Outcome of a tobacco use cessation randomized trial with high-school students.

This study analyzed quantitative data on tobacco use and dependency for 3,589 high-school students, qualitative data for 448 students, and outcome data for a randomized trial comparing the efficacy of two cessation interventions and a control condition for 337 students. Data were collected from 1988 through 1992 in California and Illinois as part of a larger longitudinal study. Smokeless tobacco users, but not smokers, were more likely than controls to maintain cessation for 4 months: biochemically validated cessation at 4 months was 6.5% versus 3.2% for smokers and 14.3% versus 0.0% for smokeless tobacco users. Implications and limitations are discussed.

Substance use among eighth-grade students who take care of themselves after school.

This investigation focused on substance use among children who regularly care for themselves after school (latchkey children). The data, collected from 4932 eighth-grade students, indicated that self-care is an important risk factor for alcohol, tobacco, and marijuana use. Data collected from 2185 parents validated these findings. Eighth-grade students, who took care of themselves for 11 or more hours a week, were at twice the risk of substance use as those who did not take care of themselves at all. This relationship held at all levels of sociodemographic status, extracurricular activities, sources of social influence, and stress. Of the 186 stratified tests of the relationship, 90% were significant; even those not found to be significant were in the direction expected. Path analyses suggest that risk-taking, having friends who smoke, and being offered cigarettes may partially explain the relationship between self-care and substance use. Those eighth-grade students who select friends who smoke and place themselves in situations in which they are offered cigarettes may be manifesting a desire to display their sense of maturity and independence. The fact that the increase in substance use occurred among almost all strata tested and the fact that mediation was not complete suggest that more than one mechanism may account for the associated increase in substance use. It is also possible that more time in self-care results in more unnoticed solitary trials of substances, as well as trials motivated by peer offers or peer pressure to use substances.

Characteristics of eighth-grade students who initiate self-care in elementary and junior high school.

The purpose of this paper is to examine whether children who care for themselves for longer periods of time are at increased risk of poor grades, truancy, anger, family conflict, stress, risk-taking, and peer influences (in addition to the increased risk of substance use previously reported). Demographic characteristics of eighth-grade students who initiate self-care in junior high school are compared with those initiating self-care in elementary school. Further, increased risks for those initiating self-care in elementary school are examined. Over two thirds of the respondents (67.8%) cared for themselves after school without adult supervision at some time during the week; 23.5% for 1 to 4 hours per week, 15.7% for 5 to 10 hours per week, and 28.6% for 11 or more hours per week. Of those in self-care, 48.5% initiated self-care during elementary school and 51.5% during junior high school. Students who were in the highest category of self-care (greater than or equal to 11 hours per week) vs those in self-care zero hours per week were 1.5 to 2 times as likely to score high on risk-taking, anger, family conflict, and stress, to be more likely to see their friends as their major source of influence, and to attend more parties. The self-reports of academic grades did not differ. The grade of initiation of self-care (elementary vs junior high school) conferred additional risk for drinking alcohol (odds ratio = 1.4), risk-taking tendencies (odds ratio = 1.5), and attending parties (odds ratio = 1.6).

Percutaneous drainage of pelvic lymphatic fluid collections in the renal transplant patient.

Seventeen renal transplant patients with pelvic lymphatic fluid collections were treated with percutaneous drainage. Eleven of 16 patients with lymphoceles (69%) were successfully managed without surgery, although seven of these patients required repeat catheter insertions, and three patients developed local infections. The patient with an ovarian cystadenoma was treated with surgery. The mean duration of catheter insertion was ten days for initial drainage and 16 days for repeat drainage. Elevated serum creatinines decreased in 14 of the patients with lymphoceles (88%), including all five patients without pelvocaliectasis, but never returned to baseline in six instances. This observation may reflect the inadequate therapy of frequently encountered concurrent renal parenchymal abnormalities (rejection, cyclosporine toxicity, acute tubular necrosis). While percutaneous management of lymphoceles is technically easy and usually ultimately effective, the interventional radiologist should be prepared for long duration of catheter insertions, repeat interventions, and variable clinical courses. Differentiation of lymphoceles from other fluid collections, such as cystic ovarian neoplasms, may be difficult.

Cost-effectiveness of a school-based tobacco-use prevention program.

OBJECTIVE: To determine the cost-effectiveness of a school-based tobacco-use prevention program. DESIGN: Using data from the previously reported 2-year efficacy study of the Project Toward No Tobacco Use (TNT), we conducted a decision analysis to determine the cost-effectiveness of TNT. The benefits measured were life years (LYs) saved, quality-adjusted life years (QALYs) saved, and medical care costs saved, discounted at 3%. The costs measured were program costs. We quantified TNT's cost-effectiveness as cost per LY saved and cost per QALY saved. INTERVENTION: A 10-lesson curriculum designed to counteract social influences and misconceptions that lead to tobacco use was delivered by trained health educators to a cohort of 1234 seventh-grade students in 8 junior high schools. A 2-lesson booster session was delivered to the eighth-grade students in the second year. The efficacy evaluation was based on 770 ninth-grade students who participated in the program in the seventh and eighth grades and in both the baseline and the 2-year follow-up survey. RESULTS: Under base case assumptions, at an intervention cost of $16 403, TNT prevented an estimated 34.9 students from becoming established smokers. As a result, we could expect a saving of $13 316 per LY saved and a saving of $8482 per QALY saved. Results showed TNT to be cost saving over a reasonable range of model parameter estimates. CONCLUSIONS: The TNT is highly cost-effective compared with other widely accepted prevention interventions. School-based prevention programs of this type warrant careful consideration by policy makers and program planners.

Prothrombin and partial thromboplastin times as preoperative screening tests.

Preoperative tests of coagulation function have been suggested to detect patients who are likely to have abnormal bleeding during and after surgery. A study was designed to determine the yield of prothrombin time (PT) and partial thromboplastin time (PTT), both in discovering patients who are at risk for abnormal bleeding and in inducing changes in patient care or outcome. Of 750 patients on three surgical services, 611 (81%) patients had no indication of a bleeding disorder on history or physical examination. Of the 139 patients who had clinical indications, 25 (18.0%) patients had an abnormal PT or PTT. Of the 611 patients without clinical indications, 480 patients had the PT or PTT determined, and 13 (2.7%) patients had abnormal results. One (0.2%) of the 480 patients might have benefited from the test result (this patient required a second operation to control arterial bleeding). The prolonged PT or PTT was of no apparent clinical importance in the remaining 12 patients without indications of bleeding disorders preoperatively. The low yield of the PT and PTT in detecting unsuspected bleeding disorders preoperatively was further obscured by the larger number of apparently false-positive results.

The patterns and predictors of smokeless tobacco onset among urban public school teenagers.

This study describes the patterns and predictors of smokeless tobacco (ST) use in a large sample of urban public school students in Los Angeles and San Diego. The use of ST is more common among men than women and among Caucasians than African Americans, Hispanics, and others. Approximately 20% of the male respondents and 5% of the female respondents reported use of ST at least once, and 10.1% of male students and 3.1% of female students who had never tried ST by seventh grade started to use it by eighth grade. Among Caucasians, about 30% of boys reported trying ST at least once and 13.7% of those who had never used ST by seventh grade initiated experimentation by eighth grade. These data are used to examine the family, peer, and intrapersonal predictors of ST onset. The family risk factors for ST onset include living with a single parent, parent-child conflicts, and parental alcohol use. The peer risk factors for ST use include peer drug use and activities with friends, such as parties and participation in sports. The intrapersonal risk factors include poor grades in school, risk taking, and stress. The study also shows that those who use cigarettes, alcohol, or marijuana are at higher risk of using ST and vice versa. This study supports a problem-prone behavior perspective of ST use and cigarette smoking. We suggest that both products be targeted because the same programs are likely to apply to both products to counteract problem-prone type variables. Medical Subject Headings (MeSH): tobacco, smokeless chewing tobacco, adolescent behavior.

The conflict between least harm and no-use tobacco policy for youth: ethical and policy implications.

This paper examines policy and ethical implementation issues associated with local drug policies that are aimed at producing a "least harm" approach toward youth, with particular application to tobacco policy as an example of a legal, but addictive drug. Research is reviewed which shows the inconsistencies between federally mandated enforcement of zero tobacco use, the Synar Amendment and local community and school policies which appear to relax enforcement of no-use policies for the purpose of retaining youth in school. The inconsistencies are described from the perspective of a "least harm" approach, in that tobacco use may be considered less harmful than absence from school, or use of other substances. The conflict between law and intent to reduce harm is examined with implications for long-term enforcement of federal policy, and for effectiveness of tobacco and other drug abuse prevention programs and other drug policies. Several strategies for reducing the conflict are recommended. These include provision of support-orientated smoking cessation programs for youth on school campuses and in community organizations, and promoting consistent no-use norms across all drugs and across multiple channels that affect youth-mass media, school, point-of-purchase settings and public settings and events.

Two-year behavior outcomes of project towards no tobacco use.

The article presents 2-year follow-up data from a school-based tobacco use prevention project designed to test the effectiveness of 3 primary components in social influence programs. The components either teach refusal skills, awareness of social value misperceptions, or physical consequences. Curricula were tested with a randomized experiment involving 48 junior high schools. These data suggested that (a) a physical-consequences curriculum is successful at attenuating increases in adolescent smokeless tobacco use, (b) cigarette experimentation may be attenuated by various approaches, and (c) a comprehensive program with all 3 components was necessary to attenuate increases in weekly use of both forms of tobacco. These results also indicate that school-based tobacco use interventions can be effective at least 2 years postprogram, after students make their transition to high school.

Group self-identification and adolescent cigarette smoking: a 1-year prospective study.

As an extension of previous work, we analyzed the longitudinal relations between group self-identification and adolescent cigarette smoking. The predictive precedence of cigarette smoking and identification with 6 different types of peer groups was examined. Results indicated that 7th-grade group self-identification predicted 8th-grade cigarette smoking, whereas 7th-grade cigarette smoking did not predict 8th-grade group self-identification. Group self-identification also was compared with 7 other psychosocial variables as predictors of smoking 1 year later. The pattern of results suggests that group self-identification is about as good a predictor of smoking as other psychosocial variables, and that group self-identification is more than a mere proxy of other psychosocial variables.

Peer-group association and adolescent tobacco use.

Mosbach & Leventhal (1988) examined the relation of cigarette smoking to peer-group identification in rural Wisconsin adolescents. They found that among dirts (problem-prone youth), regulars (average youth), hot-shots (good social or academic performers), and jocks (athletes), youth most likely to smoke were dirts and hot-shots. We performed a replication with a Southern California cohort and also for use of smokeless tobacco. We hypothesized that jocks would be the main users of smokeless tobacco. We identified the same groups and an additional one, skaters (skateboarders or surfers). As Mosbach & Leventhal found, cigarettes were used most by dirts. Contrary to their results, but consistent with other research, we found that hot-shots were least likely to smoke. Contrary to our prediction, we found that skaters and dirts were more likely to use smokeless tobacco than were jocks. Our data show that both tobacco forms are used by problem-prone youth.

Thorotrast-induced meningioma. Case report.

The authors report an adult patient with a symptomatic intracranial meningioma that was demonstrated by computerized tomography, angiography, and at surgery. The meningioma had occurred at a site where 19 years previously thorium dioxide had been injected into an abscess cavity. Pathological examination revealed the presence of thorium granules within the meningioma.

Childhood brain tumors and residential electromagnetic fields (EMF).

There are many recent comprehensive reviews of the residential EMF epidemiologic literature, but they do not attempt to cover the issue of childhood brain tumors and EMF in depth. We present here background information on descriptive epidemiology of known or suspected causes of childhood brain tumors and a detailed review of studies that have examined the associations between EMF as represented by various surrogates, and childhood brain tumors. We evaluated nine studies of childhood brain tumors and residential exposure to EMF based on wire codes, distance, measurements, and modeling, and six studies that examined the use of appliances by children or their mothers during pregnancy. For each study we discussed analytical and methodological issues including choice of cutpoints, nonconcurrent control selection, random digit dialing, differential participation, and ability of a study to detect an association. On the basis of this comprehensive review of all available childhood brain cancer studies, we do not see support for an overall association between EMF and childhood brain cancer. This lack of support applied for all surrogates of past magnetic fields, including wire code, distance, measured or calculated fields, and use of appliances by either child or mother.

Manifestations of the battered-child syndrome.

Between 1965 and 1972, 231 patients were admitted to St. Christopher's Hospital for Children in Philadelphia with the battered-child syndrome. The case records and reontgenograms of 217 patients were reviewed. About one-third of the patients repuired orthopaedic treatment. The purpose of this paper is to alert the orthopaedist to the existence and prevalence of the battered-child syndrome, to describe both the non-orthopaedic and the orthopaedic manifestations of this problem, and to delineate the orthopaedist's responsibility to the battered child and the child's family.

Experience with segmental reconstruction of the radiated mandible with alloplastic prostheses.

Reconstruction of the mandible after radiation therapy and segmental resection is often complicated by wound breakdown, osteoradionecrosis, and crippling of the oral cavity. These complications make patient salvage after radiated oral carcinoma a high-risk endeavor. Although head and neck surgeons have improved the reliability of mandibular reconstruction with microvascular free tissue transfer, medical and oncologic issues may prohibit their application. This report presents 12 selected cases undergoing alloplastic reconstruction of the mandible and soft tissue reconstruction of the oral cavity. Although not as reliable as some reports of free tissue transfers, the results were reproducible and satisfactory in these cases, with time-efficient hospitalization and functional rehabilitation. Ten of 12 prosthetic reconstructions have been durable in this study population for as long as 36 months.

Exposure assessment for power frequency electric and magnetic fields (EMF) and its application to epidemiologic studies.

Epidemiologic studies suggesting possible health effects associated with exposure to electric and magnetic fields (EMF) from the transmission, distribution, and use of electricity have motivated increased interest in and attention to EMF exposure assessment. The result has been new instruments, measurement approaches, and exposure models that can improve on what has been a weakness in past epidemiologic studies, namely EMF exposure assessment. This paper presents a status report on EMF exposure assessment that emphasizes the need for incorporation of these advances in future studies. Several factors are identified that make the assignment of contemporary or retrospective EMF exposures potentially more difficult than for other environmental agents. These include: EMF is not generally detectable by humans, exposure scenarios for EMF are generally not memorable, there is no clear mechanism for EMF effects, and the pervasive nature of EMF in an industrialized society makes identification of a low-exposure group difficult. Elements of study design that are impacted by the nature of EMF exposures include: sampling and measurement strategies, summary measures of exposure, and the choice of surrogate and/or models of exposure. Consideration of these exposure assessment issues and incorporation of recent advances can improve the overall quality of epidemiologic studies with an EMF exposure component.

The impact of a videotape on smoking cessation among African-American women.

The African-American female smokers identified stress, pleasure, and addiction as the reasons that they smoked. These reasons were similar to those provided by the other smokers. The African-American female smokers reported greater addiction to nicotine than the other smokers, as indicated by greater incidence of smoking within 30 minutes of waking. The African-American female smokers also identified with the characters depicted in the videotape more strongly than did the other smokers. African-American female smokers identified behavioral coping strategies as those that they would use in their quit attempts more frequently than did the other smokers. Cessation rates were similar for the African-American females and other smokers. Although low, the 9.7% reported cessation rate, or the 4.6% conservative cessation rate estimate, is higher than the 3% 3-month quit rate observed among a group of 50 African-American female smokers living in South-Central Los Angeles during the same time period who were not participating in a quit-smoking program. Therefore the present data suggest an effect above mere testing.

Health behavior, quality of work life, and organizational effectiveness in the lumber industry.

A major incentive for work-site health promotion activities has been the promise of increased company profitability. Some critics have challenged the economic argument based on distal outcomes such as increased employee longevity and less morbidity later in life. The purpose of this study was to examine the relationships between employee health behavior, quality of work life, and proximal organizationally valued outcomes. Data were collected from a stratified random sample of employees working at Pacific Lumber Company (N = 146), the largest single-site lumber mill in California. Although employee sleep patterns predicted health care utilization and psychological well-being, for the most part employee health behaviors were not strong predictors of proximal organizational effectiveness factors. However, quality-of-work-life factors significantly predicted organizational commitment, absenteeism, and tardiness frequency. The findings suggest the value of improving the system of work in which employees are embedded as part of comprehensive work-site health promotion efforts.

Differential influence of parental smoking and friends' smoking on adolescent initiation and escalation of smoking.

Smoking-related behaviors and attitudes of significant others (especially friends and parents) are among the most consistent predictors of adolescent smoking. However, theorists remain divided on whether the behaviors of significant others influence adolescent smoking directly or indirectly, and the relative influence of parental and peer smoking on adolescents' own smoking is still a matter of debate. In addition, little research has examined the role of significant others' behavior on different stages of smoking onset. In particular, not much information is available regarding gender and ethnic differences in social influences on smoking behavior. We use structural equation modeling to address these issues. Different theoretical perspectives from cognitive-affective theories (Ajzen 1985; Ajzen and Fishbein 1980) and social learning theories (Akers et al. 1979; Bandura 1969, 1982, 1986) have been integrated into a structural model of smoking influence. The results show that friends' smoking affects adolescent initiation into smoking both directly and indirectly, whereas parental smoking influences smoking initiation only indirectly. The data also show that friends' and parents' smoking affect smoking escalation only indirectly. In general, friends' smoking has a stronger effect on adolescents' smoking behavior, particularly on initiation. Multiple group comparisons of the structural models predicting smoking initiation among males and females reveal that parental approval of smoking plays a significant mediating role for females, but not for males. Comparisons of Whites, Blacks, Hispanics, and other ethnic groups reveal that there are some significant differences in the pathways of friends' influences among the four groups.