Katherine M. Dollar

Cigar/Cigarillo Surveillance Limitations of the U.S. Department of Agriculture System

BACKGROUND The U.S. Department of Agriculture (USDA) reports data on cigar sales in two categories: little cigars (weighing less than 3 lbs. per thousand) and large cigars and cigarillos (weighing more than 10 lbs. per thousand). A rise in the sales of little cigars in recent years is a cause for concern. The capacious second category could be obscuring the growth of sales in cigarillos. METHODS Trends in cigar use were analyzed in May 2007 using (1) the standard USDA two-level system and (2) data from the Maxwell Report that provides information on cigarillos as a separate category. The intercorrelations among cigar use trends in the three areas were also explored. RESULTS From 1993 to 2006, unit sales of little cigars increased from 37% to 47% of the cigar market, cigarillos increased from 25% to 32%, and large cigars dropped from 37% to 22%. From 1976 to 2006, cigarillo sales were strongly related to sales of little cigars (r=0.93; 95% CI=0.86-0.97), while sales of large cigars and cigarillos were modestly related (r=0.42; 95% CI=0.08-0.57). CONCLUSIONS Analyses show strong correlations between cigarillo and little cigar sales and argue for more detailed reporting of cigar sales as a function of cigar size. Tobacco surveillance should at minimum be watching the same trends as the tobacco industry. The sales of little cigars, cigarillos, and large cigars should be monitored, and the measuring of cigarillo sales in 3-5 subcategories according to size is encouraged.

Commentary: Understanding the origins of anger, contempt, and disgust in public health policy disputes: applying moral psychology to harm reduction debates.

Scientific disputes about public health issues can become emotional battlefields marked by strong emotions like anger, contempt, and disgust. Contemporary work in moral psychology demonstrates that each of these emotions is a reaction to a specific type of moral violation. Applying this work to harm reduction debates, specifically the use of smokeless tobacco to reduce harm from tobacco use, we attempt to explain why some public health disputes have been so heated. Public health ethics tend to emphasize social justice concerns to the exclusion of other moral perspectives that value scientific authority, professional loyalty, and bodily purity. An awareness of their different emotional reactions and underlying moral motivations might help public health professionals better understand each others’ viewpoints, ultimately leading to more productive dialogue.

Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)

Adherence to protocol among behavioral health providers working in co-located, collaborative care or Primary Care Behavioral Health settings has rarely been assessed due to limited measurement options. Development of psychometrically sound measures of provider fidelity may improve the translation of these service delivery models into every day practice. One hundred seventy-three integrated behavioral health providers in VA primary care clinics responded to an online questionnaire to assess the reliability and validity of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ). Psychometric assessment resulted in a reliable 48-item measure with two subscales that specified essential and prohibited provider behaviors. The PPAQ demonstrated strong convergent and divergent validity when compared to another measure of health care integration. Known-group comparisons provided partial support for criterion validity. The PPAQ is a reliable and valid self-report of behavioral health provider fidelity with implications for improving provider training, program monitoring, and clinical research.

Moving toward integrated behavioral intervention for treating multimorbidity among chronic pain, depression, and substance-use disorders in primary care.

Introduction:The importance of using integrated treatment for multimorbidity has been increasingly recognized. One prevalent cluster of health conditions is multimorbidity of chronic pain, depression, and substance-use disorders, a common triad of illnesses among primary care patients. This brief report brings attention to an emerging treatment method of an integrated behavioral approach to improve health outcomes for individuals with these 3 conditions in the outpatient setting, particularly primary care. Methods:A multidatabase search was conducted to identify studies of behavioral interventions targeting co-occurrence or multimorbidity among the 3 health conditions in the adult outpatient setting. An independent screening of the articles was accomplished by all authors with consensus on the final inclusion for review. Results:Three studies met formal inclusion criteria for this review. The included studies evaluated cognitive behavioral therapy or combined motivational interviewing with cognitive behavioral therapy. Key findings from other reviews and additional studies are also included in this review to further inform the development of a common approach for treating this triad of conditions in primary care. Conclusions:Although there has been increased recognition for more effective and practical behavioral treatments for patients with multiple chronic health conditions, the evidence-base to inform practice remains limited. The findings from this review suggest that a common approach, rather than a distinct intervention for chronic pain, depression, or substance-use disorders, is indicated and that best care can be provided within the context of a coordinated, interdisciplinary, and patient-centered primary care team.

Hormones, menstrual distress, and migraine across the phases of the menstrual cycle

Objective.—The primary objectives of the present study were to (1) contrast reproductive hormone levels and ratings of menstrual distress of female migraineurs with those of a control group in each menstrual cycle phase, (2) examine correlations between hormone levels and migraine frequency, severity, and migraine‐related disability, and (3) examine correlations between menstrual distress and migraine frequency, severity, and migraine‐related disability. A secondary objective was to evaluate the validity of a migraine disability measure modified to reflect 7‐day recall.

The Relationship of Character Strengths to Sexual Behaviors and Related Risks among African American Adolescents

Background: Relatively few studies have examined positive character traits that are associated with lower HIV/STD risks.Purpose: In the present study, the relationships of character strengths with sexual behaviors and attitudes were assessed among 383 African-American adolescents.Method: Character strengths were measured using the Values in Action Inventory of Strengths. Because the strengths were highly inter-correlated, stepwise discriminant function analyses were utilized to assess their independent associations with sexual behaviors and attitudes.Results: Greater Love of Learning was related to self-reported abstinence from sexual intercourse for boys and self-reported abstinence from drug use for boys and girls. Greater Love of Learning and Curiosity were related to the belief in no premarital sex for boys, whereas only Curiosity was significant for girls. Prudence was related to reported abstinence from sexual intimacy (e.g., touching or kissing). Judgment was related to sexual initiation efficacy for girls and boys, whereas Leadership was only significant for girls.Conclusions: The findings suggest that character strengths may be associated with lower levels of sexual behaviors and sex-related beliefs among a sample of African-American adolescents.

The Effects of Priming on a Public Health Campaign Targeting Cardiovascular Risks

Public health interventions are cost-effective methods to reduce heart disease. The present study investigated the impact of a low-cost priming technique on a public health campaign targeting cardiovascular risk. Participants were 415 individuals (66% female) ages 18 and older recruited through clinics and churches. The study consisted of three phases. In Phase I, participants completed a brief survey to assess knowledge of the cardiovascular health indicators. The survey served as the prime (intervention) for the study. At Phase II, participants were provided with access to a public health campaign consisting of an education brochure on cardiovascular health. Following the educational campaign, all participants completed a post-campaign survey in Phase III of the study. Participants who completed the surveys in both Phase I and III were placed in the intervention condition (26%) and those who only completed the Phase III survey were placed in the control condition (74%). Participants who were primed reported greater awareness of the public health campaign. Additionally, more intervention participants reported they had knowledge of their own and the normal ranges for cholesterol, glucose, and body mass index. For participants who were aware of the health promotion campaign, more participants in the primed group indicated they had knowledge of their own cholesterol and glucose levels and had made positive lifestyle changes as a result of the campaign. Results suggest the presence of a priming effect. Public health campaigns may benefit from the inclusion of a low-cost prime prior to intervention.

Prospective predictors of actual research participation among African-American adults

AimAlthough several variables appear to be associated with reluctance of African Americans to participate in research, most research on this topic has utilized hypothetical study scenarios, and there is a need for empirical studies of factors that predict actual study participation. The purpose of the present paper was to assess five potential predictors of participation in an actual study of psychological stress and health.Subjects and methodsAfrican American adults (n = 236) completed the Barriers to Research Participation Questionnaire (BRPQ), which assesses attitudes toward research participation, and indicated whether they were willing to be contacted for involvement in a study of psychological stress and health.ResultsRespondents who declined to be contacted for further involvement (n = 191) scored significantly lower (less willingness/greater barriers) on the overall BRPQ, and on the health beliefs/fears, role overload/time demands, and perceived benefits subscales than respondents who were enrolled in the study (n = 45).ConclusionInvestigators might enhance enrollment of African American adults by ameliorating health-related fears, increasing accessibility, or communicating benefits of the research.