Perceived parental reactions to substance use among adolescent vapers compared with tobacco smokers and non-users in Iceland.

OBJECTIVES: The objective is to assess perceived parental reactions to cigarette smoking, vaping, drunkenness, and marijuana use among cigarette smokers, vapers, and those who neither smoke nor vape (non-users). STUDY DESIGN: It is a population-based, cross-sectional, school survey with all accessible 13- to 16-year-old students in Iceland (response rate: 84.1%). METHODS: Data were analyzed in Mplus using multinomial logistic regression for categorical data with maximum likelihood and robust standard errors, adjusting for potential school clustering. RESULTS: Across all four outcome categories and controlling for background factors, non-users were more likely than vapers and smokers to perceive their parental reactions to substance use as negative (P < 0.01). Vapers were significantly more likely than smokers to perceive their parental reactions as negative toward all types of substance use (P < 0.01). CONCLUSIONS: Adolescent smokers, vapers, and non-users appear to form a sequential risk gradient toward perceived parental reactions to substance use, with smokers being least likely to perceive their parental reactions as negative and vapers thereafter; non-users are most likely to perceive their parental reactions toward substance use as negative.

The landscape of overweight and obesity in Icelandic adolescents: geographic variation in body-mass index between 2000 and 2009.

The prevalence of overweight and obesity has increased globally. This study examined the geographic variation in overweight and obesity trends among Icelandic adolescents in urban and rural areas. Data from two cross-sectional population-based samples of 14- and 15-year-old students attending the compulsory 9th and 10th grades of the Icelandic secondary school system in 2000 and 2009 were used to calculate body mass index (BMI). Overweight and obesity rates were represented for 17 zones on maps created with the ArcGis geographic information and imaging software. Results were that males had higher rates of overweight and obesity than females in both 2000 and 2009, with a significant difference for both genders between years. Mean BMI was higher for rural areas than urban areas in both study years. Out of 17 geographic zones, the prevalence of obesity increased between 2000 and 2009 for males in 16; however, the one remaining zone had the highest increase in overweight. Obesity increased in 13 zones for girls and decreased in four from 2000 to 2009. Mean BMI rose between the study years but fewer zones differentiated from each other in 2009 than 2000. The prevalence of overweight and obesity increased among Icelandic adolescents in both urban and rural areas; however, rural areas have higher rates of obesity, overweight, and mean BMI than urban areas. Because of diminishing differences between areas from 2000 to 2009 the increase in mean BMI, increases in overweight, and obesity appear to be more rapid in urban areas than rural areas.

Psychosocial mediators of the relationship between race/ethnicity and depressive symptoms in Latino and white patients with coronary artery disease.

BACKGROUND: The high prevalence of depressive symptoms in patients with coronary artery disease has been well documented. However, little is known about the prevalence and correlates of depressive symptoms in Latino patients with coronary artery disease. PURPOSE: Among Latino and white patients who had percutaneous transluminal coronary angioplasty (PTCA), this study examined whether differences in the prevalence of depressive symptoms exist and the degree to which psychosocial factors (years of education, employment status, stressful life events, emotional social support) explained any differences. METHODS: Using a cross-sectional design, closed-format questionnaires were used to obtain clinical and psychosocial history. The definition of high depressive symptoms was based on a score of > or =16 on the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: Compared to whites (n=492), Latinos (n=59) were younger, and a greater proportion were female, but fewer completed high school and fewer were employed (P<0.05). More Latinos reported experiencing > or =2 recent stressful life events, but fewer reported having emotional social support (P<0.05). There was a significant association between race/ethnicity and depressive symptoms (OR=2.3, 95% CI: 1.3-4.5). In multivariate analyses, the significance of this association diminished when psychosocial variables were added to the model. CONCLUSIONS: In this study, education, employment, stressful life events and emotional social support partially explained the observed racial/ethnic differences in depressive symptoms.

Changing health behaviors to improve health outcomes after angioplasty: a randomized trial of net present value versus future value risk communication.

Patients who have undergone angioplasty experience difficulty modifying at-risk behaviors for subsequent cardiac events. The purpose of this study was to test whether an innovative approach to framing of risk, based on 'net present value' economic theory, would be more effective in behavioral intervention than the standard 'future value approach' in reducing cardiovascular morbidity and mortality following angioplasty. At baseline, all patients completed a health assessment, received an individualized risk profile and selected risk factors for modification. The intervention randomized patients into two varying methods for illustrating positive effects of behavior change. For the experimental group, each selected risk factor was assigned a numeric biologic age (the net present value) that approximated the relative potential to improve current health status and quality of life when modifying that risk factor. In the control group, risk reduction was framed as the value of preventing future health problems. Ninety-four percent of patients completed 2-year follow-up. There was no difference between the rates of death, stroke, myocardial infarction, Class II-IV angina or severe ischemia (on non-invasive testing) between the net present value group and the future value group. Our results show that a net present risk communication intervention did not result in significant differences in health outcomes.

Measuring recovery after a hip fracture using the SF-36 and Cummings scales.

The objective of this study was to assess outcomes of traditional treatment of fractures using the SF-36 and the Cummings Hip Scale. In designing randomized clinical trials, it is necessary to determine the timing of assessment either for progress or for the main outcome. We set out to document the recovery of patients after surgery for hip fracture using current standard methods of medical care. This was a prospective study of a cohort of patients. Patients who were receiving standard medical care completed the SF-36 and the Cummings Hip Scale at previously determined times postoperatively. The SF-36 has eight subscales, including assessments of physical function, physical role behaviors, bodily pain, mental health, social role, emotional role, vitality and general health. Thirty-eight patients completed the questionnaires at 1 year postoperatively as well as previous time points. On the Cummings Hip Scale and the physical function, bodily pain, mental health, social function, emotional role, vitality and general health subscales of the SF-36, recovery is near complete at 6 months. Only the physical role subscale differs, with a statistically significant difference between the values at 6 months and 1 year, (p = 0.02). Patients attained over 90% of the 1 year value by 6 months for all except the physical role subscale. The physical role subscale reached 85%. For a hip fracture patient who is on the road to recovery, the majority of the recovery has therefore taken place by 6 months.

The economic impact of a multifactorial intervention to improve postoperative rehabilitation of hip fracture patients.

OBJECTIVE: To assess the cost savings associated with a patient education and high-intensity strength intervention to improve rehabilitation after hip fracture. METHODS: Economic analysis conducted alongside a randomized controlled trial, using cost-benefit ratios and net present value statistics. Study subjects were aged over 64 years and were followed for 18 months postsurgery. Resource utilization data were gathered by telephone questionnaire. Medicare reimbursement rates and prevailing costs for services not covered by Medicare were used to convert utilization patterns into costs. Intervention costs were obtained from program records. RESULTS: The cost of the intervention was $722 per patient. Over the followup period, median costs were $11,941 and $21,577 for the intervention and control groups, respectively, yielding an average program benefit of $9,636. Cost-benefit ratios exceeded 4.5, and net present value exceeded $150,974. CONCLUSION: The results indicate that the benefits of the intervention exceeded its costs.

Continuing-education needs of the currently employed public health education workforce.

OBJECTIVES: This study examined the continuing-education needs of the currently employed public health education workforce. METHODS: A national consensus panel of leading health educators from public health agencies, academic institutions, and professional organizations was convened to examine the forces creating the context for the work of public health educators and the competencies they need to practice effectively. RESULTS: Advocacy; business management and finance; communication; community health planning and development, coalition building, and leadership; computing and technology; cultural competency; evaluation; and strategic planning were identified as areas of critical competence. CONCLUSIONS: Continuing education must strengthen a broad range of critical competencies and skills if we are to ensure the further development and effectiveness of the public health education workforce.

The need for comprehensive educational osteoporosis prevention programs for young women: results from a second osteoporosis prevention survey.

OBJECTIVE: To assess osteoporosis knowledge, beliefs, and preventive behaviors among young adult women and to identify sources that they would mostly likely utilize to learn more about the disease. METHODS: Information was gathered through a cross-sectional survey of 321 women (mean age 21.6 years; 63.5% were white, 29.2% were black) enrolled in a required undergraduate health course at a southeastern state university. RESULTS: Two hundred seventy-seven (86%) of the survey participants had heard about osteoporosis, but only 3.8% of respondents reported getting both adequate exercise and the recommended 1,200 mg of calcium per day. Respondents believed that they were unlikely to develop osteoporosis and that osteoporosis is less serious than other common causes of morbidity and mortality in women, such as heart disease and breast cancer (P < 0.0001). Brochures, magazines, and short counseling sessions were preferred information sources for learning about osteoporosis. CONCLUSIONS. The majority of young women studied are at risk for developing premature osteoporosis. They prefer brochures, magazines, and short counseling sessions during medical office visits to learn about osteoporosis.

Major life events as antecedents to hip fracture.

BACKGROUND: This study sought to determine whether the number of antecedent life events reported in the year before hip fracture among elderly patients was normal for the population from which these patients derive. Major life events are events such as births, deaths, major financial dealings, and major health changes. METHODS: Life events reported in the year before a fall and hip fracture for 111 hip fracture patients were compared with those of a control sample of 90 nonfracture, community-dwelling ambulatory elderly. RESULTS: The total number of life events was higher in the hip fracture group (p = 0.0001) than in the community control group. Fracture was also associated with the number of events experienced (adjusted OR, 2.1; 95% CI, 1.6-2.7; p < 0.0007), notwithstanding age, marital status, and education. CONCLUSION: Older persons who had sustained a fall-related traumatic hip fracture experienced an increased number of major life events compared with a nonfracture population sample of community-dwelling elderly controls.

One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education.

OBJECTIVE: To determine whether gains in functioning observed immediately following participation in an 8-week program of supervised fitness walking for patients with knee osteoarthritis were sustained at 1-year followup. METHODS: Twenty-nine (61.1%) of 47 original intervention program patients and 23 (51.1%) of 45 original control patients were interviewed by telephone at 1-year followup. Patients completed the Arthritis Impact Measurement Scales physical activity, arthritis impact, pain, medication use, and general health perceptions subscales, as well as a separate visual analog pain scale and measures of perceived self-efficacy to cope with arthritis pain and other symptoms. RESULTS: Adherence to walking was low, and there were no statistically significant differences between intervention and control patients at one year. CONCLUSIONS: The failure of intervention patients to maintain regular walking resulted in loss of functional benefits that were observed at 8 weeks in the original study. Long-term adherence to walking is critical to maintenance of initial gains in functional outcomes.

The role of adjunctive therapy in the management of chronic nonmalignant pain.

The management of chronic nonmalignant pain is an increasing challenge to clinicians and their patients. Adjunctive therapy, which includes a wide range of physical, psychoeducational, and multidisciplinary interventions, can play an important role in the treatment of pain. This article discusses the role and efficacy of adjunctive therapy in the management of pain associated with musculoskeletal conditions, the most common and disabling sources of chronic nonmalignant pain. Findings from meta-analyses, review articles, and recent clinical trials are reviewed that suggest that interventions that combine exercise and psychoeducational approaches designed to enhance communication, control, problem-solving, and coping can have a clinically significant impact on reducing pain and improving functional status for many conditions.

Health education intervention strategies: recommendations for future research.

While the ultimate goal of health education interventions is to positively influence health status, more proximal indicators of success are changes in intermediate outcomes, or impact. Because health education interventions work through intermediate outcomes, the linkage to health status is often assumed to be at a conceptual or theoretical level. The term health education intervention strategy is a heuristic device used to conceptualize and organize a large variety of activities. There is a wide range of studies and reports in the literature that either test specific intervention strategies or report on larger health education efforts combining several strategies. This article organizes the discussion to focus on individual-, community-, and policy-level interventions. Mass communications are also considered, and the authors comment on program planning issues that cut across specific interventions at the individual, community, and policy levels. Eleven recommendations are offered for future health education intervention research.

Knowledge, beliefs, and behaviors among college women concerning the prevention of osteoporosis.

OBJECTIVE: To assess the knowledge of osteoporosis risk factors among young women, their beliefs about the disease, and to what extent they practice preventive behaviors, such as adequate calcium intake and physical activity. DESIGN: Cross-sectional survey. SETTING/PARTICIPANTS: One hundred twenty-seven women (mean age, 19.6 years; 92% were white) enrolled in a required undergraduate health course at a midwestern state university. RESULTS: One hundred fourteen (90%) of the survey respondents had heard about osteoporosis, but only 49 (43%) of the 114 had received information from either a health care provider or a school. There was a significant relationship between receiving osteoporosis information and the ability to correctly identify risk factors (P < or = .006). Only 6.7% of the women reported getting both adequate "osteoprotective" exercise per week and the recommended 1200 mg of calcium per day. Respondents believed that it was unlikely that osteoporosis would develop in them. They also expressed less responsibility and concern about osteoporosis and believed that it is less serious than other common causes of morbidity and mortality in women, such as heart disease and breast cancer (P < or = .02). There was no significant relationship between risk-factor identification and exercise habits, calcium intake, or beliefs about osteoporosis. CONCLUSIONS: The majority of young women are not consuming the recommended daily amount of calcium and are lacking sufficient osteoprotective exercise for building healthy bone. Health care providers and educational institutions either have missed opportunities to educate young women about osteoporosis or such information has not been received and retained. Increasing levels of osteoporosis awareness may not be associated with influencing beliefs or behaviors. However, because of the importance of building an adequate bone mass in early life, our data suggest that the development and evaluation of comprehensive osteoporosis educational interventions targeted at younger women are warranted.

A musculoskeletal outreach screening, treatment, and education program for urban minority children.

PURPOSE: A hospital-based outreach program was initiated to screen minority children in medically underserved areas of New York City for musculoskeletal diseases. We examine the number of such diseases in this population, and evaluate the program's success to facilitate referral and follow-up of children with referral conditions. METHODS: Screenings were conducted at schools and day-care centers. Children requiring further evaluation were referred to the sponsoring hospital, a major referral center for musculoskeletal diseases. Bilingual educational strategies, transportation reimbursement, and coverage for uninsured children were used to foster participation and increase follow-up. RESULTS: A total of 2,523 children were screened, 168 (6.7%) of whom were referred for one of 45 different musculoskeletal disorders, including scoliosis and back problems, foot problems, in- and out-toeing, knee or hip pain, and problems of joint range of motion. Sixty-seven percent of those referred had a follow-up medical consultation. CONCLUSIONS: A substantial proportion of urban minority children have previously undiagnosed musculoskeletal disorders that, if left untreated, have the potential to lead to significant disability in later life. Targeted screening programs can be effective in identifying such disorders, and providing and opportunity for early diagnosis, treatment, and education.