Importance of fatalism in understanding mammography screening in rural elderly women.

This study examined the relationship between demographic factors and other correlates of fatalism, and assessed the impact of fatalistic beliefs on the participation in breast cancer screening in rural women. The subjects were 220 women aged 50 and over recruited from 6 large rural counties in South Carolina. Data were collected using a demographic questionnaire and the revised Powe Fatalism Inventory. Results show significant associations between fatalism and increased age (p = 0.005), race (p = 0.0001), doctor recommendation (p = .0034) and decreased educational level (p = 0.001). Fatalism was associated with noncompliance with mammography screening in univariate analysis among African-American women (OR = .362; 95% CI: 1.11, 11.8). After adjusting for possible confounders (age, education, and doctor recommendation), fatalism was not significantly associated with noncompliance with screening. These results illustrate age, race, and education may be important predictors of fatalism and that fatalism may be one barrier that has previously gone unmeasured and unchallenged in understanding screening behavior in older women.

Associations between self-reported and objective physical environmental factors and use of a community rail-trail.

BACKGROUND: To effectively promote physical activIty, researchers and policy makers have advocated for greater use of environmental approaches, such as the construction of community paths and trails. However, research on the use of these facilities is limited. METHODS: In this cross-sectional community study, we examined associations between self-reported and objective physical environmental variables and use of the Minuteman Bikeway (Arlington, MA) in a random sample of 413 adults. Sociodemographic and perceived environmental variables were measured with a mail survey during September 1998. Geographic information system (GIS) data were used to geocode survey respondents' homes and create three objective environmental variables: distance to the Bikeway, steep hill barrier, and a busy street barrier. RESULTS: In logistic models, age and female gender showed statistically significant inverse associations with Bikeway use over the previous 4-week period. Increases in self-reported (OR = 0.65) and GIS distance (OR = 0.57) were associated with decreased likelihood of Bikeway use. Absence of self-reported busy street (OR = 2.01) and GIS steep hill barriers (OR = 1.84) were associated with Bikeway use. CONCLUSIONS: Environmental barriers such as travel distance and hilly terrain should be considered when planning community trails. A better understanding of such factors may lead to more effective promotion of trail use.

Teens' images of smoking and smokers.

The authors used qualitative and quantitative data to identify and interpret specific images teens have about smoking and smokers. Qualitative data were collected in 1996 from 793 teenagers participating in 125 focus groups at eight different sites across the United States. Most focus groups were homogeneous with respect to gender, ethnicity, and smoking status. Ages ranged from 12 to 18 years, and about half of the participants were female. The majority of participants (62%) were white and African American, the remainder (38%) were Hispanic, American Indian, and Asian/Pacific Islander. Groups were comprised of smoking and nonsmoking teens. Focus group activities were used to elicit image-related discussions about attitudes, beliefs, and perceptions of smoking. Investigators identified seven consistent and distinctive image themes: Appearance (smoking is dirty and unattractive), Activity (nonsmokers have busy, active lives), Drugs and sex (smokers are substance abusers and are sexually active), Rebellion (smokers belong to rebellious groups), Affect (smokers are depressed, angry, and stressed-out), In control (nonsmokers have self-control and are independent), and Pride (nonsmokers are proud of themselves, their families, and their heritage). A large scale, multi-site qualitative research approach can increase understanding of teen smoking. The identification of distinctive images of smoking can help researchers develop more sophisticated models of the processes of teen smoking than currently exist.

A study of the attribution style, self-efficacy, and dietary restraint in female binge and non-binge eaters.

The purpose of this study was to identify the role that attribution style and self-efficacy expectations have in overweight binge and non-binge eaters. The subjects were women (n=210) enrolled for weight control treatment, who completed a questionnaire to assess attribution style and self efficacy expectations. They were categorized into three binge eating disorder (BED) groups: non-BED, borderline BED and BED. The results of the ANOVA analysis indicated that the borderline and BED groups were significantly similar in terms of all measures of attribution and self-efficacy; and logistic regression analysis that the odds of being borderline BED or BED were greater if an individual had internal attributions, and more likely in the presence of diminished self-efficacy expectations. The subjects with low levels of eating self-efficacy and internal, global, and uncontrollable attributions were also more likely to have borderline BED and BED. The implications of the borderline BED category are discussed in relationship to the DSM-IV BED diagnosis.

Peripheral cues and involvement level: influences on acceptance of a mammography message.

The elaboration likelihood model (ELM) suggests that some communication elements are processed differently depending on a receiver's involvement with the message topic. We hypothesized that women with high levels of breast cancer involvement would be more influenced by a mammography message's arguments than by the message's peripheral cues and, conversely, that women with low levels of involvement would be more influenced by a mammography message's peripheral cues than by the message's arguments. We exposed 89 low-income African American women aged 40 to 65 years to two repetitions of a mammography promotion public service announcement embedded as a commercial within a television talk show. We used a 2 (involvement level) x 2 (argument strength) x 2 (peripheral cue favorability) factorial posttest-only design. The analysis detected a significant main effect for involvement and an interaction between peripheral cue favorability and involvement. High-involvement women reported stronger intentions than did low-involvement women to seek additional mammography information, regardless of argument strength or cue favorability. Low-involvement women reported stronger intentions to seek more mammography information only when exposed to the favorable cue condition. The analysis detected no effect for argument strength in high- or low-involvement women. The ELM appears useful for designing mammography messages. As many women may have low involvement with breast cancer, mammography promotion messages that include favorable peripheral cues may be more likely to impact mammography information seeking than argument-based-only messages.

Who's driving? college students' choices of transportation home after drinking.

Legal and educational interventions have not had a significant impact in reducing alcohol use among college students. The purpose of this study was to determine the frequency at which students placed themselves "at-risk" for alcohol-related traffic fatalities, either by driving while alcohol impaired or riding with an alcohol-impaired driver. On a given weekend night, 18% (n = 60) of students surveyed placed themselves at risk of being involved in an alcohol-related traffic fatality. Two-thirds of the "at-risk" subjects reported returning home with an alcohol-impaired driver. Recommendations are made for strengthening prevention efforts.

Community intervention. Creating opportunities and support for cancer control behaviors.

Much of the potential for reducing cancer mortality is dependent on the adoption of new behavioral patterns. Such changes demand application of the behavioral-social sciences. A shift from univariate reductionist models of causation toward multivariate systems models is needed. Decisions (and behavior) are the focus of much of the behavioral-social sciences. Determinants of decisions are delimited by controlling systems. Health care is only one of many possible influences on controlling systems, and its influence is only marginal for the behavior of the general public. Thus, community interventions that address multiple determinants within controlling systems are needed to influence most behaviors. Belief saliency hierarchies appear to psychologically mediate controlling systems. Changes in these saliency hierarchies lead to changes in behaviors. Person-valued beliefs, social-valued beliefs, and feasibility beliefs serve as the informational basis for the hierarchies. Needs activation is a primary means by which hierarchies shift. Changing environmental cues and signals also impart such shifts. Experience, persuasive communication, and value extracted from the environment also change hierarchies. Needs activation, community presence, persuasive communication, facilitation, inhibition, and experience-based interventions are discussed for tobacco use control, dietary change, and breast and cervical cancer screening behavior. Emphasis is given to how the health care system can become a part of the controlling system that influences community behavior. Issues concerning successful implementation of community education programs are raised.

Psychological and behavioral differences among females classified as bulimic, obligatory exerciser and normal control.

The compulsion to maintain a lean body shape while living in a society obsessed with food may encourage the use of dieting, binge eating and purging behaviors in young women. The body of literature on bulimia nervosa (Boskind-Lodahl and Sirlin 1977; Fairburn and Cooper 1984; Katzman and Wolchik 1984; Scott 1988) clearly establishes its relationship to the current American fashion for thinness and the value placed on physical attractiveness for self-esteem. This notion promotes a multitude of weight control strategies ranging from self-starvation (Humphrey 1983; Brownell and Foreyth 1986) to cigarette smoking (Klesges and Klesges 1988), many of which may have a profound influence on maintenance of good health. Similar to weight control, exercise behavior could be viewed as falling on a continuum from reasonable efforts to maintain physical fitness to a preoccupation with exercise that is far out of proportion to the expected benefits of a 30-minute, three to five day a week routine. Characteristics of obligatory exercise have been described by several researchers and include maintaining a rigid schedule of intense exercise; resisting temptation to lapse into nonexercising; feelings of guilt and anxiety when the exercise schedule is violated; compensatory increase in exercise to make up for lapses; pushing oneself even when tired, ill, or injured; mental preoccupation with exercise; and detailed recordkeeping on exercise (Yates et al. 1983; Blumenthal et al. 1984; Nudelman et al. 1988). In a competitive society, obsessive exercise behaviors may be linked to the development of rigid dietary guidelines while one strives toward the "optimal" lean-fat ratio of body composition.(ABSTRACT TRUNCATED AT 250 WORDS)

Student recognition of and response to suicidal peers.

A survey of 1,131 university freshmen revealed that they were able to recognize suicidal behavior in their peers, but were unsure of a helpful response to make to them. A model of self-efficacy, emotional comfort, knowledge of a helpful response, and knowledge of suicidal behavior predicted a student's intention to ask a suicidal peer directly, "Are you thinking about killing yourself?" (R2 = .38). Results of the study suggest that suicide prevention programs for adolescents should include educational experiences such as modeling, skill training, and role playing to increase self-efficacy and emotional comfort in affect-laden situations.

Variable decelerations during nonstress tests are not a sign of fetal compromise.

An examination of 908 fetal heart rate tests of 418 consecutive patients revealed brief variable decelerations in more than 50.7% of the patients. Although an association existed with nuchal cord location found at delivery, no association existed between these variable decelerations and fetal heart rate decelerations during labor, low Apgar scores at birth, or birth weight. We find no evidence to suggest that these brief variable decelerations are a sign of fetal compromise or an indication for obstetric intervention.

The relationship between weight-height indices and the triceps skinfold measure among children age 5 to 12.

This study examines several weight for height indices--Quetelet's index W/H2, W/H, and Rohrer's index W/H3--for their appropriateness in estimating adiposity among young children. Data were obtained for a sample of 1,668 children age 5-12 residing in Forsyth County, North Carolina. Although W/H2 was found to be the most useful of these indices, the results suggest that no index, including the tricep skinfold measure, can be considered completely satisfactory in estimating adiposity among children.

Weight-for-height indices as measures of adiposity in children.

This study examines the weight-for-height index q = w/h lambda where the parameter lambda is chosen to maximize the correlation of q with triceps skinfold thickness, and thus provide an indirect measure of adiposity. Using a sample of 1668 children ages 5-12 years, we estimate lambda by an iterative procedure in each age/sex category. We find that lambda does not vary simply across the age/sex categories, and that the correlation of q and skinfold thickness is never more than marginally greater than that of the Quetelet index w/h2. We indicate that almost identical properties will be evidenced by the more general two-parameter index w alpha/h beta. Our conclusion is that there is no weight-for-height index generally useful as an indirect measure of adiposity in children.

A comparison of height, weight, and triceps skinfold thickness of children ages 5-12 in Michigan (1978), Forsyth County North Carolina (1978), and HANES I (1971-1974).

Height, weight, and triceps skinfold measurements were made on 1,668 Forsyth County, North Carolina students ages 5-12 during 1978. These data were compared to a representative sample of Michigan children taken during the same year and to their United States counterparts in HANES I (1971-74). The North Carolina children more closely resembled their US counterparts than did the Michigan group, casting doubt on the secular trend toward heavier children suggested by the Michigan researchers. (Am J Public Health 1982; 72:730-733.)

Late meconium passage in labor--a sign of fetal distress?

Although the passage early in labor of thick amniotic fluid heavily stained with meconium is recognized as an indication of potential fetal asphyxia, the significance of late passage of meconium-stained fluid in labor is less certain. One hundren twenty-eight patients with late passage of meconium in labor and 134 control patients were examined, using chi 2 and discriminant analysis, to determine if any relationships existed between fetal heart rate (FHR) patterns, late passage of meconium in labor, and neonatal morbidity. In the group with late meconium passage, adequate baseline FHR variability and nonperiodic accelerations were predictive of high Apgar scores, and repeated (over 20) variable decelerations were predictive of low Apgar scores. In the control group, none of the FHR patterns examined were predictive of Apgar score. Thus, the combination of late passage of meconium in labor with other intrapartum signs may indicate a fetus at risk for asphyxia when neither sign alone is predictive. The presence of late meconium passage demands close observation of the patient in labor, including assessment by electronic FHR monitoring.

The effect of contract witnessing on motivation and weight loss in a weight control program.

To investigate the impact which commitment has on the achievement of behavioral-change goals in a weight control program, a behavioral contracting process was used. One-hundred six adult volunteers were randomly identified as treatment or control group members and co-participated in a four-week, eight-hour, behavioral self-management weight control program. As part of homework assignments, all participants were provided with three take-home contracts which were to be returned either signed by the participant only (control group with baseline commitment) or by the participant and at least one friend, relative, or peer (treatment group with enhanced commitment). Analyses of comparable treatment and control group members shows the treatment group holding significantly stronger behavioral intentions 10 to 15 weeks after the program ended and losing weight at a significantly faster rate. Implications for program planning, implementation, and evaluation are discussed.