Health-Related Stereotype Threat Predicts Health Services Delays Among Blacks.

To our knowledge, no published research has developed an individual difference measure of health-related stereotype threat (HRST). We adapted existing measures of academic stereotype threat to the health domain on a sample of black college students (N = 280). The resulting health-related stereotype threat scale-24 (HRST-24) was assessed for internal consistency, construct and incremental validity, and whether it explains variance in self-reported delays among four preventive health behaviors-blood pressure and cholesterol assays, physical exams, and routine checkups. After adjusting for several control variables, the HRST-24's (full scale α = 0.96) perceived black health inferiority (18 items; α = 0.96) and perceived physician racial bias (6 items; α = 0.85) sub-scales explained unique variance in delays among two of the four behaviors including a blood cholesterol check (p < .01) and routine checkup-albeit at marginal levels (p = .063) in the case of the latter. Overall, these data provide preliminary evidence of construct and incremental validity for the HRST-24 among blacks. Recommendations for administering the scale are provided and future directions for HRST research are discussed.

Evaluation of impaired driving assessments and special management reviews in reducing impaired driving fatal crashes in the United States.

Since 1991, State Impaired-Driving Assessments (IDAs) and Special Management Reviews (SMRs) have been conducted by the National Highway Traffic Safety Administration (NHTSA) to serve as a mechanism to assess the impaired-driving problem in the State, document the existing system, recommend improvements, and garner both political and public support to fund and implement improvements. Did these assessments and reviews serve the States as intended and provide a catalyst to reduce impaired driving? Almost half of the priority recommendations from IDAs in seven States and 60% of the priority recommendations in SMR States were implemented. Barriers to the implementation of some recommendations are discussed. IDAs and SMRs implemented at varying times were examined using logistic regression analyses of the Fatality Analysis Reporting System (FARS) for the years 1990 to 2008 to determine the effect they may have triggered on impaired driving rates in fatal crashes. States receiving IDAs and SMRs were compared to similar States not receiving them. Paired comparisons of similar States (e.g. IDA-State vs. non-IDA State) did not reveal any significant differences in impaired driving rates, but IDA and SMR States as a group showed significantly greater impaired driving declines in fatal crashes compared to non-IDA and non-SMR States as a group. IDAs and SMRs appear to provide a mechanism to examine the State's impaired-driving program by an external team of experts and reveal areas where improvement is needed and confirm strategies that appear to be effective.

Estimating alcohol and drug involvement in hospitalized adolescents with assault injuries.

PURPOSE: Adolescents using alcohol and drugs are at higher risk for assaultive behaviors. We examined adolescents aged 10 to 20 years who were hospitalized for assault injuries between July 1995 and December 1998 in Maryland to determine the demographic and injury-related predictors of the presence of drug/alcohol use among adolescents, and to estimate the presence of drug/alcohol use among adolescents with undetermined drug and/or alcohol use. METHODS: Patient records for adolescents were selected from 2189 discharges from the Maryland Trauma Registry and 1625 discharges from the Maryland Hospital Discharge data system. Three discrete groups of adolescents were identified: (1) those on the Trauma Registry and in the Hospital Discharge data system (N = 1197), (2) only those on the Trauma Registry (N = 992), or (3) only those in the Hospital Discharge data system (N = 428). Multiple logistic regression was performed to determine the predictors of the presence of drug/alcohol use among adolescents in the Trauma Registry. These models were then used to estimate the presence of drug/alcohol use among adolescents with undetermined drug and/or alcohol use. RESULTS: Age, sex, mechanism of injury, day of hospital admittance, and time of day were significant predictors of alcohol/drug use. The proportion of predicted alcohol/drug involved hospitalized cases varied from 54% to 66%. CONCLUSION: Our methodology and findings contribute to the understanding of the epidemiology of assaultive behaviors and the role of alcohol/drug use in injury among adolescents.

Random alcohol testing reduced alcohol-involved fatal crashes of drivers of large trucks.

OBJECTIVE: This study examined the impact of random alcohol testing, implemented on August 1, 1994, on the likelihood that the driver of a large truck involved in a fatal motor vehicle crash was alcohol-involved. METHOD: Among fatal crashes, the proportion of alcohol-positive large truck drivers (intervention group) was compared with the proportion of alcohol-positive light passenger vehicle drivers (control group). Annual Fatality Analysis Reporting System (FARS) data (1988-2003) were compiled for each of the 50 states and Washington, D.C., for the control and intervention groups. Using these pooled cross-sectional data, logistic regression modeled the likelihood that a driver was alcohol-positive (blood alcohol concentration > 0) before compared with after random alcohol testing. We attributed the difference-in-difference (the difference in likelihoods of being alcohol positive pretesting versus post-testing in large truck versus passenger vehicle drivers) to the impact of random testing. RESULTS: Drivers of large trucks were 18.6% less likely to be alcohol-involved after random testing was implemented than before random testing (odds ratio [OR] = 0.814, 95% confidence interval [CI]: 0.713-0.930). The control group of passenger car drivers was 4.7% less likely to be alcohol-involved after random testing was implemented (OR = 0.953, 95% CI: 0.924-0.983). The net reduction in the odds of alcohol involvement for drivers of large trucks was 14.5% (OR = 0.855, 95% CI: 0.748-0.976). CONCLUSIONS: Controlling for the general declining trend in alcohol-involved drivers in fatal crashes, random alcohol testing was correlated with a 14.5% reduction in alcohol involvement among large truck drivers.

Retail alcohol monopolies, underage drinking, and youth impaired driving deaths.

OBJECTIVE: To explore associations of state retail alcohol monopolies with underage drinking and alcohol-impaired driving deaths. DATA: Surveys on youth who drank alcohol and binge-drank recently and their beverage choices; census of motor vehicle fatalities by driver blood alcohol level. METHODS: Regressions estimated associations of monopolies with under-21 drinking, binge drinking, alcohol-impaired driving deaths, and odds a driver under 21 who died was alcohol-positive. RESULTS: About 93.8% of those ages 12-20 who consumed alcohol in the past month drank some wine or spirits. In states with a retail monopoly over spirits or wine and spirits, an average of 14.5% fewer high school students reported drinking alcohol in the past 30 days and 16.7% fewer reported binge drinking in the past 30 days than high school students in non-monopoly states. Monopolies over both wine and spirits were associated with larger consumption reductions than monopolies over spirits only. Lower consumption rates in monopoly states, in turn, were associated with a 9.3% lower alcohol-impaired driving death rate under age 21 in monopoly states versus non-monopoly states. Alcohol monopolies may prevent 45 impaired driving deaths annually. CONCLUSIONS: Continuing existing retail alcohol monopolies should help control underage drinking and associated harms.

The sidewalk survey: a field methodology to measure late-night college drinking.

Alcohol use is highly prevalent among U.S. college students, and alcohol-related problems are often considered the most serious public health threat on American college campuses. Although empirical examinations of college drinking have relied primarily on self-report measures, several investigators have implemented field studies to obtain objective measures of alcohol consumption (blood alcohol concentration) from students in ecologically valid settings. This article describes the methodology of breath-test field survey that is being conducted on the grounds of San Diego State University. Descriptive summaries of the data collected through spring 2003 are provided, and limitations to methodology are discussed.

Costs of medically treated craniofacial conditions.

OBJECTIVES: Determining the magnitude of the burden of diseases and health disorders on the U.S. population is a high priority for health policy makers. Conditions such as malignant neoplasms and injuries from craniofacial trauma contribute to adverse oral health. This study estimates the number of cases of diseases and disorders relevant to oral health that are treated annually in the medical care, as opposed to the dental care, system and associated costs. Policy makers can use this cost model to compare the impact of different conditions, to target areas for reducing costs, and to allocate appropriate health resources. METHODS: Data from four national and two state data systems were used to estimate the number of cases of selected dental, oral, and craniofacial diseases and conditions treated in the medical system annually and associated medical and wage/household work loss costs. RESULTS: Per case, the most costly conditions were estimated to be malignant neoplasms at 83,080 US dollars annually (in 1999 dollars), diabetes-related oral conditions at 51,030 US dollars, endocarditis at 48,610 US dollars, and chlamydiae at 41,100 US dollars. Total estimated costs for oral conditions treated in the medical care system in 1996 were approximately 95.9 billion US dollars, including 21.4 billion US dollars in medical costs and 74.4 US dollars billion in wage/household work loss costs. CONCLUSIONS: Conditions treated outside the dental care system are major contributors to oral health costs. They should be an important focus for the National Institute of Dental and Craniofacial Research.