J. Michael Bowling

The Prevalence of Evidence-Based Drug Use Prevention Curricula in U.S. Middle Schools in 2005

Since the promulgation of its Principles of Effectiveness in 1998, the Office of Safe and Drug-Free Schools of the U.S. Department of Education has promoted the use of evidence-based drug prevention programs in the nation’s schools. We report the results of a survey, conducted in 2005, of a nationally representative sample of 1,721 schools with middle school grades. Respondents comprised the staff member in the school identified as most knowledgeable about the school’s drug prevention programs. The total response rate was 78%. Respondents answered questions concerning which drug use prevention curricula they used, and, if they used more than one, which one they used the most frequently. Three federally-sponsored registries were used to specify which curricula were considered evidence-based. Findings from 2005 were then compared to earlier estimates based on a similar 1999 survey. We found that 42.6% of the nation’s schools with middle school grades were using an evidence-based curriculum, an increase of 8% from our 1999 estimate. The two most prevalent curricula in use, at 19% each, were Life Skills Training and Project ALERT. We note, however, that only 8% of Life Skills Training users and 9% of Project ALERT users reported using those curricula the most, and that only 23% of respondents overall reported that they used an evidence-based curriculum the most. More information is needed as to why over three-quarters of the nation’s schools with middle school grades continue to administer curricula that have not been identified as effective.

Assessing the Effects of Families for Safe Dates, a Family-Based Teen Dating Abuse Prevention Program

PURPOSE To examine the effects of a family-based teen dating abuse prevention program, Families for Safe Dates, primarily on outcomes related to testing the conceptual underpinnings of the program including (1) factors motivating and facilitating caregiver engagement in teen dating abuse prevention activities, and 2) risk factors for teen dating abuse, and secondarily on dating abuse behaviors. METHODS Families were recruited nationwide using listed telephone numbers. Caregivers and teens completed baseline and 3-month follow-up telephone interviews (n = 324). Families randomly allocated to treatment condition received the Families for Safe Dates program including six mailed activity booklets followed-up by health educator telephone calls. RESULTS There were significant (<.05) treatment effects in hypothesized directions on most of the factors motivating and facilitating caregiver engagement in teen dating abuse prevention activities including caregiver perceived severity of dating abuse, response efficacy for preventing dating abuse, self-efficacy for talking about dating abuse, knowledge of dating abuse, acceptance of dating abuse, communication skills with the teen, and belief in the importance of involvement in their male (but not female) teens dating. The latter effect was the only one moderated by sex of the teen. The targeted risk factor affected by the program was teen acceptance of dating abuse. Treatment was also significantly associated with less physical dating abuse victimization. CONCLUSIONS Modifications to the program are warranted, but overall, the findings are very favorable for the first family-based teen dating abuse prevention program to be evaluated.

Pounds Off Digitally Study A Randomized Podcasting Weight-Loss Intervention

BACKGROUND As obesity rates rise, new weight-loss methods are needed. Little is known about the use of podcasting (audio files for a portable music player or computer) to promote weight loss, despite its growing popularity. DESIGN A 12-week RCT was conducted. SETTING/PARTICIPANTS The study sample comprised overweight men and women (BMI=25-40 kg/m(2); n=78) in the Raleigh-Durham NC area. INTERVENTION In 2008, participants were randomly assigned to receive 24 episodes of a currently available weight-loss podcast (control podcast) or a weight-loss podcast based on social cognitive theory (SCT) designed by the researchers (enhanced podcast) for 12 weeks. MAIN OUTCOME MEASURES Weight was measured on a digital scale at baseline and follow-up. Both groups also completed questionnaires assessing demographic information, food intake, physical activity, and SCT constructs at the introductory and 12-week meetings. Additional questionnaires at the 12-week meeting assessed perceptions of the intervention. RESULTS Data collection and analysis occurred in 2008 and intention-to-treat was used. Enhanced group participants (n=41) had a greater decrease in weight (-2.9+/-3.5 kg enhanced group vs -0.3+/-2.1 control group; p<0.001 between groups) and BMI (-1.0+/-1.2 kg/m(2) enhanced group vs -0.1+/-0.7 kg/m(2) control group; p<0.001 between groups) than the control group (n=37) and had greater weight-loss-related knowledge (p<0.05), elaboration (p<0.001), and user control (p<0.001) and less cognitive load (p<0.001). CONCLUSIONS The results of this study suggest that the use of behavioral, theory-based podcasting may be an effective way to promote weight loss. TRIAL REGISTRATION NCT00771095.

Motivation and Its Relationship to Adherence to Self-Monitoring and Weight Loss in a 16-Week Internet Behavioral Weight Loss Intervention

OBJECTIVE To examine changes in motivation and the relationship of motivation to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight-loss intervention. DESIGN Two-group randomized design. SETTING This study was conducted over the Internet. PARTICIPANTS Sixty-six women, ages 22-65, with a body mass index (BMI) between 25 and 40, and with a home computer with Internet access, participated. INTERVENTION These data are from an Internet behavioral weight-loss program in which all participants received a face-to-face initial session followed by the 16-week Internet program. MAIN OUTCOME MEASURES Adherence to self-monitoring and weight loss were the main outcome measures. ANALYSIS Linear regression and mediation analysis using the Baron and Kenny method were conducted. RESULTS Autonomous motivation increased initially and remained high for those who ultimately achieved a 5% weight loss, but declined over time for participants who did not achieve a 5% weight loss. Autonomous motivation at 4 weeks was a predictor of adherence to self-monitoring and 16-week weight loss. Adherence mediated the relationship between autonomous motivation and weight loss. CONCLUSIONS AND IMPLICATIONS These results suggest that autonomous motivation may be a promising intervention target for promoting program procedure adherence and weight loss.

Energy Expenditure and Enjoyment during Video Game Play: Differences by Game Type

PURPOSE Play of physically active video games may be a way to increase physical activity and/or decrease sedentary behavior, but games are not universally active or enjoyable. Active games may differ from traditional games on important attributes, which may affect frequency and intensity of play. The purpose of this study was to investigate differences in energy expenditure and enjoyment across four game types: shooter (played with traditional controllers), band simulation (guitar or drum controller), dance simulation (dance mat controller), and fitness (balance board controller). METHODS Energy expenditure (METs) and enjoyment were measured across 10 games in 100 young adults age 18-35 yr (50 women). RESULTS All games except shooter games significantly increased energy expenditure over rest (P < 0.001). Fitness and dance games increased energy expenditure by 322% (mean ± SD = 3.10 ± 0.89 METs) and 298% (2.91 ± 0.87 METs), which was greater than that produced by band simulation (73%, 1.28 ± 0.28 METs) and shooter games (23%, 0.91 ± 0.16 METs). However, enjoyment was higher in band simulation games than in other types (P < 0.001). Body mass-corrected energy expenditure was greater in normal weight than in overweight participants in the two most active game types (P < 0.001). CONCLUSIONS Active video games can significantly increase energy expended during screen time, but these games are less enjoyable than other more sedentary games, suggesting that they may be less likely to be played over time. Less active but more enjoyable video games may be a promising method for decreasing sedentary behavior.

A Prospective Cohort Study of Injury Incidence and Risk Factors in North Carolina High School Competitive Cheerleaders

Background Cheerleaders suffer nearly half of catastrophic injuries observed in female scholastic athletes in the United States. However, incidence of noncatastrophic injury in this population has not been described. Hypothesis Coach, athlete, and injury circumstance variables may predict the injury rate among cheerleaders. Study Design Prospective cohort. Methods The authors investigated injury incidence in a sample of North Carolina female cheerleaders who competed interscholastically from 1996 to 1999. Injury, exposure, and demographic data were collected from squads that participated in the North Carolina High School Athletic Injury Study. Results Cheerleaders suffered 133 injuries during 1701 athlete seasons. More than 21% of the injuries were ankle sprains. The injury rate was 8.7; the 95% confidence interval (CI) was 6.5 to 11.7 per 10,000 athlete exposures. In a multivariate Poisson regression model, cheerleaders supervised by coaches with the most education, qualifications, and training (coach EQT) had a nearly 50% reduction in injury risk (rate ratio [RR], 0.5; 95% CI, 0.3-0.9), and cheerleaders supervised by coaches with medium coach EQT had a nearly 40% reduction in injury risk (RR = 0.6; 95% CI, 0.3-1.2) compared to cheerleaders supervised by coaches with low coach EQT.

Work-related hazards and workplace safety of US adolescents employed in the retail and service sectors

OBJECTIVE. Our goal was to examine the hazard exposures, work experiences, and workplace safety training of adolescents employed in retail and service jobs in the United States. METHODS. This was a cross-sectional telephone survey among working adolescents, 14 to 18 years old, in the continental United States. Data were collected in 2003. Survey items measured self-reported hazard exposures, training, and supervision experiences of working adolescents. RESULTS. Teens reported working an average of 16.2 hours per week during the school year, including working an average of 2.9 times per week after 7 pm on school nights and 2.6 nights per week after 9 pm. Thirty-seven percent of those under age 16 reported working after 7 pm on a school night, indicating employer violation of federal law. Teens typically perform multiple kinds of tasks in a given job. Higher proportions of females than males are involved in cash handling (84% vs 61%), whereas males are more likely than females to be involved in physically challenging tasks, such as lifting heavy objects (57% vs 22%) or working at heights (35% vs 17%). Despite federal regulations prohibiting teens under 18 from using certain types of dangerous equipment (eg, slicers, dough mixers, box crushers, paper balers) or serving or selling alcohol in places where it is consumed, 52% of males and 43% of females reported having performed ≥1 prohibited task. Although more males reported receiving safety training, they were also more likely to report working without supervision than their female counterparts. CONCLUSIONS. Teens are exposed to multiple hazards, use dangerous equipment despite federal prohibitions, and work long hours during the school week. They also lack consistent training and adult supervision on the job. It is important for adolescent medicine practitioners to become involved in prevention efforts through both anticipatory guidance and policy advocacy.

The Validity of a Proxy Acculturation Scale Among U.S. Hispanics

This study examines the validity of a proxy acculturation scale composed of four acculturation-related variables. The authors use data from a nationally representative sample of 1,437 U.S. Hispanics. Results indicate good internal scale reliability, a high degree of correlation between the proxy scale and the full acculturation measure, and substantial agreement between dichotomized versions of the two scales. Although reliability declines slightly, validity increases with removal of generational status from the scale. Validity is found to be high for the three largest subpopulations by country of ancestry (Mexico, Puerto Rico, and Cuba). The proxy acculturation scale is a useful tool for the measurement of acculturation level among the majority of U.S. Hispanics when use of a more comprehensive acculturation scale is infeasible or impractical.

The Influence of Stigma and Discrimination on Female Sex Workers’ Access to HIV Services in St. Petersburg, Russia

Stigma associated with HIV and risk behaviors is known to be a barrier to health care access for many populations. Less is known about female sex workers (FSW) in Russia, a population that is especially vulnerable to HIV-infection, and yet hard-to-reach for service providers. We administered a questionnaire to 139 FSW to better understand how stigma and discrimination influence HIV service utilization. Logistic regression analysis indicated that HIV-related stigma is negatively associated with uptake of HIV testing, while sex work-related stigma is positively associated with HIV testing. HIV-positive FSW are more likely than HIV-negative FSW to experience discrimination in health care settings. While decreasing societal stigma should be a long-term goal, programs that foster inclusion of marginalized populations in Russian health care settings are urgently needed.

Factors associated with annual-interval mammography for women in their 40s

BACKGROUND Evidence is mounting that annual mammography for women in their 40s may be the optimal schedule to reduce morbidity and mortality from breast cancer. Few studies have assessed predictors of repeat mammography on an annual interval among these women. METHODS We assessed mammography screening status among 596 insured Black and Non-Hispanic white women ages 43-49. Adherence was defined as having a second mammogram 10-14 months after a previous mammogram. We examined socio-demographic, medical and healthcare-related variables on receipt of annual-interval repeat mammograms. We also assessed barriers associated with screening. RESULTS 44.8% of the sample were adherent to annual-interval mammography. A history of self-reported abnormal mammograms, family history of breast cancer and never having smoked were associated with adherence. Saying they had not received mammography reminders and reporting barriers to mammography were associated with non-adherence. Four barrier categories were associated with womens non-adherence: lack of knowledge/not thinking mammograms are needed, cost, being too busy, and forgetting to make/keep appointments. CONCLUSIONS Barriers we identified are similar to those found in other studies. Health professionals may need to take extra care in discussing mammography screening risk and benefits due to ambiguity about screening guidelines for women in their 40s, especially for women without family histories of breast cancer or histories of abnormal mammograms. Reminders are important in promoting mammography and should be coupled with other strategies to help women maintain adherence to regular mammography.