Models of the relationship of stress, depression, and other psychosocial factors to smoking behavior: a comparison of a cohort of students in grades 6 and 8.

BACKGROUND: Six specific hypotheses regarding putative mechanisms by which stressful life events might lead to initiation of smoking among adolescents were proposed and tested on a Grade 6 cohort of students in Scarborough, Ontario, Canada. In addition, the data were used to determine the set of risk factors for initiation of smoking most pertinent to the experience of the cohort. METHODS: The same relationships were examined for the 1,543 students when they were in Grade 8 and compared to the earlier Grade 6 results. The hypotheses include the effects of personal resources (coping, self-esteem, social support, and mastery), social conformity, rebelliousness, attitudes, smoking environment factors, and gender differences. RESULTS: The hypotheses were not unequivocally supported, except for the hypotheses about attitudes and smoking environment as well as gender effects. Males and females differ with regard to the variables and interrelationships in both years and in the final models developed. In Grade 6, there are more smoking environment items for males than for females. By Grade 8, male smoking is influenced by mastery, social conformity, and rebelliousness, while for females environmental smoking and rebelliousness are important. CONCLUSION: Male and female students differ in how stress, depression, and smoking are related in the presence of psychosocial factors.

Smoking cessation among African Americans: what we know and do not know about interventions and self-quitting.

BACKGROUND: Many studies on cessation interventions and self-quitting have been conducted, but few have focused on African Americans. The purpose of this review was to critically evaluate the available studies and make recommendations for future research. METHODS: Articles published from 1988 to 1998 were collected using Medline and other data bases, as well as personal communication. Studies were divided into two categories: evaluations of specific cessation interventions and examinations of self-quit behaviors and related factors. Studies were tabulated using author/year, study design/sample size, variables/results, and comments. RESULTS: In the intervention studies, church-based programs may provide an effective location for cessation interventions, but the studies to date did not demonstrate unequivocal effectiveness. In clinic programs, there do not appear to be any interventions that are particularly effective. In community-based interventions, there were no differences for African and Caucasian Americans. With regard to self-quitting, sociodemographic variables were similarly related to cessation as in the general population, as were smoking history variables. All other categories did not contain enough information for firm conclusions to be drawn. CONCLUSIONS: There are some interventions that appear to be useful, but little information is available on self-quitting. More research is needed on the natural history of quitting, on the social norms for smoking among African American groups, and on the conceptual dimensions of race in the context of this research.

The degree and type of relationship between psychosocial variables and smoking status for students in grade 8: is there a dose-response relationship?

BACKGROUND: While most research focuses on simply analyzing the differences between smokers and non-smokers, dose-response analyses may be used to find evidence of the nature of the association between psychosocial variables and involvement with smoking in adolescence. METHODS: For the study, 1,614 grade 8 students from Scarborough, Ontario, Canada, completed a self-administered questionnaire that included items on sociodemographic characteristics, experience with smoking, lifestyle, health and weight, work status, and social involvement as well as parental education, occupation, and family and peer smoking. A series of scales measuring self-esteem, stress, coping, social support, mastery, social conformity, and rebelliousness was incorporated. RESULTS: Dose-response relationships were evidenced for all categories of variables and were demonstrated for the total group and, in most cases, for males and females when analyzed separately. CONCLUSIONS: Relationships between variables are not "all or none," but may vary depending on amount or level of other factors. These relationships provide insight into the mechanisms underlying initiation to, maintenance of, and cessation of smoking and should be taken into account in programs to reduce or prevent adolescent tobacco use.

Smoking initiation and cessation in African Americans attending an inner-city walk-in clinic.

OBJECTIVES: Data collected from a population of African Americans were analyzed to examine patterns of smoking initiation, smoking cessation, and factors related to smoking cessation. METHODS: Over a 4-month period, all (N = 2,928) patients attending an inner-city medicine clinic were recruited to participate in a smoking intervention trial. Over 99% participated, providing information on their smoking experiences, including smoking status (current, former, or never a smoker), duration of regular smoking, and year of quitting when applicable. Data on African Americans with complete information on these variables (n = 2,428) were analyzed with respect to initiation and duration of smoking. RESULTS: More than half of African-American smokers in the population studied initiated regular smoking after age 19. Later age of initiation of smoking and female gender were associated with short duration smoking (i.e., quitting before 10 years of regular smoking); these variables, but not age, were identified as significant factors in a Cox Proportional Hazards model with duration of smoking as the outcome variable. CONCLUSIONS: A sizable opportunity for primary prevention of regular smoking appears to exist among African Americans aged 20 to 30 years as evidenced by patterns of smoking initiation in the population studied. The importance of age at initiation of regular smoking to the duration of smoking is demonstrated in this population over a wide range of duration.

Racial and urban/rural differences in cervical carcinoma in Georgia Medicaid recipients.

BACKGROUND: The authors conducted a study of racial and geographic differences in the occurrence of cervical carcinoma in a population of uniformly low economic status: Georgia Medicaid recipients. METHODS: Medicaid reimbursement claims data for 1992 were used to calculate counts, rates, and black-to-white risk ratios for newly and previously diagnosed cases of cervical carcinoma in metropolitan Atlanta and in the remainder of the state. RESULTS: Among 615,787 female Georgia Medicaid recipients in 1992, 2050 women (333 per 100,000) had a diagnosis of carcinoma of the cervix. Of 111,208 women who had received Medicaid assistance continuously from 1988 to 1992 (5-year eligibles), a new claim for cervical carcinoma was submitted for 110 (99 per 100,000). In both analyses, rates were higher in metropolitan Atlanta than in the remainder of the state. Black women had significantly higher claims rates than white women only in metropolitan Atlanta; risk ratios were 3.7 (95% confidence interval [CI], 1.3-10.8) for new claims among 5-year eligibles, and 3.5 (95% CI, 3.0-4.1) for prevalence. There was no racial disparity in cervical carcinoma rates in rural areas. CONCLUSIONS: The current study data suggest a high risk of cervical carcinoma among metropolitan Atlanta Medicaid recipients, particularly blacks. Data from rural Georgia (but not Atlanta) support the hypothesis that racial differences in cervical carcinoma rates would largely disappear in a population of uniform economic status.

Weapon carrying among black adolescents: a social network perspective.

OBJECTIVES: This report describes the salience of social networks to the phenomena of adolescent weapon carrying. METHODS: A random-walk network sampling design was used to survey 113 adolescents about topics, including weapon carrying. RESULTS: In a probability sample of 12- to 15-year-olds, 20.9% reported ever carrying a weapon. Carriers were eight times as likely as noncarriers to report weapon carrying by an older associate, and 19 times as likely to report weapon carrying by a peer. A significant dose-response effect was present. CONCLUSIONS: This evidence supports the interpretation that modeling of weapon carrying by personal network members is important for its initiation and maintenance in adolescence.

Interactive effect of race and marital status in low birthweight.

Although unmarried mothers are at risk of delivering low-birthweight (LBW) infants, the meaning and significance of this variable need to be explored in depth. With data on 216,285 infants born to white and black mothers aged 10 to 49 years in Atlanta, Georgia, between 1980 and 1987, we examined the association of LBW and marital status and the effect of race on the association. Education and age were controlled in the analysis in an attempt to isolate the effect of race on the marital status and birthweight association. The crude LBW rate among infants born to unmarried mothers was about twice the rate among infants born to married mothers (132.8 vs 63.9 per 1000 live births). Adjustment singly for maternal race, age, and education gave risk ratios (unmarried vs married) of 1.50, 2.03, and 1.78, respectively. Simultaneous control for all factors led to a hierarchy of education-adjusted risk: unmarried black adult mothers had the highest risk of delivering an LBW infant (2.49), followed by married black adults (1.93), unmarried black teenagers (1.90), married black teenagers (1.67), unmarried white adults (1.65), unmarried white teenagers (1.35), married white teenagers (1.08), and married white adults (1.0; reference group, with an LBW rate of 51.2/1000 live births). Thus, these data demonstrate both a consistently higher risk for black women and an interactive effect of age on the association of marital status and LBW: unmarried status appears to increase the risk of LBW much more among adult women than among younger women. This finding has implications for research and prevention of LBW.

Preterm delivery and low birth weight among first-born infants of black and white college graduates.

Reproductive outcomes were investigated in black and white female college graduates, presumed to be of similar socioeconomic status and similar risk profile with respect to environmental factors. Data were gathered by mail survey from graduates (1973-1985) of four Atlanta, Georgia, colleges between February and June 1988. Of 6,867 alumnae to whom questionnaires were mailed, 3,084 responded. A follow-up study of black nonrespondents yielded responses from 14% (335) of those who did not respond to the mail survey. For all graduates with a first live born at the time of survey (n = 1,089), the rates of preterm delivery, low birth weight, and infant mortality were 80.8, 82.6, and 14.6 per thousand births (primigravida), respectively. Compared with white graduates, black graduates had 1.67 times the risk of preterm delivery and 2.48 times the risk of low birth weight. Measures of social and economic status differed significantly by race. However, adjustment for these variables did not reduce the estimated risk for black graduates compared with whites. Analysis of the nonresponder survey suggested that respondent data alone overestimates the incidence of adverse outcomes in blacks; using nonresponder data, relative risks of 1.28 (preterm delivery) and 1.75 (low birth weight) were calculated as lower limits of the increased risk for blacks.

Cancer screening intervention among black women in inner-city Atlanta--design of a study.

This experimental study attempts to determine if an in-home educational intervention conducted by lay health workers (LHWs) can increase adherence among low-income, inner-city black women to schedules for screening for breast cancer and cervical cancer, as well as increase the women's knowledge and change their attitudes regarding these cancers. This paper is a description of the purposes, hypotheses, design, subject recruitment, intervention, and evaluation of the study conducted by Morehouse School of Medicine. Subjects were recruited from a variety of sources, including patients seen in a community health center, women referred by the National Black Women's Health Project (NBWHP), residents of public and senior citizen housing projects, and persons identified in various community settings. Fewer than half of those asked to participate agreed to do so. The 321 women who were recruited were demographically diverse. Overall, about half of these volunteer subjects self-reported at least one Papanicolaou (Pap) smear and one breast examination within a year before enrollment in the study. There was little variation by source of recruitment in compliance with screening recommendations, except that referrals from NBWHP were more likely (P less than 0.01) to have had a Pap test and breast self-examination, while residents of public housing projects were somewhat less likely to have done so. About 35 percent of participants ages 35 and older had a mammogram within an appropriate interval. Participants were randomly assigned to intervention and control groups. Women in the intervention group were visited in their homes by LHWs on three occasions; the LHWs provided education on cancer and reproductive health. The groups were comparable in their baseline sociodemographic status and previous screening history.

Cancer rate differentials between blacks and whites of three metropolitan areas.

This article presents a comparison of the cancer incidence and mortality rates for the populations of the metropolitan areas of Los Angeles, Atlanta, and Nashville. The results reveal that cancer of the lung, prostate, breast, and cervix should be of major concern to all, but especially to blacks and residents of Nashville. The findings have specific implications for the prevention of cancer in the black population of the United States.

An outbreak of necrotizing enterocolitis. Association with transfusions of packed red blood cells.

Of 187 newborns admitted to a 33-bed, level III neonatal intensive care unit between January 1, 1985 and June 23, 1985, 33 developed necrotizing enterocolitis during their hospital stay. Twenty of the 33 newborns (61%) had onset of symptoms between April 1 and June 23, suggesting clustering during this period. A case-control study, with matching on birth weight class, approximate date of admission to the unit and approximate duration of stay, failed to reveal any association of the syndrome with type or timing of feeding, perinatal hypoxic events, as determined by apgar scores and labor history, or specific microbial organisms. By contrast, however, transfusion of packed red blood cells was highly and significantly associated with the syndrome (odds ratio = 15.1, 95% confidence interval = 2.59-92.51). In addition, therapy with caffeine, with theophylline, and with furosemide were moderately associated with the syndrome, although not significantly so. During this outbreak period, the incidence of necrotizing enterocolitis by birth weight was 30.6% in infants less than 1,500 gm, 10.8% in infants 1,500-2,500 gm, and 11.9% in infants 2,500 gm or more. These findings confirm the importance of low birth weight as a risk factor for development of the syndrome and suggest that insults to volume homeostasis, such as transfusion and use of diuretics, need to be considered as possible mechanisms whereby necrotizing enterocolitis is initiated.

The course of the epidemic of acquired immunodeficiency syndrome in the United States hemophilia population.

The time course of the epidemic of acquired immunodeficiency syndrome (AIDS) as it has occurred in the US hemophilia population is examined using surveillance data collected by the Centers for Disease Control (CDC). These data indicate that the epidemic course in hemophiliacs is distinguishable from that in the homosexual/bisexual and intravenous drug-using populations in at least one respect--the epidemic in the hemophilia population is characterized by a lack of consistent increase in the number of new AIDS cases in successive time intervals. This difference is interpreted as being attributable to the mechanisms by which AIDS virus is spread among hemophiliacs. In addition, the short survival following diagnosis of AIDS in hemophiliacs and the magnitude of yearly incidence rates for this group in 1984 and 1985 show the hemophilia population to have been severely affected by the epidemic.

Maternal urinary tract infection and adverse fetal outcomes.

The relationship of acute urinary tract infection occurring during pregnancy and the incidence of adverse fetal outcomes was examined with the use of birth certificate data from Washington state for the years 1980 and 1981. The two-year fetal mortality rate among urinary tract infection-associated pregnancies was found to be 17.9 per thousand livebirths, 2.4 times the rate for the state as a whole. Low birth weight newborns and small for gestational age newborns were, respectively, 2.04 and 1.57 times more frequent in urinary tract infection-associated pregnancies compared to controls. These estimates of risk were unchanged when adjusted for maternal age, race, and past obstetric history. The risk of prematurity in women with urinary tract infection and no history of fetal loss was 2.4 times the control risk. Sepsis was rare in both the urinary tract infection and control groups. These results add to the evidence implicating maternal urinary tract infection as a threat to fetal well-being.

The controlled clinical trial and decision making in family practice.

This study attempts to measure the extent to which the family physician's therapeutic and strategic decisions in selected areas are in accordance with the findings of controlled clinical trials and cohort studies bearing on the decision problem. A questionnaire was designed to present a clinical problem and elicit a choice of therapy, test, or management for that particular clinical situation, the choice being capable of classification as concordant (in best agreement with the results of pertinent cohort studies) or nonconcordant. There were 70 respondents. Out of 8 possible responses, the number of concordant responses per individual ranged from 0 to 5, with a mean of 2.57 +/- 1.2. No significant difference in concordance of response per individual by years of clinical experience (as measured by age), region of practice location, or region of medical school attendance was found. Only 18 percent of the sample had ratios (concordant/all responses) greater than 0.50. Likewise, for only one clinical area did concordance of response exceed 50 percent. As a measure of the penetrance of the clinical trial and cohort study into the practice or primary care, these data suggest that they do not exert a major influence in clinical decision making.