Reducing Physical Aggression in High School Students in KwaZulu-Natal: A Cluster Randomized Trial.

Youth violence is of public health and social concern. A South African cluster randomized trial (434 grade 10 students, 16 schools), used the Integrated Model for Behavior Change conceptual framework to implement a 20 module classroom-based intervention program. The study contributes to the literature and used a strong analytical technique since mixed effects linear regression assessed the impact of the intervention on physical violence endpoints and other socioeconomic confounders/factors. The intervention reduced students' experiencing physical violence compared to controls and social pressure for this, yet no differences were found for hitting others. Our results support findings that school programs against violence can reduce students' experience of physical violence, but translation of these findings to reduce the actual hitting of others may need further approaches and/or more time.

Parents modelling, peer influence and peer selection impact on adolescent smoking behavior: A longitudinal study in two age cohorts.

Understanding the key factors that influence smoking behavior, especially during adolescence, has a meaningful impact on public health. This study examined the impact of parent modelling, peer influence and peer selection on adolescent smoking behavior in two Portuguese cohorts followed for three years. A questionnaire was delivered in classes and schools randomly selected, three times, one per year (cohort1: time1-7th, time2-8th, time3-9th; cohort2: time1-10th, time2-11th, time3-12th graders). The sample included a total of 656 students (402 younger [time1 Mage = 13.17, SD = 0.53, 63.7% girls;] and 254 older [time 1 Mage = 16.20, SD = 0.53, 65% girls]). Longitudinal data were examined through an autoregressive cross-lagged model (ARCL). The model explained 35% of the variance in smoking behavior at T3 for the global sample (4% for the younger and 58% for the older). Over time, in both cohorts, the percentage of never smokers decreased sharply and the percentage of regular smokers increased rapidly. We observed that participants in the older cohort had higher chances of smoking if their parents smoked. Nevertheless, we did not find a parental modelling effect in the longitudinal model. Peer influence and peer selection influenced smoking behavior. However, peer selection influenced the youngest group, both processes influenced the middle age group, and only peer influence influenced the oldest. Best friend and friends had a stronger impact on the younger while friends and same grade students had a stronger impact on the older. Prevention programs should regard these differences of interpersonal influences through adolescent development and specific strategies for different age groups should be considered.

E-Liquid Flavor Preferences and Individual Factors Related to Vaping: A Survey among Dutch Never-Users, Smokers, Dual Users, and Exclusive Vapers.

Appealing product characteristics, such as flavors, may stimulate e-cigarette use. While switching to e-cigarettes may reduce harm for smokers, concerns exist about e-cigarette use among never-smokers. The role of flavors in the decision to switch to or refrain from vaping is unclear. This study used a bottom-up approach to investigate the relation between flavor preferences and individual factors related to vaping between various user groups. A cross-sectional survey was conducted among never-users (n = 407), smokers (n = 138), dual users (n = 122), and exclusive vapers (n = 61) in the Netherlands. Demographics, attractiveness of product characteristics, flavor preferences, and individual factors related to vaping (knowledge, trust, perceived susceptibility, attitude, social influence, deliberation, and intention) were assessed. The availability of different flavors was the most attractive characteristic of e-cigarettes. Dual users and exclusive vapers had most often used tobacco and menthol/mint flavors when they first started vaping. Compared to dual users, exclusive vapers currently used more fruit and sweet flavors. Never-users who were interested in trying an e-liquid flavor had more knowledge about and a more positive attitude towards e-cigarettes. Smokers who were interested in trying a flavor had a more positive attitude towards e-cigarettes and experienced the social influence towards not using e-cigarettes as less strong than those who did not want to try any flavor. Hence, individual factors related to vaping differed depending on whether never-users and smokers wanted to try an e-liquid flavor. This means that flavors may moderate differences found in individual factors related to vaping, or vice versa.

Examining the Factor Structure of the Pittsburgh Sleep Quality Index in a Multi-Ethnic Working Population in Singapore.

The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure for assessing sleep impairment. Although it was developed as a unidimensional instrument, there is much debate that it contains multidimensional latent constructs. This study aims to investigate the dimensionality of the underlying factor structure of the PSQI in a multi-ethnic working population in Singapore. The PSQI was administered on three occasions (baseline, 3 months and 12 months) to full-time employees participating in a workplace cohort study. Exploratory factor analysis (EFA) investigated the latent factor structure of the scale at each timepoint. Confirmatory factor analysis (CFA) evaluated the model identified by EFA, and additionally evaluated it against a single factor and a three-factor model. The EFA identified a two-factor model with similar internal consistency and goodness-of-fit across each timepoint. In the CFA, the two- and three-factor models were both superior to the unidimensional model. The two- and three-factor models of the PSQI were reliable, consistent and provided similar goodness-of-fit over time, and both models were superior to the unidimensional measure. We recommend using the two-factor model to assess sleep characteristics in working populations in Singapore, given that it performs as well as the three-factor model and is simpler compared to the latter.

Risk Factors for Non-Communicable Diseases at Baseline and Their Short-Term Changes in a Workplace Cohort in Singapore.

We aimed to examine the behavioural and clinical risk factors for non-communicable diseases (NCDs) at baseline and their changes over 12 months in a workplace cohort in Singapore. A total of 464 full-time employees (age ≥ 21 years) were recruited from a variety of occupational settings, including offices, control rooms, and workshops. Of these, 424 (91.4%) were followed-up at three months and 334 (72.0%) were followed up at 12 months. Standardized questionnaires were used to collect data on health behaviours and clinical measurements were performed by trained staff using standard instruments and protocols. Age-adjusted changes in risk factors over time were examined using generalized estimating equations or linear mixed-effects models where appropriate. The mean age of the participants at baseline was 39.0 (SD: 11.4) years and 79.5% were men. Nearly a quarter (24.4%) were current smokers, slightly more than half (53.5%) were alcohol drinkers, two-thirds (66%) were consuming <5 servings of fruit and vegetables per day, and 23.1% were physically inactive. More than two-thirds (67%) were overweight or obese and 34.5% had central obesity. The mean follow-up was 8.6 months. After adjusting for age, over 12 months, there was a significant increase in the proportion consuming <5 servings of fruit and vegetables per day by 33% (p = 0.030), who were physically inactive by 64% (p < 0.001), and of overweight or obese people by 15% (p = 0.018). The burden of several key NCD risk factors at baseline was high and some worsened within a short period of time in this working population. There is a need for more targeted strategies for behaviour change towards a healthy lifestyle as part of the ongoing health and wellness programs at workplaces in Singapore.

Herramienta de retorno de la inversión en control del tabaquismo: ¿qué opinan aquellos que toman decisiones? / A return on investment tool in tobacco control: what do stakeholders think?

Introducción: El Proyecto Europeo EQUIPT pretende adaptar una herramienta de retorno de la inversión en tabaco para varios países, con el fin de proporcionar información sobre el retorno de invertir en estrategias y justificar la toma de decisiones. El objetivo de este estudio es identificar las necesidades de los usuarios en España para documentar la transferibilidad de la herramienta. Métodos: Entrevistas telefónicas con actores relevantes sobre la implementación de la Herramienta EQUIPT, intención de uso y estrategias de control del tabaco. Resultados: La herramienta puede añadir valor a la información utilizada al tomar decisiones y abogar por políticas coste-efectivas. Como inconvenientes, conocer cómo funcionará la herramienta, así como la formación y el tiempo que requerirá la consistencia y los cálculos internos. Conclusión: Se recogen conocimientos e ideas de los potenciales usuarios para ayudar a adaptar la Herramienta EQUIPT, de modo que proporcione ayuda en la toma de decisiones eficientes (AU)

Introduction: The European EQUIPT study will co-create a return on investment tool in several countries, aiming to provide decision makers with information and justification on the returns that can be generated by investing in tobacco control. This study aimed to identify the needs of potential users in Spain in order to provide information on the transferability of the tool. Methods: Telephone interviews with stakeholders were conducted including questions about the implementation of the tool, intended use and tobacco control interventions. Results: Implementing the tool could provide added value to the information used in decision-making to advocate for cost-effective policies. The main drawback would be the training and time needed to learn how the tool works and for internal calculations. Conclusion: Knowledge and ideas from potential users collected in this study could inform the EQUIPT Tool adaptation. Thus, stakeholders could have an instrument that assists them on making healthcare decisions (AU)

EQUIPT: protocol of a comparative effectiveness research study evaluating cross-context transferability of economic evidence on tobacco control.

INTRODUCTION: Tobacco smoking claims 700,000 lives every year in Europe and the cost of tobacco smoking in the EU is estimated between €98 and €130 billion annually; direct medical care costs and indirect costs such as workday losses each represent half of this amount. Policymakers all across Europe are in need of bespoke information on the economic and wider returns of investing in evidence-based tobacco control, including smoking cessation agendas. EQUIPT is designed to test the transferability of one such economic evidence base-the English Tobacco Return on Investment (ROI) tool-to other EU member states. METHODS AND ANALYSIS: EQUIPT is a multicentre, interdisciplinary comparative effectiveness research study in public health. The Tobacco ROI tool already developed in England by the National Institute for Health and Care Excellence (NICE) will be adapted to meet the needs of European decision-makers, following transferability criteria. Stakeholders' needs and intention to use ROI tools in sample countries (Germany, Hungary, Spain and the Netherlands) will be analysed through interviews and surveys and complemented by secondary analysis of the contextual and other factors. Informed by this contextual analysis, the next phase will develop country-specific ROI tools in sample countries using a mix of economic modelling and Visual Basic programming. The results from the country-specific ROI models will then be compared to derive policy proposals that are transferable to other EU states, from which a centralised web tool will be developed. This will then be made available to stakeholders to cater for different decision-making contexts across Europe. ETHICS AND DISSEMINATION: The Brunel University Ethics Committee and relevant authorities in each of the participating countries approved the protocol. EQUIPT has a dedicated work package on dissemination, focusing on stakeholders' communication needs. Results will be disseminated via peer-reviewed publications, e-learning resources and policy briefs.

Smoking prevention for adolescents in Romanian schools.

This study had two objectives. The first was to assess the frequency and content of school-based anti-smoking education received by Romanian adolescents aged 14-15. Secondly, the study aimed to evaluate to what extent the implementation of a specific 5 lessons smoking prevention program influences the quality of anti-smoking school education among Romanian adolescents. The investigation was performed in twenty schools from Cluj- Napoca, Romania, which were randomly assigned to the control and experimental conditions, resulting in 55 participating classes from the seventh grade (28 in the control group and 27 in the experimental group). The experimental group participated in a school-based smoking prevention program consisting of 5 lessons. The control group beneficiated only in the standard anti-smoking education offered by their schools. Six months after the program implementation, students from both experimental and control groups filled in a questionnaire, assessing several issues regarding their exposure to anti-smoking school education in the last year. The results showed a low exposure to anti-smoking school education among the Romanian adolescents. The implementation of the specific school-based smoking prevention program increased the exposure of Romanian adolescents to a higher number of lessons of smoking prevention and influenced positively the quality of these lessons. The study identified several gaps with respect to anti-smoking education in Romanian schools. It underlines the benefits of the implementation of a school based smoking prevention program with a clear structure, which contains appropriate educational messages and it is easy to implement.

Dynamics of friendship networks and alcohol use in early and mid-adolescence.

OBJECTIVE: Similarity in alcohol consumption among adolescent friends could be caused by the influence of friends or by the selection of friends who consume similar levels of alcohol. This article aims to disentangle influence and selection processes while specifically examining changes over time in these processes and possible differences between reciprocal and nonreciprocal friendships. METHOD: The design was longitudinal with four observations (Time 1-Time 4 [T1-T4]). Data consisted of a longitudinal sample of 1,204 Finnish adolescents in 10 junior high schools. The main measurements were adolescents' friendship networks and alcohol consumption. For three successive periods, T1-T2, T2-T3, and T3-T4, actor-based models for the co-evolution of networks and behavior were analyzed (Mage: T1 = 13.6 years, T2 = 14.6 years, T3 = 15.6 years, T4 = 16.1 years). RESULTS: Selection, as well as influence processes, played an important role in adolescent alcohol consumption. Influence was found during the first period (T1-T2), whereas support for selection was found during the last two periods (T2-T3 and T3-T4). The strength of influence and selection processes did not differ for reciprocal and nonreciprocal friendships. CONCLUSIONS: The impact of selection and influence processes changed over time such that influence was only present during early adolescence, whereas selection was present during mid-adolescence. During early adolescence, youngsters would benefit from learning to resist social influence. Alcohol-consumption prevention programs targeting mid-adolescence should consider peer selection processes. These findings stress the importance of considering changes over time in future practice and research.

Avaliação longitudinal de programa de prevenção do tabagismo para adolescentes / Evaluación longitudinal del programa de prevención del tabaquismo para adolescentes / Longitudinal evaluation of a smoking prevention program for adolescents

OBJETIVO: Avaliar programa de prevenção do tabagismo para adolescentes. MÉTODOS: O programa foi realizado entre 1999 e 2002 em escolas do Distrito de Lisboa, Portugal e integrou atividades na escola, na família e na comunidade. Estudo quasi-experimental, longitudinal, baseado em ensaio de intervenção comunitária, com condição de controlo (CC) e de intervenção (CI) definidas aleatoriamente. Foram aplicados quatro questionários, no início do 7º(T1), 8º(T2) e 9º(T3) e no fim do 9º(T4) anos de escolaridade a 1.205 adolescentes, com idade média de 13 anos, dos quais 57 por cento eram meninas e 55 por cento pertenciam à condição de intervenção. A exposição às atividades de prevenção, os determinantes psicossociais do comportamento e o comportamento tabágico foram as variáveis consideradas na avaliação do programa. Utilizou-se análise de variância e regressão logística para testar as diferenças nas duas condições do estudo. RESULTADOS: A CI obteve melhores resultados nos determinantes psicossociais do tabagismo e no comportamento. Ao final do projeto, 41,8 por cento dos participantes da CI e 53,3 por cento da CC iniciaram o consumo de tabaco (OR = 0,62; IC95 por cento 0,49;0,80), e passaram a ser fumantes regulares 8,0 por cento e 12,4 por cento, respectivamente (OR = 0,59; IC95 por cento 0,40;0,87). CONCLUSÕES: O programa diminuiu a iniciação e o tabagismo regular. Os resultados surgiram no segundo ano e melhoraram no terceiro. A efetividade de programas de prevenção do tabagismo depende de implementação continuada ao longo da adolescência e de integração de medidas dirigidas directamente aos adolescentes e indirectamente, por via do seu contexto social (escola, família e comunidade).

OBJETIVO: Evaluar el programa de prevención del tabaquismo para adolescentes. MÉTODOS: El programa fue realizado entre 1999 y 2002 en escuelas del Distrito de Lisboa, Portugal. El programa integró actividades en la escuela, en la familia y en la comunidad. Estudio quasi-experimental, longitudinal, basado en ensayo de intervención comunitaria, con condición de control (CC) y de intervención (CI) definidas aleatoriamente. Se aplicaron cuatro cuestionarios, en el inicio del 7º(T1), 8º(T2) y 9º(T3) e al final del 9º(T4) años de escolaridad a 1.205 adolescentes, con edad promedio de 13 años, de los cuales 57% eran niñas y 55% pertenecían a la condición de intervención. La exposición a las actividades de prevención, los determinantes psicosociales del comportamiento y el comportamiento tabáquico fueron las variables consideradas en la evaluación del programa. Se utilizó análisis de varianza y regresión logística para evaluar las diferencias en las dos condiciones de estudio. RESULTADOS: La CI obtuvo mejores resultados en los determinantes psicosociales de tabaquismo y en el comportamiento. Al final del proyecto, 41,8% de los participantes de la CI y 53,3% de la CC iniciaron el consumo de tabaco (OR= 0,62; IC95% 0,49;0,80), y pasaron a ser fumadores regulares 8,0% y 12,4%, respectivamente (OR=0,59; IC95% 0,40;0,87). CONCLUSIONES: El programa disminuyó la iniciación y el tabaquismo regular. Los resultados surgieron en el segundo año y mejoraron en el tercer. La efectividad de programas de prevención del tabaquismo depende de implementación continuada a lo largo de la adolescencia y de integración de medidas dirigidas directamente a los adolescentes e indirectamente, por vía de su contexto social (escuela, familia y comunidad).

Avaliação longitudinal de programa de prevenção do tabagismo para adolescentes / Longitudinal evaluation of a smoking prevention program for adolescents

OBJETIVO: Avaliar programa de prevenção do tabagismo para adolescentes. MÉTODOS: O programa foi realizado entre 1999 e 2002 em escolas do Distrito de Lisboa, Portugal e integrou atividades na escola, na família e na comunidade. Estudo quasi-experimental, longitudinal, baseado em ensaio de intervenção comunitária, com condição de controlo (CC) e de intervenção (CI) definidas aleatoriamente. Foram aplicados quatro questionários, no início do 7º(T1), 8º(T2) e 9º(T3) e no fim do 9º(T4) anos de escolaridade a 1.205 adolescentes, com idade média de 13 anos, dos quais 57 por cento eram meninas e 55 por cento pertenciam à condição de intervenção. A exposição às atividades de prevenção, os determinantes psicossociais do comportamento e o comportamento tabágico foram as variáveis consideradas na avaliação do programa. Utilizou-se análise de variância e regressão logística para testar as diferenças nas duas condições do estudo. RESULTADOS: A CI obteve melhores resultados nos determinantes psicossociais do tabagismo e no comportamento. Ao final do projeto, 41,8 por cento dos participantes da CI e 53,3 por cento da CC iniciaram o consumo de tabaco (OR = 0,62; IC95 por cento 0,49;0,80), e passaram a ser fumantes regulares 8,0 por cento e 12,4 por cento, respectivamente (OR = 0,59; IC95 por cento 0,40;0,87). CONCLUSÕES: O programa diminuiu a iniciação e o tabagismo regular. Os resultados surgiram no segundo ano e melhoraram no terceiro. A efetividade de programas de prevenção do tabagismo depende de implementação continuada ao longo da adolescência e de integração de medidas dirigidas directamente aos adolescentes e indirectamente, por via do seu contexto social (escola, família e comunidade).(AU)

Longitudinal evaluation of a smoking prevention program for adolescents.

OBJECTIVE: To evaluate a smoking prevention program for adolescents. METHODS: The program was conducted between 1999 and 2002, in schools of the district of Lisbon, Portugal. The program integrated activities in the school, family and community. This was a longitudinal quasi-experimental study, based on Community Intervention Trial, with randomly defined control conditions (CC) and intervention conditions (IC). A total of four questionnaires were applied in the beginning of the 7th(T1), 8th(T2) and 9th(T3) and in the end of the 9th(T4) school grades, to 1,205 adolescents, aged 13 years on average, of which 57% were girls and 55% were included in the IC. Exposure to prevention activities, psychosocial determinants of smoking and behavior were the variables considered in the evaluation of the program. Variance analysis and logistic regression were used to test the differences between the two study conditions. RESULTS: IC obtained better results in the smoking psychosocial determinants and in behavior. At the end of the project, 41.8% of participants in the IC and 53.3% of those in the CC had tried tobacco (OR = 0.62; CI95% 0.49;0.80), while those who became regular smokers totaled 8.0% and 12.4%, respectively (OR = 0.59; CI95% 0.40;0.87). CONCLUSIONS: The program reduced the initiation of smoking and regular smoking. Results appeared in the second year and improved in the third. Effectiveness of smoking prevention programs depends on a continuous implementation throughout adolescence and on the integration of measures aimed to reach adolescents directly and indirectly through their social context (school, family and community).

Planning health behaviour change: comparing the behavioural influence of two types of self-regulatory planning.

OBJECTIVES: Recent efforts in health psychology to bridge the gap between individuals' intentions and behaviour have centered on the influence of planning strategies. This study investigated the impact of two commonly used types of self-regulatory planning in the prediction of health promoting behaviour. DESIGN: This study employed a prospective longitudinal design. Three measurements were implemented in order to assess associations between various socio-cognitive determinants, planning, and health behaviour. METHODS: Structural equation modelling (N = 572) was used to compare the value of preparatory planning, i.e. the planning of strategies and preparatory actions towards a goal behaviour, and implemental planning, i.e. the planning of when, where, and how to perform a goal behaviour, in the prediction of fruit consumption. RESULTS: Both preparatory planning (ss = 0.21; p <.001) and implemental planning (ss = 0.13; p <.01) were significant predictors of fruit consumption, over and above the influence of motivational factors. Comparison of differences in explained variance (DeltaR(2)) indicated that the contribution of preparatory planning was larger than that of implemental planning (z = 2.19; p <.05). Implemental planning did not contribute to the prediction of fruit consumption over and above the influence of preparatory planning when tested simultaneously. CONCLUSIONS: The results provide a first indication that the planning of strategic preparatory actions may be more influential in predicting health behaviour than implemental planning, focusing on when, where, and how to enact goal-directed behaviour. Implications of the results and suggestions for future research are outlined.

Correspondence between proxy and self-reports on smoking in a full family study.

OBJECTIVES: The present study investigated the reliability of proxy reports obtained from family members with self-reports on adolescent and parental lifetime and current smoking status. METHODS: Data were assessed from 416 families, consisting of both biological parents and two adolescent siblings aged 13-17 years. These families were assessed at baseline and 1 year later. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to test whether proxy reports corresponded with self-reports. RESULTS: Mothers scored higher than fathers on most measures on lifetime and current smoking status of both children. The sensitivity was low for parental reports, but moderate to high for children's reports. Specificity and positive predictive value were high in all proxy reports. The negative predictive value was moderate (parents as proxy reporters) to low (children as proxy reporters) on lifetime smoking, but high on current smoking. CONCLUSIONS: Adolescents, aged 13-17 years, can be used as a reliable source to assess the smoking status of their mothers and fathers. Parents, however, appeared to accurately identify the smoking status of their adolescent children less reliably.

Determinants of adoption of cognitive behavioral interventions in a hospital setting: example of a minimal-contact smoking cessation intervention for cardiology wards.

OBJECTIVE: The aim of our study was to identify the psychological and organizational determinants of adopting a smoking cessation intervention in cardiology wards, using the Integrated Change Model (I-Change Model) as the theoretical basis. METHODS: A cross-sectional survey by means of questionnaires was conducted among the heads of all 121 cardiology wards in Dutch hospitals, of whom 77 (64%) responded. RESULTS: Adopters had a significantly lower level of formalization and more nurses working on the ward. Adopters also had a significantly more positive attitude towards working with the intervention, perceived more positive social influences from their direct environment and had higher self-efficacy. Psychological determinants explained adoption to a greater extent than organizational determinants did. CONCLUSION: It is very important to take psychological factors into account when studying the adoption of preventive innovations and developing diffusion strategies. PRACTICE IMPLICATIONS: Programs for dissemination of preventive innovations in a hospital setting should primarily focus on psychological characteristics like social influence and self-efficacy.

Tobacco use among Romanian youth

Se revisan datos publicados entre 1990 y 2006 sobre prevalencia de tabaquismo, así como influencias individuales y contextuales respecto al hábito de fumar entre adultos jóvenes rumanos. Los hallazgos incluyen una consideración de múltiples niveles de influencia, desde factores intraindividuales (por ejemplo, demográficos y cognitivos), influencias sociales (como familia y pares), hasta niveles de influencia macro sociales/culturales (publicidad y políticas relacionadas con el tabaco, entre otros). La fuente de datos incluye artículos y notas breves publicadas en revistas científicas o en formato electrónico, leyes, estadísticas, y se ilustran con imágenes. Con base en estos datos, se establecen recomendaciones para acciones futuras de prevención y reducción del consumo de tabaco en jóvenes rumanos.

The general public's information needs and perceptions regarding hereditary cancer: an application of the Integrated Change Model.

The Integrated Change Model (the I-Change Model) was used to analyse the general public's need and perceptions concerning receiving information on the role of hereditary factors with regard to cancer. The results from a study in 457 Dutch adults showed that 25% correctly indicated the types of cancer where hereditary factors can play a role. Respondents, however, overestimated the role of hereditary factors causing breast cancer. Recognition of warning signs was low, as was the recognition of inheritance patterns. Participants wanted to know the types of cancer with hereditary aspects, how to recognise hereditary cancer in the family, personal risks and the steps to be taken when hereditary predisposition is suspected. The most popular information channels mentioned were leaflets, the general practitioner, and the Internet. Respondents interested in receiving information on heredity and cancer were more often female, had had experiences with hereditary diseases, had more knowledge, perceived more advantages, encountered more social support in seeking information, and had higher levels of self-efficacy. Education should outline the most important facts about hereditary cancer, how to get support, and create realistic expectations of the impact of genetic factors.