Reducing Unhealthy Normative Behavior: The Case of Sports and Energy Drinks.

American adolescents consume more sugar-sweetened beverages (SSBs) than any other age group. Sports and energy drinks consumption among adolescents is higher than other SSBs. For sports drinks, there is uncertainty about their "healthiness" and also beliefs that these drinks may provide health benefits such as hydration, enhanced athletic performance, heightened mental alertness, and rapid recovery after exercise. Confusion about relative healthiness and expectations of health benefits suggest that factors that may encourage youth to avoid drinking sports and energy drinks, such as athletic status, psychological reactance, and SSB media literacy, may necessitate different approaches to promoting avoidance of sports drinks compared with avoidance of energy drinks. Using a nationally representative U.S. probability-based web panel augmented by a volunteer nonprobability-based web panel of 500 adolescent participants aged 14 to 18 years, we used the reasoned action approach to model intention to avoid sports and to avoid energy drinks. The result show there are similarities and differences in the determinants associated with adolescents' avoidance of sports and energy drinks: attitudes and descriptive normative pressure are both related to increased avoidance for both types of drinks and perceived control over the avoidance behavior is positively associated for with intention to avoid for energy drinks. Sport identification, psychological reactance, and SSB media literacy also play a different role in the sports and energy drink models. Based on our results, the content of prevention messages in interventions to limit sports drinks will need to be quite different from those targeted at reducing energy drink consumption.

Athletes Drink Gatorade: DMA Advertising Expenditures, Ad Recall, and Athletic Identity Influence Energy and Sports Drink Consumption.

Understanding why sports and energy drinks remain increasingly popular among adolescents despite declines in other sugar sweetened beverages is critical. This study points to memory for advertising exposure and adolescent athletic identity as two aspects that together help to explain consumption. An online survey of U.S. adolescents aged 14-18 (n = 503) was combined with Nielsen data for television and social media advertising expenditures by sports and energy drink brands in participants' designated market areas (DMAs). Advertisement recall mediates the relationship between social media DMA expenditures and sports and energy drink consumption. Recall for television advertisements is related to consumption but is unrelated to television DMA expenditures. Athletic identity moderated the relationship between recall and consumption such that consumption increased as both recall and athletic identity increased, suggesting a role for motivated memory and motivated processing of ad messages based on athletic identity consistent with the limited capacity model of motivated media message processing. Based on these results, we conclude that effectiveness of expenditures in influencing behavior is dependent upon both ad recall and ad relevance, and that athletic identity is an important factor in ad effectiveness in the context of sports and energy drinks advertising.

How Patterns of Learning About Sexual Information Among Adolescents Are Related to Sexual Behaviors.

CONTEXT: Parents, peers and media are informal sources of sexual information for adolescents. Although the content of sexual information communicated by these sources is known to vary, little is known about what adolescents report actually learning from each source. METHODS: Data from 1,990 U.S.14-17-year-olds who participated in an online survey in 2015 were used to assess learning about four topics (sex, condoms, hormonal birth control and romantic relationships) from three informal sources (parents, peers, and television and movies). Gender and race differences in learning by source and topic were assessed using t tests. Following a factor analysis, learning about all topics was grouped by source, and regression analyses were conducted to examine associations between learning from each source and three outcomes: sexual activity, condom use and hormonal birth control use. Models included interactions between information sources and race and gender. RESULTS: White adolescents reported learning more from parents and less from media than black adolescents. Compared with males, females learned more about hormonal birth control and less about condoms from their parents, and more about relationships from peers and media. Learning from parents and from peers were positively associated with adolescents' sexual activity (unstandardized coefficients, 0.26 and 0.52, respectively). Learning from parents was positively associated with condom use (odds ratio, 1.5). CONCLUSION: Adolescents' learning about sex from informal sources varies by race and gender. Future research should examine whether sexual health interventions and message development can capitalize on these differences.

Improving the Consent Process in Foot and Ankle Surgery With the Use of Personalized Patient Literature.

A patient-specific letter was introduced to the consent process to observe the effect, if any, on information recall and satisfaction for patients undergoing elective foot and ankle surgery. The patients attending the clinic were written a personalized letter-this was a simple personalized letter that outlined their treatment options, the proposed management plan, likely treatment course, and the benefits, risks, and likely period required for recovery. The personalized letter system was compared with the 2 existing methods of consent process: signing for consent at their outpatient encounter at which they were scheduled for surgery and a separate consent clinic without the personalized letter. A total of 111 patients (87 females, 24 males) undergoing elective foot and ankle surgery were assessed on the day of surgery for recall of the procedure, risks, postoperative course, and satisfaction with the consent process. Patients receiving a personalized letter recalled more than those who had attended a routine preoperative consent clinic visit and significantly more than those who had provided consent at their last clinic visit. Patient satisfaction with the consent process was also greater in the personalized group. Our results suggest that the consent process is improved using routine preoperative consent clinics and, most notably, with patient-specific information to improve patient recall and satisfaction.

Differences in the Portrayal of Health Risk Behaviors by Black and White Characters in Popular Films.

Adolescent exposure to risk in film has been associated with behavior. We coded Black and White character involvement in sex, violence, alcohol use, and tobacco use, and combinations of those behaviors in popular mainstream and Black-oriented films (film n = 63, character n = 426). Health risk portrayals were common, with the majority of characters portraying at least one. Black characters were more likely than Whites to portray sex and alcohol use, while White characters were more likely to portray violence. Within-segment combinations of sex and alcohol were more prevalent for Black characters, while violence and alcohol were more prevalent for Whites. Throughout a film, Black characters were more likely than White characters to portray sex and alcohol, sex and tobacco, and alcohol and tobacco. Risky behaviors are prevalent, but types portrayed differ between Black and White characters. This may have implications for health disparities in Black and White adolescents.

Influence of education and diagnostic modes on glaucoma assessment by optometrists.

PURPOSE: To evaluate the influence of different clinical examination techniques, including optic nerve head (ONH) photography, visual field tests, and adjunct imaging on the diagnosis of glaucoma by Australian and New Zealand optometrists. The effect of a short-term, didactic teaching module on these is also explored. METHODS: Clinical data of 30 patients previously seen at the Centre for Eye Health was collected and compiled into glaucoma diagnostic assessment modules. Each of six modules contained different combinations of clinical examination results and required a classification of the cases as normal, suspicious or glaucoma. A cohort of 54 Australian and New Zealand optometrists were recruited for the study and allocated into two cohorts. The intervention group completed a glaucoma training course prior to the assessment while the control group completed the assessment without additional training. Diagnostic accuracy was compared between modules and optometrist groups. RESULTS: High false negative rates were observed with ONH photography, which were drastically reduced with the addition of visual field, albeit at the cost of increased false positive rates. Addition of adjunct imaging techniques partially compensated for the increase in the false positive rate from the visual field, but had limited effect on false negative rate. Educational intervention resulted in larger improvement in the diagnostic ability when multiple imaging modalities were provided. CONCLUSION: The study highlighted the importance of combining both structural and functional assessments in glaucoma. Current imaging technology demonstrated limited usefulness for event diagnosis due to the persistent difficulties of defining structural and functional loss in glaucoma, thus highlighting the need for new glaucoma assessment techniques. Short-term didactic teaching programs may only result in limited improvement of glaucoma diagnostic ability in optometrists, and hence, it may need to be combined with long-term and/or non-didactic training components to obtain a greater effect.

When it comes to lifestyle recommendations, more is sometimes less: a meta-analysis of theoretical assumptions underlying the effectiveness of interventions promoting multiple behavior domain change.

A meta-analysis of 150 research reports summarizing the results of multiple behavior domain interventions examined theoretical predictions about the effects of the included number of recommendations on behavioral and clinical change in the domains of smoking, diet, and physical activity. The meta-analysis yielded 3 main conclusions. First, there is a curvilinear relation between the number of behavioral recommendations and improvements in behavioral and clinical measures, with a moderate number of recommendations producing the highest level of change. A moderate number of recommendations is likely to be associated with stronger effects because the intervention ensures the necessary level of motivation to implement the recommended changes, thereby increasing compliance with the goals set by the intervention, without making the intervention excessively demanding. Second, this curve was more pronounced when samples were likely to have low motivation to change, such as when interventions were delivered to nonpatient (vs. patient) populations, were implemented in nonclinic (vs. clinic) settings, used lay community (vs. expert) facilitators, and involved group (vs. individual) delivery formats. Finally, change in behavioral outcomes mediated the effects of number of recommended behaviors on clinical change. These findings provide important insights that can help guide the design of effective multiple behavior domain interventions.

The effect of household smoking bans on household smoking.

OBJECTIVES: Because household smoking levels and adoption of domestic smoking rules may be endogenously related, we estimated a nonrecursive regression model to determine the simultaneous relationship between home smoking restrictions and household smoking. METHODS: We used data from a May-June 2012 survey of Philadelphia, Pennsylvania, households with smokers (n = 456) to determine the simultaneous association between smoking levels in the home and the presence of home restrictions on smoking. RESULTS: We found that home smoking rules predicted smoking in the home but smoking in the home had no effect on home smoking restrictions. CONCLUSIONS: Absent in-home randomized experiments, a quasi-experimental causal inference suggesting that home smoking rules result in lower home smoking levels may be plausible.

Increasing quality of life and reducing HIV burden: the PATH+ intervention.

The heightened risk of persons with serious mental illness (SMI) to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Our objective was test the effectiveness of a community-based advanced practice nurse intervention to promote adherence to HIV and psychiatric treatment regimens call Preventing AIDS Through Health for Positives (PATH+). We enrolled 238 HIV-positive subjects with SMI who were in treatment at community HIV provider agencies from 2004 to 2009. Participants in the intervention group were assigned an advanced practice nurse who provided community-based care management at a minimum of one visit/week and coordinated their medical and mental healthcare for 12 months. A parallel process latent growth curve model using three data points for biomarkers (baseline, 12 and 24 months) and five data points for health related quality of life (baseline, 3, 6, 12, and 24 months) showed moderate to excellent fit for modeling changes in CD4, viral load, and mental and physical SF-12 subscales. Results suggest that positive effects for PATH+ persisted at 24 months; 12 months after the intervention ended. This project demonstrates the effectiveness of a nurse-led, community-based, individually tailored adherence intervention. We demonstrated improved outcomes in individuals with HIV/SMI and regarding health-related quality of life and reductions in disease burden.

The value of clinical electrophysiology in the assessment of the eye and visual system in the era of advanced imaging.

Electrophysiological techniques allow clinical investigations to include a 'dissection' of the visual system. Using suitable electrophysiological techniques, the 'dissection' allows function to be ascribed to the different photoreceptors (rod and cone photoreceptors), retinal layers, retinal location or the visual pathway up to the visual cortex. Combined with advances in genetics, retinal biochemistry, visual fields and ocular imaging, it is now possible to obtain a better understanding of diseases affecting the retina and visual pathways. This paper reviews core electrophysiological principles that can complement other examination techniques, including advanced ocular imaging, and help the interpretation of other clinical data and thus, refine and guide clinical diagnosis.

Social buffering of the stress response: diversity, mechanisms, and functions.

Protracted or repeated activation of the hypothalamic-pituitary-adrenocortical (HPA) system is associated with a variety of physical and psychological pathologies. Studies dating back to the 1970s have documented many cases in which the presence of a social companion can moderate HPA responses to stressors. However, there also are many cases in which this "social buffering" of the HPA axis is not observed. An examination of the literature indicates that the nature of the relationship between individuals is crucial in determining whether or not social buffering of the HPA response will occur. Other factors that affect social buffering, either directly or by influencing the social relationship, include the social organization of the species, previous experience, gender, integration into a social unit, and the developmental stage at which individuals are examined. Current evidence suggests that social buffering involves mechanisms acting at more than one level of the CNS. It is suggested that, in addition to promoting health, social buffering may have evolved to direct the establishment of social relationships, and to facilitate developmental transitions in social interactions appropriate for different life stages.

Public opinion on sex education in US schools.

OBJECTIVE: To examine US public opinion on sex education in schools to determine how the public's preferences align with those of policymakers and research scientists. DESIGN: Cross-sectional survey. SETTING: July 2005 through January 2006. PARTICIPANTS: Randomly selected nationally representative sample of US adults aged 18 to 83 years (N = 1096). MAIN OUTCOME MEASURES: Support for 3 different types of sex education in schools: abstinence only, comprehensive sex education, and condom instruction. RESULTS: Approximately 82% of respondents indicated support for programs that teach students about both abstinence and other methods of preventing pregnancy and sexually transmitted diseases. Similarly, 68.5% supported teaching how to properly use condoms. Abstinence-only education programs, in contrast, received the lowest levels of support (36%) and the highest level of opposition (about 50%) across the 3 program options. Self-identified conservative, liberal, and moderate respondents all supported abstinence-plus programs, although the extent of support varied significantly. CONCLUSIONS: Our results indicate that US adults, regardless of political ideology, favor a more balanced approach to sex education compared with the abstinence-only programs funded by the federal government. In summary, abstinence-only programs, while a priority of the federal government, are supported by neither a majority of the public nor the scientific community.

Social organization predicts nature of infant-adult interactions in two species of wild guinea pigs (Cavia aperea and Galea monasteriensis).

The authors compared interactions of infants with mothers and unfamiliar females in a novel environment in 2 caviomorph rodent species: the harem-living Cavia aperea, the probable progenitor of the domestic guinea pig; and the pair-living Galea monasteriensis. In C. aperea, interactions with mothers and unfamiliar females were largely similar; in G. monasteriensis, interactions with the mother, but not unfamiliar female, were characterized by physical closeness and sociopositive behavior. In G. monasteriensis, plasma cortisol levels were lower when with the mother than when with the unfamiliar female. Results are consistent with the species' social organizations and suggest that behavioral interactions of pups with mothers and other females in domestic guinea pigs reflect primarily the social organization of the progenitor species rather than domestication.

The cost-effectiveness of the WINGS intervention: a program to prevent HIV and sexually transmitted diseases among high-risk urban women.

BACKGROUND: We evaluated the cost-effectiveness of the WINGS project, an intervention to prevent HIV and other sexually transmitted diseases among urban women at high risk for sexual acquisition of HIV. METHODS: We used standard methods of cost-effectiveness analysis. We conducted a retrospective analysis of the intervention's cost and we used a simplified model of HIV transmission to estimate the number of HIV infections averted by the intervention. We calculated cost-effectiveness ratios for the complete intervention and for the condom use skills component of the intervention. RESULTS: Under base case assumptions, the intervention prevented an estimated 0.2195 new cases of HIV at a cost of $215,690 per case of HIV averted. When indirect costs of HIV were excluded from the analysis, the intervention's cost-effectiveness ratios were $357,690 per case of HIV averted and $31,851 per quality-adjusted life year (QALY) saved. Under base case assumptions, the condom use skills component of the intervention prevented an estimated 0.1756 HIV infections and was cost-saving. When indirect HIV costs were excluded, the cost-effectiveness ratios for the condom use skills component of the intervention were $97,404 per case of HIV averted and $8,674 per QALY saved. CONCLUSIONS: The WINGS intervention, particularly the two sessions of the intervention which focussed on condom use skills, could be cost-effective in preventing HIV among women.