Susan I. Woodruff

Evaluation of a culturally appropriate smoking cessation intervention for Latinos

Background: Many believe that smoking cessation programmes for Latinos should be tailored to the values and beliefs of the culture. However, randomised studies of culturally appropriate smoking cessation interventions with Latinos are rare. Methods: Latino smokers (n = 313) were randomised to an intervention condition or a comparison group. The intervention was a three month programme based on social cognitive constructs and delivered in the smoker’s home by trained lay health advisors, or promotores. Comparison group participants were referred to the California Smoker’s Helpline in Spanish. Predictors of abstinence among all participants also were examined. Results: About one week post-intervention, validated (carbon monoxide) past week abstinence rates were more than twice as high in the intervention group (20.5%) than in the comparison (8.7%) (p ≤ 0.005). The pattern of results held for self reported abstinence, and after recoding dropouts to non-abstinence. The primary predictor of abstinence was number of cigarettes smoked per day at baseline, a common measure of addiction. Conclusions: The culturally appropriate intervention facilitated abstinence in Latino smokers, at least in the short term. Strengths and weaknesses of the study are discussed.

Injuries from combat explosions in Iraq: Injury type, location, and severity

INTRODUCTION Explosions have caused a greater percentage of injuries in Iraq and Afghanistan than in any other large-scale conflict. Improvements in body armour and field medical care have improved survival and changed the injury profile of service personnel. This studys objective was to determine the nature, body region, and severity of injuries caused by an explosion episode in male service personnel. MATERIALS AND METHODS A descriptive analysis was conducted of 4623 combat explosion episodes in Iraq between March 2004 and December 2007. The Barell matrix was used to describe the nature and body regions of injuries due to a combat explosion. RESULTS A total of 17,637 International Classification of Diseases, Ninth Revision (ICD-9) codes were assigned to the 4623 explosion episodes, with an average of 3.8 ICD-9 codes per episode. The most frequent single injury type was a mild traumatic brain injury (TBI; 10.8%). Other frequent injuries were open wounds in the lower extremity (8.8%) and open wounds of the face (8.2%), which includes tympanic membrane rupture. The extremities were the body regions most often injured (41.3%), followed by head and neck (37.4%) and torso (8.8%). CONCLUSION The results of this study support previous observations of TBI as a pre-eminent injury of the wars in Iraq and Afghanistan, with mild TBI as the most common single injury in this large cohort of explosion episodes. The extremities had the highest frequency of injuries for any one body region. The majority of the explosion episodes resulted in more than one injury, and the variety of injuries across nearly every body region and injury type suggests a complex nature of explosion injuries. Understanding the constellation of injuries commonly caused by explosions will assist in the mitigation, treatment, and rehabilitation of the effects of these injuries.

Density of Indoor Tanning Facilities in 116 Large U.S. Cities

BACKGROUND U.S. adolescents and young adults are using indoor tanning at high rates, even though it has been linked to both melanoma and squamous cell cancer. Because the availability of commercial indoor tanning facilities may influence use, data are needed on the number and density of such facilities. METHODS In March 2006, commercial indoor tanning facilities in 116 large U.S. cities were identified, and the number and density (per 100,000 population) were computed for each city. Bivariate and multivariate analyses conducted in 2008 tested the association between tanning-facility density and selected geographic, climatologic, demographic, and legislative variables. RESULTS Mean facility number and density across cities were 41.8 (SD=30.8) and 11.8 (SD=6.0), respectively. In multivariate analysis, cities with higher percentages of whites and lower ultraviolet (UV)index scores had significantly higher facility densities than those with lower percentages of whites and higher UV index scores. CONCLUSIONS These data indicate that commercial indoor tanning is widely available in the urban U.S., and this availability may help explain the high usage of indoor tanning.

Results of Language for Health: Cardiovascular Disease Nutrition Education for Latino English-as-a-Second-Language Students

This report presents the final evaluation of Language for Health, part of a federally funded initiative to develop heart disease prevention interventions for low-literate populations. Language for Health specifically intervened with recent immigrants enrolled in English-as-a-second-language classes, incorporating nutritional behavior change materials into English-language curricula. Latino participants (n = 732) were exposed to either nutrition education or stress management classes (attention-placebo group) designed specifically for low-English-literate adults. Participants completed physiological measures assessing blood pressure, total and high-density lipoprotein (HDL) cholesterol, waist and hip circumference, and weight. Self-report surveys were administered to collect students’ nutrition-related knowledge, attitudes, self-reported fat avoidance behaviors, and demographic information. Data were collected at baseline, 3-month posttest, and 6-month follow-up. Results indicated long-term effects of the intervention on nutrition knowledge and fat avoidance, yet only short-term effects on total cholesterol: HDL ratio and systolic blood pressure.

Youth Access to Artificial UV Radiation Exposure Practices of 3647 US Indoor Tanning Facilities

OBJECTIVE To assess indoor tanning facility practices in a sample of facilities in 116 cities representing all 50 states. DESIGN Cross-sectional study. SETTING United States. PARTICIPANTS Employees of 3647 indoor tanning facilities were contacted by telephone. Data collectors (ie, confederates) posed as prospective, fair-skinned, 15-year-old female customers who had never tanned before. MAIN OUTCOME MEASURES Confederates asked respondents about their facilitys practices related to parental consent, parental accompaniment, and allowable tanning session frequency. RESULTS Approximately 87% of the facilities required parental consent, 14% required parental accompaniment, 5% said they would not allow the confederate to tan owing to her age, and 71% would allow tanning every day the first week of indoor tanning. In Wisconsin, which bans indoor tanning among those younger than 16 years, 70% of facilities would not allow the confederate to tan. Multivariate analyses indicated that facilities in states with a youth access law were significantly more likely to require parental consent (P <.001) and parental accompaniment (P <.001) than those in states without a youth access law. Law was not significantly related to allowable tanning frequency (P = .81). Conclusion We recommend that additional states pass youth access legislation, preferably in the form of bans.

Effect of a retailer intervention on cigarette sales to minors in San Diego County, California

Graduate School of Public Health, San Diego State University, Behavioral and Community Health Studies, 6363 Alvarado Court, Suite 225, San Diego, California 92120, USA K D Keay S I Woodruff M B Wildey E M Kenney Abstract Objective To assess the effectiveness of a retailer educational campaign in re ducing the illegal sale of cigarettes to minors in San Diego County, California, USA. Design A pre-test post-test control group design to study the effects of the programme, including information on sales rates to minors and sales activity. Setting A variety of store types in eth nically diverse communities in San Diego County. Subjects 260 retail outlets. Primary interventions Direct retailer education, mass media, and grass roots work within the community. Main outcome measures Cigarette sales to minors. Results -260 stores were visited by minors, aged 12-17 years, with the intent of purchasing cigarettes. The minors were successful at 69.9% of the stores surveyed. The percentage of stores il legally selling cigarettes to minors was significantly reduced (to 32.2 %) in the 143 stores which had received retailer edu cation one month after the intervention ended. Control stores also showed a slight, nonsignificant, reduction (59.0%). Conclusion An intensive retailer edu cational programme can have a sig nificant effect in reducing the illegal sales rate of cigarettes to minors. (Tobacco Control 1993; 2: 145-151)

Self-Reported Age of Onset and Telescoping for Cigarettes, Alcohol, and Marijuana: Across Eight Years of the National Longitudinal Survey of Youth.

Smoking, drinking, and illicit drug use are leading causes of morbidity and mortality, both during adolescence as well as later in life. The determination of how well national and local policy and intervention efforts address teen substance use depends largely on the collection of valid and accurate data. Assessments of substance use rely heavily on retrospective self-report measures, but the reliability and validity, however, may be limited by various sources of measurement error. This study utilizes four waves of data from the National Longitudinal Survey of Youth spanning eight years. Results from multiple linear regression analyses showed that the single most consistent variable associated with telescoping was the number of years since the substance was first reported. Time since first report was the single consistent variable and was strongly associated with telescoping in each wave-to-wave comparison for all three substances under study. Implications for policy and research are discussed.

Relative Effectiveness of Continued, Lapsed, and Delayed Smoking Prevention Intervention in Senior High School Students

The relative effectiveness of continued, lapsed, and delayed smoking prevention intervention was tested with senior high school students. The original intervention was conducted during Grades 7 through 9, with significantly fewer intervention students reporting smoking than control students. The intervention was reintroduced in the 11th grade to one-half of intervention students (continued intervention), was withdrawn from the other half (lapsed intervention), and was initiated with one-half of control students (delayed intervention). The 11th-grade smoking rates of these three groups were compared to those of a fourth group, a continued control group. Results showed that continued intervention students reported significantly less smoking than continued control students and lapsed intervention students. Additionally, the delayed intervention group exhibited smoking rates lower than the lapsed intervention and continued control groups. This finding underscores the importance of continuing smoking prevention activities, as well as initiating these activities, in senior high school years.

Tobacco-refusal skills and tobacco use among high-risk adolescents

Psychosocial tobacco use prevention programs are based on the assumption that refusal skills training will have a suppressive effect on the onset of use by enabling non-using adolescents to refuse offers of cigarettes and smokeless tobacco. The present study investigated this assumption with 389 high-risk junior high-school students involved in a prevention program during their seventh, eighth, and ninth-grade years. Direct behavioral measures of refusal skills were taken by having subjects respond to audiotaped offers of tobacco and then rating the quality of their responses. These ratings were then linked to tobacco use measures obtained at the end of each of the 3 study years. Results showed that the comprehensive prevention program produced a favorable trend in delaying or preventing the onset of tobacco use. However, the refusal skills training, which was carried out throughout the 3-year intervention period, produced significant differences in overall refusal skill quality only at the seventh grade. Moreover, refusal skill quality was not related to overall tobacco use or cigarette use at any grade.

Effect of an eight week smoking ban on women at US Navy recruit training command

OBJECTIVE To examine the effect of a unique organisational smoking ban on female United States Navy recruits, a population with historically high smoking rates. SETTING AND DESIGN Study participants were female recruits (n = 5503) entering the Navy recruit training command between March 1996 and March 1997 (12 consecutive months). Participants completed smoking surveys at entry to recruit training (baseline) and again at graduation from training after exposure to an eight week, 24 hour a day smoking ban. Effects of the ban on baseline to graduation changes in perceptions of being a smoker were examined, and relapse rates among baseline ever smokers was assessed three months after leaving recruit training. RESULTS Among all recruits, 41.4% reported being smokers at entry (that is, reported any smoking in the 30 days before entering recruit training). As a result of the ban, there was a significant reduction (from about 41% to 25%, p < 0.001) in the percentage of all women recruits who reported themselves as smokers, a much larger change than expected had no ban been in place. Relapse at the three month follow up varied according to the type of smoker at entry into the Navy, with rates ranging from 89% relapse among baseline daily smokers to 31% among baseline experimenters. CONCLUSIONS Findings suggest that the ban provides some smokers who desire to quit with an external impetus and support to do so. However, high relapse rates indicate that more than an organisationally mandated smoking ban during recruit training is needed to help younger smokers, more regular smokers, and those who intend to continue smoking to quit after joining the Navy.