Norma J. Kelley

Does Proximity to Retailers Influence Alcohol and Tobacco Use Among Latino Adolescents

Despite decades of research surrounding determinants of alcohol and tobacco (A&T) use among adolescents, built environment influences have only recently been explored. This study used ordinal regression on 205 Latino adolescents to explore the influence of the built environment (proximity to A&T retailers) on A&T use, while controlling for recognized social predictors. The sample was 45% foreign-born. A&T use was associated with distance from respondents’ home to the nearest A&T retailer (−), acculturation (+), parents’ consistent use of contingency management (−), peer use of A&T (+), skipping school (+), attending school in immediate proximity to the US/Mexico border (+), and the interaction between the distance to the nearest retailer and parents’ consistent use of contingency management (+). The association between decreasing distance to the nearest A&T retailer and increased A&T use in Latino adolescents reveals an additional risk behavior determinant in the US–Mexico border region.

Predictors of adherence to treatment for latent tuberculosis infection in high-risk Latino adolescents: a behavioral epidemiological analysis

The objective was to test whether theoretical variables predict adherence to treatment for latent tuberculosis infection in high-risk Latino adolescents. 286 Latino adolescents, age 13-18 years, were recruited from 10 middle/high schools in San Diego County, San Diego, USA. Participants completed a baseline interview and up to 9 monthly interviews. The cumulative number of pills consumed in 9 months was regressed on 16 independent variables, entered hierarchically in seven blocks. The final model accounted for 25% of the variance in adherence to isoniazid (INH), F (16, 230)=4.69, p<0.001. Adherence counseling (+), age (-), grades (+), being bicultural (+), and risk behaviors (-) were significantly related to adherence. Learning theories presume that adherence to medical regimens requires social support and freedom from physical and social barriers. Results support these theories. Future studies should explore additional precepts in order to identify additional predictors and to maximize adherence to INH among Latino adolescents and other high-risk populations. Doing so should decrease the risk of active TB among high-risk racial/ethnic and foreign-born populations.

Urine testing to monitor adherence to TB preventive therapy

This study examined the validity of the Arkansas urine test. One hundred ninety-four adolescents submitted an unannounced urine specimen monthly (for 6 to 8 months). Duplicate specimens were blindly tested with high agreement (kappa >90%). Sensitivity and specificity were estimated. In 68% of test runs, adolescents recalled taking INH within 24 hr of specimen collection. For recall intervals of 24, 48, and 72 hr, sensitivity was 87, 85, and 83%, respectively. Females were less likely to test positive when INH was taken within the previous 24 hr (sensitivity 84 versus 92% males). Specificity was 57, 91, and 95% at 24, 48, and 72 hr, respectively. The Arkansas urine test was practical to use, and results correlated well with self-reported adherence to INH for treatment of latent tuberculosis infection (LTBI), over several months of follow-up. The test may be useful as part of an adherence-monitoring program when used in conjunction with self-reported measures.

Somatic complaints and isoniazid (INH) side effects in Latino adolescents with latent tuberculosis infection (LTBI)

This study examined the potential effects of INH side effects and non-specific somatic complaints on medication adherence in 96 Latino adolescents participating in a controlled trial designed to increase isoniazid (INH) adherence. These participants (who received usual medical care) were interviewed monthly over 9 months. Participants were questioned regarding medication taking, the frequency of 15 INH-related side effects from the Physicians Desk Reference (PDR) [1], and 21 non-specific somatic complaints. Participants were aged 12-19 years, 53.1% were male, 66.7% were born in Mexico, 73% had no health insurance, and 52.5% were classified as bicultural. Approximately 70% of participants experienced at least one side effect during the trial. Side effects that occurred while taking INH were not significantly related to total number of pills taken; somatic complaints that occurred during 9 months of INH were significantly negatively related to cumulative adherence. Females reported significantly more somatic complaints at baseline than males.

Randomized, Cross-Over Evaluation of Mobile Phone vs Paper Diary in Subjects with Mild to Moderate Persistent Asthma

Diaries are frequently used to evaluate therapy. Forgetfulness, however, can lead to missed entries. With paper diaries, these missing entries can be backfilled, compromising the reasons for using a diary. Electronic diaries are a potential means of mitigating this limitation. The pilot study was conducted to evaluate use of a mobile phone diary. Twelve subjects with mild persistent asthma were randomly assigned to mobile or paper diary for 2 weeks and then crossed over to use the other diary type for next 2 weeks. Of the 12 subjects, 7 preferred the mobile diary. However, the mean prevalence of missing data was greater when using the mobile (18% ± 9%) compared to paper diary (9% ± 4%; P = 0.05). In conclusion, the mobile diary was preferred by slightly more subjects. The greater prevalence of missing data when using this diary most likely results from the inability to backfill missing entries. Trial Registration: Clintrials.gov NCT00367263 (http://clinicaltrials.gov/ct2/show/NCT00367263).

Multi-Level Barriers to LTBI Treatment: A Research Note

Background This study describes the barriers to effective and timely LTBI treatment encountered in a research study on INH adherence in Latino adolescents. Method Participant study logs were reviewed, results of continuing medical education pretests for medical providers were examined, and participating medical facilities were contacted in order to construct a profile of multi-level barriers to LTBI treatment. Results A total of 285 TST positive Latino (96%) high school students were recruited into the trial. We encountered a lack of understanding of the gravity of tuberculosis infection among both the public and providers of health care. Parents and adolescents cited competing priorities, transportation problems and financial constraints as reasons for non-compliance. Discussion Improved education of the public and physicians is needed regarding the gravity of the disease and the value of treatment, as well as public and financial support for LTBI treatment by both the government and the medical community.

Predictors of Weapon Carrying in Youth Attending Drop-in Centers.

OBJECTIVE To test and compare 2 predictive models of weapon carrying in youth (n = 308) recruited from 4 drop-in centers in San Diego and Imperial counties. METHODS Both models were based on the Behavioral Ecological Model (BEM). RESULTS The first and second models significantly explained 39% and 53% of the variance in weapon carrying, respectively, and both full models shared the significant predictors of being black(-), being Hispanic (-), peer modeling of weapon carrying/jail time (+), and school suspensions (+). CONCLUSIONS Results suggest that the BEM offers a generalizable conceptual model that may inform prevention strategies for youth at greatest risk of weapon carrying.

Evaluating AIDS-Related Social Skills in Anglo and Latino Adolescents Focus on Assessment

The purpose of this study was to examine the assessment of AIDS-related social skills (measured by role play) in Anglo and Latino adolescents (N = 383) and to explore ethnic and gender differences on these skills. Eight skills were assessed on five measures evaluating molar, molecular, verbal, and nonverbal dimensions of behavior. Interrelationships between skills and measurement dimensions were examined using factor analysis. Results revealed that Anxiety and Nonverbal Behavior each loaded across different skills on individual respective factors, whereas verbal content and assertiveness measures loaded by skill on separate factors. Differences in skill emerged between female and male, and Latino and Anglo youth. Preliminary social validity data were collected for the skills assessed. Social validity results were skill specific, with judges validating certain skills and certain measurement dimensions more than others. Implications for future assessment and intervention research of AIDS-related social skills are discussed.

Latino Parenting Practices: A Comparison of Parent and Child Reports of Parenting Practices and the Association with Gateway Drug Use

Parent and adolescent self-reports are the most common sources for measuring parenting practices. This studys purpose was to compare how parent and adolescent reports of parenting behaviors differentially predict adolescent gateway drug use. The sample consisted of 252 Latino adolescent-parent dyads. After controlling for potential confounding influences, only adolescents’ reports about their parents’ parenting behaviors were significant and explained 38% of the variance in gateway drug use. Practitioners may recommend to parents seeking parenting advice that they solicit feedback from their adolescent to ensure parenting efforts are received in the manner they were intended.

Engaging Local Businesses in HIV Prevention Efforts The Consumer Perspective

Participation of different community sectors, including the private business sector, is necessary to fight the HIV/AIDS epidemic. Local businesses may be reluctant to participate in HIV prevention because of fear of negative customer reactions and loss of revenue. This study examines the extent to which residents of two communities in San Diego, California, would support HIV prevention initiatives in local businesses. A population-based household survey (N = 200) is conducted in two communities with higher versus lower risk for HIV. The survey includes questions regarding the acceptability of HIV prevention activities, such as condom and brochure distribution in businesses, and history of exposure to HIV prevention activities in local businesses. Most residents agree that (a) business involvement in prevention activities would reduce HIV (92%), (b) free or low-cost condoms available in businesses could prevent the spread of HIV (90.9%) and increase condom accessibility (87%), and (c) they would prefer to shop at businesses that supported HIV prevention versus those that did not (87.4%). These findings suggest that HIV prevention in local businesses would be supported by residents and would be unlikely to adversely affect business profits. This information could be used to design interventions to engage local businesses in HIV-prevention efforts.