Steven B. Pokorny

The Relation of Retail Tobacco Availability to Initiation and Continued Smoking

Used an ecological analysis employing multilevel random-effects regression analyses to model Level 1 (individual and social) and Level 2 (environmental) correlates of smoking initiation and continued smoking among 6th-, 7th-, and 8th-grade students. Data from 5,234 youth in 11 Midwestern communities were examined. Results indicate higher levels of retail tobacco availability (RTA) were associated with increased odds that a youth initiated smoking but not continued smoking. Among the Level 1 factors, youth who were older, male, had an adult tobacco user in the home, and had more peers who use tobacco had increased odds of initiating smoking. In contrast, only the presence of an adult tobacco user in the home and the number of peers who use tobacco were associated with increased odds that a youth continued smoking. Examining individual, social, and environmental factors simultaneously provides a clearer and more accurate model of these complex ecological influences.

Factors Influencing Middle and High Schools' Active Parental Consent Return Rates.

The authors examined factors influencing the return rates for attempting to collect active parental consent forms from 21,123 students in the 7th through 10th grades in 41 middle and high schools. Overall return rates from middle schools were higher than from high schools. Schools that offered high levels of staff support for collecting consent forms had higher return rates. Procedures where the consent form was attached to a school form that parents had to complete and return to the school yielded the highest return rate. Implications for how researchers can obtain a high parent consent form return rate are discussed.

The Relationship Between School Policies and Youth Tobacco Use

BACKGROUND The school setting is frequently used both to educate youth about risks involved in tobacco use and to implement tobacco prevention and cessation programs. Given that school-based programs have resulted in limited success, it is necessary to identify other setting-level intervention strategies. School tobacco policies represent a type of universal intervention that might have some promise for preventing or reducing tobacco use. METHODS Hierarchical linear modeling was used to assess whether school tobacco policies were related to observations of tobacco use and current smoking among 16,561 seventh through twelfth graders attending 40 middle and high schools in Illinois. RESULTS Results indicated that the enforcement of school tobacco policies, but not the comprehensiveness of those policies, was associated with fewer observations of tobacco use by minors on school grounds as well as lower rates of current smoking among students. CONCLUSIONS The school setting is a key system to impact youth tobacco use. Findings underscore the need to train school personnel to enforce school tobacco policy.

Evaluating the effects of enforcements and fines on youth smoking

Restricting access to retail sources of tobacco and fining minors for possession of tobacco products were evaluated as possible strategies to reduce the rising rates of teenage smoking. Four towns were assigned to enforce both tobacco minimum-age-of sales laws and tobacco possession laws (P). The remaining four towns were assigned to enforce only tobacco minimum-age-of sales laws (NP). Tobacco use among sixth-, seventh- and eighth-grade students was assessed. White youth who lived in communities with strict enforcement of tobacco sales and possession laws had significantly fewer increases in tobacco use than those living in communities with only moderate enforcement of tobacco sales laws. Public health interventions that involve police fining minors along with very high merchant compliance rates might decrease rates of tobacco use of white youth during a developmental time when they are susceptible to experimentation and use of tobacco products.

Efficacy of a Brief Image-Based Multiple-Behavior Intervention for College Students

BackgroundEpidemiologic data indicate most adolescents and adults experience multiple, simultaneous risk behaviors.PurposeThe purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention (MBI) for college students.MethodsA total of 303 college students were randomly assigned to: (1) a brief MBI or (2) a standard care control, with a 3-month postintervention follow-up.ResultsOmnibus treatment by time multivariate analysis of variance interactions were significant for three of six behavior groupings, with improvements for college students receiving the brief MBI on alcohol consumption behaviors, F(6, 261) = 2.73, p = 0.01, marijuana-use behaviors, F(4, 278) = 3.18, p = 0.01, and health-related quality of life, F(5, 277) = 2.80, p = 0.02, but not cigarette use, exercise, and nutrition behaviors. Participants receiving the brief MBI also got more sleep, F(1, 281) = 9.49, p = 0.00, than those in the standard care control.ConclusionsA brief image-based multiple-behavior intervention may be useful in influencing a number of critical health habits and health-related quality-of-life indicators of college students.

Are effects from a brief multiple behavior intervention for college students sustained over time

OBJECTIVE This study examined whether 3-month outcomes of a brief image-based multiple behavior intervention on health habits and health-related quality of life of college students were sustained at 12-month follow-up without further intervention. METHODS A randomized control trial was conducted with 303 undergraduates attending a public university in southeastern US. Participants were randomized to receive either a brief intervention or usual care control, with baseline, 3-month, and 12-month data collected during fall of 2007. RESULTS A significant omnibus MANOVA interaction effect was found for health-related quality of life, p=0.01, with univariate interaction effects showing fewer days of poor spiritual health, social health, and restricted recent activity, ps<0.05, for those receiving the brief intervention. Significant group by time interaction effects were found for driving after drinking, p=0.04, and moderate exercise, p=0.04, in favor of the brief intervention. Effect sizes typically increased over time and were small except for moderate size effects for social health-related quality of life. CONCLUSION This study found that 3-month outcomes from a brief image-based multiple behavior intervention for college students were partially sustained at 12-month follow-up.

Passive versus active consent: A case study in school settings

Considerable discussion has occurred over the past few years concerning the issue of passive versus active consent in psychological research involving children and adolescents. Some evaluators believe that passive consent should only be used in very restricted cases while other investigators are more comfortable in using passive consent that utilizes anonymous survey instruments which have minimal risk to the participants. The issue of passive versus active consent was examined in a case study involving youth access to tobacco study. Following the administration of questionnaires, one parent strongly objected to the use of passive consent. This issue was raised on-line via two electronic bulletin boards to solicit opinions concerning the ethics of using passive consent in this study. When these types of controversies occur, there are multiple points of view that need to be examined and considered. Issues involved in this controversy are discussed.

A Brief Image-based Prevention Intervention for Adolescents

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior-image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16-0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32-0.43, ps < .01). This study suggests that brief image-based messages may increase health behavior goal setting and reduce substance use, particularly among drug-using older adolescents.

Current smoking among young adolescents: assessing school based contextual norms

Objective: To extend research on the relation of school based contextual norms to current smoking among adolescents by using three analytic techniques to test for contextual effects. It was hypothesised that significant contextual effects would be found in all three models, but that the strength of these effects would vary by the statistical rigor of the model. Design: Three separate analytic approaches were conducted on baseline self report student survey data from a larger study to test the relation between school level perceived peer tobacco use and individual current smoking status. Participants: A representative sample of 5399 sixth through eighth grade students in 14 midwestern middle schools completed the survey. All enrolled sixth through eighth grade students were eligible to participate in the survey. The student participation rate was 91.4% for the entire sample, and did not differ significantly between the schools (range 82–100%). Main outcome measure: Thirty day cigarette smoking prevalence. Results: A level 2 only model based on aggregated individual responses indicated that students in schools with higher average reported peer tobacco use were more likely to be current smokers than students in schools with lower average peer tobacco use. Using a level 1 only model based on individual responses indicated that the effect of school level perceived peer tobacco use on current smoking was significant when individual perceived peer tobacco use was excluded from the model but was non-significant when individual perceived peer tobacco use was added to the model. A multilevel model also indicated that the effect of school level perceived peer tobacco use on current smoking was not significant when individual perceived peer tobacco use was added to the model. Conclusion: The analytic approach used to examine contextual effects using individuals’ reports of peer tobacco use norms that were aggregated to obtain a context measure of the school norms may produce statistical artefacts that distort the association of the school context in general, and peer tobacco use norms in particular, with increased risk for current smoking beyond the risk associated with individual factors.

Community Readiness for Prevention

SUMMARY This study presents an effort to adapt the community readiness model to a multi-community intervention to reduce youth access to tobacco. The background of the original community readiness model is outlined, and a behaviorally based adaptation specific to tobacco sales and tobacco possession enforcement is presented. Data on behaviorally based readiness ratings for 11 communities are presented. Correlational analyses indicate a significant relationship between ratings for sales enforcement readiness and the number of tobacco compliance checks conducted by the local police departments. The relationship between possession enforcement readiness and the rate of citations issued was in the expected direction, but was not significant. The results indicate that the behavioral adaptation of the community readiness model can: (a) provide a conceptual heuristic to understand community dynamics; (b) increase responsiveness to each communitys unique needs; (c) measure changes over time; and (d) inform future intervention strategies with the community.