The relative influence of smoking on drinking and drinking on smoking among high school students in a rural tobacco-growing county.

PURPOSE: To construct and estimate a model that contains a reciprocal relationship between smoking and drinking and to test whether the gateway drug thesis or the cumulative risk behaviors thesis best fits the data. METHODS: Data (n = 630) are from a survey of all students (50% female; aged 16.2 years on average; 2.4 grade point average; and 57% residing in homes with both mother and father present) in a rural, tobacco-growing county's two high schools, one public (85%) and one private, in 1993. The survey was conducted by the schools as part of their alcohol and other drugs (AOD) prevention programs and was coordinated by the county AOD Council. Students completed the questionnaires in their homerooms. Endogenous predictors of drinking and smoking include student's perception of adult drug behavior, peer pressure to drink, degree to which their friends' drink, and attitudes toward drinking and smoking. Path coefficients were estimated by using LISREL. RESULTS: The strong correlation between smoking and drinking resulted from shared causes, rather than from the effects of one type of drug use on the other. Approval of drinking had the strongest association with being a drinker (beta =.57) and with being a smoker (beta =.37). Those who found smoking offensive were less likely to be a smoker (beta = -.25). However, attitude toward smoking was not associated with being a drinker. Having drinking friends increased both the likelihood of being a drinker (beta =.29) and of being a smoker (beta =.23). Peer pressure to drink increased the likelihood of being a smoker (beta =.14) and of being a drinker (beta =.12). Students with lower grade point averages, males, older students, students in public school, and students with family structures other than both parents living in the same household were more likely to be a drinker and were more likely to be a smoker. CONCLUSIONS: Our results support the cumulative risk behaviors thesis. The link between both high-risk behaviors, smoking and drinking, results from common causes rather than from drinking leading to smoking.

Determinants of prostate-specific antigen test use in prostate cancer screening by primary care physicians.

OBJECTIVE: To identify determinants of prostate-specific antigen (PSA) test use in prostate cancer screening by primary care physicians. DESIGN: Self-administered, confidential surveys were mailed to 800 Ohio primary care physicians. A second mailing to nonrespondents was sent a month later. Surveys included questions on beliefs, attitudes, knowledge, and reasons for PSA prostate cancer screening. RESULTS: The response rate of usable surveys was 51% (n=408). More than half (55%) of the respondents reported using the PSA test for screening often or always. Multiple regression analysis showed physicians' reported belief that PSA screening is the standard of care in one's community was the strongest direct predictor of use (beta=.32; P<.001). Other direct predictors of PSA test use included physician feeling about the test (beta=.28; P<.001), patient requests for the test (beta=.19; P<.001), age of patient (beta=.11; P< or =.003), and recommendation of specialty or other organizations (beta=.12; P=.001). CONCLUSIONS: Although PSA prostate cancer screening has yet to be proved definitely effective in decreasing mortality or morbidity from the disease, more than half of Ohio primary care physicians surveyed reported regular screening. The rationale for such screening seems to be multifaceted, and, thus, changes in physician behavior probably will be difficult to achieve.