Measuring obesity among school-aged youth in India: a comparison of three growth references.

OBJECTIVE: To compare three growth references that can be used to assess the weight status of school-aged youth living in India, with a particular focus on identifying overweight and obese youth. STUDY DESIGN: Cross-sectional study. Kappa scores were used to measure agreement between growth references. Regression models were used to test for differences in weight status by grade level, gender, and school type, using each growth reference. SETTING: Private (n=4) and Government schools (n=4) in Delhi, India. PARTICIPANTS: Students (n=1818) in eighth and tenth grade attending the schools. MAIN OUTCOME MEASURES: Weight status was derived using age- and gender-specific cut-points provided by: (a) a national growth reference specific to India; (b) an international reference recommended by the International Obesity Task Force (IOTF); and (c) a new international reference recommended by the World Health Organization (WHO). RESULTS: The IOTF reference consistently classified participants in a lower weight status category, compared with the national reference (k=0.57) and the WHO reference (k=0.69). The agreement between the WHO and the national references was higher (k=0.84). CONCLUSIONS: To date, all published studies of childhood obesity in India have used the IOTF reference, the national reference, or an old WHO reference to measure weight status among school-going youth. The new WHO reference may be a better choice. Compared to the IOTF reference, it does not appear to underestimate obesity and can still be used to compare trends, globally.

Why are urban Indian 6th graders using more tobacco than 8th graders? Findings from Project MYTRI.

OBJECTIVE: To investigate why urban Indian 6th graders may be using more tobacco than urban Indian 8th graders. DESIGN: Cross-sectional survey of students conducted in the summer of 2004, as the baseline evaluation tool for a group-randomised tobacco prevention intervention trial (Project MYTRI). Mixed-effects regression models were used to (1) examine the relationship between 15 psychosocial risk factors and current use of any tobacco, by grade; and (2) examine differences in psychosocial risk factors, by grade. SETTING: Thirty-two private (high socioeconomic status (SES)) and government (low-mid SES) schools in two large cities in India (Delhi and Chennai). SUBJECTS: Students in the 6th and 8th grade in these schools (n = 11642). Among these, 50.6% resided in Delhi (v Chennai), 61.4% attended a government school (v a private school), 52.9% were enrolled in 6th grade (v 8th), and 54.9% were male (v female). MAIN OUTCOME MEASURE: Current (past 30 day) use of any tobacco, including chewing tobacco (for example, gutkha), bidis, or cigarettes. RESULT: Almost all psychosocial factors were significantly related to tobacco use, for students in both grades. Some of the strongest correlates included social susceptibility to and social norms about use. Exposure to tobacco advertising was a strong correlate of tobacco use for 6th graders, but not for 8th graders. Sixth graders scored lower than 8th graders on almost all factors, indicating higher risk. CONCLUSIONS: The "risk profile" of 6th graders suggests they would be vulnerable to use and to begin using tobacco, as well as to outside influences that may encourage use.

Contribution of patient defense mechanisms and therapist interventions to the development of early therapeutic alliance in a brief psychodynamic investigation.

This preliminary study examined how patients' defense mechanisms and psychotherapists' techniques influence early alliance formation. The authors assessed the relationships among defense mechanisms, therapist interventions, and the development of alliance in a sample of 12 patients undergoing Brief Psychodynamic Investigation (4 sessions). Alliance development occurred rapidly and was clearly established by the third session. Neither defensive functioning nor supportive or exploratory interventions alone differentiated early alliance development. However, the degree of adjustment of therapists' interventions to patients' level of defensive functioning discriminated a low alliance from both improving and high alliances. The adjustment of therapeutic interventions to patients' level of defensive functioning is a promising predictor of alliance development and should be examined further, alongside other predictors of outcome.

How did Project Northland reduce alcohol use among young adolescents? Analysis of mediating variables.

Project Northland is a randomized trial designed to create, implement and evaluate multilevel, community-wide strategies to prevent alcohol use among adolescents. This paper will focus on the mediating outcomes of the early adolescent phase of Project Northland when the students in the study cohort were in Grades 6-8. The project was conducted in 24 school districts and adjacent communities in northeastern Minnesota. The intervention consisted of social-behavioral curricula in schools, peer leadership activities, parental involvement and education, and community-wide activities. At the end of 3 years of intervention, significantly fewer students in the intervention school districts reported alcohol use than students in the reference districts. Mediation analyses were conducted to investigate if the intervention's effects on mediating variables could explain the reduction in alcohol use. Important mediators of Project Northland's effect on alcohol use were: (1) peer influence to use, including normative estimates, (2) functional meanings of alcohol use, (3) attitudes and behaviors associated with alcohol and drug problems like stimulus seeking, rule violations and bad judgement, and (4) parent-child alcohol-related communication around alcohol use. In addition, among those who did not use alcohol at baseline, self-efficacy to refuse offers of alcohol was a significant mediator.

Doing Our Part So Kids Don't Start. An evaluation of a statewide public awareness campaign.

This article describes outcomes related to the product and process involved in an evaluation of one component of a statewide public awareness campaign, the Doing Our Part So Kids Don't Start toolkit. The campaign was designed to garner support for and to increase compliance with a recent Minnesota law intended to reduce youth access to tobacco. More than 35,000 toolkits were distributed statewide. The results of the evaluation suggest that the toolkit was successful in reaching and engaging its target audience and should be considered a good strategy for disseminating information to a wide variety of individuals, particularly those new to tobacco control, and for encouraging them to participate in preventing tobacco use among youth. Future American Cancer Society endeavors would benefit from considering the needs of both the program planner and program evaluator before implementing new projects or programs.

The Minnesota DARE PLUS Project: creating community partnerships to prevent drug use and violence.

The research community has criticized Drug Abuse Resistance Education (D.A.R.E.) because the extant literature indicates a lack of evidence that the elementary school program prevents drug use. Yet D.A.R.E. continues to be the most widely implemented drug use prevention program in the United States and has considerable community support. To date, the junior high D.A.R.E. program has not been evaluated. The Minnesota DARE PLUS Project is a randomized trial of 24 schools and communities. During 1999-2001, students in eight schools will receive the junior high D.A.R.E. curriculum in 7th grade; eight schools also will receive the curriculum as well as additional parent involvement, peer leadership, and community components in the 7th and 8th grades; and eight schools will serve as controls. This article describes the background and conceptualization, the curriculum and additional intervention components, and the evaluation methods of the DARE PLUS Project.

An evaluation of a theatre production to encourage non-smoking among elementary age children: 2 Smart 2 Smoke.

OBJECTIVE: To evaluate the impact of a theatre production on smoking-related attitudes, norms, and intentions of children in grades 1-6 (aged 6-12 years). DESIGN: Seventeen schools were randomly selected among 160 that were participating in the implementation of the theatre production 2 Smart 2 Smoke. Schools that participated in the theatre production after 3 December 1997 were assigned as control schools. Assignment of schools to a given date for the theatre production was a random process. Students in grades 1-6 were surveyed before and after the theatre production and associated activities. The data were examined for pretest-posttest differences and intervention-control differences. The school was the unit of analysis. SETTING: Elementary schools in the Twin Cities metropolitan area. PARTICIPANTS: Students in grades 1-6 in 17 elementary schools. INTERVENTION: Two plays 2 Smart 2 Smoke for grades 1-3 (6-8 year olds) and grades 4-6 (9-12 year olds), respectively, with follow-up activities for the classroom and home. A national theatre company performed the plays at the schools. MAIN OUTCOME MEASURES: Intention to smoke in the future, normative expectations about how many people smoke, functional meanings of smoking, expected outcomes of smoking. RESULTS: 10% more students reported that they would never smoke a cigarette after the theatre production. Students in grades 4-6 showed changes in the functional meanings and expected outcomes of smoking. Students in grades 1-3 showed changes in normative expectations. CONCLUSIONS: Further research on the impact of live theatre productions as a smoking prevention strategy is recommended.

["The rose exists without a reason" (Silesius)--but how does psychotherapy induce change?]. / "Die Ros' ist ohn' Warum" (Silesius)--aber wie verändert Psychotherapie?

Basing on Heidegger's discussion of the opposing, albeit complementary, positions taken by Leibniz and by the seventeenth-century East German mystic Angelus Silesius in respect of the concept of the nature and grounds of knowledge and reason, the author attempts to extend the scope of recent experimental epistemologists such as Varela and v. Foerster, pointing out the fundamental dilemmas inherent in the act of cognition, with which--among others--researchers in psychotherapy are confronted. The range of application of the term "autopoietic system" is defined more precisely by differentiating it from "self-referential phenomena".