Jennifer R. Warren

Stereotype Threat and Health Disparities: What Medical Educators and Future Physicians Need to Know

Patients’ experience of stereotype threat in clinical settings and encounters may be one contributor to health care disparities. Stereotype threat occurs when cues in the environment make negative stereotypes associated with an individual’s group status salient, triggering physiological and psychological processes that have detrimental consequences for behavior. By recognizing and understanding the factors that can trigger stereotype threat and understanding its consequences in medical settings, providers can prevent it from occurring or ameliorate its consequences for patient behavior and outcomes. In this paper, we discuss the implications of stereotype threat for medical education and trainee performance and offer practical suggestions for how future providers might reduce stereotype threat in their exam rooms and clinics.

Communicating Prevention: The Effects of the keepin’ it REAL Classroom Videotapes and Televised PSAs on Middle-School Students’ Substance Use

This study sought to determine if exposure to two communication-oriented activities, videotapes and public service announcements, accounts for changes in substance use among adolescents participating in the Drug Resistance Strategies Projects keepin’ it REAL adolescent substance use prevention curriculum. Middle-school students (4,734, 72% Latino) responded to questionnaires related to these analyses. An analysis of covariance (ANCOVA) model was fit separately to six substance use outcomes. The results suggested that intervention students who saw four or five videos engaged in less substance use in the past month than did students who saw fewer videos. Having seen the PSAs one or more times did not predict the reported change in substance use.

Relationship between smoking reduction and cessation among light smokers.

INTRODUCTION To determine the smoking reduction patterns of light smokers (≤ 10 CPD) and whether reduction predicts future cessation. METHODS Study is a secondary analysis of data that were derived from a 2 × 2 randomized study that assessed the efficacy of nicotine gum (vs. placebo) and counseling (motivational interviewing vs. health education) for smoking cessation among 755 light smokers. Participants were categorized into three groups based on self-reported CPD smoked at time of study enrollment compared with CPD smoked a year prior to enrollment. That is, (a) those who reduced number of cigarettes per day (CPD), (b) those who smoked the same number of CPD, and (c) those who increased their number of CPD. Sociodemographic and smoking characteristics were assessed at enrollment as well as cotinine-verified 7-day smoking abstinence rates at the Week 26 follow-up assessment. A stepwise logistic regression model to predict the probability abstinence at 26-week follow-up was also performed. RESULTS Compared with a year prior to enrollment, 43.7% of participants reduced, 35.2% smoked the same, and 21.2% increased their CPD. Compared with those who smoked the same or increased their CPD, those who had reduced their CPD were older, more likely to be males, smoked fewer CPD at enrollment, initiated smoking at a younger age, and less likely to be nicotine dependent. Adjusted logistic regression showed that those who had reduced their smoking prior to enrollment were more likely to quit at Week 26 (odds ratio [OR] = 1.77; 95% CI = 1.062-2.957; p = .029). DISCUSSION Findings suggest that reducing number of CPD smoked prior to enrolling in a clinical trial is a positive predictor of abstinence. Therefore, encouraging smoking reduction prior to attempting cessation may enhance cessation outcomes for light smokers.

African American Ethnic and Class-Based Identities on the World Wide Web: Moderating the Effects of Self-Perceived Information Seeking/Finding and Web Self-Efficacy

The web is a potentially powerful tool for communicating information to diverse audiences. Unfortunately, all groups are not equally represented on the web, and this may have implications for online information seeking. This study investigated the role of class-and ethnic-based identity in self-perceived web-based information seeking/finding and self-efficacy. A questionnaire is administered, asking African Americans about their class and ethnic identities and web use to test a conceptual model predicting that these identities are positively related to web-based information seeking and web self-efficacy, which are then positively related to web-based information finding. Gender and previous web experience are expected to moderate the relationships. Structural equations modeling of these data support most of the predictions and indicate that these identities influence perceptions of online information seeking.

Targeting single parents in preadolescent substance use prevention: Internet characteristics and information relevance

Aim: This study investigates the internet as a resource for parent-based preadolescent substance use prevention information for African-American single mothers receiving public assistance in the United States. Methods: Thirty-two mothers with at least one preadolescent child participated in in-depth semi-structured interviews and usefulness studies eliciting information about their perceptions of the internet as an information and online resource for parent-based preadolescent substance use prevention. Themes were generated qualitatively through an iterative process of comparative analysis. Findings: Findings reveal a consensus that the internet is convenient, comfortable to use and provides accessibility to broad information. However, as related to parent-based preadolescent substance use prevention, participants reviewing established prevention sites (e.g. NIDA) noted that several lacked personal relevance (e.g. did not relate to life experiences and circumstances). These personal considerations override cultural concerns, although issues of representation (i.e. information related to group membership) were still important. Conclusions: Online preadolescent substance use prevention information targeting African-American single mothers would be useful and utilized as a resource if messages make sense within the day-to-day experiences of this ethnic group.

Substance use, resistance skills, decision making, and refusal efficacy among Mexican and Mexican American preadolescents.

This article examines the relationships among resistance skills, refusal efficacy, decision-making skills, and substance use for a sample of Mexican and Mexican American 5th grade students who were attending public schools in Phoenix, Arizona. An analysis of self-report questionnaire data indicated that the likelihood that male students reported ever having used one or more substances increased as they reported a greater willingness to use passive decision-making (e.g., going along) and decreased as they reported greater refusal efficacy and a greater willingness to utilize active decision making (e.g., thoughtful processing). No significant relationships emerged between the 4 predictors and lifetime substance use among the girls. These findings support the role of social skills in substance use prevention, shed light on an understudied group, and suggest the importance of continuing to examine gender differences in skills-based interventions.

Contextualizing Single Parent–Preadolescent Drug Use Talks

This article aims to examine parent–child drug talks specific to African American single mothers and their preadolescent children who live in a inner city neighborhood. Thirty-two single mothers participated in 1-hr individual interviews describing how they communicated with their preadolescent (8–12 years old) about drug use. Three areas were addressed: why drug talks occur, how drug talks take place, and the content of these talks. The interviews revealed that parent–child drug talks were culturally and communally driven, taking place out of necessity, incorporating real life situations as evidence of drug use outcomes, and occurring quite frequently with open communication regarding drug use. The implications are discussed related to the design of parent–child communication strategies in preadolescent drug use prevention.

Predicting home smoking restrictions among African American light smokers.

OBJECTIVE To determine home smoking restrictions (HSR) predictors among African American light smokers (smoke <or= 10 cigarettes per day). METHODS Data were obtained from a clinical trial testing the efficacy of nicotine gum and counseling among 755 African American light smokers. RESULTS Forty percent reported adopting HSR at week 26. Implementing HSR increased with higher baseline confidence to quit (P <0.0001) and female gender (P = 0.019) and decreased with older age (P = 0.016) and reduced confidence to quit between baseline and week 26 (P <0.0001). CONCLUSIONS Confidence to quit, gender, and age are important factors to incorporate into interventions enhancing the adoption of HSR.

Development and Validation of a Multidimensional Measure of Stress Among African American Light Smokers

UNLABELLED The complete Multidimensional Measure of Stress (MMOS) measure may be made available to interested persons by contacting the corresponding author. CONTEXT Smoking rates are higher among inner-city and lower-income African Americans, perhaps due to psychosocial barriers to cessation efforts, including stress. OBJECTIVE To describe the development of the MMOS and examine the psychometric properties of the MMOS among African American light smokers. DESIGN Secondary analysis of data generated from a 2x2 randomized clinical trial, designed to examine the efficacy of nicotine replacement and cessation counseling among 755 African American light smokers. RESULTS Fourteen items were included in the final MMOS (alpha = .83). An exploratory factor analysis identified 3 factors: interpersonal (alpha = .80), safety (alpha = .70), and financial (alpha = .75). The MMOS was significantly correlated with the Perceived Stress scale (r = 0.49, p < .001) and was associated with several demographic, psychosocial, and tobacco-related variables. CONCLUSIONS The MMOS appears to be a valid measure of stress among African American light smokers enrolled in a cessation trial.

Exploring children's secondhand smoke exposure with early child care providers.

BACKGROUND Exposure to secondhand smoke (SHS) is a contributor to the increased morbidity and mortality experienced by inner-city African-American children. Limited evidence-based programming exists regarding how to address the negative effects of SHS in this community. PURPOSE A collaboration with an early child care center provided an opportunity to explore factors related to young childrens SHS exposure as the first step in developing strategies to reduce exposure. METHODS Survey data were obtained between 2008 and 2009 from 63 African-American parents of infants and children aged ≤ 5 years at two early child care centers located in an urban Minneapolis neighborhood. Forty-three of these children had salivary cotinine levels assessed. RESULTS Parents living below the poverty level were more likely to report that their children were regularly exposed to SHS by family/friends (p = 0.01). Sixty-eight percent of participants reported complete home smoking restrictions, which was significantly correlated with advice from the childs health provider (p = 0.001). Nonsmokers and older parents were less likely to receive advice (p = 0.03). Of the 43 children in whom cotinine levels were assessed, 39.5% had levels > 0.64 ng/ml, which suggests high SHS exposure. Lower cotinine levels were significantly correlated with living in detached houses. CONCLUSIONS Exposure to SHS was common for children in this study. These findings, if supported by additional research, can be used to develop and disseminate targeted health messages about childhood SHS sources/negative effects and strategies to reduce exposure.