Kevin P. Balanda

Kurtosis: A Critical Review

We critically review the development of the concept of kurtosis. We conclude that it is best to define kurtosis vaguely as the location- and scale-free movement of probability mass from the shoulders of a distribution into its center and tails and to recognize that it can be formalized in many ways. These formalizations are best expressed in terms of location- and scale-free partial orderings on distributions and the measures that preserve them. The role of scale-matching techniques and placement of shoulders in the formalizations that have appeared in the literature are emphasized.

Identifying Trajectories of Adolescent Smoking: An Application of Latent Growth Mixture Modeling

The goal of the current study was to identify discrete longitudinal patterns of change in adolescent smoking using latent growth mixture modeling. Five distinct longitudinal patterns were identified. A group of early rapid escalators was characterized by early escalation (at age 13) that rapidly increased to heavy smoking. A pattern characterized by occasional puffing up until age 15, at which time smoking escalated to moderate levels was also identified (late moderate escalators). Another group included adolescents who, after age 15, began to escalate slowly in their smoking to light (0.5 cigarettes per month) levels (late slow escalators). Finally, a group of stable light smokers (those who smoked 1-2 cigarettes per month) and a group of stable puffers (those who smoked only a few puffs per month) were also identified. The stable puffer group was the largest group and represented 25% of smokers.

Psychologic distress in women with abnormal findings in mass mammography screening

This study was conducted to explore the psychologic morbidity of women recalled for diagnostic assessment during population‐based mammographic screening.

The needs of cancer patients and their families from rural and remote areas of Queensland

This study examines the impact of travelling for treatment on cancer patients and their families. Twenty-eight consecutive cancer patients, who were receiving radiation therapy treatment and 19 family carers, completed a structured needs assessment questionnaire and an in-depth interview. Both patients and carers reported moderate to high levels of unmet psychological need. Carers were found to have higher levels of anxiety than patients, although both groups had higher anxiety levels than the general population. Taking more responsibility for household tasks and organising new living arrangements for the family were the most frequently identified demands of a dual burden of caring. Nearly 40% of carers reported some disruption to their schedule and half reported experiencing financial difficulties. The qualitative interviews highlight the disruption that parents and children experience under the present system, particularly in relation to the demands of family life and the need to maintain some level of continuity and security for children.

Evaluation of a Three-Year School-Based Intervention to Increase Adolescent Sun Protection

The efficacy of a school-based intervention was evaluated using a randomized controlled trial in Australia. In consecutive grades (8, 9, and 10), students in the intervention group received components of a program that addressed issues related to the need to protect yourself from the sun, behavioral strategies related to using sunprotective measures, personal and social images of having a tan, the use of sun-safe clothing, and howto change their schools through forms of structural change. Pre-and postintervention measures among junior high school students showed greatest improvement in the intervention group’s knowledge scores and minimal changes in sun protection behavior from Grade 8 to Grade 9, which were not maintained through Grade 10. Results of the study highlight some limitations of school-based interventions for changing sun protection behaviors.

Smoking Relapse Prevention Methods for Pregnant Women: A Formative Evaluation:

While there was no statistical difference between the intervention and control groups, the overall relapse rate of 22% (78% nonsmoking), was lower compared to most of the published data from other studies. Results from the historical comparison group from the smoking cessation trial confirmed a 35% relapse rate during pregnancy in this population.

Predictors of Sun Protective Behaviors Among School Students

A random sample of students (N = 3,655) in Grades 7, 9, and 11 from 55 schools in Queensland (Australia) were surveyed about their sun protection knowledge, attitudes, and behaviors. An aggregate sun protection behavior index (SPBI) was developed from self-reported behaviors on a school day and a weekend day. Repeated measures regression analyses revealed that negative views of sun protection measures were associated with low scores on the SPBI, an association that was strongest among older students and in larger schools. Low perceived parental sun protective behaviors were associated with low SPBI ratings, and this association was greatest in small schools and on Saturdays. Older students had lower SPBI ratings, but their scores increased on Saturdays. Gender did not appear to be independently related to the SPBI after adjustment for the other variables. These findings reinforce the need for adolescent sun protection programs to address the complex interactions among psychological, social, and environmental factors that influence different subgroups of the student population.

Community perceptions about the important signs of early melanoma

BACKGROUND Detecting melanoma early often relies on patient concern about a particular pigmented lesion. However, it is not clear what specific features the public views as being important. OBJECTIVE Our purpose was to explore the importance persons place on various features of skin lesions when looking for early signs of melanoma. METHODS This study comprised 1148 respondents (participation rate, 78%) from 60 rural communities in Queensland, Australia, who participated in a telephone interview. RESULTS The following features were considered important and are listed in order of importance: change in the lesion (clearly identified as the most important), more than one color, uneven edges, elevation, large size (the last three of equal importance), and hairiness of the lesion. Age, sex, education, self-efficacy, perceived knowledge, and recent self-examination influenced importance levels, but having a recent skin examination by a family physician did not. CONCLUSION To increase the skin self-examination skills of the community, guidelines may have to become more specific and all opportunities fully utilized to educate the public.

Dissemination of an Efficacious Antenatal Smoking Cessation Program in Public Hospitals in Australia: A Randomized Controlled Trial

This study investigated the impact of a behaviorally based intervention designed to increase the number of hospitals that routinely provide effective smoking cessation programs for pregnant women. In Queensland, Australia, 70 publicly funded hospitals were matched on numbers of births and maternal socioeconomic status and randomly allocated to an awareness-only intervention group or a behaviorally based intervention group. Success was defined as the routine offer of an evidence-based smoking cessation program to at least 80% of the pregnant clients who smoke. At 1 month, 65% of the behaviorally based intervention hospitals agreed to provide materials about smoking cessation programs for their antenatal patients, compared with 3% of the awarenessonly hospitals. After 1 year, 43% of the intervention hospitals still provided the material, compared with 9% of the awareness-only hospitals. These findings showthat a brief intervention to hospitals can encourage antenatal staff to provide smoking cessation materials to pregnant women.

Comparison of two self-help smoking cessation booklets.

OBJECTIVE To compare two self-help smoking cessation booklets distributed to callers to a Quitline telephone service in Queensland (Australia). DESIGN Callers were randomised to receive either a structured 14-day quit programme (Time to quit) or another booklet that described four broad stages of quitting (Can quit). Approximately one month later, these callers were interviewed by telephone. MAIN OUTCOME MEASURES Self-reported smoking status at one month and recent quit attempts together with process measures. RESULTS Altogether, 521 callers (78.3%) were interviewed. They were heavier smokers when compared with all Queensland smokers: on average they had smoked for more than 15 years, smoked nearly 25 cigarettes per day, and almost two-thirds had attempted to quit smoking in the past year. In each group, significant proportions either did not begin to use the booklet (50.5–56.0%), or did not complete its use (77.4–82.3%). There were no differences in the self-reported quit rates at one month (17.0%vs 16.1%; p = 0.93). In an ordinal regression modelling procedure involving age, sex, number of recent quit attempts, number of cigarettes smoked per day, smoking status of partner, number of five closest friends who smoke, education, and booklet received, only the number of cigarettes smoked per day was significantly related to smoking status at one month. CONCLUSIONS Callers to telephone Quitline services are typically heavier smokers than the general smoking population, and simple strategies, such as self-help booklets, appear to achieve relatively high success. Nevertheless, there is potential to improve the effectiveness of these materials by making a range of materials available and encouraging callers to make a serious attempt to quit smoking.