Perceived smokeless tobacco addiction among adolescents.

Although the prevalence and associated factors of smokeless tobacco (SLT) use are well-documented, there are no data on the prevalence and associated factors of SLT dependence-addiction. From a survey of 11,057 adolescents in the nonurban Southeastern United States, 3,726 reported having tried SLT, and 17% of those who had tried SLT perceived that they were addicted to it. Years of SLT use, frequency of use per day, and hours of exposure per day were strongly related to perceived addiction. Those using SLT for 1 year or longer had perceived addiction rates of 37% and were over 12 times more likely to report being addicted than were those using for less than 1 year. After controlling for level of SLT use, other factors including parental SLT use, perceived control over health, and racial-ethnic group also contributed minimally but significantly to reported SLT addiction.

Prediction of students' USMLE step 2 performances based on premedical credentials related to verbal skills.

PURPOSE: To examine the relationship between the objective premedical credentials and performances on Step 2 on the United States Medical Licensing Examination (USMLE) of 480 students in three classes at the Virginia Commonwealth University Medical College of Virginia School of Medicine. The purpose of the study was to seek those selection criteria that might best predict performance on an examination designed to assess problem-solving skills, the essence of clinical medicine. METHOD: Premedical data from two classes (1193, 1994) were analyzed, and a regression equation was used to calculate theoretical USMLE Step 2 scores for the students in the class of 1995, who had not yet taken this examination. The premedical variables were scores on the verbal and math section on the Scholastic Aptitude Test (SAT), scores on the six sections of the pre-1991 Medical College Admission Test (MCAT), grade-point average (GPA) in science courses required of premedical students, and undergraduate major. Once the class of 1995 had taken the USMLE Step 2, the equation was cross validated, and the theoretical and actual scores of the class of 1995 were correlated. RESULTS: The correlation between theoretical and actual scores was r = .443. In the analysis for the classes of 1993 and 1994, the single variables most highly predictive of USMLE Step 2 performance were scores on the verbal section of the SAT (r = .317) and the Skills Analysis: Reading section of the MCAT (r = .331). However, the MCAT scores were excluded from the final regression analysis because of the pre-1991 MCAT cannot be useful in predicting the performances of present medical school applicants. The resulting regression equation (using the SAT verbal section and premedical GPA) was able to account for 21.2% of the variance for the class of 1995. CONCLUSION: The use of the verbal section of the SAT as a predictive factor is unique. It is significant that this variable was strongly related to premedical GPA, suggesting that high verbal aptitude serves one well, even when coping with complex scientific concepts.

Evaluation of serum and tissue levels of alpha-tocopherol.

This study was designed to test the effect of supplementation of several antioxidants, including alpha-tocopherol, on the clinical reduction of premalignant oral lesions. Samples of oral mucosa and serum were taken from baseline to 9 months of supplementation from patients with premalignant oral lesions and analyzed for alpha-tocopherol by HPLC. Statistical increases in both serum and tissue alpha-tocopherol were found after supplementation. There was no statistical relationship between alpha-tocopherol and beta-carotene levels.

The medical context of hypochondriacal traits.

OBJECTIVE: This study examines the effects of two medical contexts on the relationship of hypochondriacal traits and their potential correlates. METHOD: Correlates of hypochondriacal traits were compared from a matched sample of fifty-five general medical inpatients with a sample of fifty-five medical inpatients referred for psychiatric evaluation. Patients completed questionnaires assessing emotional distress and health attitudes, beliefs, and behaviors, and their attending physician completed ratings of the patient's illness and illness behavior. RESULTS: Patients referred for psychiatric consultation exhibited significantly higher levels of hypochondriacal illness presentation than the matched nonreferred sample. Moderated regression analyses revealed three trends regarding the interactive effects of group status on the relationship of hypochondriacal traits to their potential correlates: 1) presence of angry feelings and interpersonal friction was positively associated with hypochondriacal concerns for the psychiatric referred patients only, 2) the tendency to deny life stresses and attribute all problems to the effects of illness was positively associated with a misinterpretation of the severity of their illness and hypochondriacal illness presentation for the psychiatric referred patients, whereas this association was negative for the nonreferred medical patients, and 3) the association of reports of emotional distress symptoms with hypochondriacal illness preparation was negative for the psychiatric referred patients and positive for the nonreferred medical patients. CONCLUSIONS: Study results suggest that hypochondriasis may not represent a uniform nosological disorder and that the context of its study can significantly influence etiologic findings.

Adult smokeless tobacco use and age of onset.

To determine if an earlier age of onset is associated with greater levels of adult smokeless tobacco (SLT) use and to evaluate if this relationship differs by SLT type, 345 current adult SLT users were interviewed to obtain the age at first onset and current frequency of SLT use. The results indicated that more than twice as many SLT users began during adulthood than during preadolescence. Although preadolescent onset was associated with greater chewing tobacco use than adolescent onset, the greatest levels of both chewing tobacco and snuff use were associated with adult onset, suggesting an increased need for SLT prevention programs for young adults.

Clinical and lymphocyte responses to beta-carotene supplementation in 11 HIV-positive patients with chronic oral candidiasis.

Eleven HIV-positive patients with chronic oral candidiasis were supplemented with 60 to 120 mg of beta-carotene daily for 3 to 7 months. Lymphocyte profiles were evaluated at intervals to help assess immune competence. Although there was a modest increase in some lymphocyte values at 2 months, there was a significant decrease in numbers of CD4 and CD8 cells and CD4 percentage of lymphocytes after 6 months of beta-carotene supplementation. Serum triglyceride and liver enzyme levels were not affected by the beta-carotene supplementation. No improvement was observed in the control of the oral candidiasis. Under the conditions of the study, there was no indication that daily beta-carotene supplements enhanced immune competence or was of benefit in managing oral candidiasis.

A clinical trial of antioxidant supplements in the treatment of oral leukoplakia.

Seventy-nine patients with oral leukoplakia that was histologically verified as either hyperkeratosis or epithelial dysplasia with hyperkeratosis were enrolled in an antioxidant supplementation program for the treatment of the oral lesions. The patients received 30 mg of beta-carotene, 1000 mg of ascorbic acid, and 800 IU of alpha-tocopherol per day for 9 months. Clinical improvement of the oral lesion was noted in 55.7% of the patients and was more likely to occur in patients who reduced their use of alcohol or tobacco (p = 0.0056). Although risk-factor reduction was important, approximately half of the patients who did not alter their exposure to either alcohol or tobacco showed clinical improvement. The antioxidant supplementation significantly increased serum and tissue levels of beta-carotene, ascorbic acid, and alpha-tocopherol, but these changes did not correlate strongly with clinical improvement.

Comparison of articles published in Oral Surgery Oral Medicine Oral Pathology in 1972 and 1992.

The articles published in the Oral Pathology section of Oral Surgery Oral Medicine Oral Pathology in 1972 and 1992 were analyzed and compared. A significant increase in the number of authors and the number of references per article was noted. There was also a significant increase in the number of articles that dealt with bacterial/viral/fungal diseases. A trend toward the origination of more articles from outside the United States was noted.

Evaluation of serum and tissue levels of beta-carotene.

Interest in beta-carotene (BC) has increased as studies show that low dietary or serum BC is associated with increased risk of cancer. Patients with oral epithelial dysplasia had serum and oral mucosa punch biopsy samples taken before supplementation of 30 mg/day of beta-carotene and after 6 and 9 months of supplementation. BC was analyzed for 28 patients by high-performance liquid chromatography. At baseline, serum BC and gender accounted for 48% of tissue BC variance: Tissue BC = -0.13 + 0.08(Serum BC) + 1.21(Sex) with sex as male = 0 or female = 1. Following supplementation, serum BC had an exponential relationship to tissue BC which accounted for 52% of tissue variance: Tissue BC = 1.15 + 5.7 x 10(-5)(Serum BC)2 + 3.91(Sex). Women had higher mean concentrations of serum and oral mucosal BC before and during supplementation. The need for oral mucosal sampling may be eliminated by the correlation between serum and tissue BC.

Oral melanotic macules. A review of 353 cases.

Clinical and histopathologic data were obtained on 353 cases of oral melanotic macules. The mean age at the time of diagnosis for all sites was 43.1 years. A significant predilection for females (p < 0.001) was noted and the most common location was the lower lip (33.0%). The mean size of the lesions was 6.8 mm. Brown was the most common color (64.9%), and most (66.0%) of the lesions were described as flat. Melanin was evident in both the basal cell layer and lamina propria in 93.5% of the cases.

The prevalence of oral lesions in smokeless tobacco users and an evaluation of risk factors.

BACKGROUND: The widespread use of smokeless tobacco (ST) has prompted concern in regard to the development of oral lesions in long-term users. METHODS: For inclusion in the current study, a subject must have used an ST product, either snuff or chewing tobacco, for at least 6 months. The subjects were recruited by advertising, and none was referred for the evaluation of an oral lesion. The following were performed on all subjects: assessment of exposure to ST, cigarettes, and alcohol; examination of the oral cavity; a biopsy, if an oral lesion was found; and analysis of a blood sample for beta-carotene. The dietary intake of most of the subjects was analyzed. RESULTS: Of the 347 ST users, all of whom were white male subjects, 45 (13.0%) had an oral lesion. Thirty-five of the lesions were hyperkeratosis and 10 were epithelial dysplasia. CONCLUSIONS: Snuff exposure was associated significantly with the presence of an oral lesion (P < 0.0001). A decreased vitamin C intake also was found among the ST users with oral lesions (P < 0.01). The ST users with epithelial dysplasia, as compared with those with hyperkeratotic lesions, were slightly older, had a lower intake of vitamin C (P < 0.05), and were more likely to have used chewing tobacco than snuff.

The relationship of anger and child psychopathology.

This study examines the relationship of anger to child psychopathology in an inpatient psychiatric sample. Results suggest that anger as assessed by the Children's Inventory of Anger is not highly correlated with other affective experiences or behavioral dispositions, yet may provide incremental data pertinent to distinguishing children with concurrent disturbances of emotion and conduct from children with disturbances in either emotion or conduct.

Derivation and implications of MMPI cluster groups in clinically depressed inpatient females.

The purpose of this study was to subclassify clinically depressed patients based on a cluster-analytic examination of the MMPI. Subjects were 79 female inpatients with major depression. A cluster analysis of the MMPI validity and clinical scales resulted in three clusters labeled psychotic (287 MMPI profile), hostile (24 MMPI profile), and histrionic (32 MMPI profile) depression. The psychotic group exhibited the greatest depression as measured by the Beck Depression Inventory (BDI). The psychotic and hostile groups, however, did not differ on other associated aspects of depression, such as negative cognitions, nonassertiveness, or personality style. The hostile group reported the fewest physical difficulties and the most excessive alcohol use. The groups, however, did not differ on other aspects of depression history or presentation such as family history of depression or previous hospitalizations. A repeated measures ANOVA for the three cluster groups on the BDI at admission, discharge, and 6 months after discharge indicated that all groups showed improvement at discharge but that only the hostile depressive group continued to show improvement at the 6-month follow-up.

The role of race and ethnic status on the psychosocial correlates of smokeless tobacco use in adolescent males.

From a stratified, random sampling of non-urban high schools in the Southeast, survey data were obtained from 5374 adolescent males. Over half reported trying smokeless tobacco, and approximately one third of these reported a regular, substantial level of use. The average age at initial use was 12.2 yr. and was negatively correlated with the level of use. Factor analysis of the psychosocial items resulted in four factors: substance use/deviant style, modeling, perceived negative consequences, and health behavior. Discriminant analysis of initial use indicated that substance use and modeling influences were the strongest predictors of trying smokeless tobacco. Regression analysis of level of smokeless tobacco use indicated that substance use, modeling, and perceived negative consequences were equivalent in their contribution. Separate analyses were performed for American Indian, Black, and White males. Although predictors of initial use were similar, level of smokeless tobacco use was most associated with the use of other substances in Blacks and with modeling influences in Whites.

Examining emotional distress during pediatric hospitalization for school-aged children.

Emotional distress was examined in 80 school-aged children during pediatric hospitalization. Using multiple regression analyses, children's depressive and anxious symptoms were positively related to duration of physical symptoms and parental distress. Depressive symptoms were negatively related to age and the perceived social support available from the family. Unexpectedly, the frequency of medical procedures and previous hospitalization experiences were not associated with depressive or anxious symptoms. Because many of the children in this study had experienced enduring symptoms and frequent previous hospitalizations, it was hypothesized that they may have habituated and adjusted to many of the experiences of hospitalization and thus were not adversely affected by such experiences.

The relationship of the Allen Cognitive Level Test to cognitive abilities and psychopathology.

The cognitive factors measured by the Allen Cognitive Level Test (ACL) (Allen, 1982) as well as the test's relationship to level of psychopathology were examined through a retrospective study of 71 patients from a general hospital psychiatry unit. Pearson correlations, computed for the ACL score with the Shipley Institute of Living Scale (Shipley, 1940), a general measure of intellectual functioning, were significant. A strong correlation was found between the ACL and the Symbol-Digit Modalities Test (Smith, 1982), a measure of motor speed and concentration often used as a neurological screening instrument. This suggests the potential usefulness of the ACL to screen for cognitive dysfunctions associated with organicity. Contrary to hypothesis, there was no significant correlation between the ACL and measures of psychopathology such as the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Minnesota Multiphasic Personality Inventory (Hathaway & McKinley, 1940). The relationship of the ACL to other recognized measures of cognitive functioning increases its usefulness as a valid measure of day-to-day limitations in the functioning of psychiatric patients. Effective communication of the implications of these cognitive levels to a multidisciplinary treatment team is enhanced by knowledge of the relationship of the ACL to measures of cognitive functioning and psychopathology used by other disciplines.

Smokeless tobacco use in adolescent females: prevalence and psychosocial factors among racial/ethnic groups.

From a stratified, random sampling of Southeastern, nonurban high schools, survey data on smokeless tobacco use and potential psychosocial risk factors were obtained from 5683 adolescent females. Of the 15.3% who reported trying smokeless tobacco, most (75%) reported only experimental use. Factor analysis of the psychosocial items resulted in four factors: perceived negative consequences, substance use, modeling, and active lifestyle. Discriminant analysis on use indicated that modeling influences and use of other substances were the strongest predictors of initial smokeless tobacco use. Level of use, however, was most strongly associated with lower perceived negative consequences for use and the use of other substances. Separate analyses on American Indian, Black, and White subgroups suggested that factors associated with initial use were similar but that substantial differences exist between subgroups on risk factors for level of smokeless tobacco use.

The Depressive Experiences Questionnaire: validity and psychological correlates in a clinical sample.

This study sought to compare the original and revised scoring systems of the Depressive Experiences Questionnaire (DEQ) and to assess the construct validity of the Dependent and Self-Critical subscales of the DEQ in a clinically depressed sample. Subjects were 103 depressed inpatients who completed the DEQ, the Beck Depression Inventory (BDI), the Hopelessness Scale, the Automatic Thoughts Questionnaire (ATQ), the Rathus Assertiveness Schedule (RAS), and the Minnesota Multiphasic Personality Inventory (MMPI). The original and revised scoring systems of the DEQ evidenced good concurrent validity for each factor scale, but the revised system did not sufficiently discriminate dependent and self-critical dimensions. Using the original scoring system, self-criticism was significantly and positively related to severity of depression, whereas dependency was not, particularly for males. Factor analysis of the DEQ scales and the other scales used in this study supported the dependent and self-critical dimensions. For men, the correlation of the DEQ with the MMPI scales indicated that self-criticism was associated with psychotic symptoms, hostility/conflict, and a distress/exaggerated response set, whereas dependency did not correlate significantly with any MMPI scales. Females, however, did not exhibit a differential pattern of correlations between either the Dependency or the Self-Criticism scales and the MMPI. These findings suggest possible gender differences in the clinical characteristics of male and female dependent and self-critical depressive subtypes.