Posttraumatic stress disorder and extent of trauma exposure as correlates of medical problems and perceived health among women with childhood abuse.

This study examined the relative contributions of Posttraumatic Stress Disorder (PTSD) symptoms and the extent of trauma exposure as factors contributing to the current health status of childhood abuse survivors. Sixty-seven women with a history of familial childhood abuse (sexual and/or physical) and twenty-nine women with no abuse history were assessed on two distinct aspects of health status: reported number of medical problems and perceptions of overall health. Women with abuse were found to have a greater number of medical problems and poorer perceived physical well-being than the no abuse comparison group. Regression analyses of the women with abuse histories revealed that trauma exposure was a stronger predictor than PTSD symptoms of medical problems. PTSD symptoms, however, were better predictors of the experience of physical well-being than trauma exposure. These results suggest that the nature of a traumatic exposure, especially when there is repeated, cumulative trauma may be more significant to medical problems than the psychological symptoms of PTSD. Perceived health, however, appears to be predominantly influenced by psychological factors, suggesting the importance of these variables in the quality of life of multiply traumatized women.

Eating attitudes and behaviors in pregnancy and postpartum: global stability versus specific transitions.

Global changes in eating attitudes were examined prospectively across pregnancy and 4 months postpartum in a sample of 90 women. In addition, specific changes in dieting behavior and weight/shape satisfaction were assessed at 4 months postpartum for concurrent and retrospective time points. Measures included the Eating Attitudes Test (EAT) and weight/shape satisfaction in pregnancy and at 4 months postpartum, as well as prepregnancy, pregnancy, and postpartum weight loss efforts. While global EAT scores were stable across time, dieting scores (Factor I) increased between pregnancy and postpartum. Weight/shape satisfaction was higher in pregnancy, and satisfaction was related to EAT scores at 4 months postpartum but not during pregnancy. Prepregnancy dieters and nondieters were best discriminated by higher weights, elevated pregnancy dieting scores, and lower postpartum weight/shape satisfaction. Results emphasize the importance of looking beyond changes in global eating attitudes and behaviors to more specific eating concerns or behaviors. Lastly, the results have implications for identifying women at risk for eating- and weight-related concerns during this period of rapid physical change.

Unsafe motor vehicle practices among substance-using college students.

This study examines the relationship between substance use and behaviors that increase the risk for motor vehicle crashes and crash-related injuries. The investigation uses National College Health Risk Behavior Survey data collected in 1995 by the Centers for Disease Control and Prevention. These data are representative of 2- and 4-year undergraduate college students in private and public colleges and universities in the United States. Smokers, episodic heavy drinkers, marijuana users and users of illegal drugs in combination with alcohol were significantly more likely to drive after drinking alcohol and ride with a driver who had been drinking alcohol and significantly less likely to wear safety belts while driving or while riding in a car as a passenger. This study indicates that college students who are substance users are more likely to behave in a manner which increases their risk for motor vehicle crashes and motor vehicle crash injuries.

Barriers to pediatric injury prevention counseling.

OBJECTIVES: Physicians cite numerous barriers to incorporating injury prevention counseling into routine care. Health behavior models suggest that beliefs about barriers are associated with physician characteristics. This study explores associations between physician characteristics and physician perceptions of barriers. METHODS: Self administered structured questionnaires were sent to all five North Carolina (United States) pediatric residency programs. A total of 160 (72%) physicians training in pediatrics or medicine-pediatrics in these programs replied. Associations between perceived barriers and knowledge, gender, training, experience, and correlation between perceived barriers and other physician beliefs about injury prevention counseling, were measured. RESULTS: Although most residents believed that talking to parents about injury prevention during routine visits was important, they felt they lacked time, did not think to ask parents about injury prevention, or had more important things to do. The more importance residents placed on asking parents about hazards, the less the extent to which barriers were perceived (r = 0.32). Barriers were perceived to a greater extent by residents who thought their preceptors did not expect them to counsel about injury prevention (r = 0.28), lacked confidence that their counseling helped parents (r = 0.32), or felt uncomfortable counseling parents about injury prevention (r = 0.18). Knowledge, residency year, training, and previous experience with injury were not related to perceived barriers. CONCLUSIONS: Residency programs should teach the importance of injury prevention; provide opportunities for residents to become comfortable talking with parents about this; and train residents in the appropriate use of counseling as one strategy for addressing injury prevention.

Injuries and violence: risk factors and opportunities for prevention during adolescence.

More adolescent in the United States die from injuries than from any other cause. This chapter describes the three leading causes of death among adolescents-interpersonal violence, suicide, and motor vehicle-related injuries. The authors examine risks associated with alcohol use and access to firearms as well as injuries that occur at work and while playing sports, and end with recommendations for preventing adolescent injuries for health care providers, schools and communities.

School violence, substance use, and availability of illegal drugs on school property among US high school students.

To determine if school violence is associated with substance use and availability of illegal drugs at school, this study examined data from the 1995 Youth Risk Behavior Survey, a nationally representative sample of 10,904 high school students. Adjusted odds ratios were calculated to describe the associations of tobacco, alcohol, and marijuana use (on and off school property), and availability of illegal drugs at school with five indicators of school violence--weapon-carrying, physical fighting, having property stolen or damaged, being threatened or injured, and being absent from school because of feeling unsafe. School violence indicators increased with the number of substances used and the location of use (on school property vs. off school property). School violence was associated with availability of illegal drugs at school, even among students who did not use substances. These findings suggest a need for coordinated violence and substance use prevention programs for youth in school and community settings.

Social determinants of pediatric residents' injury prevention counseling.

BACKGROUND: Social norms imparted by preceptors and the requirements necessary to pass American Board of Pediatrics' examinations are potentially important contributors to physician behavior. OBJECTIVE: To explore the relationships between perceived professional norms regarding injury prevention and the injury prevention topics discussed, and counseling strategies employed, by pediatric residents. DESIGN: A self-administered survey. SETTING: All 5 North Carolina pediatric residency programs. PARTICIPANTS: Physicians training in pediatrics or medicine-pediatrics in these programs (N = 160, 72% response rate). MAIN OUTCOME MEASURE: Correlation between perceived professional norms and self-reported content of injury prevention counseling and use of behavior change strategies. RESULTS: Although 95% of the pediatric residents reported counseling all or almost all parents with children younger than 1 year about car seat use, only 19% reported counseling this many parents about gun safety. Of the 7 behavior change strategies that residents were asked about, respondents were most likely to report "showing approval for safe behaviors" to all almost all parents (78%). Two thirds reported asking all or almost all parents about the safety of their homes. Pediatric residents' reported injury prevention counseling was correlated with their perceived professional norms regarding such counseling for most of the content areas and behavior change strategies. CONCLUSIONS: Perceived professional norms regarding injury prevention are related to pediatric residents' counseling, Preceptors should be aware that they transmit professional norms to residents. Also, the American Board of Pediatrics can increase residents' attention to injury prevention by informing them that it will be a topic included in the board examination.

Home visitors' beliefs and practices regarding childhood injury prevention.

Injuries are the leading cause of death for children under age 19. Prevention efforts focus on eliminating hazards or changing individuals' behavior. Few interventions address psychosocial factors that contribute to injuries. Home visiting programs target families' functioning and help parents overcome, barriers that inhibit their readiness and ability to address injury prevention. This study, a telephone interview with 87 public health nurses and social workers, assessed home visitors' preparedness to address childhood injury prevention, their practices and factors influencing their ability to undertake injury prevention activities. Results showed that 41% of home visitors talked to parents about injury prevention during visits. To identify hazards, most visitors (81%) assessed the home environment as they did other things; 51% never used a home safety checklist. Most home visitors discussed hot water temperature (82%), smoke detectors (76%), and firearms (50%). To respond to hazards, most relied on verbal education. Other priorities and time constraints were major barriers to injury prevention activities. Home visitors' beliefs in the importance of injury prevention and willingness to implement strategies suggest that home visiting can be an effective delivery strategy for injury prevention. It is important to consider how to include, in a systematic manner, injury prevention in home visitor training.

Teens at work: a statewide study of jobs, hazards, and injuries.

PURPOSE: Occupational injury is an ongoing and serious threat to American youth. However, little is known about the environments in which youth work or the hazards to which they are exposed. The purpose of this study was to document the patterns of work, exposures to hazardous equipment and situations, and work-related injury experiences of adolescents. METHODS: We identified a statewide targeted sample of North Carolina households with teens age 14-17 years and interviewed those who had ever worked for pay or worked on a farm. RESULTS: Five hundred sixty-two teens from 700 eligible households reported that they had worked non-farm jobs for pay. One-third were paid for work before age 14 years; two-thirds had held more than one paid job. Place of employment was most often someone's home, a retail store, or a restaurant. Common jobs were lawn care worker, cashier, and dishwasher. Common hazards to which teens were exposed included ladders or scaffolding; forklifts, tractors or riding mowers; and working around loud noises. Over half were injured at least once while working a paid job, most often from being cut or burned. CONCLUSIONS: Work among youth is common. Teens hold a variety of jobs, mostly in the retail trade and the service sector, exposing them to hazardous equipment and situations. Injuries at work are frequent and some are serious. This study supports the need to include an occupational history and work-related safety counseling in clinical encounters with adolescents.

Pediatric injury prevention counseling priorities.

OBJECTIVE: Child health care providers have a unique opportunity to conduct injury prevention counseling but limited empirical evidence for choosing prevention strategies. Efficient use of time requires that prevention strategies of higher priority be discussed before lower priority strategies. Our aim was to assess consensus among experts about the prioritization of prevention strategies for office based injury prevention counseling for parents of children under age two. DESIGN: We used a modified Delphi technique with 23 childhood injury prevention experts nationwide. Participants were blinded to the identities of each other. MEASURES: The first questionnaire, distributed via facsimile transmission, consisted of open ended questions about prevention strategies participants believe should be included and their prioritization methods. The second questionnaire was closed ended and based on the results of the first. RESULTS: Seventeen injury problems and 21 prevention strategies were suggested for counseling. Participants emphasized environmental strategies over more active, educational ones. Motor vehicle occupant injuries and car seats were given high priority scores by all participants. Smoke detectors, lowering the hot water heater temperature, and pool fencing also received high priority ratings. Participants based their decisions on the severity of the injury, the frequency with which the injury occured, and the availability of environmental strategies. However, they disagreed about the relative importance of these factors. Time constraints and parents' inability to absorb information led them to suggest limiting, to fewer than four, the number of prevention strategies addressed at any one visit. CONCLUSIONS: This study illustrates areas of consensus as well as unresolved dilemmas about pediatric injury prevention counseling. A rational decision making approach to prioritizing elements of clinical counseling is needed. Meanwhile, clinicians can use the findings of this study to derive their own judgments.

Psychological treatment of bulimia nervosa and binge eating disorder.

The field of eating disorders has grown rapidly, amassing an impressive body of treatment research in the past 20 years. In particular, researchers have focused on binge eating problems, which include bulimia nervosa (BN) and the more recently recognized binge eating disorder (BED). Numerous controlled treatment trials have shown cognitive-behavioral therapy (CBT) to be equally or more efficacious than any other BN treatment to which it has been compared. Although CBT also seems to be effective for BED, research is in a preliminary stage. Further combinations and adaptations of treatments for BED are needed to address the additional problem of obesity in this population. Preliminary data suggest that behavioral weight control treatment for BED is effective in reducing binge eating, and it may have the added benefit of weight loss. Interpersonal psychotherapy (IPT), the combination of CBT and medication, and self-help manuals are promising treatment alternatives for both BN and BED. Future treatment trials should include longer-term followup periods and more consistent definitions of successful treatment outcome. In addition, further study is needed in the areas of treatment nonresponders, pre-treatment predictors, a stepped-care treatment model, and methods for a wider dissemination of validated treatments.

Farm work is dangerous for teens: agricultural hazards and injuries among North Carolina teens.

Children who work in agriculture suffer more than 23,000 injuries and 300 fatalities on American farms every year. Using survey data collected from a random sample of working teens (ages 14 to 17) in North Carolina, the authors analyze the farm-based hazard exposure and injury experiences of teens who work on farms. The group of farmworking teens (N = 141) is 72 percent male, has a mean age of 16.6 years, and is, on average, in the 10th grade. The data show that teens working on farms in North Carolina are exposed to significant safety hazards throughout their farmworking careers. A majority of the respondents in this group of farmworkers reported exposure to tractors, large animals, all-terrain vehicles, farm trucks, and rotary mowers, and more than one-third reported exposure to pesticides and tobacco harvesters. Common reported injuries include insect stings, cuts, burns, and falls. The researchers find that gender, age, and farmwork experiences are related to variations in types of hazards to which teens are exposed and in the types of injuries they suffer. These variables also are related to the overall complexity of the teens' farmwork experiences and the burden of injury endured by teens.

Work patterns and occupational hazard exposures of North Carolina adolescents in 4-H clubs.

OBJECTIVES: This study documents sex differences in work patterns, injuries, and hazard exposures among adolescents in homes, farms, and other work sites. METHODS: 14 to 17 year old 4-H club members were asked to complete self administered questionnaires regarding their lifetime experience of work, hazard exposure, and injuries. RESULTS: Of 323 respondents, more than two thirds had ever worked paid jobs. Fifty seven per cent were injured during non-farm work and hazards were part of the non-farm work environment for 54% of the respondents. Males were more likely to work in hazardous conditions, including operating heavy equipment on farms or construction sites. Almost three quarters of the teens who worked on farms reported being injured there and 100% were exposed to at least one farm hazard. CONCLUSIONS: Adolescents perform jobs at homes, farms, or other work sites where they are exposed to numerous safety hazards. Prevention efforts should target specific hazards youths are exposed to rather than the general work site.

The future of the national laboratories.

The end of the Cold War has called into question the activities of the national laboratories and, more generally, the level of support now given to federal intramural research in the United States. This paper seeks to analyze the potential role of the laboratories, with particular attention to the possibility, on the one hand, of integrating private technology development into the laboratory's menu of activities and, on the other hand, of outsourcing traditional mission activities. We review the economic efficiency arguments for intramural research and the political conditions that are likely to constrain the activities of the laboratories, and analyze the early history of programs intended to promote new technology via cooperative agreements between the laboratories and private industry. Our analysis suggests that the laboratories are likely to shrink considerably in size, and that the federal government faces a significant problem in deciding how to organize a downsizing of the federal research establishment.

Adherence to dietary regimens. 1: An overview of research.

In recent government reports, scientists have highlighted the link between diet and health and have concluded that dietary changes could reduce risks for some major chronic illnesses (ie, cancer and cardiovascular disease). As a result, the feasibility of lasting dietary change has become a central concern. Despite mixed findings from dietary adherence studies, there is evidence that meaningful dietary modification and adherence are possible, although not easily accomplished. Psychological, cultural, environmental, and behavioral factors exert an influence on whether individuals try to change their eating habits. Given the complex interaction between these factors, it is not surprising that education alone rarely produces lasting change. To develop comprehensive approaches to dietary management, practitioners must integrate theoretical and empirical information across a number of fields. In addition to focusing on individual behavior change, the authors suggest, those concerned with the nation's health should give serious consideration to the possibility of changes at the policy level.

Adherence to dietary regimens. 2: Components of effective interventions.

Diet has an important impact not only on health but also on daily functioning, cognitive performance, and, perhaps, psychological well-being. Much is known about the specific dietary changes necessary to improve these factors, yet it becomes ever more clear that information about proper diet is rarely sufficient to change dietary behavior. Interventions aimed at changing diet must consider the typical dietary practices of the population in question and, as a corollary, must deal with the cultural obstacles to eating the "proper" foods. Psychological factors are paramount in setting the stage for dietary change. These include the individual's perception of being at risk, perceived benefits of a change in diet, confidence that the necessary change can be made, and the symbolic and real role food plays in a person's life. Nutrition education has traditionally focused on what changes should be made, and behavioral psychology has emphasized how to make the changes. These two fields must come together, and there must be recognition that nutrition education can provide necessary information, and behavioral change strategies can provide the necessary skills. There is now a considerable amount of information on strategies for nutrition education and on principles and techniques for behavioral change. Many intervention programs to alter dietary behavior have been undertaken. These have varied from programs aimed at an entire country, such as the National Cholesterol Education Program in the United States, to programs aimed at individuals. Although these vary considerably in size, strategy, and effects, collectively they yield valuable information on effective methods for changing behavior and for maintaining behavioral change. Programs that integrate behavioral procedures such as self-monitoring, stimulus control, coping skills, and relapse prevention appear to hold the most promise. Policy is an area that has received little attention as a means of changing dietary behavior. Government officials have made major efforts to enhance food safety, improve nutrition labeling on foods, and educate the public about a balanced diet. Much more may be possible, however. Financial incentives might be offered to increase production of healthy foods, thereby lowering cost and increasing availability. Legislation could govern food advertising and food availability (eg, vending machines) to which the entire population or selected groups (eg, children) are exposed. Existing studies on dietary adherence span different interventions, populations, disease targets, methods of evaluation, and other factors, so it is not surprising that results across studies are mixed. Enough of the studies have shown positive findings, however, to lead to the conclusion that meaningful dietary modification is possible, at least in some individuals making some dietary changes.(ABSTRACT TRUNCATED AT 400 WORDS)

Privatizing public research.

With the end of the cold war, national defense has given way to international competitiveness as the theme for federal support of research. As it now stands, the idea will probably not work well.