Health care providers' attention to food insecurity in households with children.

OBJECTIVE: To determine the extent to which physicians and nurse practitioners monitor household food insecurity (FI) of families with children, and to examine factors that influence FI monitoring. METHOD: A 2007 mail survey of family practice and pediatric physicians and nurse practitioners in the Portland, Oregon, region yielded 186 responses. Factor analysis was used to identify barriers to asking about FI. Regression analysis was used to determine whether monitoring of household food status was predicted by those barriers, attentiveness to potential FI indicators, and other variables. RESULTS: Most respondents did not routinely inquire about household FI during clinic visits. However, 88.8% expressed willingness to use a standardized screening question, if available. Monitoring of household food nutritional quality was significantly predicted by one of three identified barriers (providers' time availability). Monitoring of household food sufficiency was predicted by years in practice, attentiveness to FI indicators, and the remaining two identified barriers (inadequate knowledge about FI, discomfort in discussing FI). CONCLUSION: Routine monitoring of patients' household FI by health care providers is an underutilized strategy for reducing this condition, which poses serious risks to children's health and development. Addressing providers' concerns and introducing standardized screening procedures can increase their monitoring behaviors.

Tobacco use by early adolescents in Norway.

BACKGROUND: This study examined trends in the prevalence of smoking and snuff use among Norwegian adolescents in lower secondary school (ages 13-15 years) from a national survey conducted every 5 years between 1975 and 1995. METHODS: Pupils completed a brief written questionnaire on tobacco use and related information. Local school administrators coordinated data collection and forwarded a sample of completed questionnaires to the National Council on Tobacco and Health for compilation and analysis. Effects for age, gender and survey year were examined using logistic regression analysis. Overall, 24,127 pupils in five different cohorts were included. RESULTS: Smoking was highest in 1975 when 45.5% of youth reported smoking either daily or occasionally (figures adjusted for age and gender). Smoking declined each year thereafter through to 1990 (23.6%) but increased in 1995 (26.0%), primarily due to an increase in occasional smoking. Like smoking, snuff use declined between 1985 and 1990 but increased in 1995. All changes across survey years were statistically significant. Smoking was higher among girls than boys, while snuff use was much higher among boys. CONCLUSION: Several hypotheses that might account for the recent increase were examined with the most likely factor being Norway's low allocation of resources for educational interventions and public information campaigns during the years studied. However, in the past 2 years Norway has undertaken a number of new tobacco control initiatives that may result in reversal of the most recent trends.

Research on resilience and its implications for tobacco prevention.

The concept of resilience refers to successful developmental processes in children who grow up in stressful or high-risk environments. Protective factors that increase the likelihood of positive developmental outcomes, as identified by longitudinal studies, include personal-level characteristics of autonomy, self-regulation, and problem-solving skill; family characteristics of warm but demanding relationships with parents, high parental expectations, and affectionate bonds with other family members; and community characteristics of social support, effective schools, and the availability of opportunities at major life transition points. Challenges include several cross-study ambiguities in the fundamental concepts, as well as potential misapplications of this research by policymakers who believe that children can be made 'invulnerable' to environmental stressors. It is recommended that: (1) Researchers should seek to understand those cases that do not conform to predictive statistical models; clinically oriented, qualitative methodologies can be useful for this purpose. (2) Greater focus needs to be placed on identifying individual differences in children's attraction to tobacco and their motivations for use. (3) Tobacco use can be studied as an instrumental strategy on the part of adolescents for dealing with critical developmental tasks. (4) Understanding the development of stress and coping processes in children can shed light on their use of tobacco as a coping mechanism, particularly in later phases of the uptake process. Overall, the study of resilience suggests a broad lifespan view of development, in which tobacco use is just one aspect of adaptation to critical developmental tasks.

Stress reduction in child-abusing families: global and specific measures.

This study compared in-home treatment to traditional county services for their ability to reduce stress in child-abusing families. 47 families who were at risk for having at least one child removed from the home for child abuse were referred to Families First for an intensive 6-wk., in-home therapy program. A comparison group of 29 families who were also at risk for having at least one child removed for abuse received traditional county services but no in-home therapy. Stress scores used were derived from a factor analysis of the Family Inventory of Life Events and Changes (FILE) that had identified 10 stress factors. The stress data were analyzed by a series of 2 x 2 analyses of variance, group and time being the independent variables and the stress factors the dependent variables. Total stress was significantly reduced over time for both groups, and several specific stress factors were also significantly reduced over time. In secondary analyses, 2 x 3 (group by time) analyses identified interactions for total stress and three of the individual stress factors. In-home treatment was effective in reducing stress, but traditional services were also effective. Some possible explanations were discussed. A major finding was that, by including analyses using the specific stress factors (rather than just the Total Stress score), a much richer understanding of the role stress plays in abusive families is provided. It was concluded that, although global stress may be reduced by different methods, some specific types of stress are more likely to be reduced than others.

The importance of social interaction: a new perspective on social epidemiology, social risk factors, and health.

Social epidemiology research has provided persuasive evidence of the link between the social environment--especially socioeconomic status--and health outcomes, but has failed to identify underlying mechanisms that might account for the association. The research may have been limited to date by its reliance on traditional epidemiological methods that emphasize a search for specific causal factor-disease relationships. It is time to take the research evidence and recast it to find practical solutions. We argue that the human development perspective supplies a framework for understanding the critical interaction between elements of social environment and health: Analyzing the social epidemiological research from this perspective can help to explain why and how the most potent factor, socioeconomic status, affects health outcomes. Equally important, this alternative perspective also presents health education practice implications.

Marketing smokeless tobacco in California communities: implications for health education.

In the first phase of a 5-year research project aimed at curtailing smokeless tobacco use among youth, we examined the marketing of smokeless tobacco within California. Observational data were collected from almost 200 retail stores located near high schools and colleges in 14 California counties. Interviews were conducted with over 100 school personnel and youth leaders in 13 counties and with seven retailers from 4 counties. Overall, 81% of the stores in the sample carried smokeless tobacco, and even in urban areas most stores (71%) had these products for sale. Urban stores were more likely to have materials promoting them (e.g., posters, displays, coupon offers). Almost all (98%) stores that carried smokeless tobacco sold moist snuff. Most (78%) school personnel and youth leaders, especially in urban areas, were aware of advertisements for it, particularly on television and in magazines. Rogers' theory regarding the diffusion of innovations was the basis of the discussion of our results. The implications of marketing for the development of health education programs are examined.