Awareness and knowledge of Human papillomavirus (HPV) among ethnically diverse women varying in generation status.

Although Human papillomavirus (HPV) is a common sexually transmitted infection, there is limited knowledge of HPV with ethnic/racial minorities experiencing the greatest disparities. This cross-sectional study used the most recent available data from the California Health Interview Survey to assess disparities in awareness and knowledge of HPV among ethnically/racially diverse women varying in generation status (N = 19,928). Generation status emerged as a significant predictor of HPV awareness across ethnic/racial groups, with 1st generation Asian-Americans and 1st and 2nd generation Latinas reporting the least awareness when compared to same-generation White counterparts. Also, generation status was a significant predictor of HPV knowledge, but only for Asian-Americans. Regardless of ethnicity/race, 1st generation women reported lowest HPV knowledge when compared to 2nd and 3rd generation women. These findings underscore the importance of looking at differences within and across ethnic/racial groups to identify sub-groups at greatest risk for poor health outcomes. In particular, we found generation status to be an important yet often overlooked factor in the identification of health disparities.

Depressive Symptoms and Smoking among US Black Adults: Absence of a Relationship.

Depressive symptoms play a major role in cigarette smoking among US White adults, but it is not known if this holds for US Blacks. Hence, the relationship between depressive symptoms and smoking was examined among 520 US Black adults sampled from 10 randomlyselected community census tracts. Results revealed no relationship between depression and smoking, but education levels did contribute; Black high school drop-outs were four times more likely than Black college graduates to be smokers.

Is skin color a marker for racial discrimination? Explaining the skin color-hypertension relationship.

It is widely assumed that dark-skinned Blacks have higher rates of hypertension than their lighter-skinned cohorts because the former experience greater racial discrimination. However, there is no empirical evidence linking skin color to discrimination. This study tested the extent to which skin color is associated with differential exposure to discrimination for a sample of 300 Black adults. Results revealed that dark-skinned Blacks were 11 times more likely to experience frequent racial discrimination than their light-skinned counterparts; 67% of subjects reporting high discrimination were dark-skinned and only 8.5% were light-skinned. These preliminary findings suggest that skin color indeed may be a marker for racial discrimination and highlight the need to assess discrimination in studies of the skin color-hypertension relationship.

Racial discrimination and cigarette smoking among Blacks: findings from two studies.

We present the first studies to explore the relationship between racial discrimination and cigarette smoking among Blacks. One hundred fifty-three (Study 1) and 300 (Study 2) Black adults completed a survey on their experiences with discrimination and their smoking. Logistic regressions revealed that racial discrimination was the best predictor of smoking among Blacks in both studies, and was a better predictor than status variables. Smoking prevalence rates for Blacks who experience frequent vs infrequent discrimination were 26.7% and 6.4%, respectively; and for those who experience racial discrimination as extremely vs mildly stressful, rates were 42.2% and 20.8%, respectively. We conclude that the stress of racial discrimination may play an important role in smoking among Blacks and, therefore, warrants further investigation.

Sociocultural variables in youth access to tobacco: replication 5 years later.

BACKGROUND: A prior study presented the only systematic investigation of the role of sociocultural variables in youth access to tobacco. White, black, and Latino girls and boys attempted to purchase cigarettes in the same 72 stores at the same time of day. Results revealed significantly greater sales to girls than to boys and to minorities than to whites. Before concluding that sociocultural variables must be addressed in merchant intervention programs designed to reduce youth access to tobacco, this study must be replicated, particularly in light of the significant decreases in youth access in the past 5 years. This article presents that replication. METHOD: The stores used in the prior study were selected, and 12 white, black, and Latino girls and boys attempted to purchase cigarettes in those stores at the same time of day. Results Youths' access rate in 1999 (12.7%) was significantly lower than in the prior (1993-1995) study (41%). No effect for minors' gender was found, but the ethnicity effect again emerged: Black and Latino youth were 2.5 times more likely to be sold cigarettes than their white counterparts. CONCLUSIONS: Multiple sociocultural variables affect youth access to tobacco when access rates are high, but only youth ethnicity plays a role when access rates are low. Merchant interventions designed to reduce youth access to tobacco must address ethnic issues.

Minors' access to tobacco before and after the California STAKE Act.

OBJECTIVE: To assess the effect of implementation and enforcement of the California STAKE Act on minors' access to tobacco by examining sales over time in the same stores. DESIGN: Sixteen year old girls and boys attempted to purchase cigarettes in the same 72 stores, in the same manner, in five time periods: August 1994 (before implementation of legislation); August 1995 (immediately after implementation); August 1996; March 1998; and January 1999 (all postimplementation). OUTCOME MEASURE: Percentage of successful cigarette purchases over time, in different ethnic communities. RESULTS: Minors' access rate decreased significantly from 41.2% before implementation of legislation (1994) to 12.7% after implementation (1998). The same stores were 3-5 times more likely to sell cigarettes to minors before than after the legislation was implemented, irrespective of ethnic census tract. CONCLUSIONS: The California STAKE Act and its enforcement have been effective in reducing minors' access to tobacco in all ethnic communities.

Racial segregation and cigarette smoking among blacks: findings at the individual level.

This study explored the role of racial segregation in cigarette smoking among US blacks. Five hundred and twenty black adults sampled door-to-door in 10 randomly selected, southern California census tracts completed a survey assessing their degree of racial segregation, experiences with racial discrimination, smoking, and income. Results revealed that the prevalence of smoking among highly segregated blacks (32.9 percent) was significantly higher than that of their less segregated cohorts (19.9 percent). Income, gender, and experiences with racial discrimination did not play a role in smoking but low education levels contributed. Early childhood segregation appeared to be the specific segregation variable associated with smoking among black adults.

Acculturation and cigarette smoking among African Americans: replication and implications for prevention and cessation programs.

We report a replication of a 1996 study on the role of acculturation in smoking among African American adults. Results with the current sample were nearly identical to the prior ones: smokers tended to be traditional and nonsmokers acculturated, with nearly 70% of Black smokers in both studies being highly traditional in their cultural orientation. Given that coming from a highly traditional Black family was a strong predictor of smoking in both studies, we suggest that new smoking prevention and cessation programs might be culturally tailored for Blacks by focusing on smoking as a familywide issue.

Do blacks believe that HIV/AIDS is a government conspiracy against them?

BACKGROUND: We present the first study to explore the possibility that blacks believe that the human immunodeficiency virus was developed by the federal government in order to exterminate the black population. METHODS: Five hundred twenty black adults sampled door to door in 10 randomly selected census tracts completed a written survey in exchange for $10. They indicated their degree of agreement with the statement, "HIV/AIDS is a man-made virus that the federal government made to kill and wipe out black people." RESULTS: Twenty-seven percent of blacks held AIDS-conspiracy views and an additional 23% were undecided. Endorsing AIDS-conspiracy beliefs was not related to blacks' age or income but was related to higher levels of education. Blacks who agreed that AIDS is a conspiracy against them tended to be culturally traditional, college-educated men who had experienced considerable racial discrimination. CONCLUSIONS: The prevalence and health-related implications of blacks' AIDS-conspiracy beliefs must be fully investigated, and such beliefs must be addressed in culturally tailored, gender-specific AIDS prevention programs for blacks.

Minors' access to single cigarettes in California.

OBJECTIVE: As the cost of a pack of cigarettes continues to increase, minors may resort to purchasing single cigarettes ("loosies"), but no clear data on their rate of access to singles are available. This study examined the availability of singles to minors by gender, age, and ethnicity. DESIGN: In a factorial experiment, 36 minors of different sexes, ages, and ethnic groups each attempted to purchase a single cigarette once in half of a group of 72 randomly selected stores in middle-class California communities, for a total of 1,271 single cigarette purchase attempts. RESULTS: Minors were able to purchase singles 7.9% of the time, with this access rate being significantly higher (16.2%) for older (16-year-old) minors. Minors were typically charged 15 cents for the single, and singles were sold by 28 of the 72 (38.9%) stores. CONCLUSIONS: Minors have considerable access to single cigarettes in middle-class, California communities, despite California laws banning their sale. Minors' rate of access to singles in poorer communities and in states that lack legislation against selling them is probably significantly higher. Because singles facilitate cigarette purchases by minors who lack money, any legislation that increases the cost of a pack of cigarettes must also explicitly ban the sale of singles.

An instrument for assessing the quality of tobacco-control policies: the ACT-L scale.

BACKGROUND: Efforts to prevent and decrease tobacco use and tobacco-related disease include improving the quality of tobacco-control laws to make them more stringent in controlling tobacco advertising, youth access, and exposure to environmental tobacco smoke (ETS). However, because there are no instruments to empirically evaluate the quality of such laws, it has been difficult to demonstrate that their quality is associated with decreased youth access or tobacco-related morbidity. We present the first instrument for empirically assessing the quality of tobacco-control policies. METHODS: Recommendations for the content of an ideal, comprehensive tobacco-control policy were used as the 55 items in the Assessment of the Comprehensiveness of Tobacco Laws Scale (ACT-L Scale). Raters evaluated 71 tobacco-control laws with the scale; 70 of these were actual California laws and 1 was a model law from Americans for Non-smokers' Rights (ANR). RESULTS: Interrater (r = 0.64-0.89) and internal-consistency (r = 0.63-0.88) reliability of the scale and subscales were high, and validity was established by demonstrating that the ANR model law received a significantly higher total score (mean = 18.75) than all actual laws (mean = 2.04). California tobacco-control laws were poor in all areas (youth access, ETS, tobacco advertising). CONCLUSIONS: The ACT-L scale can be used to compare and evaluate the quality of tobacco-control laws, highlight areas in which further policy efforts are needed, quantify improvement in such policies, and empirically demonstrate the positive health impact of high-quality tobacco-control laws.

An experimental analysis of sociocultural variables in sales of cigarettes to minors.

OBJECTIVES: This study assessed the role of age, racial/ethnic group, and gender, as well as that of other sociocultural variables, in minors' access to tobacco. METHODS: Thirty-six minors attempted to purchase cigarettes once in each of 72 stores (2592 purchase attempts). The minors represented equal numbers of girls and boys; 10-year-olds, 14-year-olds, and 16-year-olds; and Whites, Blacks, and Latinos. Equal numbers of stores were in Black, White, and Latino neighborhoods. RESULTS: Older children were more likely than younger ones to be sold cigarettes, and Latino children were more likely than Whites to be sold cigarettes. Older Black children (irrespective of gender) were the single most likely group to be sold cigarettes. Cigarettes were significantly more likely to be sold to children by male than female clerks and in specific sociocultural contexts. CONCLUSIONS: Interventions with retailers must address sociocultural variables to improve effectiveness in reducing minors' access to tobacco.

The effects on children of participating in studies of minors' access to tobacco.

BACKGROUND: Ethical concerns about the effect on children of participating in studies of minors' access to tobacco are frequently raised by human subjects' committees but have not been assessed empirically. Data on the effects of such participation on the smoking-related behavior of minors are needed. METHOD: Forty-eight children were screened and selected in 1993 to participate in a study of minors' access to tobacco. All 48 attended tobacco-education workshops, none were smokers, and all denied an intention to smoke in the future. Thirty-six of them were (randomly) assigned to the experimental group who made 2,567 purchase attempts (PAs) between 1993 and 1994, and 11 were assigned to a control group who made no PAs. Two years after screening (1 year after completion of the study) all were sent a follow-up questionnaire assessing current intentions to smoke and other smoking-related behaviors. RESULTS: Minors who made PAs were significantly less likely than those who did not to indicate an intention to smoke in the future; only 12.5% of experimental vs 71.4% of control group minors intended to (or might) smoke in the future. Minors who made PAs also were significantly more likely than those who had not to discuss smoking with peers and to encourage peers and family to quit smoking or to avoid initiating smoking. In 2,567 PAs, minors were never physically threatened, touched, or harmed, and they were treated with verbal hostility in only 73 (2.8%) of their PAs. CONCLUSIONS: These findings suggest that participating in a study of minors' access to tobacco does not increase smoking or intentions to smoke among the minors. Rather, such participation may be associated with low intentions to smoke and with increased tobacco-control efforts on the part of the minors. The effects of participating in such studies may be positive for the minors, their families, and their peers. Participating in such studies does not place minors at risk for physical harm, and their risk for verbal abuse is low.

Introduction: the state of research on black women in health psychology and behavioral medicine.

In this article we briefly review data on the poor state of Black women's health and then analyze the nature of research on their health in health psychology and behavioral medicine. We demonstrate that health psychology and behavioral medicine not only exclude Black women as participants in empirical studies, but also fail to thoroughly investigate the problems that are most prevalent among and accountable for the poor health of Black women. We conclude that this special issue devoted to Black women's health is crucial and long overdue.

Conclusions: the future of research on black women's health.

The preponderance of studies on Black women's health cited in the eight articles of this special issue were published in medical and public health journals, rather than in health psychology journals. Health psychology stands conspicuously apart from other health disciplines in this neglect and exclusion of Blacks and Black women. On the other hand, although there are many studies of Black women's health published in medical and public health journals, these studies have neglected a variety of important cultural and social-contextual variables, and often are methodologically inadequate. Hence, we conclude that studies on Black women's health that examine neglected variables and employ rigorous methods are needed in health psychology, behavioral medicine, and the other health disciplines as well. Specific variables and hypotheses that might be addressed in such future research are highlighted.

Acculturation and cigarette smoking among African American adults.

The relationship between acculturation and cigarette smoking among African Americans was examined with 444 adults. Results revealed that African American smokers were more traditional (less acculturated) than their nonsmoking counterparts, irrespective of gender, and that acculturation was a better predictor of smoking than status variables such as income and education. The prevalence of smoking among traditional African Americans was 33.6% and similar to the national data (33.2%), whereas the prevalence of smoking among acculturated African Americans was 15.3%; 68.49% of African American smokers were highly traditional. These findings suggest that acculturation is a factor in smoking among African Americans and highlight the need for further exploration of the role of acculturation in African American health and health-related behavior.

Asking age and identification may decrease minors' access to tobacco.

BACKGROUND: Many merchant education programs entail efforts to increase cashiers' requests for minors' age and/or identification (proving themselves old enough to purchase cigarettes) as a means of decreasing minors' access to tobacco. However, whether such questions are actually associated with decreased sales to minors has never been investigated. We present the first investigation of the role of such questions in sales of tobacco to minors. METHODS: Thirty-six minors, representing equal numbers of girls, boys, whites, blacks, and Latinos and of 10-, 14-, and 16-year-olds, each attempted to purchase cigarettes once in each of 72 stores, for a total of 2,567 purchase attempts. The frequency of asking the children their age and/or for identification (ID) was analyzed along with the role of these questions in subsequent sales. RESULTS: The data revealed that requesting age/ID was rare (occurring 17% of the time) despite the laws in California requiring clerks to do so. When age was asked, however, minors were refused cigarettes 95.8% of the time, and when ID was requested, they were refused cigarettes 99.0% of the time. Asking for ID may be more strongly associated with decreased sales than asking age. For example, for 16-year-olds, asking age decreased sales from 57.2% (when no questions were asked) to 8.5% of the time, and asking ID decreased sales to 2.4% of the time. CONCLUSIONS: These data provide empirical support for the widespread belief that the success of interventions with retailers can be improved by enhancing efforts to increase merchants' requests for children's ID.

Culture and gender diversity in commonsense beliefs about the causes of six illnesses.

One hundred seventy-eight subjects attributed a variety of causes to six illnesses/diseases: AIDS, the common cold, diabetes, hypertension, lung cancer, and headaches. Factor analysis of these causal attributions yielded four factors which were more complex than those in the existing literature. Each of the six illnesses was seen as caused by different factors. Ethnic and gender differences in causal attributions also were assessed. Although there were no differences between minorities and whites in the perceived causes of the six illnesses, a number of gender differences did emerge. Women were more likely than men to view illness as caused by Sin and Sex and as a form of punishment. Results are discussed in terms of their implications for ethnic and gender differences in health behavior, health service utilization, and somatic symptoms, and suggestions for future research are offered.