (participation rate x abstinence) was 0.39 percent for the local contest and 0.09 percent for the statewide contest. Localized community contests offered in conjunction with statewide or national campaigns may represent cost-effective methods of reaching large numbers of smokers.