Vincent Chen

Social exchange of cigarettes by youth

Objective: This study seeks to determine the magnitude, nature, and correlates of social exchange of cigarettes among youth who smoke. Design: Cross sectional survey. Setting: Schools in 29 Minnesota communities. Participants: All students in grades 8, 9, and 10 (ages 13–16 years) in each participating school. The parent/child response rate for the survey was 90%. Analyses included 4124 respondents who smoked at least one cigarette in the month before the survey. Outcome measures: Social exchange scale, consisting of 16 items assessing aspects of social provision and acquisition of cigarettes. Results: Almost 90% of youth in this study had obtained a cigarette from, and about 75% of them had provided cigarettes to, another teen in the prior month. Daily smokers provided to more teens and provided more often than those who smoked less than daily. Daily smokers also reported having more social sources, both teens and adults, than lighter smokers, and were more likely to have both bought from and sold cigarettes to other teens (p < 0.0001 for all comparisons between daily and less than daily smokers). In a multivariate analysis, social exchange was associated with grade, whether siblings and friends smoke, level of smoking, age of smoking initiation, parental influences and community norms about teen smoking, and buying cigarettes. Conclusions: Social provision and acquisition of cigarettes among teens are widespread, reciprocal behaviours. Parental and community expectations about smoking influence social exchange, possibly by providing opportunities or barriers for social smoking. Commercial and social availability are not mutually exclusive; rather social exchange extends the reach of commercial sources.

Socioeconomic status and self-management in epilepsy: Comparison of diverse clinical populations in Houston, Texas

We compared the scores on self-management and associated psychosocial scales of patients with epilepsy at two clinics in Houston, TX, USA, to determine if there were systematic differences associated with socioeconomic status (SES). Patients of low SES reported higher scores on overall, information, and safety management (P<0.03) and no differences on medication, seizure, and lifestyle management. The two groups were similar with respect to the pattern of high and low scores. Reported levels of self-efficacy, depression, social support, stigma, desire for control, and outcome expectations were higher for those of high SES (P<0.01). Knowledge of epilepsy and satisfaction with care were lower (P<0.01). Again, the patterns of high and low scores were similar. Tests of association between psychosocial factors and self-management revealed that people with higher levels of self-efficacy and social support also reported higher self-management (P<0.01) regardless of demographics, seizure frequency, and SES (P<0.05). These findings provide little support for SES-related disparities in self-management and suggest that the focus of strategies to improve self-management may be similar across diverse populations.

Booster Breaks in the workplace: participants’ perspectives on health-promoting work breaks

Increasing sedentary work has been associated with greater cardiovascular and metabolic risk, as well as premature mortality. Interrupting the sedentary workday with health-promoting work breaks can counter these negative health effects. To examine the potential sustainability of work-break programs, we assessed the acceptance of these breaks among participants in a Booster Break program. We analyzed qualitative responses from 35 participants across five worksites where one 15-min physical activity break was taken each workday. Two worksites completed a 1-year intervention and three worksites completed a 6-month intervention. Responses to two open-ended questions about the acceptance and feasibility of Booster Breaks were obtained from a survey administered after the intervention. Three themes for benefits and two themes for barriers were identified. The benefit themes were (i) reduced stress and promoted enjoyment, (ii) increased health awareness and facilitated behavior change, and (iii) enhanced workplace social interaction. The barrier themes were the need for (iv) greater variety in Booster Break routines and (v) greater management support. This study provides empirical support for the acceptance and feasibility of Booster Breaks during the workday. Emphasizing the benefits and minimizing the barriers are strategies that can be used to implement Booster Breaks in other workplaces.

Characterizing and Comparing Young Adult Intermittent and Daily Smokers

We interviewed 732 smokers (from five US upper Midwestern states) via telephone in 2006 to examine young adult smoking patterns. We first defined two groups of intermittent smokers—low (who smoked for 1–14 days in the past 30 days) and high (who smoked for 15–29 days in the past 30 days), and then analyzed differences between these two groups and daily smokers. Low intermittent smokers were much less likely to consider themselves smokers, feel addicted, or smoke with friends than high intermittent smokers. Daily smokers were more likely to feel addicted and have trouble quitting smoking than high intermittent smokers. Implications, limitations, and ideas for future studies will be discussed.

Do Cigarette Prices Vary by Brand, Neighborhood, and Store Characteristics?

Objective. We assessed the price variability of cigarettes by brand, neighborhood characteristics (racial/ethnic and youth composition, number of schools, and number of stores), and store type. Methods. Trained research staff purchased three different brands of cigarettes (premium, menthol, and discount—all produced by the same company) at 214 stores in one metropolitan area. We assessed associations between price and neighborhood/store characteristics through multivariate regression, using four price variables as dependent variables—the price of each brand of cigarettes and the mean price across the three brands. Results. We found that the price of cigarettes varied by neighborhood and store characteristics, although this variability differed by brand. For the same brand, the maximum price was 1.7 to 1.8 times higher than the lowest price. We found a positive association between the percentage of a neighborhood that was nonwhite and the price of discount and premium cigarettes as well as the overall mean price of cigarettes, but not with the price of the menthol brand. We found a negative association between the percentage of youth in a neighborhood and the price of premium cigarettes as well as the mean price, but not with the price of the other two brands. In addition, we found a greater likelihood of higher discount brand prices at independent vs. chain-operated stores. Conclusions. Our findings showed that cigarette prices do vary by brand, the youth and racial/ethnic composition in a neighborhood, and store type, suggesting that the tobacco industry might vary its marketing strategies based on brand as well as neighborhood and store characteristics.

The Booster Break program: Description and feasibility test of a worksite physical activity daily practice

OBJECTIVE Work breaks are underutilized opportunities to promote health. The Booster Break program is a co-worker led physical activity group session devoted exclusively to standard 15-minute work breaks. The purpose of this study was to report the fidelity, attendance, feasibility, and sustainability of the Booster Break program and to explore its potential impact. PARTICIPANTS The study site was a small business that provides legal and court reporting services to lawyers. The companys services include legal videography, litigation, records retrieval, and videoconferencing to civil attorneys. Established in 1973, the organization has 14 employees (8 women and 6 men), from 32 to 66 years of age. METHODS For six months, this small business implemented the Booster Break program. Booster Break facilitators conducted the group sessions according to protocol, which included describing, cueing, and executing the physical activity sequence. RESULTS During the six month period, 117 sessions were conducted. The average monthly attendance ranged from 76% to 86%. Participants significantly improved HDL cholesterol (p=0.04) and lost an average of 14 pounds. CONCLUSIONS The Booster Break program is a feasible physical activity program for small business settings. The implications of the Booster Break program for future research in worksite settings are discussed.

Patient Specific Instrumentation

Patient specific instrumentation (PSI) has recently been developed as a replacement for traditional instrumentation in total knee arthroplasty (TKA). The study aim was to assess efficiency via the mean total OR time using the PSI versus computer-assisted (CAS) TKAs with accuracy as a secondary endpoint. Sixty patients were randomized to CAS or PSI. A formula was developed to derive a profit ratio (PR) that incorporated costs, revenue, and total OR time. The PSI cases were 1.45 times more profitable than CAS allowing for approximately 3 PSI cases versus 2 CAS cases in one 8 hour OR day. Results from this series show that PSI improves OR efficiency, but does not improve accuracy.

Awareness and reported consequences of a cigarette tax increase among older adolescents and young adults.

Purpose: To determine the prevalence and predictors of the awareness of cigarette price increases following a cigarette tax increase, and assess the association of the tax increase and attempts to quit and reduce smoking among adolescents and young adults. Design: We used a prospective cohort design. Setting: Surveys were conducted in Minnesota before and after a

Smoking Policies in Small Worksites in Minnesota

0.75 cigarette tax increase Subjects: We surveyed 3167 adolescents and young adults, including a subsample of 781 past–30-day smokers. Measures: Outcome measures were awareness of cigarette price increases and, among past–30-day smokers, reported changes in smoking behaviors because of the tax increase. Predictors included demographics, social factors, and prior smoking behaviors. Analysis: We estimated the prevalence of the outcomes and their associations with the predictors using logistic regression. Results: Among all participants, 42% noticed an increase in cigarette prices after the tax increase, including 76% of past–30-day smokers. Being a heavier smoker, living with smokers, having more smoking close friends, and generally being aware of cigarette price changes prospectively predicted the awareness of the price increase after the tax increase. Among past–30-day smokers, 16.7% reported quit attempts and 24.1% reported reducing smoking because of the tax increase. Conclusion: Because fewer than half of the participants noticed the cigarette tax increase, media campaigns to raise awareness of tax changes may increase their effectiveness.

Parental, family, and home characteristics associated with cigarette smoking among adolescents.

Purpose. To examine correlates of smoking policies in a stratified sample of small worksites in Minnesota and to determine knowledge and attitudes of the owners and managers regarding the Minnesota Clean Indoor Air Act (MCIAA) rules that newly applied to their businesses. Design. Cross-sectional survey. Setting. Minnesota offices and factories/warehouses with 5 to 50 employees. Subjects. Owners or managers of offices and factories/warehouses; sample size = 233; response rate = 66%. Measures. Existence and strength of worksite smoking policies. Analysis. Comparison of factories/warehouses and offices in metropolitan and greater Minnesota using chi square and linear and logistic regression analyses. Results. Approximately two-thirds of the worksites claimed to have a smoking policy, but only 26% of the total sample had a policy in writing. Worksites that offered health insurance to their employees were more likely to have a written policy (p < .0001), as were offices in the metro area compared with other worksites (p = .003). Policies of both types of outstate worksites were stronger compared with those at metro sites, and offices had stronger policies than factories and warehouses in the metro area. Only about one-third of the businesses had heard of the MCIAA rule changes. Conclusion. Most small businesses in Minnesota do not have a smoking policy in writing and thus their employees are at risk of exposure to secondhand smoke at work.