Locus of control, self-efficacy perception and treatment adherence in kidney transplant patients.

OBJECTIVE: Among the factors forming the health behavior are the concept of locus of control and the perception of health self-efficacy. Studies investigating self-efficacy beliefs and the impact of health locus of control on immunosuppressive drugs are not adequate in number. Therefore the study sought to determine locus of control, self-efficacy perception and treatment adherence in kidney transplant patients. METHODS: The sample of the study comprised 276 kidney transplant patients who applied to a university hospital. We collected the data using the Personal Information Form, the Multidimensional Health Locus of Control Scale, the Health Self-efficacy Perception Scale and the Compliance to Immunosuppressive Treatment Scale. RESULTS: The study found the patients' mean Multidimensional Health Locus of Control scale external locus of control score to be 21.51 ± 3.74, mean Internal locus of control score to be 21.36 ± 3.92 and mean chance/fate score to be 15.48 ± 5.43. This result in the study demonstrates that kidney transplant individuals tend to believe in external forces in the disease management. The study determined the mean Health Self-efficacy Perception scale score of the kidney transplant patients to be 25.34 ± 3.89 and the patients had moderate level of self-efficacy perception. The study found that the patients' mean Compliance to Immunosuppressive Treatment Scale score was 11.26 ± 0.96 and their immunosuppressive treatment adherence was high but not adequate. The study found a significant negative weak correlation between the Health Self-efficacy Perception scale and the Multidimensional Health Locus of Control scale chance/fate subscale (p < 0.01). The study found no significant correlation between the Health Self-efficacy Perception scale and the Compliance to Immunosuppressive Treatment Scale (p > 0.05). CONCLUSION: In order to increase drug adherence, we recommend that patients be supported to reinforce their self-efficacy perception. It is necessary to develop internal locus of control in kidney transplant patients in terms of treatment adherence and positive health behaviors.

Role of Psychologist in Adolescent Medicine: An International Perspective.

Adolescent Medicine addresses the health care of adolescents, young adults, and their families. Adolescent psychology constitutes an important part. The COVID-19 pandemic has given insight into adolescent needs, bringing the focus on prevention rather than mere correction. One needs to factor in the unique aspects of adolescence, their need to impress peers and gain acceptance, and their unique information processing, not calculating trade-offs between risk and reward the way adults might, in a linear, rational, logical, and verbal manner. The article focuses on the need for collaborative training among the various stakeholders in Child and Adolescent Mental Health.

The Response of More Health Focused and Less Health Focused People to a Physical Activity Calorie Equivalent Label on Discretionary Snack Foods.

A Physical Activity Calorie Equivalent (PACE) label shows the minutes of physical activity required to burn off the caloric content of a particular food. This study investigated the influence of PACE labelling on liking and consumption of discretionary snack foods in a group of more health focused and less health focused consumers. Participants (n = 97) tasted and rated (i.e., liking, prospective consumption) a range of snack foods with or without a PACE label. Total sampling consumption was also measured. Participants completed a shortened version of the International Physical Activity Questionnaire and the General Health Interest Scale questionnaire. Paired samples t-test, independent samples t-tests, a General Linear Model and Chi-Square tests were used to check for statistical significance. For more health focused participants (n = 57), the PACE label decreased only liking (p = 0.02). The PACE label was not effective in reducing liking (p = 0.49), prospective consumption (defined as the amount of the sample participants thought that they could consume) (p = 0.10) or consumption (p = 0.41) of energy-dense discretionary snack foods for less health focused individuals (n = 40). The level of participants' physical activity did not facilitate the influence of PACE labelling on liking, consumption or prospective consumption. The PACE label was found to not be effective among less health focused individuals or the overall sample population. Therefore, the PACE label may not be an effective labelling strategy to reduce the liking or consumption of discretionary snack foods.

Knowledge, Attitudes, and Behaviors Related to Sodium Intake and Reduction Among Adult Consumers in the United States.

PURPOSE: To describe the prevalence and determinants of sodium-related knowledge, attitudes, and behaviors among U.S. adults Design. A cross-sectional survey was used. SETTING: The study was set in the United States in 2012. SUBJECTS: Participants were 6122 U.S. adults. MEASURES: Sodium-related knowledge, attitudes, and behaviors were measured. ANALYSIS: Chi-squared tests were used to determine differences in sodium-related knowledge, attitude, and behaviors by respondent characteristics; multiple logistic regression was used to examine associations between selected respondent characteristics and health professional advice, reported action, or knowledge, attitudes, and behaviors (adjusted for all other respondent characteristics). RESULTS: About three-fourths of respondents answered eating too much sodium is "somewhat" or "very" harmful to their health. Twenty-six percent reported receiving health professional advice, and 45% reported taking action to reduce their sodium intake. The prevalence of reported action was highest among adults receiving advice, those with hypertension, blacks, and those aged ≥65 years. Sixty-two percent who reported action agreed that most of their sodium comes from processed or restaurant foods. Of those reporting action, the most common tactics to reduce sodium intake were checking nutrition labels, using other spices than salt, and choosing low-sodium foods; requesting lower-sodium options when eating out was the least common tactic. CONCLUSION: Results suggest almost half of adults overall and the vast majority of those receiving health professional advice are taking some action to watch or reduce sodium intake. Although a substantial proportion report using recommended tactics to lower intake, many are not using the most effective tactics. In order to reach the general population, health communication messages could be simpler and focus on the most effective tactics to reduce sodium intake. Furthermore, health professionals can help reduce sodium intake by discussing the benefits of sodium reduction and tactics to do so, regardless of a hypertension diagnosis.

Development and Pilot Test of the Workplace Readiness Questionnaire, a Theory-Based Instrument to Measure Small Workplaces' Readiness to Implement Wellness Programs.

PURPOSE: To develop a theory-based questionnaire to assess readiness for change in small workplaces adopting wellness programs. DESIGN: In developing our scale, we first tested items via "think-aloud" interviews. We tested the revised items in a cross-sectional quantitative telephone survey. SETTING: The study setting comprised small workplaces (20-250 employees) in low-wage industries. SUBJECTS: Decision-makers representing small workplaces in King County, Washington (think-aloud interviews, n = 9), and the United States (telephone survey, n = 201) served as study subjects. MEASURES: We generated items for each construct in Weiner's theory of organizational readiness for change. We also measured workplace characteristics and current implementation of workplace wellness programs. ANALYSIS: We assessed reliability by coefficient alpha for each of the readiness questionnaire subscales. We tested the association of all subscales with employers' current implementation of wellness policies, programs, and communications, and conducted a path analysis to test the associations in the theory of organizational readiness to change. RESULTS: Each of the readiness subscales exhibited acceptable internal reliability (coefficient alpha range, .75-.88) and was positively associated with wellness program implementation ( p < .05). The path analysis was consistent with the theory of organizational readiness to change, except change efficacy did not predict change-related effort. CONCLUSION: We developed a new questionnaire to assess small workplaces' readiness to adopt and implement evidence-based wellness programs. Our findings also provide empirical validation of Weiner's theory of readiness for change.

Effects of Smoking Cessation Media and Community Campaigns in Taiwan.

PURPOSE: To examine the effects of a smoking cessation campaign. DESIGN: Data from the 2010-2011 Taiwan Adult Tobacco Surveys were analyzed. SETTING: The study was set among a nationally representative sample of adults in Taiwan. SUBJECTS: The surveys included 16,282 and 16,886 adults in 2010 and 2011, respectively, while our analyses focused on current smokers, 2518 and 2507 adults in 2010 and 2011, respectively. INTERVENTION: In 2010 the Taiwanese government launched a national smoking cessation campaign through mass media in conjunction with community-based smoking cessation programs throughout the nation. MEASURES: Outcome variables include awareness of cessation services, quit attempts, intention to quit, and use of quitting method. ANALYSIS: Multivariate logistic regressions were used to analyze data. RESULTS: The implementation of the national smoking cessation campaign was associated with an increase in awareness of cessation services (odds ratio [OR] = 1.36; 95% confidence interval [CI] = 1.20-1.53), in quit attempts (OR = 1.12; 95% CI = 1.01-1.25), in use of unassisted quitting methods (OR = 1.39; 95% CI = 1.13-1.72), and in intention to quit smoking (OR = 1.15; 95% CI = 1.02-1.30). CONCLUSION: The implementation of the national smoking cessation campaign through media and community programs was effective in increasing smokers' awareness of cessation services, quit attempts, and intention to quit.

Promoting Diet and Physical Activity in Nurses.

OBJECTIVE: To systematically review the effectiveness of intervention studies promoting diet and physical activity (PA) in nurses. DATA SOURCE: English language manuscripts published between 1970 and 2014 in PubMed, Scopus, CINAHL, and EMBASE, as well as those accessed with the PICO tool, were reviewed. STUDY INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria comprised (1) nurses/student nurses working in a health care setting and (2) interventions where PA and/or diet behaviors were the primary outcome. Exclusion criteria were (1) non-peer-reviewed articles or conference abstracts and (2) interventions focused on treatment of chronic conditions or lifestyle factors other than PA or diet in nurses. DATA EXTRACTION: Seventy-one full texts were retrieved and assessed for inclusion by two reviewers. Data were extracted by one reviewer and checked for accuracy by a second reviewer. DATA SYNTHESIS: Extracted data were synthesized in a tabular format and narrative summary. RESULTS: Nine (n = 737 nurses) studies met the inclusion criteria. Quality of the studies was low to moderate. Four studies reported an increase in self-reported PA through structured exercise and goal setting. Dietary outcomes were generally positive, but were only measured in three studies with some limitations in the assessment methods. Two studies reported improved body composition without significant changes in diet or PA. CONCLUSIONS: Outcomes of interventions to change nurses' PA and diet behavior are promising, but inconsistent. Additional and higher quality interventions that include objective and validated outcome measures and appropriate process evaluation are required.

The Introduction of a Supermarket via Tax-Credits in a Low-Income Area.

PURPOSE: Interest and funding continue to grow for bringing supermarkets to underserved areas, yet little is known about their impact. DESIGN: A quasi-experimental study was used to determine the impact of a new supermarket opening as a result of tax and zoning incentives. SETTING: The study took place in the South Bronx, New York City, New York. SUBJECTS: Studied were residents of two South Bronx neighborhoods deemed high need. MEASURES: Food purchasing and consumption were examined via surveys and 24-hour dietary recalls before and at two points after the supermarket opened (1-5, 13-17 months). ANALYSIS: Data were analyzed using difference-in-difference models controlling for gender, race and ethnicity, age, education, marital status, and self-reported income. Ordinary least squares and logistic regression models were estimated for continuous and binary outcomes, respectively. RESULTS: At baseline, 94% to 97% of consumers shopped at a supermarket. There was a 2% increase in this behavior in the intervention community ( p < .05) not seen in the comparison community. One year later there was a 7% net increase in eating at home ( p < .1) and a 20% decrease in drinking sugary beverages ( p < .05), but no appreciable change in fruit/vegetable consumption or overall dietary quality. CONCLUSION: The new supermarket did not result in substantial or broad changes in purchasing patterns or nutritional quality of food consumed, though smaller, positive changes were observed over a 1-year period. Future work should examine different contexts and a broader set of outcomes, including economic development.

Impact of California Children's Power Play! Campaign on Fruit and Vegetable Intake and Physical Activity among Fourth- and Fifth-Grade Students.

PURPOSE: Examine the impact of the Children's Power Play! Campaign on fruit and vegetable (FV) intake and physical activity (PA). DESIGN: Study design was a cluster randomized, controlled trial. SETTING: Forty-four low-resource public schools in San Diego County, California, were included in the study. SUBJECTS: Study subjects comprised a total of 3463 fourth/fifth-graders (1571 intervention, 1892 control), with an 86.9% completion rate. INTERVENTION: Throughout 10 weeks, activities were conducted during/after school, including weekly FV/PA lessons and PA breaks; biweekly classroom promotions/taste tests; posters displayed in/around schools; and weekly nutrition materials for parents. MEASURES: Self-reported FV intake (cups/d) and PA (min/d) were collected at baseline and follow-up using a diary-assisted, 24-hour dietary recall and Self-Administered Physical Activity Checklist. ANALYSIS: Multivariate regression models adjusted for demographics and cluster design effects were used, with change as the dependent variable. RESULTS: Intervention children, compared with controls, showed gains in daily FV intake (.26 cups, p < .001) and PA time at recess/lunch (5.1 minutes, p = .003), but not total daily PA minutes. CONCLUSION: Power Play! can help schools and community organizations improve low-income children's FV intake and PA during recess/lunch.

New Pathways From Short Sleep to Obesity? Associations Between Short Sleep and "Secondary" Eating and Drinking Behavior.

PURPOSE: The association between short sleep and obesity risk is well established. However, we explore a new pathway between short sleep and obesity: whether short sleep is linked to more time spent in secondary eating or drinking, that is, eating or drinking (beverages other than water, such as sugar-sweetened beverages) while primarily engaged in another activity, such as television watching. DESIGN: This pooled cross-sectional study uses data from the American Time Use Survey (ATUS) from 2006 to 2008. SETTING: The study takes place in the United States. SUBJECTS: Subjects are 28,150 adults (55.8% female) aged 21 to 65 who were surveyed in the ATUS. MEASURES: Outcomes are time spent on (1) secondary eating and drinking and (2) primary eating and drinking. Our main predictor variable is sleep duration. ANALYSIS: Controlling for demographic and socioeconomic characteristics of the respondents, we estimate multivariate regression-analysis models for the full sample, as well as by weekday/weekend status, race, and gender subgroups. RESULTS: In multivariate models, compared to respondents reporting normal sleep, short sleep was associated with additional 8.7 (SE = 2.1) minutes per day of secondary eating (p < .01) and additional 28.6 (SE = 4.2) and 31.28 (SE = 5.0) minutes per day of secondary drinking on weekdays and weekends, respectively (p < .01). CONCLUSIONS: We find that short sleep is associated with more time spent in secondary eating and, in particular, secondary drinking. This potentially suggests a pathway from short sleep to increased caloric intake in the form of beverages and distracted eating and thus potential increased obesity risk, although more research is needed.

The Effect of Changes in Physical Activity on Sedentary Behavior: Results From a Randomized Lifestyle Intervention Trial.

PURPOSE: To investigate whether changes in physical activity (PA) have an impact on sedentary behavior (SB) during a lifestyle intervention. DESIGN: Study design was a randomized trial. SETTING/SUBJECTS: Participants (n = 204) were individuals with low PA and high sedentary leisure screen time from the Chicago area. INTERVENTION: Participants were randomized to either increase PA (iPA) or decrease sedentary leisure (dSED). The intervention consisted of decision support, coaching, and financial incentives. For iPA participants, the goal was at least 60 min/d of self-reported moderate-tovigorous-intensity PA (MVPA). For dSED participants the goal was less than 90 min/d of sedentary leisure screen time. MEASURES: Daily accelerometer-based measures of SB and bout-corrected MVPA were obtained. ANALYSIS: Linear mixed-effects models were fit to estimate the effect of the intervention on MVPA and total SB and to estimate the effect of daily changes in MVPA on daily SB. RESULTS: The iPA participants increased their bout-corrected MVPA by 14 min/d (p < .001) and decreased their total SB by 18 min/d (p < .001). The dSED participants did not significantly change their PA or their total SB. On days when participants exercised, each 10-minute bout of MVPA was associated with a 6-minute decrease in SB on the same day (p < .001). CONCLUSION: In an intervention study designed to increase MVPA, participants who increase their time spent exercising will obtain much of this time by reducing their SB.

Active8! Technology-Based Intervention to Promote Physical Activity in Hospital Employees.

PURPOSE: Increase physical activity in health care employees using health messaging, and compare e-mail with mobile phone short-message service (SMS) as delivery channels. DESIGN: Randomized controlled trial Setting. U.K. hospital workplace. SUBJECTS: Two hundred ninety-six employees (19-67 years, 53% of study Web site visitors). INTERVENTION: Twelve-week messaging intervention designed to increase physical activity and delivered via SMS (n =147) or e-mail (n =149); content tailored using theory of planned behavior (TPB) and limited to 160 characters. MEASURES: Baseline and 6, 12, and 16 weeks. Online measures included TPB constructs, physical activity behavior on the Global Physical Activity Questionnaire, and health-related quality of life on the Short-Form 12. ANALYSIS: General linear models for repeated measures. RESULTS: Increase in duration (mean h/d) of moderate work-related activity and moderate recreational activity from baseline to 16 weeks. Short-lived increase in frequency (d/wk) of vigorous recreational activity from baseline to 6 weeks. Increase in duration and frequency of active travel from baseline to 16 weeks. E-mails generated greater changes than SMS in active travel and moderate activity (work and recreational). CONCLUSION: Minimal physical activity promotion delivered by SMS or e-mail can increase frequency and duration of active travel and duration of moderate intensity physical activity at work and for leisure, which is maintained up to 1 month after messaging ends. Both channels were useful platforms for health communication; e-mails were particularly beneficial with hospital employees.

Which Type of Antismoking Advertisement Is Perceived as More Effective? An Experimental Study With a Sample of Australian Socially Disadvantaged Welfare Recipients.

PURPOSE: Evaluate the perceived effectiveness of key antismoking messages among highly disadvantaged smokers and assess the impact of nicotine dependence and cessation cognitions on message processing. DESIGN: The experimental crossover trial, undertaken between March and December 2012, randomly exposed participants to two of three antismoking advertisements delivered via touchscreen computer. SETTING: Welfare recipients were recruited from a community service organization in New South Wales, Australia. SUBJECTS: Subjects were 354 smokers (79% response rate). Participants resided in government rental housing (52%), earned less than AUD$400/wk (72%), and received their primary income from government welfare (95%). INTERVENTION: Three 30-second antismoking television advertisements representing common campaign themes: why to quit (graphic imagery), why to quit (personal testimonial), or how to quit. MEASURES: An 11-item scale assessed perceived effectiveness and message acceptance. An eight-item cessation cognitions index assessed motivations and readiness to quit, and the heaviness of smoking index was used to classify nicotine dependence. ANALYSIS: Descriptive statistics, generalized linear mixed models, and multiple linear regression analyses are reported. RESULTS: Why-to-quit advertisements were perceived as significantly more effective than the how-to-quit advertisement (all p < .0001). Smokers with positive cessation cognitions were more likely to accept antismoking messages (p = .0003) and perceive them as effective (p < .0001). Nicotine dependence level did not influence message acceptance (p = .7322) or effectiveness (p = .8872). CONCLUSION: Highly emotive advertisements providing good reasons to quit may be the most effective in promoting the antismoking message among groups with high smoking rates.

Support for Food and Beverage Worksite Wellness Strategies and Sugar-Sweetened Beverage Intake Among Employed U.S. Adults.

PURPOSE: Sugar-sweetened beverage (SSB) consumption is high among U.S. adults and is associated with obesity. Given that more than 100 million Americans consume food or beverages at work daily, the worksite may be a venue for interventions to reduce SSB consumption. However, the level of support for these interventions is unknown. We examined associations between workday SSB intake and employees' support for worksite wellness strategies (WWSs). DESIGN: We conducted a cross-sectional study using data from Web-based annual surveys that gather information on health-related attitudes and behaviors. SETTING: Study setting was the United States. SUBJECTS: A total of 1924 employed adults (≥18 years) selected using probability-based sampling. MEASURES: The self-reported independent variable was workday SSB intake (0, <1 or ≥1 times per day), and dependent variables were employees' support (yes/no) for the following WWSs: (1) accessible free water, (2) affordable healthy food/drink, (3) available healthy options, and (4) less available SSB. ANALYSIS: Multivariable logistic regression was used to control for sociodemographic variables, employee size, and availability of cafeteria/vending machine. RESULTS: About half of employees supported accessible free water (54%), affordable healthy food/drink (49%), and available healthy options (46%), but only 28% supported less available SSB. Compared with non-SSB consumers, daily SSB consumers were significantly less supportive of accessible free water (adjusted odds ratio, .67; p < .05) or less available SSB (odds ratio, .49; p < .05). CONCLUSION: Almost half of employees supported increasing healthy options within worksites, although daily workday SSB consumers were less supportive of certain strategies. Lack of support could be a potential barrier to the successful implementation of certain worksite interventions.

"Get drunk. Smoke weed. Have fun.": A Content Analysis of Tweets About Marijuana and Alcohol.

PURPOSE: To explore the sentiment and themes of Twitter chatter that mentions both alcohol and marijuana. DESIGN: Cross-sectional analysis of tweets mentioning both alcohol and marijuana during 1 month was performed. SETTING: The study setting was Twitter. PARTICIPANTS: Tweets sent from February 4 to March 5, 2014, were studied. METHOD: A random sample (n = 5000) of tweets that mentioned alcohol and marijuana were qualitatively coded as normalizing both substances, preferring one substance over the other, or discouraging both substances. Other common themes were identified. RESULTS: More than half (54%) of the tweets normalized marijuana and alcohol (without preferring one substance over the other), and 24% preferred marijuana over alcohol. Only 2% expressed a preference for alcohol over marijuana, 7% discouraged the use of both substances, and the sentiment was unknown for 13% of the tweets. Common themes among tweets that normalized both substances included using the substances with friends (17%) and mentioning substance use in the context of sex or romance (14%). Common themes among tweets that preferred marijuana over alcohol were the beliefs that marijuana is safer than alcohol (46%) and preferences for effects of marijuana over alcohol (40%). CONCLUSION: Tweets normalizing polysubstance use or encouraging marijuana use over alcohol use are common. Both online and offline prevention efforts are needed to increase awareness of the risks associated with polysubstance use and marijuana use.

Social Smoking and Mental Health Among Chinese Male College Students.

PURPOSE: China has a high prevalence of smoking, but the characteristics of social smoking in Chinese college students have not been investigated. We examined the pattern of social smoking and explored the association between social smoking and personal cessation efforts and mental health factors among Chinese male college students. DESIGN: Study design was a cross-sectional survey. SETTING: P. R. China was the setting of the study. SUBJECTS: Participants were a random sample of 1327 male college students. MEASURES: All participants completed a self-administered questionnaire that examined their smoking behaviors and a group of specific mental health factors (loneliness, self-harm, suicide, depression, and anxiety). ANALYSIS: Analysis was conducted using descriptive statistics, χ2 analysis, and multivariate logistic regression. RESULTS: Of a total of 207 current smokers, 102 (49.3%) were identified as social smokers. Compared with nonsmokers, social smokers had increased risks for depression (odds ratio, 1.74; 95% confidence interval, 1.15-2.65). Among daily smokers, social smokers were less likely to have an intention to quit smoking than nonsocial smokers (odds ratio, .08; 95% confidence interval, .01-.57). CONCLUSION: This study reveals unique psychologic characteristics related to social smoking. College students are a particular group of interest because unhealthy behaviors initiated during adolescence may continue through adulthood. Our findings provide evidence for future tobacco control intervention among this population.

A Qualitative Examination of Smoke-Free Policies and Electronic Cigarettes Among Sheltered Homeless Adults.

PURPOSE: To examine attitudes toward smoke-free policies and perceptions of e-cigarette use among homeless adults. APPROACH: A cross-sectional qualitative study was conducted. SETTING: Study setting comprised seven transitional homeless shelters with indoor smoke-free policies in San Diego County; facilities differed in outdoor restrictions on smoking. PARTICIPANTS: Sixty-six current or former smokers were the study participants. METHOD: Participants completed a questionnaire on smoking behaviors, perceived antitobacco norms, and attitudes toward smoke-free policies, and attended a focus group interview that explored these topics. We used a directed content analysis approach to analyze the focus group transcripts. RESULTS: Clients in facilities with outdoor restrictions on smoking had stronger perceived antitobacco norms than those in facilities without such restrictions. We identified the following major themes: attitudes toward smoke-free policies, the use of e-cigarettes, the addictive potential of cigarettes, vulnerability to tobacco industry marketing, and interest in smoking cessation. The consensus was that smoke-free policies were important because they limited secondhand smoke exposure to nonsmokers and children. All were curious about e-cigarettes, particularly if they could be smoked in areas where smoking was prohibited and/or used as a cessation aid. CONCLUSION: In this study of homeless adults, there was strong support for indoor and outdoor smoke-free policies. However, misperceptions that e-cigarettes could be used indoors could threaten antitobacco norms, highlighting opportunities to educate about the potential risks of e-cigarette use among homeless individuals.

Telephone-Based Coaching.

PURPOSE: Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations. DESIGN: Retrospective cohort study comparing wellness coaching participants with two groups of controls. SETTING: Kaiser Permanente Northern California, a large integrated health care delivery system. SUBJECTS: Two hundred forty-one patients who participated in telephonic tobacco cessation coaching from January 1, 2011, to March 31, 2012, and two control groups: propensity-score-matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing-based coaching sessions that engaged the patient, evoked their reason to consider quitting, and helped them establish a quit plan. MEASURES: Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up. ANALYSIS: Logistic regressions adjusting for age, gender, race/ethnicity, and primary language. RESULTS: After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, p < .001) and comparable to those of class attendees (31% vs. 29%, p = .28). Coaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, p < .001). CONCLUSION: Telephonic wellness coaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health.

Rural Print Media and a Tailored Advocacy Intervention for Smoke-Free Policy.

PURPOSE: To examine frequency, prominence, and content of local print media after a 4-year policy advocacy intervention. DESIGN: This was a controlled community-based trial. SETTING: The study took place in 39 rural counties (22 intervention, 17 comparison). SUBJECTS: Subjects consisted of 2525 newspaper articles monitored over 18 quarters (July 2007 to December 2011). INTERVENTION: One key element of the tailored policy advocacy intervention delivered by community advisors was building demand for smoke-free policy via media advocacy strategies. MEASURES: Media clips were coded to assess number of articles; percent of tobacco-related articles on the front page or bold heading section; percent of pro-health articles; and percent of articles with secondhand smoke (SHS)-relevant topics or themes. ANALYSIS: Coded data were entered into Atlas.ti software. Article frequencies and attributes were compared between groups and over time using negative binomial regression for longitudinal data, with county-level demographics as covariates. RESULTS: In the last 3 years, there were approximately twice as many articles in intervention than in comparison counties. Media clips from newspapers in intervention counties were between 1.4 and 2 times more likely to have front page placement and percent of relevant topic or theme than were those in comparison counties. There was no difference in rate of pro-health articles by group. CONCLUSION: The policy advocacy intervention to promote smoke-free policy increased media attention to SHS and may have increased public awareness of issues related to smoke-free policy.

Perceptions of Food Intake, Physical Activity, and Obesity Among African-American Children in the Lower Mississippi Delta.

PURPOSE: To explore the nutrition and physical activity perceptions of children for planning a healthy weight curriculum to address childhood obesity in African-American children living in the Lower Mississippi Delta (LMD). DESIGN: Six children's focus group sessions. SETTING: Two Louisiana parishes in the LMD. SUBJECTS: Seventy 8- to 13-year-old African-American children, 46 (66%) females and 24 (44%) males, participated in the focus group sessions. MEASURES: Interview questions were based on personal and environmental determinants and content and strategies for a healthy lifestyle program for children. ANALYSIS: Focus group discussions were audio recorded and transcribed, observer recorded, and analyzed to identify recurring trends and patterns among focus groups. Content analysis consisted of coding focus group transcripts for recurrent themes and review of data by an independent reviewer to confirm the themes. RESULTS: Emerging themes were categorized as healthy lifestyle opinions within the social cognitive theory constructs of personal and environmental determinants and curriculum content. CONCLUSION: LMD youth recognized a healthy eating pattern and that overweight and obesity result from poor eating habits and physical inactivity. Children's food intake pattern did not reflect this understanding, suggesting a need for culturally tailoring an intervention to impact the poor food intake and physical inactivity in two low-income African-American Delta communities.