Christine C. Edwards

The long-term prevention of tobacco use among junior high school students: classroom and telephone interventions.

OBJECTIVES The purpose of this study was to implement and evaluate the effectiveness of a long-term tobacco use prevention program for junior high school students that used college undergraduate change agents and telephone boosters. METHODS A psychosocial intervention combining refusal skills training, contingency management, and other tobacco use prevention methodologies such as telephone and mail boosters was implemented in 11 junior high schools in San Diego County, California. Eleven other junior high schools served as controls. Of the 2668 participants, 57% were White/non-Hispanic, 24% were Hispanic, and 19% were of other racial/ethnic groups. College undergraduates served as change agents for both the classroom and booster interventions, the latter of which was delivered in the third (ninth-grade) year of the program. RESULTS At the end of the third year, the prevalence of tobacco use within the past month was 14.2% among the intervention students and 22.5% among the controls, yielding an odds ratio of 0.71 for analysis at the school level. CONCLUSIONS Both college undergraduate change agents and direct one-to-one telephone interventions appear to provide cost-effective tobacco-related behavior modification.

A middle school immunization law rapidly and substantially increases immunization coverage among adolescents.

OBJECTIVES This study assessed the effectiveness of a middle school vaccination requirement for raising second-dose measles, mumps, and rubella vaccine and hepatitis B vaccine coverage among adolescents. METHODS Random-digit-dialed telephone surveys were conducted before (1998) and after (1999) the implementation of a vaccination requirement for entry into the seventh grade in San Diego, Calif. RESULTS Vaccination coverage was higher among children subject to the vaccination requirement (seventh-grade students; 60%) than among fifth- and sixth-grade students 1 year before the requirement (13%, P <.001), and 8th- through 12th-grade students not subject to the requirement (27%, P <.0001). CONCLUSIONS Middle school-entry vaccination requirements can rapidly and substantially raise vaccination coverage among students subject to the law.

Effect of an eight week smoking ban on women at US Navy recruit training command

OBJECTIVE To examine the effect of a unique organisational smoking ban on female United States Navy recruits, a population with historically high smoking rates. SETTING AND DESIGN Study participants were female recruits (n = 5503) entering the Navy recruit training command between March 1996 and March 1997 (12 consecutive months). Participants completed smoking surveys at entry to recruit training (baseline) and again at graduation from training after exposure to an eight week, 24 hour a day smoking ban. Effects of the ban on baseline to graduation changes in perceptions of being a smoker were examined, and relapse rates among baseline ever smokers was assessed three months after leaving recruit training. RESULTS Among all recruits, 41.4% reported being smokers at entry (that is, reported any smoking in the 30 days before entering recruit training). As a result of the ban, there was a significant reduction (from about 41% to 25%, p < 0.001) in the percentage of all women recruits who reported themselves as smokers, a much larger change than expected had no ban been in place. Relapse at the three month follow up varied according to the type of smoker at entry into the Navy, with rates ranging from 89% relapse among baseline daily smokers to 31% among baseline experimenters. CONCLUSIONS Findings suggest that the ban provides some smokers who desire to quit with an external impetus and support to do so. However, high relapse rates indicate that more than an organisationally mandated smoking ban during recruit training is needed to help younger smokers, more regular smokers, and those who intend to continue smoking to quit after joining the Navy.

Out of the smokescreen II: will an advertisement targeting the tobacco industry affect young people's perception of smoking in movies and their intention to smoke?

Objective: To evaluate the effect of an antismoking advertisement on young people’s perceptions of smoking in movies and their intention to smoke. Subjects/setting: 3091 cinema patrons aged 12–24 years in three Australian states; 18.6% of the sample (n = 575) were current smokers. Design/intervention: Quasi-experimental study of patrons, surveyed after having viewed a movie. The control group was surveyed in week 1, and the intervention group in weeks 2 and 3. Before seeing the movie in weeks 2 and 3, a 30 s antismoking advertisement was shown, shot in the style of a movie trailer that warned patrons not to be sucked in by the smoking in the movie they were about to see. Outcomes: Attitude of current smokers and non-smokers to smoking in the movies; intention of current smokers and non-smokers to smoke in 12 months. Results: Among non-smokers, 47.8% of the intervention subjects thought that the smoking in the viewed movie was not OK compared with 43.8% of the control subjects (p = 0.04). However, there was no significant difference among smokers in the intervention (16.5%) and control (14.5%) groups (p = 0.4). A higher percentage of smokers in the intervention group indicated that they were likely to be smoking in 12 months time (38.6%) than smokers in the control group (25.6%; p<0.001). For non-smokers, there was no significant difference in smoking intentions between groups, with 1.2% of intervention subjects and 1.6% of controls saying that they would probably be smoking in 12 months time (p = 0.54). Conclusions: This real-world study suggests that placing an antismoking advertisement before movies containing smoking scenes can help to immunise non-smokers against the influences of film stars’ smoking. Caution must be exercised in the type of advertisement screened as some types of advertising may reinforce smokers’ intentions to smoke.

Implementing a seventh grade vaccination law: school factors associated with completion of required immunizations.

OBJECTIVES We investigated school factors associated with successful implementation of a seventh grade vaccination requirement. METHODS The proportion of students vaccinated with hepatitis B vaccine and measles containing vaccine was determined from records of schools in San Diego County, California. A school survey identified compliance strategies. Analysis identified factors associated with coverage. RESULTS In October 1999, 67.2% of 38,875 students had received the required vaccine doses. Of 315 schools, coverage was less than 40% in 60 schools and exceeded 80% in 111 schools. Factors associated with high coverage included private schools, early and frequent notice to parents, and, for public schools, higher overall socioeconomic status of students. CONCLUSIONS In preparation for a middle school vaccination requirement, early and frequent notification of parents improves coverage. Schools with a high percentage of low socioeconomic status students may require extra resources to support implementation.

Increasing Response Rates to a Smoking Survey for U.S. Navy Enlisted Women

This study examined the effectiveness of several persistent strategies to increase the response to a smoking survey among newly enlisted U.S. Navy women. The stepped approach, which included the use of incentives, repeated mailings, alternative survey administration modes, and reminders, was evaluated in terms of effects on response rates and response bias. Demographic and baseline smoking-related characteristics were compared for those responding on time to the initial mailed follow-up survey, reluctant respondents who did not respond initially but eventually completed a survey after further prompting, and nonrespondents. Results showed that incentives and persistent efforts were effective in substantially increasing the response among 2,231 eligible participants, more than doubling the response rate (from 24.9% to 52.7%). The characteristics of ontime, reluctant, and nonrespondents did not differ significantly in terms of sociodemographic characteristics. On the other hand, on-time respondents were different from both reluctant respondents and nonrespondents in terms of smoking-related behaviors.

Teen Smoking Cessation Help Via the Internet: A Survey of Search Engines

The objective of this study was to assess Web sites related to teen smoking cessation on the Internet. Seven Internet search engines were searched using the keywords teen quit smoking. The top 20 hits from each search engine were reviewed and categorized. The keywords teen quit smoking produced between 35 and 400,000 hits depending on the search engine. Of 140 potential hits, 62% were active, unique sites; 85% were listed by only one search engine; and 40% focused on cessation. Findings suggest that legitimate on-line smoking cessation help for teens is constrained by search engine choice and the amount of time teens spend looking through potential sites. Resource listings should be updated regularly. Smoking cessation Web sites need to be picked up on multiple search engine searches. Further evaluation of smoking cessation Web sites need to be conducted to identify the most effective help for teens.

Youth Advocacy as a Tool for Environmental and Policy Changes That Support Physical Activity and Nutrition: An Evaluation Study in San Diego County

Background As evidence grows about the benefits of policy and environmental changes to support active living and healthy eating, effective tools for implementing change must be developed. Youth advocacy, a successful strategy in the field of tobacco control, should be evaluated for its potential in the field of obesity prevention. Community Context San Diego State University collaborated with the San Diego County Childhood Obesity Initiative to evaluate Youth Engagement and Action for Health! (YEAH!), a youth advocacy project to engage youth and adult mentors in advocating for neighborhood improvements in physical activity and healthy eating opportunities. Study objectives included documenting group process and success of groups in engaging in community advocacy with decision makers. Methods In 2011 and 2012, YEAH! group leaders were recruited from the San Diego County Childhood Obesity Initiative’s half-day train-the-trainer seminars for adult leaders. Evaluators collected baseline and postproject survey data from youth participants and adult group leaders and interviewed decision makers. Outcomes Of the 21 groups formed, 20 completed the evaluation, conducted community assessments, and advocated with decision makers. Various types of decision makers were engaged, including school principals, food service personnel, city council members, and parks and recreation officials. Eleven groups reported change(s) implemented as a result of their advocacy, 4 groups reported changes pending, and 5 groups reported no change as a result of their efforts. Interpretation Even a brief training session, paired with a practical manual, technical assistance, and commitment of adult leaders and youth may successfully engage decision makers and, ultimately, bring about change.

Enhancing Response Rates To a Smoking Survey for Enlisted U.S. Navy Women

This study examined the effectiveness of a stepped approachfor increasing response rates to a mailed follow-up smoking survey among newly enlisted women in the navy. The effect of the stepped approach on response rates and on the characteristics of respondents was evaluated. Also, costs were estimated for each of the steps to determine their relative benefits. Results showed that the stepped approach was effective in more than doubling the survey response rate among smokers. Reluctant respondents did not differ from on-time respondents in terms of demo- graphics or baseline smoking, although nonrespondents were less educated and heavier smok ers than on-time and reluctant respondents. Strategies documented here could well apply to sur vey efforts with other hard-to-reach populations.

Comparing telephone and written surveys to assess local adolescent immunization coverage rates.

To identify adolescent hepatitis B coverage levels, a survey was conducted of seventh grade parents in San Diego County, California, using a random digit-dial telephone survey. A written survey was fielded also that was distributed at selected schools. Results were validated using data from a mandated report from all schools. Both survey methods overestimated the proportion completing the hepatitis B series by about 10%. Parents accurately reported immunization shot dates from the childs parent-held immunization shot record on the telephone and written surveys. The written survey, in addition to having a somewhat lower cost, may be useful when focusing on a localized area, whereas the telephone survey permits a more representative sample of a larger county-wide population.