Peg Allen

Explanations of ethnic and gender differences in youth smoking: A multi-site, qualitative investigation

Two of the most powerful predictors of adolescent smoking are ethnicity and gender, but little research has focused on understanding how these factors play a role in adolescent smoking. This paper reports results from a qualitative, multi-site investigation of explanations for ethnic and gender differences in cigarette smoking with five ethnic groups: whites, African-Americans, Hispanics, Native Americans, and Asian-American/Pacific Islanders. Across 11 states, we conducted 178 focus groups with a total of 1175 adolescents. The groups explored such major research themes as reasons for smoking and not smoking; images of smoking and smokers; messages youth receive about smoking and not smoking; and the social context of smoking. We synthesized data from the focus groups through multiple cross-site collaborations and discussions, with an emphasis on identifying consistent themes across a majority of groups and sites. Striking differences emerged across ethnic and gender sub-groups in reasons for not smoking. African-American females in particular viewed not smoking as a positive identity marker. Asian-American/Pacific Islander females similarly reported strong mandates not to smoke. Youths perceptions of family messages about smoking also varied by ethnicity and gender, with African-American, Hispanic, and Asian-American/Pacific Islander youth consistently reporting strong, clear anti-smoking messages from family. These findings, notable in their consistency across geographic regions, may shed light on the discrepant prevalence of smoking across ethnic and gender groups.

Environmental, policy, and cultural factors related to physical activity in sedentary American Indian women.

SUMMARY Focus group interviews were conducted to explore socio-cultural, environmental, and policy-related determinants of physical activity among sedentary American Indian women. Thirty women aged 20 to 50 years (mean = 37.4 ± 10.6 years) participated. Three sessions were conducted with women aged 20 to 34 years and three with women aged 35 to 50 to evaluate response differences by age. Because no obvious age differences were observed, data were pooled. Barriers to physical activity included inadequate support for household and child care responsibilities and difficulties balancing home-related and societal expectations with physical activity. In addition, women reported little support from their communities and work sites to be physically active. Environmental barriers included lack of safe outdoor areas and accessible walking trails. Weather and stray dogs were also commonly mentioned. Sociocultural barriers included giving family obligations priority above all other things, being expected to eat large portions of high-fat foods, and failing to follow a traditionally active lifestyle. Enablers of physical activity included support from family and coworkers and participation in traditional community events. Suggested intervention approaches included accessible and affordable programs and facilities, community emphasis on physical activity, and programs that incorporated the needs of larger women and of families. Participants emphasized a preference for programs that were compatible with the role expectations of their families and communities, and they expressed the desire for acceptance and encouragement to be physically active from the family, the community, the worksite, and their tribal leaders.

Commuting Distance, Cardiorespiratory Fitness, and Metabolic Risk

BACKGROUND Limited evidence exists on the metabolic and cardiovascular risk correlates of commuting by vehicle, a habitual form of sedentary behavior. PURPOSE To examine the association between commuting distance, physical activity, cardiorespiratory fitness (CRF), and metabolic risk indicators. METHODS This cross-sectional study included 4297 adults who had a comprehensive medical examination between 2000 and 2007 and geocoded home and work addresses in 12 Texas metropolitan counties. Commuting distance was measured along the road network. Outcome variables included weekly MET-minutes of self-reported physical activity, CRF, BMI, waist circumference, triglycerides, plasma glucose, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, and continuously measured metabolic syndrome. Outcomes were also dichotomized using established cut-points. Linear and logistic regression models were adjusted for sociodemographic characteristics, smoking, alcohol intake, family history of diabetes, and history of high cholesterol, as well as BMI and weekly MET-minutes of physical activity and CRF (for BMI and metabolic risk models). Analyses were conducted in 2011. RESULTS Commuting distance was negatively associated with physical activity and CRF and positively associated with BMI, waist circumference, systolic and diastolic blood pressure, and continuous metabolic score in fully adjusted linear regression models. Logistic regression analyses yielded similar associations; however, of the models with metabolic risk indicators as outcomes, only the associations with elevated blood pressure remained significant after adjustment for physical activity and CRF. CONCLUSIONS Commuting distance was adversely associated with physical activity, CRF, adiposity, and indicators of metabolic risk.

Taking a first puff: cigarette smoking experiences among ethnically diverse adolescents.

OBJECTIVES To study the social contexts and physiological consequences of an initial cigarette smoking experience among adolescents from four ethnic groups (African American, European American, Hispanic, Native American) who vary by gender and locale (e.g. urban vs rural). METHOD A qualitative study using individual interviews and focus groups. RESULTS Results both amplify and reinforce conclusions about peer and family influences on adolescent smoking initiation reported in quantitative studies of teen smoking. Within the broader themes of peers and family, several important sub-themes emerged. The study findings suggest that peer influence can be characterized as social conformity or social acceptance. Males were more likely than females to describe experiences involving peers exerting strong messages to conform to smoking behaviors. Roles played by family members in the initiation process were complex and included those of initiator, prompter, accomplice, and inadvertent source of cigarettes. European American and Hispanic girls provided descriptions of parents/family members as instigators of their first smoking experience. Hispanic adolescents descripted instances in which family members prompted cigarette use at a young age by encouraging the young person to light the adults cigarette. Finally, ethnic differences in the physiological responses to initial smoking suggest the need to further explore the role of brand preference and variations in inhaling among ethnically diverse adolescents. CONCLUSION In order to design effective cigarette smoking prevention programs for adolescents, it is important to understand the meaning of smoking behaviors for adolescents from different ethnic and social backgrounds.

An Exploration of Family Influences on Smoking among Ethnically Diverse Adolescents

In an attempt to better understand mechanisms throughwhich families might influence adolescent smoking, focus group data collected as part of a larger study of ethnic and gender differences in teen smoking were analyzed for family-related themes. Across six sites, 132 focus groups were conducted with African American, American Indian, Hispanic, Asian/Pacific Islander, and White youth. Similarities across race/ethnicity were evident in the content of antismoking messages and the feeling among youth that theywould get in trouble with their parents if caught smoking. African American and Asian/Pacific Islander youth appeared more concerned about their parents thinking less of them if they smoked than were youth from other racial/ethnic groups. White and American Indian youth were more likely to discuss that their parents felt it was their own decision as to whether or not to smoke than were the other groups.

Systems Analysis of Collaboration in 5 National Tobacco Control Networks

OBJECTIVES We studied 5 members of the National Network Consortium on Tobacco Control in Priority Populations. These networks, which consist of governmental and nongovernmental organizations, targeted lesbian, gay, bisexual, and transgender persons; Asian Americans, Native Hawaiians, and Pacific Islanders; American Indians and Alaska Natives; African Americans; and persons with low socioeconomic status, respectively. METHODS We used statistical network analysis modeling to examine collaboration among these national networks in 2007. RESULTS Network size and composition varied, but all 5 networks had extensive interorganizational collaboration. Location and work area were significant predictors of collaboration among network members in all 5 networks. Organizations were more likely to collaborate with their networks lead agency; collaborations with other agencies were more likely if they were geographically close. Collaboration was perceived to be important for achieving the goals of the national network. CONCLUSIONS The similarity of collaboration patterns across the 5 networks suggests common underlying partnership formation processes. Statistical network modeling promises to be a useful tool for understanding how public health systems such as networks and coalitions can be used to improve the nations health.

Reducing Diabetes Risk in American Indian Women

BACKGROUND American Indians experience high rates of type 2 diabetes. The impact of low-intensity interventions on diabetes risk among young American Indian women is unknown. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS Community-based; participants were 200 young urban American Indian women who were block-randomized on fasting blood glucose (FBG) into intervention and control groups. Inclusion criteria included self-reported identity, aged 18-40 years, not pregnant, willingness to stay in urban area for 2 years, and not having type 2 diabetes. Measures were taken at baseline, 6, 12, and 18 months. Data were gathered in 2002-2006 and analyzed in 2006-2007. INTERVENTION Five discussion group sessions (one meeting per month for 5 months) were held focusing on healthful eating, physical activity, goal-setting, and social support. MAIN OUTCOME MEASURES Primary outcomes included dietary fat and vegetable consumption and self-reported physical activity. Secondary outcomes included cardiorespiratory fitness, insulin sensitivity, blood pressure, lipid profiles, percent body fat, BMI, intake of fruit, total sugar and sweetened beverages, FBG, and television viewing. RESULTS Mean vegetable and fruit intake increased significantly more in the intervention group than in the control group over time (group by visit interaction, p=0.02 and p=0.002, respectively). Both groups had significant increases in percent body fat and decreases in waist circumference, insulin sensitivity, blood cholesterol, LDL, television viewing, and total intakes of energy, saturated fat, sugar, and sweetened beverages. CONCLUSIONS A culturally influenced, low-intensity lifestyle intervention can improve self-reported intakes of vegetables and fruit over 18 months in young, urban American Indian women.

Understanding administrative evidence-based practices: findings from a survey of local health department leaders.

BACKGROUND There are sparse data showing the extent to which evidence-based public health is occurring among local health departments. PURPOSE The purpose of the study was to describe the patterns and predictors of administrative evidence-based practices (structures and activities that are associated with performance measures) in a representative sample of local health departments in the U.S. METHODS A cross-sectional study of 517 local health department directors was conducted from October through December 2012 (analysis in January-March 2013). The questions on administrative evidence-based practices included 19 items based on a recent literature review (five broad domains: workforce development, leadership, organizational climate and culture, relationships and partnerships, financial processes). RESULTS There was a wide range in performance among the 19 individual administrative evidence-based practices, ranging from 35% for providing access to current information on evidence-based practices to 96% for funding via a variety of sources Among the five domains, values were generally lowest for organizational climate and culture (mean for the domain=49.9%) and highest for relationships and partnerships (mean for the domain=77.1%). Variables associated with attaining the highest tertile of administrative evidence-based practices included having a population jurisdiction of 25,000 or larger (adjusted ORs [aORs] ranging from 4.4 to 7.5) and state governance structure (aOR=3.1). CONCLUSIONS This research on the patterns and predictors of administrative evidence-based practices in health departments provides information on gaps and areas for improvement that can be linked with ongoing quality improvement processes.

Promoting state health department evidence-based cancer and chronic disease prevention: a multi-phase dissemination study with a cluster randomized trial component

BackgroundCancer and other chronic diseases reduce quality and length of life and productivity, and represent a significant financial burden to society. Evidence-based public health approaches to prevent cancer and other chronic diseases have been identified in recent decades and have the potential for high impact. Yet, barriers to implement prevention approaches persist as a result of multiple factors including lack of organizational support, limited resources, competing emerging priorities and crises, and limited skill among the public health workforce. The purpose of this study is to learn how best to promote the adoption of evidence based public health practice related to chronic disease prevention.Methods/designThis paper describes the methods for a multi-phase dissemination study with a cluster randomized trial component that will evaluate the dissemination of public health knowledge about evidence-based prevention of cancer and other chronic diseases. Phase one involves development of measures of practitioner views on and organizational supports for evidence-based public health and data collection using a national online survey involving state health department chronic disease practitioners. In phase two, a cluster randomized trial design will be conducted to test receptivity and usefulness of dissemination strategies directed toward state health department chronic disease practitioners to enhance capacity and organizational support for evidence-based chronic disease prevention. Twelve state health department chronic disease units will be randomly selected and assigned to intervention or control. State health department staff and the university-based study team will jointly identify, refine, and select dissemination strategies within intervention units. Intervention (dissemination) strategies may include multi-day in-person training workshops, electronic information exchange modalities, and remote technical assistance. Evaluation methods include pre-post surveys, structured qualitative phone interviews, and abstraction of state-level chronic disease prevention program plans and progress reports.Trial registrationclinicaltrials.gov:NCT01978054.

Understanding the Independent and Joint Associations of the Home and Workplace Built Environments on Cardiorespiratory Fitness and Body Mass Index

This observational study examined the associations of built environment features around the home and workplace with cardiorespiratory fitness (CRF) based on a treadmill test and body mass index (BMI) (weight (kg)/height (m)(2)). The study included 8,857 adults aged 20-88 years who completed a preventive medical examination in 2000-2007 while living in 12 Texas counties. Analyses examining workplace neighborhood characteristics included a subset of 4,734 participants. Built environment variables were derived around addresses by using geographic information systems. Models were adjusted for individual-level and census block group-level demographics and socioeconomic status, smoking, BMI (in CRF models), and all other home or workplace built environment variables. CRF was associated with higher intersection density, higher number of private exercise facilities around the home and workplace, larger area of vegetation around the home, and shorter distance to the closest city center. Aside from vegetation, these same built environment features around the home were also associated with BMI. Participants who lived and worked in neighborhoods in the lowest tertiles for intersection density and the number of private exercise facilities had lower CRF and higher BMI values than participants who lived and worked in higher tertiles for these variables. This study contributes new evidence to suggest that built environment features around homes and workplaces may affect health.