Formative development of an intervention to stop family tobacco use: the Parents and Children Talking (PACT) intervention.

Intervening with families is a promising strategy for addressing the continuing problem of adult and youth tobacco use. A four-step formative process was used to develop an innovative self-directed family-based intervention: (1) planning and strategy development through structured telephone interviews, a focus group, and a literature review; (2) development and pretesting of concepts, messages, and materials by using feedback from children and adults on prototypic materials; (3) implementing the program by mailing 6 modules to 50 families (composed of at least one adult smoker and a 9-12-year-old) with overall high levels of engagement; and (4) assessing effectiveness and making refinements by measuring the intervention effect on smoking-related communication, skills, and attitudes. Inconsistent intervention effects related to the difficulty of cessation and the influence of parental smoking suggested needed refinements. Engaging smokers willing to make a quit attempt during the intervention time frame may augment children's appreciation for the difficulty of cessation. Content related to stress management may need greater emphasis. Enhancing the personal context in which the influence of parental behavior is conveyed may be needed. Although the family context offers the opportunity to address the parent-child reciprocal nature of tobacco use, it requires sensitivity to the challenges of addressing this topic.

Testing the interaction between parent-child relationship factors and parent smoking to predict youth smoking.

PURPOSE: To examine if parental smoking modifies the association between parent-child connectedness and parental disapproval of youth smoking with smoking behavior among minority youth. METHODS: Baseline data from an urban Seattle, Washington neighborhood-based intervention trial to reduce risk behaviors among minority males and females aged 11-15 years were used to identify 428 minority youth-parent/guardian pairs. Parental smoking status, assessed by telephone interview, and youth reports of connectedness and parental disapproval, assessed by questionnaire, were tested in Chi-squared stratified analysis and logistic regression to predict youth smoking. RESULTS: The majority (86%) of the parents/guardians were the natural parent of the surveyed child (67% mother; 19% father). Parental mean age was 41 years, 54% reported household incomes less than $30K, and 26% were current smokers. Youth had a mean age of 13 years, 28% self-identified as African-American, 37% as Asian, and 35% as "Multiethnic"; 41% reported ever smoking, and 9% reported smoking within the past 30 days. Perceived parental disapproval of smoking was not associated with youth smoking behavior. Among youth whose parent did not smoke, those who reported low level of parent-child connectedness were two times more likely to report ever having smoked than those who reported high levels of connectedness. Among youth whose parent smoked, connectedness was not associated with youth smoking. The interaction between connectedness and parental smoking status and its relationship to youth smoking remained significant after controlling for covariates. CONCLUSION: Overall, high levels of parent-child connectedness are protective against youth smoking. However, family connectedness may not protect children from becoming smokers when parents smoke.

Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions.

BACKGROUND: Sexually transmitted diseases (STDs) are a major public health problem among young people and can lead to the spread of HIV. Previous studies have primarily addressed barriers to STD care for symptomatic patients. The purpose of our study was to identify perceptions about existing barriers to and ideal services for STDs, especially asymptomatic screening, among young people in a southeastern community. METHODS: Eight focus group discussions including 53 White, African American, and Latino youth (age 14-24) were conducted. RESULTS: Perceived barriers to care included lack of knowledge of STDs and available services, cost, shame associated with seeking services, long clinic waiting times, discrimination, and urethral specimen collection methods. Perceived features of ideal STD services included locations close to familiar places, extended hours, and urine-based screening. Television was perceived as the most effective route of disseminating STD information. CONCLUSIONS: Further research is warranted to evaluate improving convenience, efficiency, and privacy of existing services; adding urine-based screening and new services closer to neighborhoods; and using mass media to disseminate STD information as strategies to increase STD screening.

Smoking, exercise and dietary behaviors among mothers of elementary school-aged children in a rural North Carolina county.

Tobacco use, poor diet, and physical inactivity are risk behaviors established during childhood and influenced by parents. Improving health habits of rural families poses particular challenges because resources may be limited in number and reach. To characterize the kinds of prevention programs needed by rural families, 501 surveys were mailed to caregivers of elementary school children living in a rural North Carolina county. Health behaviors, related attitudes, and demographic characteristics were assessed. Risk behaviors were defined as eating less than 5 fruits and vegetables a day, exercising less than 20 minutes 3 times a week, and being a smoker. Two hundred and sixty-one adults (55%) completed the surveys. Two hundred and forty-four (93%) were female, with a mean age of 37 years, 55% had a high school or less education, 89% reported at least one risk behavior, and 57% reported 2 or more risk behaviors. Female caregivers with multiple risk behaviors had lower educational levels (p < 0.007) and placed less importance on children's health behaviors (p < 0.009) than other caregivers. Female caregivers with multiple risk behaviors were no less confident they could change their behavior than those with only one risk behavior. The majority of female caregivers of elementary school children in this rural population engaged in and modeled multiple health risk behaviors for their children. Health promotion activities that address multiple risk factors and involve children are needed by young families in rural communities.