Beth Howard-Pitney

The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults.

OBJECTIVES This study was undertaken to test the effectiveness of the Stanford Nutrition Action Program, an experimental trial to reduce dietary fat intake among low-literacy, low-income adults. METHODS Twenty-four paired adult education classes (351 participants, 85% women, mean age = 31 years) were randomly assigned to receive a newly developed dietary fat curriculum (the Stanford Nutrition Action Program) or an existing general nutrition curriculum. Food frequency and nutrition-related data, body mass index, and capillary blood cholesterol were collected at baseline and at two postintervention follow-ups. RESULTS The Stanford Nutrition Action Program classes showed significantly greater net improvements in nutrition knowledge (+7.7), attitudes (/0.2), and self-efficacy (-0.2) than the general nutrition classes; they also showed significantly greater reductions in the percentage of calories from total (-2.3%) and saturated (-0.9%) fat. There were no significant differences in body mass index or blood cholesterol. All positive intervention effects were maintained for 3 months postintervention. CONCLUSIONS The Stanford Nutrition Action Program curriculum, tailored to the cultural, economic, and learning needs of low-literacy, low-income adults, was significantly more effective in achieving fat-related nutritional changes than the general nutrition curriculum.

Independent Evaluation of the California Tobacco Control Program: Relationships Between Program Exposure and Outcomes, 1996-1998

OBJECTIVES This study sought to determine the effects of the California Tobacco Control Program on tobacco-related attitudes and behaviors. METHODS In 1996 and 1998, a telephone survey was conducted among adults in randomly selected households in 18 California counties. Tenth-grade youths in 84 randomly selected high schools completed a written survey. In analyses conducted at the county level, differences in outcomes were regressed on an index of program exposure. RESULTS Among adults, program exposure was associated with decreased smoking prevalence rates, increased no-smoking policies in homes, and decreased violations of workplace no-smoking policies. Among youths, there was no effect of program exposure on outcomes. CONCLUSIONS These results suggest that the California Tobacco Control Program may have reduced adult smoking prevalence rates and exposure to environmental tobacco smoke.

PEER INFLUENCES AND SUSCEPTIBILITY TO SMOKING AMONG CALIFORNIA ADOLESCENTS

Using data from a diverse statewide sample of 10th-grade adolescents in California, in 1996–97, this study investigated the associations between peer influence variables and susceptibility to smoking. Peer influence variables included attitudes about the social consequences of smoking and subjective norms, as described by the Theory of Reasoned Action. Among never-smokers (N = 2681) and ever-smokers (N = 4248), attitudes about social consequences of smoking and subjective norms each were associated with an increased risk of susceptibility to smoking. The model explained a larger proportion of the variance in susceptibility among ever-smokers than among never-smokers. Results indicate that peer influences, including perceptions of the social consequences of smoking and perceived social norms, may make adolescents susceptible to smoking.

Help-Seeking Behavior of Native American Indian High School Students

A sample of 139 Zuni adolescents were surveyed to explore the relationships among their helpseeking behavior, psychological problems, and personal characteristics. No significant differences were found between the help-seeking behaviors of girls and boys. Students were most likely to seek help from a friend, parent, or relative for personal problems and to use professional help sources primarily for academic and career problems. Correlational analysis indicated that adolescents who experienced thoughts of suicide and global distress were more likely to seek help from a greater number of resources for their most serious problems. The implications of these findings for work with Native American Indian adolescents are discussed. Most young people, at some time during adolescence, experience problems that seem beyond their capacity to solve alone (Rickwood & Braithwaite, 1994; Simmons & Blyth, 1987). For many, seeking help is one means for beginning to cope with and resolve these problems. Evidence suggests that teens who have numerous psychological problems and life stresses are more likely than their peers to seek help (Barker & Adelman, 1994; Cheatham, Shelton, & Ray, 1987; Greenley & Mechanic, 1976). Little research on help seeking has focused on Native American Indian adolescents, however. Native American Indian youth are likely to experience a larger number of complex problems, such as drug and alcohol abuse (Beauvais, 1992), suicide (Howard-Pitney, LaFromboise, Basil, September, & Johnson, 1992; LaFromboise & Howard-Pitney, 1994; May, 1987), vio

Chewing Tobacco: Who Uses and Who Quits? Findings From NHANES III, 1988–1994

OBJECTIVES This study identified mutually exclusive groups of men at high and low risk for use of chewing tobacco and for quitting. METHODS Analyses used a national sample of 1340 non-Hispanic Black, 1358 Mexican American, and 1673 non-Hispanic White men, aged 25 to 64, who participated in the National Health and Nutrition Examination Survey III from 1988 to 1994. Signal detection analysis was used to delineate high- and low-risk subgroups; survival analysis was used to estimate hazard curves for comparing age at onset for chewing tobacco use with that for smoking. RESULTS Rural, lower-income Black and White men had the highest regular use of chewing tobacco (33.3%), followed by rural, higher-income men regardless of race/ethnicity (14.9%). Southern men who began using chewing tobacco during adulthood had the lowest quit rate (22.5%). In sharp contrast to smoking, chewing tobacco showed a continued onset throughout adulthood. CONCLUSIONS Because subgroups of men show highly different chewing tobacco use and quit rates and because age at chewing tobacco onset occurs across the life span, prevention and cessation programs should be specific to different risk groups and distinct from smoking programs.

Development of a Curriculum to Lower Dietary Fat Intake in a Multiethnic Population with Low Literacy Skills

Abstract Low-literate, low-income populations face unique issues as they attempt to modify their diet to lower risk of chronic disease. The goal of the Stanford Nutrition Action Program (SNAP) was to design a curriculum that would address such issues and stimulate reduction of dietary fat. Initial focus groups and pilot tests were conducted to assess nutrition knowledge, interests, and dietary habits of a multiethnic, low-literate population. These investigations revealed that a nutrition education curriculum tailored to a population with low literacy skills would need to address the taste, cost, and convenience of low-fat foods, and teach participants how to incorporate low-fat foods and cooking methods into their familys diet with minimal disruption. These findings, combined with published data on food intake and preferences, were used to design the SNAP curriculum. The SNAP classroom curriculum operationalized principles of adult education, constructs from social learning theory, and followed established national guidelines on how to develop appropriate print materials for low-literate adults. Each of its six lessons included role modeling, goal setting, problem solving, group activities, and skills building tasks; many included SNAP videotapes, food demonstrations, and posters that enhanced group discussions. Print materials were written at or below the 5th grade reading level. The SNAP curriculum combined interactive teaching techniques and behavior change methods to successfully teach and stimulate the interest of low-literate, low-income population to overcome barriers to reducing fat.

What factors are associated with local enforcement of laws banning illegal tobacco sales to minors? A study of 182 law enforcement agencies in California.

OBJECTIVES The aims of this study were to understand the attitudes of local law enforcement staff regarding policies to reduce youth access to tobacco, to determine what proportion of these agencies have conducted unannounced compliance checks in the past year, and to examine factors associated with conducting compliance checks. METHODS A written questionnaire was completed by 182 law enforcement officials representing 200 cities and counties in California (some officials represented multiple jurisdictions). Logistic regression analyses were conducted to identify factors associated with conducting compliance checks. RESULTS Only 36% of local enforcement agencies reported conducting one or more compliance checks in the previous year. Agencies were more likely to conduct compliance checks if they perceived fewer barriers to enforcement, reported more frequent collaboration with other community agencies to enforce youth access laws, and believed that youth access to tobacco is a problem in their community. CONCLUSIONS Because active enforcement of youth access laws using unannounced compliance checks has been shown to reduce the rate of illegal tobacco sales to minors and may reduce youth smoking, efforts to increase the level of enforcement should be promoted. These study results may be used to inform efforts to encourage local agencies to enforce existing youth access laws.

Generalizability of findings from a chewing tobacco cessation clinical trial

This study examined selection bias by comparing characteristics of a general population sample of tobacco chewers, participants in a chewing tobacco cessation trial, and non-participants in the trial. A population-based sample of chewers (n = 155) was surveyed by telephone to assess demographics, tobacco-use patterns, and quitting history. Six months later, chewers from this same population were recruited for a cessation trial (n = 401 participants and 68 non-participants). Trial participants differed little from general population chewers on demographics, but they used more chew and were more dependent on nicotine. They were more likely to have tried to quit, received advice to quit and experienced tobacco-related health problems. Trial non-participants were virtually identical to participants on demographic and tobacco use measures. The findings suggest that clinically tested treatments are generalizable beyond the research setting, because trial participants are demographically representative of the general population of chewing tobacco users, are not biased toward light users, and are representative of those chewers most likely to seek out community-based cessation services outside the trial context.