Lung cancer screening decisional needs among African American smokers of lower socioeconomic status.

OBJECTIVES: Adherence to most evidence-based cancer screenings is lower among African Americans due to system- and individual-level factors that contribute to persistent disparities. Given the recommendation for low-dose computed tomography (LDCT) screening among individuals at high risk for lung cancer, we sought to describe aspects of decision-making for LDCT among African Americans and to examine associations between select components of decision-making and screening-related intentions. DESIGN: African Americans (N = 119) with a long-term smoking history, aged 55-80 years, and without lung cancer were recruited to participate in a cross-sectional survey. We measured knowledge, awareness, decisional conflict, preferences, and values related to lung cancer screening. RESULTS: The majority of the study population was of lower socioeconomic status (67.2% had an annual income of ≤$20,000) and long-term current (79%) smokers. Participants had a median 20 pack-years smoking history. Most participants (65.8%) had not heard of LDCT and the total lung cancer screening knowledge score was M = 7.1/15.0 (SD = 1.8). Participants with higher scores on the importance of the pros and cons of screening expressed greater likelihood of talking with a doctor, family, and friends about screening (p's < .10). CONCLUSIONS: Findings have implications for addressing the decisional needs of lower socioeconomic African American current and former smokers to promote informed decision-making for LDCT.

Correction to: Development of Decisional Values Statements for Lung Cancer Screening among African American Smokers.

The original version of this article unfortunately contained mistakes in Tables 1 and 3.

Development of Decisional Values Statements for Lung Cancer Screening Among African American Smokers.

Lung cancer screening via low-dose computed tomography (LDCT) has been underutilized by high-risk current and former smokers since its approval in 2013. Further, lower use of other evidence-based cancer screening tests (e.g., colorectal cancer, breast cancer) has been noted among African Americans when compared with other racial and ethnic groups. Reasons for low uptake are multilayered but include the need for consideration of patients' personal values about the screening decision. The goal of the present study was to (1) identify positive and negative factors specific to lung cancer screening via LDCT and (2) develop statements to capture values about the screening test for use in a new measure of decisional values. Key informant interviews (n = 9) identified several benefits and risks of lung cancer screening that may be important to African American smokers. Based on these interviews, a pool of items with the values statements was administered to a convenience sample of 119 African Americans [aged 55-80 years, current or former smokers (who quit < 15 years), and without lung cancer]. An exploratory factor analysis revealed two components explaining 64% of the variance: cons of screening (e.g., "make you feel badly about your smoking history") and pros of screening (e.g., "lowering your risk of dying from lung cancer"). The final 12-item measure had very good internal consistency (α = 0.89 overall; α = 0.86 and 0.88 for subscales, respectively). This tool provides a promising values measure for lung cancer screening among African Americans and could inform future values clarification tools promoting informed and shared decision-making.

Social context of drinking among older adults: Relationship to alcohol and traffic risk behaviors.

OBJECTIVE: Alcohol use among older adults is a major public health concern given potentially negative effects to health and functioning in this population. Little is known about context in which alcohol use among older adults occurs, or how context of use is associated with risk behaviors. METHOD: Invitation letters were mailed to licensed drivers 65 years and older in Maryland. A total of 825 participants completed an online survey that assessed demographic characteristics, alcohol use, social context of drinking, and driving behaviors. RESULTS: The analytic sample consisted of 604 older adult current drinkers (55% male). A factor analysis revealed three separate contexts of drinking: social facilitation, emotional comfort, and relaxation. Drinking in the context of social facilitation was associated with driving after drinking. Drinking in the context of emotional comfort was associated with getting drunk, driving after drinking, and running a stop sign or red light. Drinking in the context of relaxation was associated with traffic risk behaviors, including running a stop sign or red light and getting in a near crash or collision. CONCLUSIONS: Understanding the social context of alcohol use among older adults may be useful for targeting and attempting to modify risky alcohol use and driving behaviors.

Medical Students' Beliefs About Screening for Intimate Partner Violence: A Qualitative Study.

Researchers have found that medical students who have received training on intimate partner violence (IPV) report greater comfort with screening for IPV and improved IPV interviewing skills than their counterparts. However, less is known about medical students' beliefs toward screening female patients for IPV and behavioral intention to screen. Semistructured, qualitative interviews were conducted with medical students to assess their beliefs, using the theory of planned behavior and social cognitive theory as theoretical frameworks for the interview questions. Most students felt that screening for IPV could help identify victims but could also potentially offend patients. Perceived barriers to screening included time and negative patient reactions, while perceived facilitators to screening included receiving IPV training and provision of IPV screening questionnaires while interviewing patients. Interviewees identified physicians as both supporters and nonsupporters of IPV screening. Behavioral intention scores ranged from 17 to 50 out of a possible 11 to 55. Findings from the study can help inform the IPV training needs of medical students.

Trait aggression and problematic alcohol use among college students: the moderating effect of distress tolerance.

BACKGROUND: Trait aggression has been linked to alcohol-related problems among college students. However, the individual conditions underlying this association are unknown. Empirical evidence and theory suggest the importance of distress tolerance, defined as an individual's ability to withstand negative affective states, in the relationship between trait aggression and alcohol use. Therefore, the purpose of the current study was to examine whether distress tolerance moderates the relationship between trait aggression and problematic alcohol use. METHODS: Participants were 646 undergraduate students in a large university, who reported any lifetime alcohol use. The dependent variable, problematic alcohol use, was measured using the Alcohol Use Disorders Identification Test total score. The main independent variable, trait aggression, was assessed on the negative emotionality scale of the Multidimensional Personality Questionnaire, and the moderator, distress tolerance, was determined using the Distress Tolerance Scale. RESULTS: Hierarchical linear regression analyses indicated a significant interaction between trait aggression and distress tolerance in predicting problematic alcohol use, adjusting for demographic variables, regular substance use, depressive symptoms, and anxiety symptoms. Specifically, a significant positive relationship between trait aggression and problematic alcohol use was present among those with low, but not high, distress tolerance. CONCLUSIONS: Results provide evidence that college students with high levels of trait aggression are more likely to engage in problematic alcohol use if they also evidence an inability to tolerate negative affective states. Study implications are discussed, including the development of prevention and intervention programs that target distress tolerance skills.

Social contexts of drinking and subsequent alcohol use disorder among college students.

BACKGROUND: Previous research has suggested important contextual factors that can differentiate problem and nonproblem drinkers. OBJECTIVES: To evaluate the strength of the prospective association between social contexts of drinking and subsequent alcohol use disorder and drunk driving 2-3 years later. METHODS: The sample consisted of 652 individuals who were originally recruited at college entry, had complete data on at least one social context subscale, met the minimum criteria for Year 1 drinking, and had nonmissing data on at least one of the outcome variables in Years 3 and/or 4. Social contexts of drinking were assessed in Year 1 by using previously validated scales measuring six different situational and motivational contexts in which alcohol is consumed. DSM-IV criteria for alcohol abuse and dependence and drunk driving were assessed annually. RESULTS: Holding constant gender, race/ethnicity, and baseline drinking frequency, the frequency of drinking in a context of social facilitation, sex-seeking, or in a motor vehicle during Year 1 was significantly related to a greater likelihood of alcohol abuse, alcohol dependence, and drunk driving in Years 3 and/or 4. Drinking in a context of emotional pain was related to alcohol dependence and drunk driving but not to alcohol abuse. CONCLUSIONS: The Social Context of Drinking Scales have utility for identifying students who are at risk for developing alcohol-related problems. SCIENTIFIC SIGNIFICANCE: Identifying college students who might develop alcohol dependence requires an assessment of both situational and motivational factors that influence drinking, especially drinking in a motor vehicle.

Trends in alcohol-related traffic risk behaviors among college students.

BACKGROUND: Alcohol-impaired driving is a major public health problem. National studies indicate that about 25% of college students have driven while intoxicated in the past month and an even greater percentage drive after drinking any alcohol and/or ride with an intoxicated driver. The purpose of this investigation was to examine the change in these various alcohol-related traffic risk behaviors as students progressed through their college experience. METHODS: A cohort of 1,253 first-time first-year students attending a large, mid-Atlantic university were interviewed annually for 4 years. Repeated measures analyses were performed using generalized estimating equations to evaluate age-related changes in prevalence and frequency of each behavior (i.e., ages 19 to 22). RESULTS: At age 19, 17%(wt) of students drove while intoxicated, 42%(wt) drove after drinking any alcohol, and 38%(wt) rode with an intoxicated driver. For all 3 driving behaviors, prevalence and frequency increased significantly at age 21. Males were more likely to engage in these behaviors than females. To understand the possible relationship of these behaviors to changes in drinking patterns, a post hoc analysis was conducted and revealed that while drinking frequency increased every year, frequency of drunkenness was stable for females, but increased for males. CONCLUSIONS: Alcohol-related traffic risk behaviors are quite common among college students and take a significant upturn when students reach the age of 21. Prevention strategies targeted to the college population are needed to prevent serious consequences of these alcohol-related traffic risk behaviors.

Driver experiences with the alcohol ignition interlock: Comparing successful and poor performers.

OBJECTIVES: The purpose of this investigation was to compare the drinking patterns and experiences (both positive and negative) among DUI offenders who had installed an ignition interlock. The association between those experiences and interlock performance as measured by the number of times they had a lockout, was also assessed. METHODS: Over 300 DUI offenders who installed an interlock in the State of Florida were recruited and completed an on-line survey at the beginning and end of their interlock restriction. A record of the interlock performance data from each was downloaded and used to determine how many lockouts they experienced during their interlock restriction period. Offenders were defined into two groups; successful cases (having 0 or 1 lockout) or poor performers (have 2 or more lockouts). Chi-square and binary regressions were used to assess differences between groups. RESULTS: Poor performers reported significantly more drinking and were more likely to drink in a context of emotional comfort, yet they were more likely to report positive experiences with the interlock, especially as to its ability to remind them to avoid another DUI by reducing their drinking and driving. No difference was found between these two groups for the interlock's ability to reduce drinking. CONCLUSIONS: People with a more serious drinking pattern and who may be most at risk for recidivating may be more inclined to recognize the potential benefits of the interlock as a DUI preventive countermeasure. More research is needed to identify and influence high risk DUI offenders while on the interlock to increase its effectiveness once the interlock is removed.

Situational context and motives of alcohol use among graduate student drinkers.

Extensive research has examined alcohol use context and motives among undergraduates, but less is known about where, when, and why graduate students drink. The current study aimed to describe the motives and situational context of graduate student alcohol use, identify demographic and program characteristics associated with alcohol use motives and context, and assess how alcohol use motives and context are associated with alcohol use behavior. A sample of master's and doctoral-level students who drank during the past month (n = 2091; 63% female) completed an online survey. An exploratory factor analysis yielded two situational context factors: drinking in social situations (e.g., with friends, at a bar) and non-social situations (e.g., alone, at home). Graduate students most frequently endorsed social and enhancement drinking motives. Results of multivariate linear regression models showed that age, sex, race/ethnicity, and international student, marital, parental, and employment status were all associated with motives and context. Drinking for enhancement and drinking to cope were the motives most strongly associated with increased alcohol quantity and frequency, respectively. Drinking in social contexts was positively associated with alcohol quantity and frequency, and drinking in non-social contexts was positively associated with alcohol use frequency but inversely related to alcohol quantity. Graduate students who drink for enhancement reasons and in social situations might be at increased risk for higher quantity alcohol use, or graduate students who drink for coping reasons and in non-social situations might be at increased risk for more frequent alcohol use. Future longitudinal research is needed to explore whether drinking in certain contexts and with certain motivations is predictive of alcohol problems during and after graduate school.

Lessons learned from evaluating Maryland's anti-drunk driving campaign: assessing the evidence for cognitive, behavioral, and public health impact.

The evidence concerning Maryland's anti-drunk driving program, Checkpoint Strikeforce, is reviewed. To date, there is no evidence to indicate that this campaign, which involves a number of sobriety checkpoints and media activities to promote these efforts, has had any impact on public perceptions, driver behaviors, or alcohol-related motor vehicle crashes and injuries. This conclusion is drawn after examining statistics for alcohol-related crashes, police citations for impaired driving, and public perceptions of alcohol-impaired driving risk. Comparisons are also made with other states in the mid-Atlantic region, where similar campaign activities have occurred. Reasons for this failure in Maryland include insufficient levels of enforcement (e.g., too few sobriety checkpoints and vehicle contacts occurred to raise public perceptions of risk pertaining to impaired driving) and inadequate publicity surrounding this campaign. Suggestions for overcoming these problems are offered.

Alcohol, Driving, and Health among Community-dwelling Older Adults.

OBJECTIVE: The purpose of this investigation was to examine the relationships among alcohol use, driving behavior, and indicators of health among older adults. METHODS: A sample of 818 adults ages 65 and older were recruited through the state motor vehicle administration and completed an online survey. Regression models were used to assess the associations between alcohol use, driving behaviors, and 6 health indicators. RESULTS: Whereas more frequent alcohol use was associated with fewer health conditions, higher quantity alcohol use was associated with increased likelihood of having at least one health condition. Participants who drove several days a week and those who drove every day had higher perceived health status, a lower number of past-year health conditions, and a lower number of past-year health events when compared to less frequent drivers. Persons who had at least one past-year negative driving behavior or event were significantly less likely to have positive health status, had lower perceived health status, and had a higher number of past-year health conditions and events. CONCLUSIONS: High quantity alcohol use and risky driving behavior among older adults are indicative of poorer health. Continued efforts are needed to educate older adults on the relationships among alcohol use, driving behavior, and health.

Driving concerns among older adults: Associations with driving skill, behaviors, and experiences.

OBJECTIVES: The purpose of this investigation was to determine what older adults find most concerning about driving as they age and how these concerns are related to driving skill, behaviors, and experiences. METHODS: In partnership with the Maryland Motor Vehicle Administration, a sample of 751 older adults ages 65 and older completed an online survey between October 2017 and May 2018. A content analysis was used to code open-ended responses about driver concerns, and multivariate logistic regression models were used to analyze the associations between driving concerns and driving skill, behavior, and experiences. RESULTS: Eighty-four percent of participants reported at least one driving concern, with 44% concerned about others' driving, 34% concerned about their own driving, and 24% concerned about driving conditions. The most frequently mentioned driving concerns were other drivers in general, driving at night, visual ability and awareness, and other drivers being aggressive or reckless. Being concerned with their own driving was significantly associated with decreased perceived driving skill and increased odds of experiencing negative driving experiences in the past year. Being concerned about others' driving was associated with increased odds of wearing a seat belt (adjusted odds ratio [AOR] = 2.67; 95% confidence interval [CI], 1.02, 7.00), having high perceived driving skills in emergency situations (AOR = 1.56; 95% CI, 1.14, 2.12), and getting in a near crash or collision in the past year (AOR = 1.50; 95% CI, 1.04, 2.18). CONCLUSIONS: Older adult drivers are frequently concerned about their own driving as well as the driving of others. Implications for future research and health practice are discussed.

Graduate degree completion: Associations with alcohol and marijuana use before and after enrollment.

Research has shown that alcohol and marijuana use are associated with academic performance difficulties, but the relationship to completion of a graduate degree has not been explored. Undergraduate students (n = 1253) were assessed during their first year of college and annually thereafter until age 29. Among the subset of the original sample who enrolled in graduate school (n = 520), measures of alcohol and marijuana use were averaged separately for the time periods before and after graduate school enrollment. Logistic regression models were developed to examine the associations between these variables and graduate degree completion, adjusting for other factors. In general, a minority of the sample were excessive drinkers or frequent marijuana users. The majority of drinkers (70%) drank an average of twice a week or less each year, and 62% of marijuana users used marijuana once a month or less each year. After adjusting for demographic and program characteristics, marijuana use frequency after graduate school enrollment was negatively associated with odds of graduate degree completion. Alcohol use frequency before graduate school enrollment was positively associated with odds of graduate degree completion. Results add to the growing body of literature on marijuana use and decreased academic achievement, but results should be interpreted with caution given the small, but significant, effect sizes found. The positive association between alcohol use frequency and degree completion might be attributed to engagement in the academic environment. Future studies should examine the potential mechanisms through which alcohol and marijuana use are related to the academic achievement of graduate students.

Substance Use, Academic Performance, and Academic Engagement Among High School Seniors.

BACKGROUND: Substance use is prevalent and is associated with academic performance among adolescents. Few studies have examined the association between abstinence from all substances and academic achievement. METHODS: Data from a nationally representative sample of 9578 12th graders from the 2015 Monitoring the Future survey were analyzed to examine relationships between abstinence from substance use and 4 academic variables: skipping school, grades, academic self-efficacy, and emotional academic engagement. Participants were categorized as lifetime non-users, former users, and past-year users based on the use of 14 substances. RESULTS: Approximately one-fourth of participants had never used cigarettes, alcohol, or other drugs during their lifetime, and 8%wt used at least one substance during their lifetime but not during the past year. Adjusting for demographic variables, past-year substance users had 2.71 greater odds of skipping school during the past month than lifetime non-users and 1.74 greater odds of having low grades. Lifetime non-users reported greater academic self-efficacy and emotional academic engagement than past-year users. CONCLUSIONS: Many 12th graders have abstained from all substance use during their lifetime, and these adolescents experience better academic outcomes than their substance-using peers. Substance use prevention programs should be evaluated as a way to promote academic achievement.

A Mixed Methods Examination of Sleep Throughout the Alcohol Recovery Process Grounded in the Social Cognitive Theory: The Role of Self-Efficacy and Craving.

Sleep disturbances can accompany alcohol use disorders during various phases of the disease. This analysis utilized a mixed methods approach to assess whether sleep-related beliefs and/or behavior of individuals who are alcohol dependent were associated with sleep quality both pre- and postdischarge from a clinical research facility providing inpatient alcohol rehabilitation treatment. Individuals with higher self-efficacy for sleep (SE-S) reported better sleep quality at both time points. Individuals with fewer dysfunctional beliefs about sleep had poorer sleep quality at both time points. Individuals with higher unhealthy sleep-related safety behaviors had poorer sleep quality at both time points. In a linear regression model, only the difference in SE-S scores from pre- to postdischarge (ß = -.396, p = .01) and the postdischarge Penn Alcohol Craving Score (ß = .283, p = .019) significantly predicted the change in sleep quality. Thus, those whose SE-S scores increased and those with lower postdischarge craving scores were more likely to experience a decrease on Pittsburgh Sleep Quality Index scores from pre- to postdischarge even after controlling for covariates. References to behavior or personal factors were often discussed during the qualitative interviews in tandem with the environment. Participants reported both (1) self-medicating anxiety with alcohol and (2) self-medicating the inability to fall asleep with alcohol. Given the success of behavioral sleep interventions in various populations and the unique potential contributions of mixed methods approaches to examine sleep and alcohol use, assessing sleep-related cognitions and behaviors of individuals with severe alcohol use disorders may be important in understanding sleep quality and subsequent relapse.

Social context of drinking and alcohol problems among college students.

OBJECTIVE: To examine how social contexts of drinking are related to alcohol use disorders, other alcohol-related problems, and depression among college students. METHODS: Logistic regression models controlling for drinking frequency measured the association between social context and problems, among 728 current drinkers. RESULTS: Drinking for social facilitation was associated with drinking and driving and housing violations. Drinking in the context of motor vehicles was associated with alcohol abuse/ dependence. Drinking in a context of emotional pain was associated with clinical depression. CONCLUSIONS: Alcohol-free programming that fulfills needs for conviviality and addresses early signs of depression might reduce alcohol problems among college students.

A structural model of alcohol use pathways among Latino youth.

OBJECTIVES: To determine the pathways to alcohol use among adolescents. METHODS: A cross-sectional study of risk and protective factors among a sample of Latino youth (aged 11-13) was conducted. RESULTS: Peer norms and school connectedness had direct pathways to alcohol use. Self-concept was related to peer norms. Youth who were less acculturated were more likely to believe that their peers drank. Family monitoring, connectedness, and academic support did not have direct pathways to alcohol use. CONCLUSIONS: Peer norms appear critical in shaping adolescent involvement with alcohol. The protective influence of family and academic support appear to be indirect.

Motivational factors associated with drowsy driving behavior: a qualitative investigation of college students.

OBJECTIVES: This qualitative investigation sought to identify the motivational factors that contribute to drowsy driving in college students and to discover important messaging strategies that may help prevent or reduce this behavior in this population. DESIGN: Four focus groups of college students. SETTING: A large university in the Washington, DC, metropolitan area during the Fall 2016 term. PARTICIPANTS: Twenty-six undergraduate students between the ages of 18 and 25 years. MEASUREMENTS: Notes and transcripts from the focus group sessions were analyzed to identify recurring themes regarding attitudes, motivations, experiences, influences, and potential preventive messaging strategies related to drowsy driving. RESULTS: Although most participants had heard of drowsy driving and were concerned about it, they did not associate it with legal risks and were more concerned about alcohol-impaired and distracted driving as crash risks. Participants viewed drowsy driving as a normal and unavoidable part of their lives over which they had little control. For potential anti-drowsy driving messaging strategies, participants preferred messages delivered via audiovisual or social media that featured graphic and emotional portrayals of crashes and their consequences. Participants also voiced strong support for preventive messaging strategies equating various degrees of sleep deprivation to known impairing levels of alcohol, as well as messages providing cues to action to actual drowsy drivers on roadways. CONCLUSIONS: Increased enforcement, education, and public messaging campaigns are needed to increase knowledge and influence attitudes and opinions among young drivers about the dangers and social unacceptability of drowsy driving.

Evaluation of Maryland's state police impaired driving reduction effort (SPIDRE).

OBJECTIVE: Alcohol-impaired driving is a significant factor in fatal and serious injury-producing crashes in the United States and many other countries. In 2013, the State of Maryland implemented an anti-driving under the influence (DUI) enforcement program, called the State Police Impaired Driving Reduction Effort (SPIDRE). This enforcement effort consisted of a select team of 7 police officers from the Maryland State Police who engaged in high-intensity driving under the influence (DUI) enforcement. The purpose of this evaluation was to determine the impact of the SPIDRE program on impaired-driving crashes, DUI arrests, DUI adjudicative outcomes, and public perceptions of DUI enforcement. METHODS: Data from alcohol-related crashes, arrests, and adjudicative outcomes of those arrests were used, along with data obtained from public opinion and bar patron surveys, to compare counties where the SPIDRE program operated and non-SPIDRE counties where it did not. The evaluation period extended from 2010 to 2016 in monthly intervals. Autoregressive integrated moving average (ARIMA) methods were used for the data analyses of crashes and arrests. RESULTS: There was no significant reduction in alcohol-related crashes as reported by the police associated with the SPIDRE program. However, there was a statistically significant decrease in the ratio of single-vehicle nighttime to multiple-vehicle daytime crashes in the SPIDRE counties but not in any other counties, suggesting a positive effect using this surrogate measure of impaired-driving crashes. The specific comparison counties as well as the other non-SPIDRE counties in Maryland experienced a statistically significant decrease in DUI arrests during the evaluation period, whereas the SPIDRE counties did not show such a decrease. Further, the arrests made by the SPIDRE team resulted in a significantly higher rate of positive adjudicative outcomes than arrests made by non-SPIDRE officers in those counties where the SPIDRE team operated. There was no evidence that the public was more aware of DUI enforcement efforts in the SPIDRE counties than in the non-SPIDRE counties. CONCLUSIONS: The SPIDRE program appeared able to prevent a downward trend in DUI arrests, experienced by the rest of the state, and achieved higher quality arrests resulting in more positive adjudicative outcomes. The way in which the SPIDRE team was deployed may have lacked sufficient duration and intensity (e.g., only 2-3 months of activity in any given county) to achieve a reduction in alcohol-impaired-driving crashes as reported by the police. It is recommended that the SPIDRE team increase its enforcement activities for at least 9-12 consecutive months in the county where they are employed.