Profiles of substance use related protective and risk factors and their associations with alcohol and tobacco use initiation among black adolescents.

Insufficient attention to protective and risk factors of particular salience for Black youth (e.g., racial identity and racial discrimination) in population-based substance use studies has left gaps in our understanding of alcohol and tobacco use development in Black adolescents. The current study aimed to capture the clustering of such understudied factors and their collective influence on alcohol and tobacco use initiation among Black adolescents. Data were drawn from The National Survey of American Life (n = 1,170; age range = 13-17; 6.9% Afro Caribbean, 93.1% African American; 50.0% female). Latent profile analysis applied to 11 indicators representing family, community, and individual level protective and risk factors revealed (1) High Vulnerability (high risk, low protective factors; 17.5%), (2) Moderate Vulnerability (moderate on both; 63.2%), and (3) Low Vulnerability (high protective, low risk factors; 19.3%) classes. Classes differed significantly by religious community support, school bonding, quality of relationship with mother, religious involvement, and interpersonal trauma. Relative to Class 2, Class 1 had higher odds of alcohol (OR = 1.518, CI:1.092-2.109) and tobacco use (OR = 1.998, CI:1.401-2.848); Class 3 had lower odds of alcohol (OR = 0.659, CI:0.449-0.968) but not tobacco use (OR = 0.965, CI:0.611-1.523). Findings suggest that alcohol and tobacco use initiation among Black adolescents is shaped by the collective influence of community and family level support, with commonly experienced risk factors such as non-interpersonal trauma distinguishing liability to a lesser degree. The equally modest prevalence of tobacco use among low and moderate vulnerability classes further indicates that fostering these connections may be especially effective in reducing tobacco use risk.

Treatment modality and outcomes in larynx cancer patients: A sex-based evaluation.

BACKGROUND: To evaluate the differences in treatment modality and outcomes between male and female patients with laryngeal squamous cell carcinoma (SCC) in the United States. METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results Database for patients with laryngeal SCC (2004-2013). Overall survival (OS), disease specific survival (DSS), and multivariate analyses were conducted. RESULTS: Among women, supraglottic cancers were the most prevalent (61.2%); whereas the majority of men developed glottic cancers (64.2%; P < .001). Women with T4 disease were more likely to undergo primary radiation (56.8% vs 45.3%; P < .001) and less likely to undergo open surgery were than men (37.1% vs 48.2%; P < .001). Women had significantly better OS in glottic and supraglottic cancers, and comparable survival in subglottic cancer. Sex remained an independent prognostic factor for both DSS and OS. CONCLUSION: Sex is an independent prognostic factor for DSS and OS in patients with laryngeal SCC.

Evaluation of an Experiential and Self-Learning Approach to Teaching Evidence-Based Decision Making to Dental Students.

The aim of this study was to evaluate the impact on predoctoral dental students of an experiential and self-learning pedagogical approach to evidence-based decision making. Dental students at one U.S. dental school in 2014 and 2015 participated in an evidence-based decision making course that consisted of minimal lecturing, learning through assigned readings and open-book online quizzes, and individual assignments to reach an evidence-based decision on a clinically relevant question. Before and after the course, each cohort completed a validated survey assessing students' knowledge, attitudes, access of evidence, and confidence related to evidence-based practice. In 2014, of 43 students enrolled in the course, all 43 (100%) completed the pre-course survey, and 33 (77%) completed the post-course survey. In 2015, of 35 students enrolled in the course, all 35 (100%) completed the pre-course survey, and 34 (97%) completed the post-course survey. Of those, the identifier codes for 23 students in 2014 and 25 students in 2015 matched for the pre-course and post-course surveys, allowing direct comparisons. Both cohorts of students showed a significant increase in knowledge regarding critical appraisal of the literature from the pre-course survey results to after the course (p<0.001). Students' reported frequency of accessing evidence from various sources also significantly increased from before to after the course for both cohorts (p<0.01). Students' confidence in evaluating various aspects of a published research report also increased significantly from before to after the course for both cohorts (p<0.001). However, no consistent change was found in students' attitudes about evidence-based practice. In this study, an experiential and self-learning approach to teaching evidence-based decision making in the classroom appeared to be successful in improving students' knowledge, use of evidence, and confidence in critical appraisal skills, though it did not have a consistent impact on their attitudes about evidence-based practice.

Forensic experts' perceptions of expert bias.

How do expert witnesses perceive the possible biases of their fellow expert witnesses? Participants, who were attendees at a workshop at the American Academy of Psychiatry and Law were asked to rate for their biasing potential a number of situations that might affect the behavior of an opposing expert. A Rasch analysis produced a linear scale as to the perceived biasing potential of these different kinds of situations from the most biasing to the least biasing. Working for only one side in both civil and criminal cases had large scaled values and also were the first factor. In interesting contrast, a) an opposing expert also serving as the litigant's treater and b) an opposing expert being viewed as a "hired gun" (supplying an opinion only for money) were two situations viewed as not very biasing. Order of Hierarchical Complexity also accounted for items from the 1st, 2nd and 3rd factors. The result suggests that the difficulty in understanding the conceptual basis of bias underlies the perception of how biased a behavior or a situation is. The more difficult to understand the questionnaire item, the less biasing its behavior or situation is perceived by participants.