Psychometric properties of a Brief Smoking Consequences Questionnaire for Adults (SCQ-A) among African American light smokers.

Despite a decline in cigarette smoking over the past few decades, rates remain unacceptably high for certain segments of the population, such as urban African Americans (AAs). AA smokers, on average, smoke fewer cigarettes per day than European American samples; however, AA smokers are less likely to achieve abstinence during a quit attempt. Outcome expectancies have previously been association with cessation outcomes, but prior research has not examined expectancies among treatment-seeking AA light smokers. The 33-item Smoking Consequences Questionnaire-Adult (SCQ-A) was evaluated among 751 AA light smokers (i.e.,

Seeking help for disaster services after a flood.

OBJECTIVES: This article describes how the frequency of exposure to a flood is associated with the probability of seeking help from agencies (eg, Federal Emergency Management Agency, Red Cross) that provide disaster-related services. The article also describes the population characteristics for the people who are most likely to seek help for disaster services. METHODS: Prospective cohort data from 1735 respondents of the Iowa Health Poll were used. Multivariate logistic regression was used to model the odds of seeking help from any agency for flood-related problems. RESULTS: Overall, most people, regardless of flood exposure, did not seek help from disaster service agencies. Disaster services were sought by 23% of respondents who experienced 1 flood, 31% who have experienced 2 floods, and 26% who have experienced 3 or more floods. Multivariate adjusted odds of seeking help were associated with number of flood experiences (odds ratio [OR] 1.58), white race (OR 0.24), economic hardship (OR 1.43), urban residence (OR 0.43), and social support (OR 0.55). CONCLUSIONS: On average, the probability of seeking disaster relief services increases with the number of flood experiences. Racial/ethnic minorities, rural residents, economically challenged individuals, and people with low levels of perceived social support may be more likely than people without these characteristics to seek services.

Understanding smoking cessation in rural communities.

CONTEXT: Rural communities are adversely impacted by increased rates of tobacco use. Rural residents may be exposed to unique communal norms and other factors that influence smoking cessation. PURPOSE: This study explored facilitating factors and barriers to cessation and the role of rural health care systems in the smoking-cessation process. METHODS: Focus groups were conducted with smokers (N = 63) in 7 Midwestern rural communities. Qualitative analysis and thematic coding of transcripts was conducted. FINDINGS: Three levels of pertinent themes--intrinsic, health-system resource, and community/social factors--were identified. Intrinsic factors facilitating cessation included willingness to try various cessation methods, beliefs about consequences of continuing smoking (eg, smoking-related illnesses), and benefits of quitting (eg, saving money). Intrinsic barriers included skepticism about resources, low self-efficacy and motivation for smoking cessation, concern about negative consequences of quitting (eg, weight gain), and perceived benefits of continued smoking (eg, enjoyment). Key health-system resource facilitators were pharmacotherapy use and physician visits. Resource barriers included infrequent physician visits, lack of medical/financial resources, limited local smoking-cessation programs, and lack of knowledge of existing resources. In terms of community/social factors, participants acknowledged the negative social impact/image of smoking, but also cited a lack of alternative activities, few public restrictions, stressors, and exposure to other smokers as barriers to cessation. CONCLUSIONS: Smokers in rural communities face significant challenges that must be addressed. A multilevel model centered on improving access to health care system resources while addressing intrinsic and community/social factors might enhance smoking-cessation interventions and programs in rural communities.

Smoking cessation in homeless populations: a pilot clinical trial.

This study, which tested two motivational interviewing treatment approaches, assessed the feasibility of conducting a community-based smoking cessation intervention among homeless smokers. Participants (N = 46) were recruited from multiple facilities in the Kansas City area and were randomized to two counseling conditions in which they received five individual motivational interviewing sessions, six group meetings, and their choice of 8 weeks of 21-mg nicotine patch or 4-mg nicotine lozenge. The two counseling conditions consisted of motivational interviewing targeted either to smoking behaviors exclusively (smoking only) or to smoking and other addictions or life events that could affect ability to quit (smoking plus). Group meetings were designed to provide educational information and social support. Measures of feasibility assessed included the proportion of participants who returned for randomization among those eligible, adherence to prescribed nicotine replacement therapies, retention rates at the week 26 final study visit, and biochemically verified 7-day abstinence at week 26. Most participants (69.6%) chose nicotine patches, and 32% of those participants reported using at least four patches per week. Carbon monoxide verified 7-day abstinence rates in the smoking-only and smoking-plus groups were 13.04% and 17.39% (ns), respectively, at week 8 and 8.70% and 17.39% (ns), respectively, at week 26. Participants who used at least four patches per week were more likely to have quit at 8 weeks than were those who used fewer patches (33.3% vs. 10.5%, p = .30). Results support the feasibility of conducting a smoking cessation intervention among homeless smokers. Findings also show promising effects for nicotine replacement therapy and counseling in this population. Developing programs to improve smoking cessation outcomes in underserved populations is an essential step toward achieving national health objectives and for ultimately reducing tobacco-related health disparities.

Strategies for recruiting African-American residents of public housing developments into a randomized controlled trial.

OBJECTIVES: Two community-based strategies used to implement a clinical trial within public housing developments are discussed: 1) hiring and training community outreach residents (CORE) team members to recruit and retain primarily African-American participants; and 2) conducting health fairs to recruit participants into a trial examining the effects of nicotine gum and motivational interviewing on smoking cessation rates. DESIGN: A cluster randomized, community-based clinical trial. SETTING: This trial was conducted in housing developments within a metropolitan area in the Midwest. PARTICIPANTS: Over a period of 20 months, the research team recruited 813 residents, 80% of whom were African-American, to attend health fairs. Of this number, 273 (33%) smokers were identified, and 173 were ultimately enrolled into the study. RESULTS: Attendance at health fairs of public housing development residents ranged from 8%-66% across the housing developments, with an average of 21%. A brief survey was conducted at the health fair to assess smoking status, fruit/vegetable consumption, and physical activity. CONCLUSIONS: A number of possible explanations for the relatively high participation rates among a community-based trial include engaging the community in the research process, offering free health screening services, building recruitment incentives for the CORE, and tailoring health education/promotion materials according to the demographic make-up of the developments. Details regarding the development of recruitment strategies that may boost recruitment rates in community-based clinical trials with predominantly ethnic minorities are provided.

Stage of change movement across three health behaviors: the role of self-efficacy.

PURPOSE: In this study, we examined the influence of self-efficacy in predicting stage of change (SOC) movement, without intervention, over a 1-month period for smoking cessation, exercise adoption, and dietary fat reduction. DESIGN: The design of this study was longitudinal. Patients' stage of change and self-efficacy were assessed at baseline, and stage of change was reassessed at a 1-month follow-up. Patients were categorized as (1) Regressors (moved backward at least one stage), (2) Stables (no change), or (3) Progressors (moved forward at least one stage). Chi-square analyses were used to determine the ability of self-efficacy to predict stage movement at 1-month follow-up. SETTING: The data were collected at a large, inner city, academic hospital in the southeastern United States. Patients were attending primary care clinics. SUBJECTS: Five hundred fifty-four low income, predominantly African-American, individuals attending primary care clinics were participants in the study. MEASURES: Previously validated scales of stage of change and self-efficacy from Prochaska's laboratory were used in this study. RESULTS: Results showed statistically significant differences between predicted and actual SOC movement for smoking cessation, exercise adoption, and dietary fat intake reduction. Baseline self-efficacy ratings were significantly related to stage progression, regression, and stability of stage of change for all three health behaviors. Thirty-seven percent of smokers who were predicted to progress on the basis of their self-efficacy scores progressed. For exercise adoption and dietary fat reduction, 50% and 44%, respectively, of individuals expected to progress at least one stage on the basis of self-efficacy scores progressed. CONCLUSION: Self-efficacy influences SOC movement for smoking cessation, dietary fat reduction, and exercise adoption.

Development of a culturally relevant body image instrument among urban African Americans.

OBJECTIVE: To validate a culturally relevant body image instrument among urban African Americans through three distinct studies. RESEARCH METHODS AND PROCEDURES: In Study 1, 38 medical practitioners performed content validity tests on the instrument. In Study 2, three research staff rated the body image of 283 African-American public housing residents (75% women, mean age = 44 years), with the residents completing body image, BMI, and percentage body fat measures. In Study 3, 35 African Americans (57% men, mean age = 42) completed body image measures and evaluated their cultural relevance. RESULTS: In Study 1, 97% to 100% of practitioners sorted the jumbled figures into the correct ascending order. The correlation between the body image figures and the practitioners' weight classifications of the figures was high (r = 0.91). In Study 2, observers arrived at similar ratings of body size with excellent consistency (alpha = 0.95). Ratings of body image were strongly correlated with participant BMI (r = 0.89 to 0.93 across observers and 0.81 for all participants) and percentage of body fat (r = 0.77 to 0.89 across observers and 0.76 for all participants). In Study 3, body image ratings with the new scale were positively correlated with other validated figural scales. The majority of participants reported that figures in the new body image scale looked most like themselves and other African Americans and were easiest to identify themselves with. DISCUSSION: The instrument displayed strong psychometric performance and cultural relevance, suggesting that the scale is a promising tool for examining body image and obesity among African Americans.

Gender, smoking expectancies, and readiness to quit among urban African American smokers.

The relationship between smoking expectancies and readiness to quit as well as gender differences in expectancies and readiness to quit was examined among 484 urban African American smokers. Univariate analyses revealed that higher positive expectancies were generally associated with less readiness to quit and higher negative expectancies were associated with greater readiness to quit. A multivariable model indicated that stimulation/state enhancement, taste/sensorimotor manipulation, and weight control were most strongly related to intention to quit. Although men and women did not differ on readiness to quit, women reported higher scores on the negative affect reduction subscale than did men.

Use of a brief Smoking Consequences Questionnaire for Adults (SCQ-A) in African American smokers.

Purposes of the present study were to (a) examine psychometric properties of a brief Smoking Consequences Questionnaire-Adult (SCQ-A) among an African American sample and (b) explore differences in smoking expectancies across levels of smoking-nicotine dependence. Four hundred eighty-four smokers attending an urban health clinic completed the brief SCQ-A. Maximum likelihood factor extraction with a varimax rotation specifying 9 factors replicated 9 factors of the original SCQ-A. Evidence for the brief SCQ-A's reliability and validity was found. Heavier and/or more dependent smokers had significantly higher scores than lighter and/or less dependent smokers on positive expectancies SCQ-A subscales. Results suggest the brief SCQ-A may be a useful alternative to the full scale SCQ-A. Results also provide evidence for the SCQ-A's validity with African American smokers.

Applying exercise stage of change to a low-income underserved population.

OBJECTIVES: To validate the transtheoretical model for exercise behavior and the constructs of decisional balance and self-efficacy for exercise in a low-income, poorly educated primary care sample. METHODS: Patients attending public primary-care clinics from 4 separate sites in Louisiana were interviewed regarding their health behaviors. RESULTS: The data provide equivocal support for applying the transtheoretical model for exercise and integrating it with other models of behavior change within this population. CONCLUSIONS: Further studies modifying the decisional balance measures are necessary before definitive statements regarding the applicability of these models to exercise within this specialized population can be made.