Predicting smokers' non-compliance with smoking restrictions in public places.

OBJECTIVE: The present study aimed to identify the predictors of non-compliance with smoking restrictions among Greek college student smokers. Differences in attitudes to smoking bans and tobacco control policies between current smokers and non-smokers were also examined. METHODS: Data were collected from college students (n = 229, mean (SD) age 21.27 (3.15) years). Measures included tobacco dependence, attitudes to tobacco control policies, outcome expectancy and normative beliefs. RESULTS: The majority of current smokers reported non-compliance with existing restrictions. Logistic regression analysis showed that non-compliance was significantly predicted by (less) anticipated regret from tobacco-related health harm, tobacco dependence and perceived prevalence and social acceptability of smoking. Analysis of variance indicated that current non-smokers held significantly more positive attitudes to smoking bans and tobacco control policies than current smokers. CONCLUSIONS: Smoking was highly prevalent, and more than half of current smokers reported not complying with existing regulations in public places. Smokers' attitudes to smoking bans and tobacco control policies did not have an effect on compliance behaviour. Future policies to promote compliance with smoking restrictions in Greece should target health-related anticipated regret, and perceived social norms.

Parenting the premature infant: balancing vulnerability and quality of life.

BACKGROUND: Relationships between child quality of life (QOL), maternal well-being and parenting were explored in a questionnaire study. METHOD: Mothers of 126 full-term (FT) and 91 pre-term (PT) infants during the child's second year of life completed measures of their own and the child's quality of life and behavioural difficulties. We developed a measure of parenting style derived from Regulatory Focus Theory (RFT), to distinguish greater reported use of promotion as opposed to prevention strategies (emphasising gains rather than losses, and encouraging pursuit of goals rather than prevention of harm). RESULTS: The two groups of mothers showed no differences on the parenting measure, but those in the PT compared with the FT group described their infant as having lower QOL and more behavioural and mood problems, and rated their own well-being as less satisfactory. Greater use of promotion was associated with reports of fewer difficulties (better QOL) for the child and better mothers' well-being. Differences in mothers' well-being as a function of group (FT vs. PT) and promotion were strongly mediated by mothers' perceptions of their child's difficulties. At the same time, associations with child difficulties were partly mediated by mothers' well-being, suggesting that maternal distress may have partly contributed to higher perceptions of such difficulties. Among PT infants, the degree of prematurity predicted child difficulties, but was not consistently related to mothers' well-being. DISCUSSION: Mothers of PT infants report more physical health and behavioural difficulties than mothers of FT infants, but specific parenting styles can contribute to child difficulties and QOL in both infants and their mothers. CONCLUSION: We conclude that RFT has potential for understanding the conflicts experienced by parents caring for vulnerable children.

Screening for diabetic retinopathy is well received by patients and may improve self-management intentions.

AIMS: To investigate patients' views of screening for diabetic retinopathy and the effects of the screening process on health beliefs and behavioural intentions. SETTING: A retinal screening clinic at a GP surgery in SW England. METHODS: Questionnaires administered before and immediately after screening by retinal photography. RESULTS: One hundred patients attended (94% of those invited); 12 had Type 1 and 88 Type 2 diabetes. Over 90% found the information, and seeing their retinal photograph, helpful. Sixty-three were found to have no problem and 37 had some type of eye problem detected. Overall, patients rated the news given at screening as better than expected (P < 0.001) and even those found to have problems mostly rated the news as good (P < 0.001). Detection of problems led patients to rate their recent eye health more negatively, but to be less pessimistic about future deterioration (P < 0.01). Patients with diabetes-related eye problems were more likely (P < 0.05) to say that they both should and would make changes to their self-management, but only after controlling for duration of diabetes. Those who had had diabetes longest declared least intention to change. CONCLUSIONS: Screening by retinal photography is acceptable to patients. Results suggest that screening modified health beliefs but had limited effect on behavioural intentions, with patients of longer disease duration being more reluctant to change their self-management. Opportunities during retinal screening for advice on self-management could be more effectively exploited.

Randomized controlled trial of a midwife-delivered brief smoking cessation intervention in pregnancy.

OBJECTIVE: To evaluate the efficacy of a brief smoking cessation intervention with pregnant women practicable routinely by midwives. DESIGN: Midwives were randomized to deliver the experimental intervention or usual care. The 10-15-minute intervention was based on brief counselling, written materials, arrangements for continuing self-help support and feedback on expired-air carbon monoxide levels. The intervention was tailored to the women's needs: those who did not want to stop smoking received a brief motivational intervention, those who wanted to stop received an intervention designed to assist them and those that had stopped recently (recent ex-smokers) received a relapse prevention intervention. SETTING: Booking interviews with pregnant women in nine hospital and community trusts. SUBJECTS: A total of 1120 pregnant women in the third month of pregnancy (249 recent ex-smokers and 871 current smokers). MAIN OUTCOME MEASURES: Three indicators of biochemically validated abstinence were collected. Continuous abstinence for at least 3 months prior to delivery, point prevalence abstinence immediately post-delivery, and continuous abstinence from 3 months pre-delivery to 6 months post-delivery. RESULTS: Only a small proportion of the women who would have been eligible to take part in the trial were actually recruited by 178 recruiting midwives, with lack of time being cited as the main barrier. The intervention and usual care groups differed in post-delivery point prevalence abstinence rates for recent ex-smokers (65% vs. 53%, p < 0.05, one-tailed), but not in other outcome measures. Overall, 54% of "recent ex-smokers" at booking and 7% of "current smokers" at booking had been abstinent for at least 3 months at the time of delivery, and 23% and 3%, respectively, were still abstinent by the time the child was 6 months old (i.e. 12 months post-intervention). Smoking status at follow-up was predicted by dependence indexed by time to first cigarette in the morning. CONCLUSIONS: A brief "one-off" smoking cessation intervention by midwives does not seem to be a practicable or effective method of helping pregnant smokers to stop. Other options such as tailored self-help materials and telephone counselling and other specialist treatments should be examined. Current smoking cessation rates in pregnancy are very low.

Evaluation of primary prevention initiatives for skin cancer: a review from a UK perspective.

To ensure effective primary prevention of skin cancer, aimed at changing behaviour in the sun, and ultimately at reducing the incidence and mortality rates from skin cancer, sufficient information needs to be known about the relationship between sun exposure and skin cancer, the effectiveness of sun protection measures, and the acceptability and uptake of protective measures by the general public. This review specifically addresses the quality and outcome of studies designed to evaluate the impact of primary prevention initiatives in the U.K. Four main areas of concern are highlighted: (i) teenage behaviour in the sun is difficult to change; (ii) fashion, in part, dictates adult and adolescent behaviour in the sun; (iii) there are practical problems related to response rates, follow-up and interpretation of self-reported behaviour; and (iv) a strategy for primary prevention in the U.K. may be falsely based on the experience and results of Australian and American programmes. Standardized methods for monitoring general population behaviour are needed in the U.K. Evaluation of interventions targeting specific groups, especially parents and young children, and the relative costs of different strategies should be reported. Primary prevention messages and strategies should be adapted to the type of ultraviolet radiation exposure experienced, and the overall low risk of melanoma, while addressing controversies on the health effects of sun exposure and sun screens.

Feasibility of targeted early detection for melanoma: a population-based screening study.

The feasibility of targeted screening for cutaneous malignant melanoma in the UK using a postal questionnaire and invitation to screening by a consultant dermatologist was investigated in a population based cross-sectional survey. A total of 1600 people aged 25-69 years, stratified by the social deprivation score of wards within one general practice, were randomly selected from a population of 8000.1227 (77%) returned the questionnaire and 896 (56%) attended the screening clinic. Uptake was lower for men (P<0.001), those aged under 50 (P<0.001), people from deprived areas (P<0.001) and skin types III and IV (men only, P<0.001). Twenty per cent of women and 10% of men felt nervous about attending the clinic, but only 4% were worried by the questionnaire. The level of agreement between the self- and dermatologist's assessments of risk factors was best for hair colour (Kappa = 0.67, sensitivity 73% and specificity 98%). People tended to under-report their level of risk. Over 95% knew about at least one major sign, but 54% reported incorrect signs of melanoma. Targeted screening for melanoma in the UK will be hampered by difficulties in accurately identifying the target population. Strategies to improve skin self-awareness rather than screening should be developed and evaluated.

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening.

OBJECTIVES: To study the feasibility of developing targeted screening for those at high risk of melanoma by examining how attitudes relate to (a) acceptance of an invitation for a free skin check and (b) self assessed and clinically assessed risk factors for developing cutaneous melanoma. DESIGN: A population based cross sectional survey. SETTING: A general practice with a broad mix of socioeconomic groups in one district health authority. SUBJECTS: A total of 1600 subjects aged 25-69 years stratified using the social deprivation score of wards were randomly selected from a population of 8000; 77% (1227) returned the questionnaire and 56% (896) attended for screening. MAIN OUTCOME MEASURES: Questionnaire measures of confidence in own ability to self assess risk factors for melanoma, attitudes to seeking medical help for skin abnormalities, and self assessment of relative risk of developing melanoma. RESULTS: Clinic attenders were less confident in their ability to self assess risk factors (p<0.005), more favourable towards seeking help (p<0.001), and more pessimistic about developing melanoma (p<0.001) than non-attenders. Those from more affluent wards were more willing to seek help (p<0.001). Those clinically assessed as at higher risk were more pessimistic about developing melanoma (p<0.001) but clinical assessments were inconsistently related to help seeking attitudes and self assessment confidence. CONCLUSIONS: Barriers to the uptake of screening included greater optimism about not developing melanoma, confidence in self assessment, and reluctance to seek professional help. Such reluctance was greater in more deprived social groups. Targeting screening at high risk groups cannot depend on self identification and self referral.

Communication and interpretation of risk.

The 'new genetics' enables people's risk status for many diseases and disorders to be assessed much more accurately than before, yet considerable uncertainty remains over how risk information will be evaluated and acted upon. This paper summarises some of the main themes of psychological research on risk. Risk is traditionally defined in terms of probability. However, people often have difficulty in processing statistical information and may rely instead on simplified decision rules. Decision making under risk is also critically affected by people's subjective assessments of benefits and costs. In the field of genetic risk, such assessments may vary greatly between individuals, reflecting personal and cultural preferences and ethical concerns. The goals of risk communication should, therefore, not be merely the imparting of statistical 'facts' or the reduction of anxiety, but also enabling individuals and their families to make important decisions under conditions of uncertainty.

Diet, smoking and exercise: interrelationships between adolescent health behaviours.

A questionnaire measuring smoking status, exercise and dietary behaviour was administered to 932 high school pupils during regular classroom periods. Pupils were taken from three year groups which included 327 year 8 (12-13 years), 313 year 9 (13-14 years) and 292 year 10 (14-15 years). Pupils also indicated whether they could recall classroom teaching on 15 food- and health-related issues. Scores were derived representing self-reported frequency of eating foods that were high in fat, and fresh fruits and vegetables. Smoking was found to be associated with lower levels of exercise, consumption of less fresh foods and greater consumption of fatty foods. In addition, consumption of fresh foods was found to be positively correlated with exercise. These findings have implications for the organization of school-based health education efforts and suggest that health education programmes need to adopt an integrated approach rather than treat health behaviours in isolation from each other.

The role of monitoring in determining quality of life following treatment for a bone tumor.

Interviews were conducted with 34 young people who had previously been treated for a malignant bone tumor around the knee. These interviews focused on the impact of treatment on activities and perceptions of the risk of recurrence and need for future surgery A coding schema based on a "monitoring-blunting" framework was adopted (Miller, 1995). Quality of life was assessed using a generic and disease-specific measure. Based on interview data, respondents were categorized as negativistic monitors, adaptive monitors, and nonmonitors. There were no differences between groups in terms medical indicators (number of operations). Negativistic monitors reported poorer quality of life compared with the other two groups. There was no increase in nonmonitoring with time since diagnosis as reported in previous work. It is suggested that patients' self-ratings of quality of life are related to the way in which they monitor information and this may be independent of clinical function. Clinical implications, especially in terms of how potentially threatening information about late-effects of treatment are given to patients, are discussed.

Skin cancer attitudes: a cross-national comparison.

A questionnaire concerning attitudes towards skin cancer, sun exposure and general environmental issues was administered to 132 holiday-makers on a beach in south-west England and (in translation) to 142 visitors to another beach in north-west Italy. Following the Janis & Mann (1977) classification of strategies for coping with decision conflicts, subscales were derived measuring tendencies to 'avoid' thinking about environmental issues, to 'bolster' prior attitudes (by playing down the seriousness of the risk of skin cancer while attending to the pleasures of sunbathing), and to be 'vigilant' concerning risk information and the need for specific protective behaviour (e.g. sunscreen use). The British scored higher than the Italians, and women higher than men, on vigilance, but there were no gender or nationality differences on the other subscales considered as a whole. Responses were also related to the covariates of age and self-reported vulnerability to sunburn. Those who showed less concern with environmental issues also tended to play down the risks of skin cancer and be less vigilant with regard to self-protection. It is suggested that health promotion should address both cultural norms concerning exposure to the sun and people's intuitive notions about their relative personal vulnerability.

Parents' attributions about childhood cancer: implications for relationships with medical staff.

Improvements in therapy have resulted in increasing numbers of children being successfully treated for cancer. However, the aggressiveness of therapy and uncertainty about prognosis are associated with many adverse effects, psychological as well as physical, for both the child and family. This study investigates family coping with treatment in relation to attributions about cause and responsibility for onset of the disease. We interviewed parents of 30 children with cancer (28 mothers and 23 fathers) about their attributions of causality, and perceptions of responsibility for the diagnosis and care of the child. Coping strategies which were found to be helpful were assessed using the Coping Health Inventory for Parents (CHIP). Fathers were more likely than mothers to accept that there was no known cause for the child's illness. Fathers who blamed doctors for failing to diagnose the condition found medical staff less helpful up to 2 years later. The theoretical importance of blaming others more than oneself is discussed, along with practical implications for services in paediatric oncology.

Coping and confidence among parents of children with diabetes.

Sixty-two mothers and 45 fathers of children with diabetes completed questionnaires to assess their confidence to manage the disease and treatment. Implications of parental confidence for attitudes to (1) child-rearing, (2) coping and (3) perceived restrictions of the disease were considered. Mothers and fathers differed in reported child-rearing behaviours and strategies for coping. More confident fathers reported that information was helpful in coping with the disease, while more confident mothers reported that support from the family was more helpful. Predictors of children's locus of control scores differed between mothers and fathers. However, children expressed more external locus of control beliefs where parents believed their children to be more restricted.

Adjustment to chronic disease in relation to age and gender: mothers' and fathers' reports of their childrens' behavior.

Investigated age and gender differences in adjustment to chronic disease in children suffering from one of five conditions: diabetes, asthma, cardiac disease, epilepsy, and leukemia. Ratings of adjustment and disease-related restrictions were obtained separately from mothers and fathers. Factor analysis of the adjustment scale yielded 6 subscales which differentiated between children in terms of age and disease type, and to a lesser extent, gender. Mothers' and fathers' ratings of adjustment and restrictions were comparable, though fathers made less differentiation on the basis of disease or age. For both parents, perceived restrictions of the disease were associated with poorer adjustment in the child, and this was particularly reflected on indices of peer relations and work.

A trial of health education aimed to reduce cigarette smoking among pregnant women.

Three hundred and forty-six women who reported smoking one or more cigarettes per day prior to the 20th week of gestation were recruited into a trial of health educational counselling to stop or reduce cigarette smoking. Counselling was begun at the first prenatal visit and then continued subsequently in the home. Among the 319 women included in analysis, at first follow-up visit those who received counselling smoked 1.7 fewer cigarettes a day than control women (P less than 0.05) and 10.4% had stopped smoking, compared to 5.4% in the control group (NS). Similar but not significant differences were noted at the end of pregnancy. Study effects were limited to the 284 women smoking five or more cigarettes a day at booking. This report refers primarily to them. At first follow-up visit the proportion of such women in the counselled group who ceased smoking (9.3%) was significantly greater than in the control group (2.6%; P less than 0.05). The magnitude of this difference persisted through late pregnancy (11.8% vs. 4.3%; NS) and delivery (10.6% vs. 4.7%; NS). The differences between counselled women and controls in numbers of cigarettes reported smoked at first and last prenatal follow-up visits (2.4 and 2.1) and at delivery (2.0) were all statistically significant. While there was no effect of counselling on either serum thiocyanate or end expiratory carbon monoxide, the counselled group gained slightly more weight than controls during the study (0.47 vs. 0.44 kg per week among controls; NS), and their infants had modestly higher birthweight (44 g; NS).

Adolescent health behaviour and similarity-attraction: friends share smoking habits (really), but much else besides.

Smoking habits and related attitudes were assessed in a sample of 4059 11- to 16-year-olds who also identified their best friends from among their fellow respondents. Subjects' responses were directly collated with those of their friends and indicated a clear covariation of smoking status (controlling for sex and age) as anticipated from previous research in which adolescents have been asked to report on the smoking habits of their friends. Such covariation, however, was not specific to smoking habits, but generalized to related measures of attitude and normative beliefs, alcohol use, health locus of control, school performance, spending habits and socio-economic status. Similarities on these other attributes were much the same, whether or not friends shared each others' smoking habits. It is concluded that these data argue against a simplistic view of unidirectional 'peer group influence' and invite an interpretation of friendship choice based on multiple dimensions of similarity.

Discipline strategies and parental perceptions of preschool children with asthma.

Parents of 37 children with asthma (aged between three and five years) and of 37 healthy controls were interviewed about their involvement in everyday care, discipline practices, perceptions of their child and situations which were particularly stressful. There was little correlation between mothers' and fathers' preferences for different discipline practices. There was, however, greater agreement in their perceptions. Parents of children with asthma did not differ from those of healthy controls in discipline practices. However, children with asthma were perceived to be generally less healthy. Parents of those with asthma also reported a greater number of everyday situations to be stressful. These data do not support traditional assumptions that parents of children with asthma are more permissive or overindulgent. At least in this preschool sample, there was only limited indication of adverse effects of chronic disease on parenting practices.

Scene schemata and scripts in children's understanding of hospital.

In a first study, 90 children (aged 3-5 years) were shown a photograph of a hospital scene, and then asked to identify which of 12 separate items were present in the original scene. Children made more plausible than implausible errors, suggesting that they had well-organized schemata for hospital scenes. In a second study, we investigated children's knowledge of hospital-related routines and activities. A total of 152 children (aged 3-5, 6-8 and 9-10 years) were shown five photographs of hospital and five photographs of school, and asked to arrange each set to 'tell a story'. Children in different age groups showed relatively high agreement in their orderings, and also in selecting the 'most important photograph'. The data suggest that children's knowledge of hospital is organized around rudimentary schemata and scripts, which enable them to make very plausible inferences about hospital scenes and activities.

How adolescents compare AIDS with other diseases: implications for prevention.

Four hundred ten adolescents, ages 14-16 years, completed a questionnaire concerned with their understanding of the social and emotional consequences of AIDS and 5 other illnesses (lung cancer, German measles, chicken pox, asthma, and diabetes). Pupils distinguished between the diseases on all measured items, but younger pupils were more likely to believe that individuals were personally responsible for the onset of AIDS, lung cancer, and diabetes. The data are discussed in terms of the implications for health education campaigns.

Health locus of control and health beliefs in relation to adolescent smoking.

Results from a survey of 10,579 schoolchildren aged 11-16 years indicated various relationships between age, smoking behaviour, health locus of control beliefs, expressed concern with different consequences of illness and beliefs in the efficacy of different strategies for staying healthy. In particular, smokers, compared with non-smokers, showed less belief in the importance of 'powerful others' or 'personal control' but more belief in the importance of 'chance' as an influence on health outcomes. With regard to consequences of illness, smokers cared more than non-smokers about not being allowed to see friends, but less about getting behind in school or being a nuisance to others; they were also less convinced of the benefits of preventive health behaviours such as eating good food and taking exercise. Implications for health education approaches are discussed.