Activating multi-ethnic youth for smoking prevention: design, baseline findings, and implementation of project SPLASH.

BACKGROUND: Achieving significant reductions in tobacco use by youth is an important challenge. There is a pressing need to develop and evaluate innovative strategies that stimulate youth involvement and are effective in multi-ethnic populations. This article describes an innovative tobacco prevention trial, and reports baseline characteristics of participants and findings about implementation of the curriculum. METHODS: The aim of Project SPLASH is to evaluate the impact of a school-based smoking prevention intervention that emphasizes active involvement of middle school students, on rates of smoking initiation and regular smoking in a multi-ethnic cohort of youth in Hawaii. Project SPLASH is a group randomized trial that compares a 2-year innovative intervention with a social influence prevention program, in 20 public schools in Hawaii. The main outcome is mean 30-day smoking prevalence rates. RESULTS: The response rate was 78.4%. Approximately 1 in 4 students had tried smoking and 30-day smoking prevalence at baseline was 8%. Intervention and control groups were comparable in terms of tobacco use, gender, ethnicity, behavioral, environmental, and psychosocial characteristics. Differences in ethnic identification, socio-economic status, acculturation, and involvement in prevention activities may be due to chance. The intervention was well implemented by teachers across both the intervention and control school classes. CONCLUSION: For this study, 20 schools in Hawaii with close to 4000 participating students were recruited. Student smoking behavior and curriculum implementation were comparable by group status. The intervention study has the potential to elucidate how youth respond to an intervention with student involvement that incorporates cognitive and social action components.

Synchronous liver cancers: A rare tumor combination in an elderly Japanese woman.

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) may occur simultaneously in a person with primary liver cancer However HCC and CC arising from separate foci is extremely rare. This is a case presentation of a 66-year-old woman with primary combined HCC-CC, who had no risk factors for either tumor.

Development and reliability of a brief skin cancer risk assessment tool.

This study aimed to develop and pilot test a brief skin cancer risk assessment tool (BRAT), a self-administered instrument that can be reliably used to assess skin cancer risk. To develop the BRAT, we critically reviewed published literature on risk factors; formulated a draft questionnaire; pilot tested the questionnaire; and retested 1 month later. The BRAT items address the key risk factors for melanoma and other keratinocyte skin cancers: ethnicity, personal and family history of skin cancer, mole count, freckles, childhood residence, sunburn history, and sun sensitivity factors (skin color, natural hair color, ease of sunburning and tanning). One hundred sixty-five persons completed the initial BRAT pilot study, and 52 additional people at moderate- or high-risk completed a second BRAT pilot study. Results were as follows: using a dichotomous risk measure, about 90% of subjects would be correctly classified at baseline and follow-up. Weighted kappa for the total BRAT score (0.41-0.68) and for individual items (0.57-0.99) were fair to good, as were correlation coefficients. The BRAT has acceptable to good reproducibility. Reliability statistics compared favorably with those reported in the literature for similar measures.

Participant reactions to a computerized telephone system for nutrition and exercise counseling.

This paper reports on an evaluation of the reactions of participants in a computer-controlled telephone conversation system (telephone-linked care, TLC) designed to offer nutrition and exercise counseling. After 6 months in the study, subjects were asked a series of questions about their opinions of the TLC system, including overall satisfaction and the system's helpfulness. One hundred and ninety individuals completed the attitude survey. On a scale of 0-100, respondents rated the overall satisfaction and helpfulness of the system at 63.6 and 62.3. Subjects using the nutrition counseling version of TLC rated it significantly higher on satisfaction (73.0 versus 52.4) and helpfulness (70.3 versus 53.7) than did subjects using the exercise version. Satisfaction and helpfulness were correlated with perceived usability, amount of contact, realism, and credibility (P < 0.01). Multivariate analyses showed that treatment group and number of calls made accounted for the greatest amount of variance in ratings of satisfaction and helpfulness. The findings suggest that the amount of contact with this technology, reflected by the number of calls, and the treatment group, nutrition or exercise, were significant predictors of reported satisfaction and perceived helpfulness of the system.

Preventing underage drinking: a "roll of the dice".

This study examines the efficacy of a video entitled "Underage Drinking: A Roll of the Dice," and accompanying discussion guide. The video illustrates the civil and criminal consequences of underage drinking. The video and discussion aimed to: (1) increase awareness about the problem of underage drinking; (2) increase viewers' and participants' knowledge and perceptions of the risks and responsibilities and reduce the perceived acceptability of underage drinking; and (3) encourage discussion between youths and adults about underage drinking. The "Roll of the Dice" was evaluated in 19 school and community groups in Hawaii. Groups were randomly assigned to receive follow-up materials or no follow-up materials. Evaluation involved three surveys: pretest, posttest, and follow-up. Three hundred youths and adults responded to the first two surveys, and 220 people completed a third survey. Youths and adults showed increases in short-term knowledge, perceived risk, and perceived responsibility, and a decrease in perceived acceptability of underage drinking after viewing the video. Significant improvement between the pretest and follow-up was observed, although the changes were not entirely maintained at the time of the posttest. The results showed that legal consequences of underage drinking are not common knowledge, and that a well-designed one-time program can make a difference. This video and discussion session provide an inexpensive way to raise adults' and youths' awareness of the laws and penalties, resulting in effects maintained for at least a month after the program. Additional follow-up materials did not enhance retention of changes in knowledge and attitudes.

A randomized trial of skin cancer prevention in aquatics settings: the Pool Cool program.

Skin cancer is increasing, and prevention programs are essential. This study evaluated the impact of a skin cancer prevention program on sun-protection habits and swimming pool environments. The intervention included staff training; sun-safety lessons; interactive activities; providing sunscreen, shade, and signage; and promoting sun-safe environments. A randomized trial at 28 swimming pools in Hawaii and Massachusetts tested the efficacy of this program (Pool Cool) compared with an attention-matched injury-prevention control program. Results showed significant positive changes in children's use of sunscreen and shade, overall sun-protection habits, and number of sunburns and improvements in parents' hat use, sun-protection habits, and reported sun-protection policies and environments. Observations corroborated the positive findings. Pool Cool had significant positive effects at swimming pools in diverse audiences.