Susanne Montgomery

Waterpipe smoking and nicotine exposure: A review of the current evidence

The waterpipe, also known as shisha, hookah, narghile, goza, and hubble bubble, has long been used for tobacco consumption in the Middle East, India, and parts of Asia, and more recently has been introduced into the smokeless tobacco market in western nations. We reviewed the published literature on waterpipe use to estimate daily nicotine exposure among adult waterpipe smokers. We identified six recent studies that measured the nicotine or cotinine levels associated with waterpipe smoking in four countries (Lebanon, Jordan, Kuwait, and India). Four of these studies directly measured nicotine or cotinine levels in human subjects. The remaining two studies used smoking machines to measure the nicotine yield in smoking condensate produced by the waterpipe. Meta-analysis of the human data indicated that daily use of the waterpipe produced a 24-hr urinary cotinine level of 0.785 microg/ml (95% CI = 0.578-0.991 microg/ml), a nicotine absorption rate equivalent to smoking 10 cigarettes/day (95% CI = 7-13 cigarettes/day). Even among subjects who were not daily waterpipe smokers, a single session of waterpipe use produced a urinary cotinine level that was equivalent to smoking two cigarettes in one day. Estimates of the nicotine produced by waterpipe use can vary because of burn temperature, type of tobacco, waterpipe design, individual smoking pattern, and duration of the waterpipe smoking habit. Our quantitative synthesis of the limited human data from four nations indicates that daily use of waterpipes produces nicotine absorption of a magnitude similar to that produced by daily cigarette use.

Stress, Coping, and Social Support among Homeless Youth.

Evaluated in this study was the extent to which stress, coping strategies, and social support were associated with depressive symptoms, poor physical health, and substance use in homeless youth. Data were obtained from a stratified random sample of 432 homeless youth recruited.from service sites and street sites in Los Angeles, California. Stres,sful life events were associated positively with symptoms of depression, poor physical health, and substance use. Use of emotion-focused coping strategies increased the risk of symptoms of depression, poor health, and substance-use disorders, whereas use of problem-focused coping strategies decreased the risk of alcohol use disorder and poorhealth. Social support decreased the risk of symptoms of depression and poor health but was not related to the risk of substance use. Results indicate that effective coping skills and social support may counteract the negative efficts of stressful life events on physical and psychological health in homeless youth.

Homeless youths and young adults in Los Angeles : Prevalence of mental health problems and the relationship between mental health and substance abuse disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults is increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems, as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorder included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.

Magnitude and determinants of behavioral risk reduction: Longitudinal analysis of a cohort at risk for AIDS

Abstract The magnitude and predictors of longitudinal behavioral change are reported in a cohort of homosexual men at risk for AIDS. Self-reports of sexual behavior were obtained at two points in time separated by an interval of approximately six months. These self-reports were used to construct both dichotomous and continuous measures of changes in behavior consistent with reduction in the transmission of the AIDS virus (HIV). Although there was considerable variability in behavior. mean changes were consistently in the desired direction. Avoidance of anonymous sexual partners, monogamy, and modification of receptive anal sex to reduce exposure to semen by condom use or withdrawal prior to ejaculation appeared to be especially important in this cohort. Both multiple linear regression and multiple logistic regression were used to examine the relationship between a model of health behavior and these outcomes. Variables examined included knowledge of AIDS. perceived risk of AIDS. the perceived efficacy of b...

Psychosocial Predictors of Reported Behavior Change in Homosexual Men at Risk for AIDS

Carol-Ann Emmons, Jill G. Joseph, Ronald C. Kessler, Camille B. Wortman, Susanne B. Montgomery, and David G. Ostrow are with the University of Michigan, Ann Arbor, Michigan. This work was supported by research funding from the National Institute of Mental Health (2 R01 MH39346-02A1) and the University of Michigan. The authors are grateful to Anita DeLongis for comments made on an earlier draft. Please refer questions, comments, and requests for reprints to Jill G. Joseph, PhD, Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109. This article investigates the relationship between psychosocial factors and gay men’s attempts to change their sexual behavior in response to the threat of AIDS. Questionnaire data collected from 909 homosexual men at risk of AIDS were used to quantify potential psychosocial predictors of health behavior. Multiple logistic regression analyses were used to estimate the relationship between these predictor variables and five

Effect of Early Skin-to-Skin Mother—Infant Contact During the First 3 Hours Following Birth on Exclusive Breastfeeding During the Maternity Hospital Stay:

This was a nurse-driven, hospital-based, prospective cohort study of data collected in 19 hospitals in San Bernardino and Riverside counties by California Perinatal Services Network on all mothers (n = 21 842) who delivered a singleton infant (37-40 weeks gestation) between July 2005 through June 2006. Multivariate ordinal logistic regression showed that maternal infant-feeding method intention (measured prior to birth), sociodemographic characteristics, intrapartum variables, and early skin-to-skin mother—infant contact during the first 3 hours following birth (controlling for delivery hospital) were correlated with exclusive breastfeeding during the maternity hospitalization. Compared with mothers with no early skin-to-skin contact, exclusive breastfeeding was higher in mothers who experienced skin-to-skin contact for 1 to 15 minutes (odds ratio [OR] 1.376; 95% confidence interval [CI], 1.189-1.593), 16 to 30 minutes (OR 1.665; 95% CI, 1.468-1.888), 31 to 59 minutes (OR 2.357; 95% CI, 2.061-2.695), and more than 1 hour (OR 3.145; 95% CI, 2.905-3.405). The results demonstrate a dose—response relationship between early skin-to-skin contact and breastfeeding exclusivity.

Diffusion of School-Based Substance Abuse Prevention Programs

Despite promising evidence of the effectiveness of psychosocial-based approaches to drug abuse prevention, these programs have not been widely adopted by schools. This article considers the feasibility of widespread diffusion of empirically based prevention programs in school settings. The literature on determinants of diffusion is reviewed, results of recent research on strategies to increase diffusion are discussed, and barriers to successful diffusion in school settings are identified. The article concludes by presenting implications of these research findings for policy, practice, and future research.

Effects of a community-based prevention program on decreasing drug use in high-risk adolescents.

OBJECTIVES This study investigated the secondary prevention effects of a substance abuse primary prevention program. METHODS Logistic regression analyses were conducted on 4 waves of follow-up data from sixth- and seventh-grade baseline users of cigarettes, alcohol, and marijuana taking part in a school-based program in Indianapolis. RESULTS The program demonstrated significant reductions in cigarette use at the initial follow-up (6 months) and alcohol use at the first 2 follow-ups (up to 1.5 years). Models considering repeated measures also showed effects on all 3 substances. CONCLUSIONS Primary prevention programs are able to reach and influence high-risk adolescents in a nonstigmatizing manner.

Validation of nutrient intake using an FFQ and repeated 24 h recalls in black and white subjects of the Adventist Health Study-2 (AHS-2)

OBJECTIVE To validate a 204-item quantitative FFQ for measurement of nutrient intake in the Adventist Health Study-2 (AHS-2). DESIGN Calibration study participants were randomly selected from the AHS-2 cohort by church, and then subject-within-church. Each participant provided two sets of three weighted 24 h dietary recalls and a 204-item FFQ. Race-specific correlation coefficients (r), corrected for attenuation from within-person variation in the recalls, were calculated for selected energy-adjusted macro- and micronutrients. SETTING Adult members of the AHS-2 cohort geographically spread throughout the USA and Canada. SUBJECTS Calibration study participants included 461 blacks of American and Caribbean origin and 550 whites. RESULTS Calibration study subjects represented the total cohort very well with respect to demographic variables. Approximately 33 % were males. Whites were older, had higher education and lower BMI compared with blacks. Across fifty-one variables, average deattenuated energy-adjusted validity correlations were 0.60 in whites and 0.52 in blacks. Individual components of protein had validity ranging from 0.40 to 0.68 in blacks and from 0.63 to 0.85 in whites; for total fat and fatty acids, validity ranged from 0.43 to 0.75 in blacks and from 0.46 to 0.77 in whites. Of the eighteen micronutrients assessed, sixteen in blacks and sixteen in whites had deattenuated energy-adjusted correlations >or=0.4, averaging 0.60 and 0.53 in whites and blacks, respectively. CONCLUSIONS With few exceptions validity coefficients were moderate to high for macronutrients, fatty acids, vitamins, minerals and fibre. We expect to successfully use these data for measurement error correction in analyses of diet and disease risk.

Homeless Youth: Drug Use Patterns and HIV Risk Profiles According to Peer Group Affiliation

Research was conducted to identify subcultural peer groups within a homeless youth population and determine whether these groups differ with respect to drug use patterns and HIV risk. Using systematic sampling methods, 309 homeless youth (ages 13–23 years) were recruited from street and service sites. Drug use patterns and HIV risk profiles were found to vary according to group affiliation. Respondents in the punks and gay/bisexual groups were more likely to have a substance abuse disorder. Respondents in the “punker” group also were at increased risk for having unprotected sex and sharing needles. Respondents in the “gay/bisexual” and “hustler” groups were at increased risk for having survival sex. Yet, unlike the “gay/bisexual group,” the “hustler” group was more likely to report being tested for HIV. These findings suggest that outreach and intervention strategies may need to be tailored to the specific norms, values, and behavioral risk profiles of each peer group.