Why do those who request smoking treatment fail to attend the first appointment?

As part of a larger trial of pharmacological and counseling interventions for light smokers, we performed a telephone-screening interview followed by a scheduled time for an in-person eligibility appointment. Of the 407 who screened positive and expressed interest in participation, 202 failed to attend the first scheduled appointment. This article examines person, study, and study-site characteristics that differentiated those who did follow through from those who did not. The study also examined the self-reported quit rates of both groups 12 weeks later, the time of the study termination. Analyses suggested that nonattendees were more likely to be younger, unemployed, and African American. The most frequently cited reasons for missing the eligibility appointment were work/family obligations, inconvenient appointment times, and personal schedule problems. Those who kept the initial appointment were more likely to report smoking abstinence at 12 weeks. The study has implications for increasing the utilization of potentially effective treatments for smokers.

Elder abuse: disparities between older people's disclosure of abuse, evident signs of abuse, and high risk of abuse.

OBJECTIVES: To assess and compare three types of assessment tools for identifying elder abuse: direct questions to elicit disclosure of abuse if it exists, identification of evident signs of abuse, and assessment of high risk for abuse. DESIGN: Cross-sectional. SETTING: Rambam and Hadassah medical centers, Israel. PARTICIPANTS: Seven hundred thirty persons aged 70 and older hospitalized in general hospitals in 2004/05 and their principal caregivers. MEASUREMENTS: Expanded indicator of abuse (E-IOA) tool, questionnaires looking for evident signs of abuse, and direct experience of abusive behavior. RESULTS: Although 5.9% of respondents disclosed experiencing abusive behaviors, 21.4% were identified with evident signs of abuse, and 32.6% were classified as being at high risk for abuse. More than 70% of those who disclosed abuse were identified with evident signs and were at high risk for abuse. Those who disclosed being abused suffered particularly from physical and sexual abuse. According to logistic regression, higher caregiver subjective burden was a predictor of disclosure (odds ratio (OR)=1.81, 95% confidence interval (CI)=1.19-2.74), evident signs of abuse (OR=1.86, 95% CI=1.45-2.35), and high risk of abuse (OR=1.55, 95% CI=1.27-1.88); heavier objective caregiver load was a predictor of evident signs of abuse (OR=1.14, 95% CI=1.05-1.24) and of high risk (OR=1.18, 95% CI=1.06-1.38) only; and respondent functional status was a predictor of evident signs of abuse (OR=1.88, 95% CI=1.70-2.37). CONCLUSION: The use of the three assessment tools is needed for optimal identification of abuse, whereas assessment for high risk proved an efficient method in the absence of respondent disclosure or professional detection of signs of abuse. Hospitalization provides an excellent opportunity for identifying elderly persons at risk of abuse.

Development of a screening tool for identifying elderly people at risk of abuse by their caregivers.

OBJECTIVE: This study developed and assessed an instrument to identify older people at high risk of abuse based on Reis and Nahmiash's Indicators of Abuse (IOA) screen. METHOD: A total of 108 people 65 and older, hospitalized in internal medicine departments at two major hospitals in Israel, were screened together with their principal caregivers. The interview was based on the expanded IOA (E-IOA) and a list of evident signs of abuse. RESULTS: Reliability and validity of the E-IOA were tested and confirmed. Indicators proved to be a significant predictor of evident signs of abuse. The E-IOA correctly discerned 92.7% of those at high risk for abuse and 97.9% of those who did not suffer abuse. The main indicators for risk were behavioral problems, emotional problems, and family problems of the caregiver and the elderly person. Fourteen (13%) experienced abuse. DISCUSSION: The proposed assessment tool can be an instrumental guide to identify elderly people who suffer abuse (unidentified) or who are at high risk.

TV viewing habits and body mass index among South Carolina Head Start children.

The present study tested the hypothesis that TV viewing habits and overweight would be associated among 4-year-old children. A convenience sample of Head Start students was enrolled (N=148). Parents were asked to complete a questionnaire on their children's TV viewing habits for a typical weekday, and for Saturday and Sunday. Height and weight of the children were assessed by the authors. As BMI increased, average hours of TV viewing increased slightly. Nearly 97% of children whose BMI was greater than the 95th percentile for age and sex watched more than one hour of TV, compared with less than 80% of children below the 95th percentile (chi2=6.0, P=.01). The present study suggests that TV viewing habits relate to BMI among 4-year old children to approximately the same degree as in older cohorts.

Ranking of cities according to public health criteria: pitfalls and opportunities.

Popular magazines often rank cities in terms of various aspects of quality of life. Such ranking studies can motivate people to visit or relocate to a particular city or increase the frequency with which they engage in healthy behaviors. With careful consideration of study design and data limitations, these efforts also can assist policymakers in identifying local public health issues. We discuss considerations in interpreting ranking studies that use environmental measures of a city population's public health related to physical activity, nutrition, and obesity. Ranking studies such as those commonly publicized are constrained by statistical methodology issues and a lack of a scientific basis in regard to design.

Successful recruitment and retention strategies for a randomized weight management trial for people with diabetes living in rural, medically underserved counties of South Carolina: the POWER study.

We evaluated the feasibility of recruiting overweight adults with diabetes, living in rural, medically underserved communities, to a weight management intervention consisting of a 12-month clinical trial of two weight management programs and usual care. The sampling frame consisted of adults ages 45 years and older with clinically diagnosed diabetes from two community health centers. The recruitment process included medical record review, prescreening telephone call, two screening visits, and a randomization visit. Over 1,400 medical records were reviewed; 78.6% met eligibility criteria; 60.1% were contacted for telephone prescreening, and 35.5% remained eligible and were interested in participating. Of these, 187 completed visit 1, 164 completed visit 2, and 143 were randomized. Forty-six people were randomized who entered the study as walk-ins at screening visit 1, resulting in 189 subjects. The final yield was 21.5%. Subject mean age was 60.4 years, mean body mass index was 36.4 kg/m(2), 80% were African-American, and 46.6% had less than a high school education. Retention at 12 months was 81.5%. Successful strategies included partnering with community health centers, positive reinforcement and social supportiveness, monitoring progress, and free transportation. This work provides a useful example of an academic-community partnership designed to reach groups previously considered hard to reach.

Physical activity and body mass index among US adolescents: youth risk behavior survey, 1999.

OBJECTIVE: To investigate associations of underweight and overweight with physical activity among high school students in the United States. METHODS: A nationally representative sample of 15 349 US high school students participated in the 1999 Youth Risk Behavior Survey; 13 295 were included in these analyses. Five measures of physical activity were examined as dichotomous variables: (1) vigorous-intensity physical activity (>/=3 vs <3 sessions lasting at least 20 minutes each per week); (2) moderate-intensity physical activity (>/=5 vs <5 sessions lasting at least 30 minutes each per week); (3) strength training (>/=3 vs <3 sessions per week); (4) enrollment in physical education (yes or no); and (5) sports participation (yes or no). Using body mass indexes, students were categorized by percentiles as underweight (5th to 15th to <85th percentiles), at risk for overweight (>/=85th to <95th percentiles), or overweight (>/=95th percentile). Potential associations between physical activity and body mass index were examined using logistic regression. RESULTS: On several measures, adolescent boys who were underweight or overweight were less likely to be physically active than boys of normal weight (eg, odds ratio [OR], 0.23; 95% confidence interval [CI], 0.12-0.45; and OR, 0.75; 95% CI, 0.61-0.93; for boys who were underweight and overweight, respectively, for strength training). Adolescent girls who were overweight or at risk for overweight were less likely (OR, 0.62; 95% CI, 0.50-0.78; and OR, 0.63; 95% CI, 0.46-0.85; respectively) to be involved with sports than girls of normal weight; and girls who were underweight were less likely (OR, 0.44; 95% CI, 0.22-0.91) to be enrolled in physical education. CONCLUSIONS: Weight status among high school students is correlated with selected physical activity behavior, especially among adolescent boys. Interventions to increase physical activity for high school students should target adolescents of all shapes and sizes, and may best be achieved by school policies requiring physical education or after-school sports.

Evaluation of a two-part survey item to assess moderate physical activity: the Cross-Cultural Activity Participation Study.

PURPOSE: This study evaluated a two-part survey item that assessed adherence to the national moderate physical activity (MPA) recommendation (>/=30 min/day on >/=5 days/week). METHODS: Participants were African American (n = 137), Native American (n = 129), and Caucasian (n = 50) women >/= 40 years from South Carolina and New Mexico, who were participating in a study validating physical activity surveys. The survey item was compared with data obtained from MPA recorded in PA records (min/day), Caltrac accelerometers (Muscle Dynamics, Torrance, CA) (kcal/day), and pedometers (steps/day). RESULTS: Approximately 64% of the participants reported meeting the MPA recommendation on the survey item. Adjusted analyses showed that those who reported meeting the recommendation were more active than those who reported not meeting the recommendation (109.2 vs. 83.9 min/day, 2171.2 vs. 2088.4 kcal/day, and 5795.7 vs. 4797.2 steps/day, respectively; all p < 0.0001). The types of activities recorded in the PA record did not differ by self-reported adherence to the MPA recommendation except for walking (25.2 vs. 14.0 min/day for those who reported meeting vs. not meeting the recommendation, respectively; p < 0.05). A higher proportion of those who reported meeting the recommendation also reported participating in conditioning activities compared with those who reported not meeting the recommendation (31% vs. 19%, respectively; p < 0.05). CONCLUSIONS: The two-part survey item can reliably differentiate between higher and lower levels of activity. Those who perceive themselves as meeting the MPA recommendation are, on average, likely to have higher activity levels than those who perceive that they do not meet the recommendation.

Assessment of a pilot video's effect on physical activity and heart health for young children.

This article assessed the effects of a video, "Dynamotion," on children's knowledge, self-efficacy, and attitude about physical activity and heart health. A quasi-experimental design was used; 12 classrooms (grades K-2) were assigned to intervention (N = 116) or comparison (N = 92) groups. Students completed a 9-item pre- and posttest; only the intervention group was exposed to the video, during which qualitative assessments were made. Repeated measures analyses were used to detect changes. Overall, the intervention group had greater gains in knowledge and self-efficacy than did the comparison group (p < 0.001), and they seemed to enjoy the video. The results suggest that exposure to a short, interactive, educational video may promote health among young children.