Initial effects of graduated driver licensing on 16-year-old driver crashes in North Carolina.

CONTEXT: Since 1997, 32 states have enacted graduated driver licensing (GDL) systems to reduce crash rates among young novice drivers. OBJECTIVE: To determine the initial effect of the North Carolina GDL system on crashes among 16-year-old drivers. DESIGN, SETTING, AND SUBJECTS: Comparison of population-based North Carolina motor vehicle crash rates before (1996-1997) and after (1999) 16-year-old drivers were licensed under the GDL system. To control for other factors that might have influenced crashes, changes for 16-year-old drivers were compared with those of drivers 25 to 54 years of age. Crashes per licensed driver were also examined. INTERVENTION: The North Carolina GDL system, enacted December 1, 1997, requires beginning drivers 15 to 17 years of age to hold level 1 licenses, allowing driving only while supervised by a designated adult for a full year; followed by level 2 licensure, allowing unsupervised driving from 5 AM to 9 PM and supervised driving at any time for at least 6 months; and, finally, level 3-a full, unrestricted license. MAIN OUTCOME MEASURES: Rates of motor vehicle crashes among 16-year-old drivers in 1996-1997 vs 1999, overall and by crash severity (fatal, injury, and noninjury), time (night vs day), type (single vs multiple vehicle), driver alcohol use, and driving environment (more vs less rural counties). RESULTS: Crash rates declined sharply for all levels of severity among 16-year-old drivers after the GDL program was implemented. Following GDL, 16-year-old driver crashes were substantially less likely. Comparing 1996 with 1999, fatal crashes declined 57%, from 5 to 2 per 10 000 population (rate ratio [RR], 0.43; 95% confidence interval [CI], 0.27-0.70); crashes with no or minor injuries decreased 23%, from 1068 to 826 per 10 000 (RR, 0.77; 95% CI, 0.75-0.80). Nighttime crashes were 43% less likely (156 vs 88 per 10 000; RR, 0.57; 95% CI, 0.52-0.61) and daytime crashes decreased by 20% (951 vs 764 per 10 000; RR, 0.80; 95% CI, 0.78-0.83). Single-vehicle crashes (245 vs 175; RR, 0.71; 95% CI, 0.67-0.76) declined somewhat more than multiple-vehicle crashes (866 vs 681; RR, 0.79; 95% CI, 0.76-0.81). CONCLUSION: In its initial years, the North Carolina GDL system produced substantial declines in 16-year-old driver crashes.

Personality and coping with a common stressor: cardiac catheterization.

The association between coping and personality was examined in a sample of 204 cardiac catheterization patients who were asked to evaluate the use of specific coping strategies used to deal with their cardiac catheterization. Personality, as measured by the NEO Five-Factor Inventory (FFI), was moderately correlated with coping measures. In multivariate analyses, after considering confounding factors, Neuroticism was positively and Extraversion was negatively related to avoidance coping and Neuroticism was negatively associated with counting one's blessings as a coping strategy. Personality was not related to either problem solving or seeking social support coping strategies for individuals experiencing a cardiac catheterization. However, important covariates were associated with coping strategies. Not being married was negatively correlated with use of seeking social support and not having a confidant was negatively related with seeking social support and positively with avoidance. These results suggest that there are specific relationships between personality and coping, but these relationships are, for the most part, moderate in persons coping with a cardiac catheterization, and that coping processes are associated with individual differences in available social resources.

Measurement of dietary intake in the UNC Alumni Heart Study. University of North Carolina.

BACKGROUND: Research needs to identify diet and disease associations to provide direction about effecting change in individuals with dietary behaviors that increase risk of chronic disease. Inclusion of dietary assessment in the University of North Carolina Alumni Heart Study (UNCAHS) provides the opportunity to prospectively investigate dietary intake and chronic disease associations with measures of personality and behavioral risk factors. METHODS: Development of the UNCAHS food frequency questionnaire and nutrient intake of 4,443 middle-aged men and women is provided stratified by total fat and vitamin A intake within demographic and health behavior categories. RESULTS: Alumni consume diets close to that recommended by current dietary guidelines. Both men and women have low calcium intake. Thirty-nine percent of the alumni consume diets with 30% of kilocalories from fat or less and 88% meet the RDA for vitamin A. Never smokers had lower fat diets and greater intakes of vitamin A than former or current smokers. Over 54% of alumni currently took vitamin/mineral supplements. CONCLUSIONS: UNCAHS participants will be tracked as they approach older ages with apparently less risk for diet-related chronic diseases than many Americans. The psychosocial correlates of these eating behaviors will be evaluated as disease endpoints occur.

Hostility in marital dyads: associations with depressive symptoms.

We examined the relations of hostility (of self and spouse) with self-ratings of depressive symptoms in 898 spouse pairs. Self-ratings of hostility were initially examined as predictors of depression. Next, spouse self-ratings of hostility were added to the model. Finally, the interaction of self x spouse hostility was investigated. These relations were explored for three components of hostility (Cynicism, Aggressive Responding, and Hostile Affect). Age and education were controlled in all models and effects were examined separately for women and men. Self-ratings of Hostile Affect were positively related to depressive symptoms for both women and men. Self-ratings of Cynicism were also significantly related to depression, but only for men. All three components of spouse's hostility were positively related to one's own symptoms of depression for women. For men, however, spouse's hostility was not related to symptoms of depression. These findings highlight the need to study psychosocial risk factors in social units and have potential implications for intervention.

Self-perceptions of stability and change in personality at midlife: the UNC Alumni Heart Study.

The finding of personality stability in adulthood may be counterintuitive to people who perceive a great deal of change in their own personality. The purpose of this study is to determine whether self-reported perceived changes in personality are associated with actual changes based on a 6- to 9-year follow-up of 2,242 middle-aged male and female participants of the UNC Alumni Heart Study (UNCAHS). Respondents completed the Revised NEO Personality Inventory on two occasions and were asked to reflect back over a 6-year period and assess changes in their personality. The majority of respondents (n = 1,177; 52.5%) reported they had "stayed the same," while 863 (38.5%) reported they had "changed a little" and 202 (9%) reported they had "changed a good deal." Coefficients of personality profile agreement computed to evaluate global personality change for the three perceived change groups were essentially equivalent. Further, directional analyses of domain-specific changes in personality showed that perceived changes were weak predictors of residual gain scores. In an absolute sense, perceptions of stability or change were discordant in 8 of 15 (53%) comparisons. Self-perceptions of change are not an adequate substitute for objective assessments.

Relationships among breast cancer concern, risk perceptions, and interest in genetic testing for breast cancer susceptibility among African-American women with and without a family history of breast cancer.

There has been very little research exploring the relationships among perceptions of, and concern about, getting breast cancer and interest in genetic testing for breast cancer among African-American women with and without a family history of breast cancer. This study explored these issues among 130 and 136 African-American women with and without a family history of breast cancer, respectively. Women with a family history reported having greater perceived breast cancer risks and concerns than women without a family history of breast cancer. Knowledge of breast cancer risk factors was very poor and correlated weakly with perceptions of risk and concern. In attributional analyses, acknowledging one's family history status was the strongest predictor of perceived risk only among women with a family history. Women with a family history of breast cancer expressed greater interest in genetic testing for breast cancer susceptibility than women without a family history, although interest in testing was high overall. Increasing perceptions of breast cancer risks and concerns were related to a greater interest in genetic testing, and this relationship was not moderated by family history status. Attributions of risk and knowledge of breast cancer risk factors generally were not related to interest in testing. Overall, these results suggest that: (a) African-American women with a family history are more concerned about and do recognize their greater risk of breast cancer; (b) knowledge of risk factors and attributions of risk are not directly related to interest in genetic testing; and (c) concerns, rather than beliefs about one's risk, are more powerfully related to interest in genetic testing, independent of family history status.

Perceptions of menopausal stage and patterns of hormone replacement therapy use.

In 1994, as part of their participation in the University of North Carolina Alumni Heart Study, 1101 women aged 45-51 years answered questions about their menopausal status and current use of hormone replacement therapy (HRT). Little is known about the use of HRT in younger women. We were interested in determining both patterns of HRT use and patient characteristics associated with HRT use in this cohort of women approaching the average age of menopause. After excluding women with breast, endometrial, and ovarian cancer, we studied 1080 women. These women identified themselves as: "There is no indication that I am near menopause" (stage 1, n = 326), "I think I may be close to or in the beginning stages of menopause but am not sure" (stage 2, n = 410), "I have begun menopause" (stage 3, n = 202), and "I have been through menopause" (stage 4, n = 142). The overall rate of HRT use was 22% (0% in stage 1, 8% in stage 2, 52% in stage 3, and 76% in stage 4). Both patterns of HRT use and patient characteristics associated with HRT use differed based on the woman's perception of her menopausal stage. In logistic regression models, where HRT use was the outcome variable, independent predictors of HRT use included stage of menopause, having had a hysterectomy, having had a bilateral oophorectomy, no family history of breast cancer, having had a pelvic examination in the last year, being married, and not participating regularly in physical exercise. A woman's perception of her stage in the process of reproductive aging correlates with her use of HRT. Informed decision making about HRT use should be tailored to the individual's perception of her menopausal stage.

Differential responsivity of monocyte cytokine and adhesion proteins in high- and low-hostile humans.

This study tested the general hypothesis that high- and low-hostile respondents would show different patterns of change in monocyte cytokine and adhesion protein (MCAP) expression in response to pharmacologically induced alterations in sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) balance. On 3 separate days, 4 high- and 4 low-hostile respondents received isoproterenol infusions after saline, atropine (PNS blockade), or neostigmine (PNS stimulation) pre-treatment. Dual color flow cytometry with fluorescently labeled monoclonal antibodies to CD 14 (monocyte market), interleukin-1, leukocyte function activator (LFA-1), Class II major histocompatibility complex (MHC-II), and tumor necrosis factor was used to quantify cytokine and adhesion protein expression on monocytes in blood samples drawn before and after the combination drug infusions on the 3 test days in each respondents. Following PNS stimulation and istoproterenol infusion there was a decrease (compared to saline pretreatment) in MHC II expression in high hostiles that was significantly (p<.02) different from an increase in low hostiles. A similar trend (p = .08) was seen for LFA-1 expression, with high hostiles showing an increase and low hostiles a decrease. These findings support the broad hypothesis that high-and low-hostile respondents will show different MCAP responses to pharmacologically induced alterations in SNS-PNS balance. Such differences could contribute to accelerated atherogenesis among high-hostile individuals.

Relation of mood ratings and neurohormonal responses during daily life in employed women.

Diurnal variations in urinary norepinephrine, epinephrine, cortisol, and self-reported mood states were examined in 101 employed women. Urine was collected on 2 consecutive workdays at 3 time periods: (1) overnight, (2) daytime, and (3) evening. Self-reports of 14 mood states were combined to correspond with the urinary collection periods. Factor analyses revealed 3 mood factors: Pressured (rushed, busy, stressed, hassled, and tense), Distressed (afraid, depressed, bored, and nervous), and Contented (satisfied, thoughtful, excited, and calm). The Distressed factor was significantly associated with norepinephrine excretion (p <.001). The Pressured factor was significantly associated with cortisol, epinephrine, and norepinephrine excretion (p <.001) independent of age, ethnicity, marital status, parental status, department within the company and activity level. Secretion of urinary hormones and the Pressured factor followed the same diurnal pattern. Specifically, as women's self-ratings of feeling pressured initially increased and then decreased over the course of the workday, urinary hormones also peaked and then dropped. Once time of day was statistically controlled, however, the mood factors were no longer significantly related to the urinary hormones.

Predictors of adoption of mammography in women under age 50.

Women in the University of North Carolina Alumni Heart Study reported their knowledge of and attitudes toward mammography as well as their adoption of mammography by 1991. Personality measured in 1988-1989 at the age of 42 was associated with the pattern of adoption of mammography reported 2 years later. Adoption of regular mammograms was predicted by conscientiousness, extraversion, and lower depression but not by anxiety. After adjusting for 8 traditional predictors of mammography shown to be significant in this population, the previous personality factors did not maintain their significance. When the women were divided into those who reported breast problems and those who did not, the same set of adjustment factors reduced, but did not eliminate, the association of conscientiousness with adoption of mammography for women without breast problems.