Alcohol consumption and attitudes towards banning alcohol sales on campus among European university students.

OBJECTIVES: The European Commission's new health strategy for improving health at the European Union (EU) level includes tackling alcohol consumption. This study aimed to assess the prevalence of alcohol consumption and problem drinking, as well as students' attitudes towards banning the sale of alcohol on campus. STUDY DESIGN: In total, 5826 students from universities in seven European countries (Denmark, Germany, Spain, Lithuania, Poland, Bulgaria and Turkey) took part in this cross-sectional study. METHODS: A self-administered questionnaire assessed sociodemographic information, frequency of alcohol consumption, problem drinking and attitudes towards banning the sale of alcohol on campus. RESULTS: The highest prevalence of drinking alcohol more than once per week was reported in Bulgarian (males 46%, females 64%) and Spanish students (males 59%, females 64%). Among those students who drank alcohol (n=3170), problem drinking (CAGE score >1) was found in 24% of males and 13% of females. Male gender, depressive moods and a low importance of good grades at university were risk factors for drinking alcohol more than once per week as well as for problem drinking. There were substantial country differences in the proportion of students who would support a ban of alcohol sales on campus (23% in Denmark, 88% in Poland). Support for a ban was higher among female students and among students who drank alcohol once or less per week. CONCLUSIONS: Problem drinking is a concern among students in many European countries, especially among males. Students' support for banning the sale of alcohol on campus varies between countries and should be considered in developing EU policy.

Cancer screening among Korean Americans.

PURPOSE: Cancer is a leading cause of death among Korean Americans (KAs), one of the most rapidly growing ethnic minority communities in the United States. An understanding about cancer screening practices among Koreans (Ks) living in Korea can be useful in designing culturally sensitive health promotion programs in the United States. The purpose of this study was to describe the cancer screening knowledge and behaviors of a sample of KAs in Los Angeles, California, compared with a similar sample of Ks in Korea. DESCRIPTION OF STUDY: This descriptive survey used a convenience sample of 140 KAs age 40 and older, living in Los Angeles, California, in 1998. A random sample of 149 Ks from Pusan, Korea, in 1995 to 1996 was used as a comparison group. KAs had lived in the United States for an average of 15 years. A Korean and English language 58-item self-administered questionnaire assessed knowledge of cancer screening tests and personal cancer screening practices. RESULTS: The findings demonstrate that both KAs and Ks had low participation in cancer screening. Breast cancer screening was significantly more likely among KA women than among Ks; screening rates for cervical cancer and gastrointestinal malignancies were not significantly different between the two groups. CLINICAL IMPLICATIONS: These data can be used to assist healthcare professionals in the development of educational tools and strategies for promoting cancer screening programs for KAs. The unique contribution of this study was the opportunity to compare findings from an immigrant Korean population with a similar population in the country of origin.

Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States.

BACKGROUND: Little is known about cancer-screening practices of various Asian subgroups, and even less is known about factors that may predict screening in these populations. DESIGN: Two independent surveys were conducted with 218 Filipino and 229 Korean female immigrants, aged 50 years and older, residing in Los Angeles. RESULTS: In these convenience samples, 48% of Filipino and 41% of Korean women reported receipt of a Pap smear within the past 2 years; 41% of Filipino and 25% of Korean women reported receipt of a mammogram and a clinical breast exam within the past 2 years; and 25% of Filipino and 38% of Korean women reported colorectal cancer screening (blood stool test within the past 12 months or sigmoidoscopy/colonoscopy within the past 5 years). Only 14% of Filipino and 10% of Korean women were adherent to cancer-screening guidelines for all three sites. These differences in screening rates were statistically significant in multivariate analyses of the combined sample, controlling for all demographic characteristics, including age, percent of lifetime in the United States, education, marital status, health insurance, employment, and ethnicity. The two variables that were most consistently independently associated with adherence to cancer screening in both samples were higher percentage of lifetime spent in the United States and ever having had a checkup when no symptoms were present. CONCLUSIONS: These two variables-percent of lifetime in the United States and ever having had a checkup when no symptoms were present-can alert a physician that cancer-screening tests may be overdue among Korean and Filipino immigrants in the United States. Future research should identify predictors of cancer screening among other Asian immigrant groups and U.S.-born Asian women to assist in targeting intervention efforts.

Knowledge and attitudes toward condom use--do they predict behavior among Filipino Americans?

Face-to-face interviews were conducted with 211 Filipino-American adolescents and young adults residing in Los Angeles County to assess AIDS related knowledge, attitudes and behaviors. Among both sexually active and never sexually active respondents, HIV knowledge and self-efficacy with respect to condom use were generally high, and the majority held peer norms that were supportive of condom use. More than half of sexually active respondents reported condom use at last intercourse. Knowledge of HIV transmission, demographic variables, barriers to condom use, peer norms, and being comfortable asking a steady partner to routinely use condoms were not related to condom use at last intercourse. Higher self-efficacy (odds ratio 2.4, P<.06) and carrying condoms (odds ratio 1.9, P<.08) were the only two variables that approached statistical significance in their relationship to condom use at last intercourse. Findings suggest that variables that are related to AIDS risk behavior among non-Asian populations may not explain condom use among Filipinos. Therefore, future studies should identify determinants of AIDS risk behavior among Filipinos and other Asian American populations as a first step towards developing culturally relevant AIDS prevention programs for these groups.

Tailored risk notification for women with a family history of breast cancer.

BACKGROUND: Evidence indicates that although first-degree relatives of breast cancer cases are at increased risk of developing the disease themselves, they may be underutilizing screening mammography. Therefore, interventions to increase the use of mammography in this group are urgently needed. METHODS: A randomized two-group design was used to evaluate an intervention to increase mammography use among women (N = 901) with at least one first-degree relative with breast cancer. A statewide cancer registry was used to obtain a random sample of breast cancer cases who identified eligible relatives. The mailed intervention consisted of personalized risk notification and other theoretically driven materials tailored for high-risk women. RESULTS: An overall significant intervention effect was observed (8% intervention group advantage) in mammography at post-test. There was an interaction of the intervention with age such that there was no effect among women <50 years of age and a fairly large (20% advantage) effect among women 50+ and 65+. Health insurance, education, and having had a mammogram in the year before baseline assessment were positive predictors of mammography at post-test. Perceived risk, calculated risk, and relationship to index cancer case were not associated with mammography receipt. CONCLUSION: The intervention was successful in increasing mammography rates among high-risk women 50+ years of age. Further work is needed to determine why it was ineffective among younger women.

Condom use in young blacks and Hispanics in public STD clinics.

BACKGROUND AND OBJECTIVES: Young blacks and Hispanics are an emerging risk group for contracting HIV. The goal of this study was to assess the most salient correlates of condom use for young Hispanics and blacks in Los Angeles county sexually transmitted diseases (STD) clinics as a first step toward designing a short clinic-based intervention. STUDY DESIGN: Face-to-face interviews were conducted with 376 patients younger than the age of 27 years at six STD clinics operated by the Los Angeles County Department of Health Services. Assessment included several attitudinal variables and AIDS risk behaviors. RESULTS: Condom use at last intercourse ranged from 40% among Hispanic females to 48% among black males. Among females, condom users were more likely to report high self-efficacy regarding condom use, peer norms supporting condom use, and more sexual communication than respondents who did not use a condom at last intercourse. Among males, no relationship was found between condom use at last intercourse and these attitudinal variables, except for sexual communication. The most important correlate of condom use among males and females was the frequency of carrying condoms. CONCLUSIONS: Our findings suggest that offering educational group sessions and attractive means for carrying condoms to patients in STD clinics may have the potential to increase condom use. The efficacy of these intervention strategies should be explored in future studies.

PIP: This study identifies the most salient correlates of condom use for young Hispanic and Black patients in Los Angeles county sexually transmitted disease (STD) clinics. A total of 376 patients aged under 27 years were interviewed from April to December 1995 at six STD clinics. The questionnaire used was developed to measure AIDS-related attitudes and behavior and included 1) self-efficacy with respect to condom use; 2) perceived peer norms regarding condom use; 3) sexual communication; 4) expected partner reactions; and 5) barriers to condom use. The study revealed that condom use during last intercourse ranged from 40% among Hispanic females to 48% among Black males. Female condom users were more likely to report high self-efficacy regarding condom use, peer norm supporting condom use, and more sexual communication than respondents who did not use a condom at last intercourse. On the other hand, among males, no relationship was found between condom use at last intercourse and these attitudinal variables, except for sexual communication. The frequency of carrying condoms was the most important correlate of condom use among males and females. This study suggests that offering educational group sessions and attractive means for carrying condoms to patients in STD clinics may increase condom use.

Mammography utilization and related attitudes among Korean-American women.

The purpose of this study was to assess mammography utilization among Korean-American women and to identify their knowledge, attitudes and barriers related to screening. Face-to-face interviews were conducted in the Korean language with a convenience sample of 229 predominantly low-income Korean women 50 years and older residing in Los Angeles. Forty-nine percent had ever had a mammogram, 24% had had a screening mammogram in the past 12 months, and 36% had had one in the past two years. Variables positively related to "ever had a screening mammogram" included: having health insurance; income > or = $25,000; having received a physician's recommendation to obtain a mammogram; holding positive group norms; longer duration of residency in the U.S.; and greater acculturation. Variables negatively related to screening included: concerns about finding cancer; taking time to get a mammogram; transportation; embarrassment; and discomfort requesting the procedure from the physician. Strategies to increase mammography utilization among Korean-American women are discussed.

Misconceptions and mammography use among Filipino-and Korean-American women.

Face-to-face interviews were conducted with a convenience sample of 218 Filipino and 229 Korean women residing in Los Angeles County. This paper describes the women's knowledge and misconceptions regarding breast cancer risk factors, their utilization of traditional and westernized preventive health care, and the relationship of these variables to mammography utilization. Sixty-six percent of Filipino women and 49% of Korean women ever had a mammogram. Both Filipino- and Korean-American women share many of the same misconceptions about breast cancer risk factors. More instructive, however, is that these beliefs do not affect mammography utilization. Acculturation and modesty were associated with mammography utilization in both groups. Use of traditional medicine was negatively related and use of westernized preventive health care was positively related to mammography screening only among Filipino women. Practicing health care professionals should use these findings as they develop culturally sensitive breast cancer control programs.

Breast cancer screening and related attitudes among Filipino-American women.

This study assessed mammography screening rates and related attitudes and intervention preferences in Filipino-American women, a group that has been neglected in cancer control research. Face-to-face interviews were conducted in English and Tagalog with a convenience sample of 218 Filipino women 50 years and older residing in Los Angeles. Sixty-six % had ever had a screening mammogram, 42% had had one in the past 12 months, and 54% in the past 2 years. These rates are about 20% lower than those found among African-American and white women in the 1994 California Behavioral Risk Factor Survey. Women who had received a doctor's recommendation to obtain a mammogram, women stating that they were very likely to obtain a mammogram if a physician recommended it, and women who felt very comfortable requesting a mammogram from a physician were more likely to have been screened. Women who had friends and relatives who had obtained mammograms those stating that their friends and relatives would be very supportive of their getting a mammogram, and those who felt that it was very worthwhile to obtain a mammogram were also more likely to have been screened. The following variables were negatively related to the outcome: concern over cost, the attitude that mammograms are only needed in the presence of symptoms, perceived inconvenience of taking the time and difficulties getting to the mammography facility, and embarrassment. Implications for interventions to increase breast cancer screening are discussed.

Cross-sectional versus prospective predictors of screening mammography.

Data from a population-based longitudinal study were used to compare cross-sectional versus prospective predictors of screening mammography. Although the results of the two analyses were not dramatically different, some important differences emerged. More attitudinal variables were related to future behavior compared with past behavior. Using purely cross-sectional data from this study to design an intervention would result in potentially important variables being deemphasized or omitted, which could have a significant impact on the strength of the intervention. Our findings strongly suggest that it may be unwise to generalize cross-sectionally obtained data to a longitudinal situation.

AIDS-related attitudes and risk behaviors: a survey of a random sample of California heterosexuals.

BACKGROUND: This paper describes the results of an AIDS knowledge, attitudes, and behaviors survey of a random sample of heterosexual California adults. METHODS: The study was conducted from August 1990 until February 1991 and consisted of telephone interviews conducted in English and Spanish, with a household probability sample of 3,545 California adults, undersampling those age 44 and older. RESULTS: Approximately one-third of the sample believed that HIV/AIDS is contracted by donating blood, and 20% believed the infection could result from insect bites. Tolerance toward HIV-infected persons was highest among young, male, white, employed individuals with higher levels of education and income. Twenty-seven percent of males and 14% of females were categorized as high risk based on the presence of at least 1 of 7 risk factors. High-risk respondents tended to be male, young, employed, never married, U.S. born, and English speaking. Compared to low-risk respondents, they were less likely to use condoms and more likely to use alcohol and drugs in conjunction with sex. Most common sources of AIDS information were television, newspapers, and magazines. CONCLUSIONS: More strenuous efforts are needed to reach young adults, especially those beyond college age, with AIDS prevention messages. Creative messages via popular media venues should be explored.

Prevalence of anal sex among heterosexuals in California and its relationship to other AIDS risk behaviors.

This paper describes the prevalence of anal sex among heterosexual adults in California and investigates the relationship of anal sex to other risk behaviors associated with AIDS and STDs. The study consisted of telephone interviews with a household probability sample of 3,545 California adults undersampling those age 44 and older. Seven percent of the sexually active respondents, 8% of males, and 6% of females reported having anal sex at least once a month during the year prior to the survey. Of these, most engage in this activity one to five times per month, and about 60% report never using condoms. Younger respondents and those who were not married were more likely to report anal intercourse. Respondents who had anal sex were more likely to report standard AIDS risks and lifestyle risks associated with STDs, and to engage in recreational use of drugs and alcohol. Both anal sex and condom use during anal intercourse were poorly predicted by these demographic and risk variables. It is concluded that a non-trivial proportion of California heterosexual adults engages in anal sex regularly, most without condoms, and those who have anal sex are more likely to have other risk behaviors associated with AIDS and STDs. These results suggest that anal sex must be addressed specifically in clinical and educational programs designed to reduce the spread of AIDS.

AIDS risk behaviours and correlates in teenagers attending sexually transmitted diseases clinics in Los Angeles.

OBJECTIVE: Of all age groups, teenagers have the highest rates of sexually transmitted diseases. Therefore, it is particularly important to target interventions at this group. Teenagers attending STD clinics are at particularly high risk since behaviours that lead to an STD can also result in the transmission of HIV. The goal of this study was to collect information concerning the prevalence and correlates of high-risk behaviours in this population as a first step in the design of an effective intervention programme. METHODOLOGY: Face-to-face interviews were conducted with patients attending five STD clinics operated by the Los Angeles County Department of Health Services. RESULTS: In the exclusively heterosexual teenage subgroup (N = 100, 55% Hispanic, 28% African-American, 10% White), males became sexually active at a younger age than females (14 years vs 14.9 years, p < 0.02), had more partners in the last 12 months (4.1 vs 2.0, p < 0.003), more "steady" partners (2.2 vs 1.4, p < 0.02) and more life time partners (14.1 vs. 4.1, p < 0.001). Only 10.0% of males and 3.8% of females reported consistent condom use with steady partners and 36% of both male and female respondents with non-steady partners. The decision to use condoms during vaginal sex was most likely made by the respondent, whereas the decision not to use condoms was most likely a joint decision. CONCLUSIONS: An intervention aimed at improving sexual communication regarding condom use could increase this behaviour among many adolescents, since only few teenagers in our sample perceived condom use as unpleasant.

Initial and repeat mammography screening in a low income multi-ethnic population in Los Angeles.

Low income, older, minority women are at high risk for underutilization of screening mammography. One strategy for increasing utilization is to conduct interventions targeting local and state health departments where a majority of these women seek health care. A prerequisite for conducting effective screening programs is to obtain current and accurate information on baseline screening rates to understand the nature and scope of the problem and to plan appropriate intervention strategies. The sample consisted of 3240 women who were 50+ years of age from 2 hospitals and 2 comprehensive health centers operated by the Los Angeles County Department of Health Services. Reviews of medical records indicated that only 21% of the sample had received a mammogram in the 12 months prior to the clinic visit on which they were sampled and 23% of the sample received a mammogram in the following 9 months. Approximately 5% of the total sample received a repeat mammogram in the 21-month period over which they were tracked. Prospective independent predictors of screening were age, number of visits to primary care clinics, number of visits to specialty care clinics, and history of breast abnormalities. The results underscore the importance of implementing programs to increase mammography implementing programs to increase mammography screening within public facilities serving low income multiethnic women. An important finding is that a large number of older women are seen in specialty clinics, which represents an untapped resource for increasing screening in this population. Innovative interventions targeting such specialty clinics could substantially contribute to increasing screening rates. A comprehensive approach targeting system, physician, and patient barriers is recommended.

Evaluation of an intervention to increase mammography screening in Los Angeles.

METHODS. A randomized pretest post-test control group design was used to evaluate the effectiveness of a mail-out intervention for increasing screening mammography rates. A random sample of 802 women, 40+, residing in Los Angeles County, was surveyed by telephone at baseline and again 12 months after the intervention. RESULTS. Fifty percent of the intervention group and 56% of the control group had obtained a screening mammogram during the follow-up period. This difference was not statistically significant, indicating that the low-cost intervention was not successful in influencing screening mammography rates in this sample. In the combined intervention and control group, a stepwise logistic regression analysis revealed four baseline variables to be significant prospective predictors of mammography behavior during the follow-up period: Women who were adherent to the age-specific screening guidelines at baseline and women who had health insurance were more likely to obtain a mammogram during the follow-up, as were older women. Also, women who were greatly concerned about radiation exposure during a mammogram were about two and a half times less likely to obtain a mammogram during the follow-up than women who were less concerned. Self-reported reasons for adherence and nonadherence to screening guidelines are also described.

Breast cancer knowledge, attitudes, and behaviors: a comparison of rural health and non-health workers.

The present study surveyed the current levels of knowledge and the attitudes, beliefs, and behaviors of health workers (mostly nurses) with respect to breast cancer and its early detection. In addition, health workers were compared with non-health workers to determine whether the two groups differed with respect to the above variables. The sample comprised 402 women sampled from work sites in a rural community in the Midwest. The results indicated that health workers (n = 96) scored very high on knowledge, had a very positive attitude toward the notion of early detection, and reported strong intentions concerning future participation in a variety of early detection behaviors. Fifty % performed breast self-examinations once a month or more frequently. A stepwise discriminant analysis found that, compared to non-health workers, health workers saw mammography as less dangerous, believed breast cancer to be less common and its causes less controllable, and were less likely to perceive early detection as being beneficial. On the other hand, health workers scored higher than non-health workers on self-efficacy, breast self-examination frequency, and importance of breasts in determining one's self concept. Health workers also rated breast cancer as being more life-threatening and were more likely to believe that the disease was caused by external as opposed to internal factors.

Effects of a social support group, as an adjunct to diabetes training, on metabolic control and psychosocial outcomes.

The purpose of this present study was to evaluate a social support group as an adjunct to an intensive outpatient diabetes training program. Insulin-treated and non-insulin-treated patients (n = 204) were randomized into two groups: the control group received the training program only, whereas the experimental group was offered the same program plus eight support group meetings. At the 7-month follow-up, patients in both groups showed improved metabolic control, diabetes knowledge, frequency of practicing recommended diabetes management behaviors, and emotional adjustment. Although no additional improvement was seen in those outcome measures in patients who attended support group meetings, results of a subjective evaluation of the support group showed that patients experienced positive feelings in the groups that may contribute to patient health. A better understanding of the possible contribution of support groups to health is necessary before such groups are routinely recommended to patients.

Coefficients of agreement between observers and their interpretation.

The measurement of agreement between ratings of patient symptomatology by two or more psychiatrists is discussed. It is noted that coefficients which allow for possible chance agreement are to be preferred, but they involve assumptions about the way in which chance factors may operate. Assumptions which involve prior probabilities of the incidence of a symptom appear to be too stringent, and a new coefficient, called the RE coefficient, is recommended in which is assumed to operate in a purely random way. Binary scales are discussed in detail, but methods of dealing with scales of wider range are also referred to.

The learning of motor movements: a neurostatistical approach.

From a factor analysis of data from a learning experiment evidence is presented which appears to support the Blomfield-Marr thesis that in the learning of motor actions the cerebellum operates by the turning off of incorrect movements rather than by the turning on of correct ones. The factor model employed is that due to Godfrey Thomson which gives a neurostatistical explanation of the origin of mental factors.