Evaluation of a simple method for measuring blood cholesterol levels using non-laboratory observers.

PURPOSE: Blood cholesterol is a good estimator of risk for coronary heart disease. Six criteria for a screening cholesterol measurement are: (1) high predictive value of elevated cholesterol compared with a "gold standard" cholesterol measurement; (2) high correlation with the national reference system for cholesterol; (3) acceptable results obtainable by volunteer observers; (4) results available quickly; (5) reproducible results; and (6) low cost. We hypothesized that cholesterol measurements performed on the Reflotron by volunteer nurses would meet these criteria. SUBJECTS AND METHODS: We recruited 345 subjects (160 men, 185 women, aged 20 to 84) and measured their blood cholesterol level by a method calibrated under the National Heart, Lung, and Blood Institute Lipid Standardization Program (Lab-chol) and on the Reflotron (R-chol method). RESULTS: Comparison of the results showed good agreement (slope = 0.937; intercept = 0.27 mmol/liter). Comparison of the risk assignments made by the R-chol method against those made by the Lab-chol method, using the 1987 Adult Treatment Panel classification criteria, showed that the R-chol method has a sensitivity of 0.79 and a specificity of 0.98. Assuming a national prevalence of hypercholesterolemia of 25 percent, the positive predictive value is 0.92 and the negative predictive value is 0.93. The cost per screen was $1.25. CONCLUSION: These data show that volunteer observers can obtain screening cholesterol results on the Reflotron that are accurate, reliable, quickly available at a low cost, and have high predictive value for hypercholesterolemia.

Smoking prevention among urban minority youth: assessing effects on outcome and mediating variables.

We tested the effectiveness of a social resistance/competence enhancement approach to smoking prevention among predominantly Hispanic seventh graders (N = 3,153) from 47 New York City schools. After blocking on school type (public and parochial) and ethnic composition (percent Hispanic), schools were randomly assigned either to receive the 15-session prevention program or to serve as no-contact controls. Using the school as the unit of analysis, significant program effects were found for cigarette smoking, normative expectations concerning peer and adult smoking, smoking prevalence knowledge, social acceptability knowledge, and knowledge of smoking consequences. Using structural modeling techniques, a significant relation was found between the normative expectation and knowledge variables affected by the intervention and posttest smoking, suggesting that changes on these variables mediated the impact of the intervention on cigarette smoking. This study extends the results of previous prevention research and demonstrates the generalizability of this approach to predominantly Hispanic urban minority students.

Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: results of a 3-year study.

Students (N = 4,466) attending 56 schools in New York State were involved in a 3-year study testing the effectiveness of a cognitive-behavioral approach to substance abuse prevention. In a randomized block design, schools were assigned to receive (a) the prevention program with formal provider training and implementation feedback, (b) the prevention program with videotaped provider training and no feedback, or (c) no treatment. After pretest equivalence and comparability of conditions with respect to attrition were established, students who received at least 60% of the prevention program (N = 3,684) were included in analyses of program effectiveness. Significant prevention effects were found for cigarette smoking, marijuana use, and immoderate alcohol use. Prevention effects were also found for normative expectations and knowledge concerning substance use, interpersonal skills, and communication skills.

Capacity building and resource needs of state health agencies to implement community-based cardiovascular disease programs.

State Health Agencies play a critical role in the Nation's efforts for health promotion and disease prevention. This role is especially critical in efforts to reduce the burden of CVD through community-based programs. Resources SHAs need to facilitate implementation of community-based CVD prevention programs fall into three general categories: (a) Adequate time to plan, carry out and evaluate, (b) Financial resources to support staff, community organization and demonstration programs, and (c) Personnel with requisite technical expertise, skills and technological resources. Six critical activities for building state-level CVD program capacity include: (1) Forming a statewide CVD oversight committee, (2) Developing a state CVD plan, (3) Developing quality assurance standards and guidelines, (4) Developing new paradigms of community assessment and evaluation, (5) Planning for institutionalization, and (6) Translation of research to application. SHA roles vary from direct service delivery to serving as a linking agent, transferring information and resources and coordinating efforts between agencies.

AIDS risk knowledge, attitudes, and behavioral intentions among multi-ethnic adolescents.

The purpose of this study was to determine how much young adolescents know about AIDS and AIDS risk and to identify areas of confusion that might serve as important targets of educational intervention. A multiethnic (43% white, 33% black, 18% Latino) sample of 303 seventh-grade students (48% male) in 3 schools in the greater New York area completed questionnaires assessing knowledge, attitudes, and behavioral intentions concerning AIDS and AIDS risk. Consistent with previous studies with older adolescents, the major finding in this study was that young adolescents had a high degree of knowledge concerning AIDS and AIDS risk. There were 2 areas of confusion concerning AIDS risk. Specifically, 31% of adolescents did not correctly identify "not having sex" as the most effective way of preventing AIDS, and 33% believed that AIDS could be spread through casual contact. Findings are discussed in terms of their implications for prevention.

Attitudes toward AIDS and AIDS education among multi-ethnic parents of school-aged children in New York City.

To explore the attitudes of a multi-ethnic sample (African-American, Caucasian, Latino) of parents, a telephone survey was conducted with 297 parents whose children attend school in New York City (98 African-Americans, 100 Latinos, and 99 Caucasians). The survey interview assessed a wide range of issues related to AIDS and AIDS education. In a series of logistic regressions that controlled for education, we compared each ethnic group (African-Americans, Latinos) with Caucasians as the reference. The majority of parents indicated that they supported AIDS education efforts in the schools, but there was considerable mistrust of the government and health professionals, particularly among the African-American parents. African-American and Latino parents were more likely to perceive AIDS as a threat and believe that AIDS education is more effective for Caucasians. We discuss implications for AIDS prevention and recommend strategies to overcome barriers to AIDS education and prevention in multi-ethnic communities.

Smoking behavior of adolescents exposed to cigarette advertising.

The purpose of the study was to explore the relationship between the exposure of adolescents in the seventh and eighth grades to cigarette advertising and their being smokers. A survey questionnaire given to 602 adolescents assessed their exposure to cigarette advertising and provided measures of their smoking behavior, demographic characteristics, and some psychosocial variables. The results indicated that exposure to cigarette advertising and having friends who smoked were predictive of current smoking status. Adolescents with high exposure to cigarette advertising were significantly more likely to be smokers, according to several measures of smoking behavior, than were those with low exposure to cigarette advertising. The findings extend previous research identifying factors that may play a role in the initiation and maintenance of smoking among adolescents.

A psychosocial approach to smoking prevention for urban black youth.

Despite the high rates of smoking-related cancers among black Americans, little is known about the type of smoking prevention program that might be effective with black youth. The current study pilot-tested a promising smoking prevention approach to determine its feasibility, acceptability, and effectiveness. A total of 608 students in nine predominantly black urban junior high schools were stratified by community and randomly assigned to treatment and control conditions. Students in the treatment condition participated in a 12-session smoking prevention program which taught resistance skills and general life skills. Process data indicated that this prevention approach was feasible and acceptable to students, teachers, and administrators. Outcome data indicated that this program reduced the proportion of children who smoked in the past month by 56 percent, and it increased knowledge of the adverse consequences of smoking and normative expectations concerning adult and peer smoking. These results are discussed in terms of their implications for prevention and modifications which might further strengthen the efficacy of this approach for urban black adolescents.

Smokeless tobacco use among adolescents: correlates and concurrent predictors.

Seventh grade students (N = 1539) from three regions of New York State were surveyed to determine the prevalence of smokeless tobacco use and its relationship to seven background variables, 13 substance use variables, and 19 psychosocial variables. Significant correlations with smokeless tobacco use were found within each of these variable domains. Concurrent predictors for each domain were determined using logistic regression analysis. The resulting three models were combined in a stepwise fashion in an effort to determine the most complete prediction model. The final model indicated that individuals at the highest risk for using smokeless tobacco were rural males who had smoked more than four cigarettes in their lifetime, were more heavily involved with alcohol, had a lower degree of assertiveness and social anxiety, and had reported eating as a coping response. Implications for prevention are discussed.

Social influence predictors of alcohol use among New York Latino youth.

We examined demographic and social influence predictors of adolescent drinking among New York City Latino adolescents, including specific Latino subgroups (i.e., Puerto Rican, Dominican, Colombian, and Ecuadorian). Sixth- and seventh-grade students (N = 3129) who identified themselves as Latino or Hispanic on the survey questionnaire comprised our Latino sample. The survey included self-reported frequency of alcohol use, demographic items, and measures of social influences for drinking. Logistic-regression analyses revealed that social influences (how many friends drink, attitudes of parents and friends toward respondent's drinking) are strong predictors of current drinking (defined as drinking at least once a month) for the overall sample of Latino youth, as well as for Puerto Rican youth and Dominican youth. Findings are discussed in terms of their implications for prevention.

Correlates and predictors of smoking among black adolescents.

Little is known about the etiology of cigarette smoking among minority populations. This study examines the correlates and predictors of smoking among inner-city black seventh graders (N = 608). Enhanced self-reports of cigarette smoking were collected along with data concerning demographic, social, and psychological factors hypothesized to promote smoking initiation. Results indicate that social environmental factors, such as the smoking status of friends and siblings, and individual factors, such as refusal assertiveness, general assertiveness, and age are predictive of current smoking. Similarly, the smoking status of friends, attitudes concerning the harmful effects of smoking, and low self-esteem concerning schools are predictive of behavioral intention to smoke in the future. Overall, the factors that were the most salient predictors of smoking for the black adolescents in this study are generally congruent with the existing literature for other populations.

Factors promoting cigarette smoking among black youth: a causal modeling approach.

A longitudinal model of Black adolescent smoking was tested using 223 seventh-grade students attending public schools in northern New Jersey. Interpersonal and intrapersonal factors were hypothesized to have an impact on Black seventh graders' decision to smoke. After conducting an exploratory Principal Factor Analysis (PFA) using a varimax rotation with the Time 1 data, a structural equation model was developed and refined through successive iterations. The final model revealed friends' smoking to be the most significant predictor of Black adolescent smoking at Time 1, but perceived smoking norms and intrapersonal factors such as decision making, self-efficacy, and self-esteem at home and at school exerted an important influence on smoking at Time 2. These results suggest that social influence factors may be important early in the smoking initiation process, but factors such as perceived smoking norms and intrapersonal factors may play an important role in maintaining the smoking habit in Black adolescents.

Substance abuse prevention: competence enhancement and the development of positive life options.

Recent advances in the field of substance abuse prevention have derived from a consideration of the etiology of substance use and have also been solidly grounded in psychological theory. Evaluation studies of psychosocial prevention interventions have become increasingly rigorous, and clearly demonstrate that there are effective approaches to prevention. The Life Skills Training Program is an example of a competence enhancement approach to substance abuse prevention. While research with this approach demonstrates its effectiveness at reducing substance use behavior, experience working with disadvantaged youth suggests the need to broaden the concept of competence enhancement. Specifically, recommendations are made for formalizing the concept of positive life options as a potentially important component of substance abuse prevention.

Eleven components of effective drug abuse prevention curricula.

A review of school-based drug abuse prevention programs was conducted for 1989-1994. In addition to a comprehensive literature review, interviews were conducted with a panel of 15 leading experts in prevention research. Key elements of promising prevention curricula were identified. Effective prevention programs were found to be based on a sound theoretical or research foundation. They included developmentally appropriate information about drugs, social resistance skills training, and normative education. Broader based personal and social skills training appeared to enhance program effects. Effective programs used interactive teaching techniques and teacher training, and provided adequate coverage and sufficient follow-up. Cultural sensitivity to the target population was found to be critical to program success. Additional program components were expected to enhance curriculum effectiveness. Finally, experts agreed that adequate evaluation of prevention curricula was critical. Unfortunately, despite information about the types of curricula that are effective, the most promising prevention curricula are not widely disseminated. Reasons for under-utilization are explored, and recommendations made for correcting the situation.

A review of the evaluation of 47 drug abuse prevention curricula available nationally.

This review determined how many drug prevention curricula available to schools have been shown in rigorous research studies to reduce substance use behavior. Forty-seven curricula which met the following criteria were included: 1) they focused on primary prevention of alcohol and/or drug use, 2) they were classroom-based curricula designed for any grade level P-12, 3) they were nationally and currently available, and 4) program distributors were willing to provide samples of curriculum materials to determine drug abuse prevention content. Of the 47 drug abuse prevention curricula identified, 10 (21%) had been subjected to sufficiently rigorous evaluations. At least eight of the 10 programs have been shown effective at reducing tobacco or drug use, in at least some studies. The remaining two programs did not appear to have sustained effects on drug use, although they had variable success at reducing substance use early on. One of the 10 programs has been shown to have positive effects lasting into young adulthood. Six of the 10 curricula have been shown to have effects lasting for at least two years after the pretest. Two curricula have not been evaluated beyond the post-test, so it is impossible to know whether their effectiveness will last. Recommendations to increase the number of programs rigorously evaluated are offered.

Nine critical elements of promising violence prevention programs.

To identify approaches to school-based violence prevention that are most promising and those that may not be effective, a review of the literature was conducted. In addition, telephone interviews were conducted with 15 experts on topics related to school-based violence prevention. Nine critical ingredients of promising approaches to violence prevention were identified. Specifically, the approaches are comprehensive and multifaceted; begin in the primary grades and are reinforced across grade level; are developmentally tailored: and cover appropriate content area. Appropriate content areas include information; anger management; social perspective taking; decision making and social problem solving; peer negotiation and conflict management; social resistance skills; active listening and effective communication; and material on prejudice, sexism, racism and male-female relationship. In addition, promising programs use interactive teaching techniques, are culturally sensitive, and provide teacher training. They promote a positive school climate and foster norms against violence. Six violence prevention activities that appear not to be effective are also discussed. The authors conclude with a discussion of the need for more rigorous evaluation of violence prevention programs.

Determinants of intentions of Junior High School students to become sexually active and use condoms: implications for reduction and prevention of AIDS risk.

The purpose of this study was to examine factors associated with young adolescents' increased risk for AIDS. A multiethnic sample of 303 seventh-grade students in three schools in the greater New York area completed questionnaires assessing their basic demographic characteristics (gender and ethnicity), AIDS knowledge, substance use (cigarette smoking, alcohol use), and decision-making skills. AIDS knowledge, substance use, decision-making skills, gender, and ethnicity predicted intentions to engage in sexual behavior in the future. Relevant knowledge of AIDS was associated with lower intentions to engage in sexual behavior in the future. More frequent substance use, less frequent use of decision-making skills, and being male increased intentions to engage in sexual behavior in the future. Our findings are discussed in terms of their implications for education and prevention of adolescent sexual activity and AIDS-risk reduction.

PIP: Factors related to plans to engage in sexual activity and unsafe sexual behavior in the future were investigated to provide data necessary to design the most appropriate AIDS risk reduction interventions for young adolescents. Data were collected using questionnaires administered to 303 seventh-grade students (145 male) at three schools in metropolitan New York City (43% White, 33% Black, 18% Hispanic, and 6% "other") in February 1990. The schools offered no AIDS prevention programs. The confidential questionnaires elicited information on intentions to become sexually active and to use a condom and on gender, ethnicity, AIDS knowledge, cigarette smoking and alcohol use, and decision-making skills. Data were analyzed using SPSS/PC. The dependent measures (sex activity and condom intentions) were submitted to multiple regression. Gender, two AIDS knowledge items, ethnicity, frequency of cigarette and alcohol use, and decision-making skills were simultaneously regressed on each of the dependent measures. It was found that the likelihood of planning to have sex before marriage was greater among boys and among students who used alcohol more frequently and was less among Hispanics and students who knew that refraining from sex is the most effective way to prevent AIDS. The intention to refuse sex with a longterm dating partner was influenced by gender (boys less likely to refuse), current alcohol use (users less likely to refuse), and decision-making (skilled decision-makers more likely to refuse). Those who intended to have sex before finishing high school were more likely to be boys, frequent smokers, and frequent alcohol users. Intention to use a condom was positively determined by knowledge that condom use reduces the risk of AIDS and by decision-making skills. These results indicate that social skills programs designed to prevent substance use and premature sexual activity may offer the best strategy in deterring problem behaviors and reducing the risk of AIDS. This study was limited by its small sample size, by its reliance on intended behavior, and by the cross-sectional rather than longitudinal nature of the data.

The false consensus effect: predicting adolescents' tobacco use from normative expectations.

A longitudinal sample of 916 adolescents was examined to assess the extent to which the perceived smoking prevalence of adults' or peers' smoking was related to cigarette smoking. Questionnaires were distributed to junior high school students in Grade 7 and again in Grade 9. Prevalence of perceived peers' smoking and prevalence of perceived adults' smoking were significantly related to cigarette smoking both cross-sectionally and longitudinally. Adolescents who believed that half or more than half of all adults or peers smoked cigarettes showed the most smoking involvement, and those who believed that fewer than half of adults or peers smoked were least involved. These findings provide further evidence that adolescent normative expectations about cigarette smoking are an important determinant of smoking initiation.

Validation of an acculturation measure for Hispanic adolescents.

Based on the continuing growth and youthfulness of the Hispanic population in the United States, valid cultural measures are needed for Hispanic adolescents. Hispanics living in this country experience acculturation or cultural change during their exposure to American culture. A matched sample of 994 Hispanic students and their parents completed acculturation measures. Scores on a 10-item acculturation scale completed by the adolescents' parents correlated significantly .49 with a single-item rating, a measure of acculturation by adolescents. This finding supports construct validity for a measure of language use as an index of linguistic acculturation for Hispanic adolescents.

Worksite cholesterol and nutrition: an intervention project in Colorado.

The study purpose was to determine whether group intervention or an individual self help program proved to be more effective at lowering heart disease risk factors among employees in different worksites. Eight worksites and 502 employees in the Denver metropolitan area were selected for the project, with four randomized to Usual Care and four to the Special Intervention. Most worksites had < 200 employees. Employees were randomly assigned to either a control group receiving usual nutrition education or one of two special intervention groups in which employees selected to attend group nutrition education classes or complete an individual self paced nutrition education program. Results indicated that offering a choice of methods for the special nutrition education intervention was valuable, and both approaches modified behavior and certain physiological outcomes. Results suggested that enhanced nutrition education efforts in worksites may be effective and will realize greater benefits than a pamphlet or brief discussion following a worksite screening.