State helmet laws and helmet use among fatally injured moped riders in the United States, 2011-2015.

OBJECTIVE: Research has found that mandatory motorcycle helmet laws increase helmet use and reduce motorcycle-related fatalities. However, the association between state moped helmet laws and helmet use in the United States has not been examined. This study investigated this association among a census of fatally injured moped riders in the United States. METHODS: A logistic regression model was constructed to analyze data extracted from the Fatality Analysis Reporting System (FARS) to examine risk factors for helmet nonuse among 572 moped riders fatally injured between 2011 and 2015. RESULTS: Fatally injured moped riders in states with universal helmet laws had 69 times the odds of wearing a helmet (P < .001). CONCLUSIONS: Findings suggest that universal moped helmet laws increase helmet use. However, additional research is needed to examine helmet laws and use among nonfatally injured moped riders.

Characteristics of drinking events associated with heavy episodic drinking among adolescents in the United States.

PURPOSE: To examine associations between characteristics of drinking events and the quantity of alcohol consumed by adolescents in the United States. METHODS: Analyses relied on 2011-2015 data from the National Survey on Drug Use and Health (NSDUH). The study sample included 8110 adolescents, ages 12-17years old, who drank alcohol in the past 30days. A logistic regression model, weighted for national estimation, was constructed to examine factors associated with heavy episodic drinking (HED; 5+ drinks for males, 4+ drinks for females) during the underage drinker's most recent drinking event. These models were adjusted for study year and individual characteristics, including past year drinking frequency, age of drinking onset, and demographic variables. RESULTS: Buying alcohol off-premise or from another person and being given alcohol from non-parent social sources were associated with greater odds of HED compared to being given alcohol by one of their parents. Drinking alcohol at someone else's house or multiple locations were associated with heavier alcohol consumption compared to drinking at one's own home. Being older and an earlier age of alcohol onset were associated with greater odds of HED. CONCLUSIONS: This study identifies contextual factors associated with HED by adolescents. Compared to global association studies, the findings from these event-specific analyses provide strong evidence of the environmental conditions that contribute to HED in American adolescents. Although no level of alcohol consumption is safe for adolescents, knowledge of event-level risk factors can inform targeted interventions.

The association between nonmedical use of prescription drugs and extreme weight control behavior among adolescents.

Although extreme weight control behavior (EWCB) is associated with substance use, no research has examined the association between the nonmedical use of prescription drugs (NMUPD) and EWCB. Self-report data were collected from a sample of 4,148 students in Grades 9-12 enrolled in 5 high schools across the United States. Logistic regression models were constructed to examine the nonmedical use of prescription pain relievers, depressants, stimulants, and a composite measure for any NMUPD, and the EWCB of fasting, use of diet pills, powders, or liquids, and vomiting or laxative use. Models were estimated before and after controlling for key covariates for males and females. Approximately 16% of respondents reported any EWCB during the past 30 days, while 11% reported any NMUPD during the past 30 days. After covariate adjustment, any NMUPD was associated with any EWCB in both males and females (p < .05), and all EWCB remained significant in females who reported prescription pain reliever use (p < .01), with 2 out of 3 remaining significant for prescription stimulant and depressant use (p < .01). The only significant association detected for males was between prescription pain reliever use and using diet pills, powders, or liquids (OR = 2.2, p < .01). Results suggest significant associations between NMUPD and EWCB, with variations by sex. These findings provide directions for additional research and point to several potential identification and intervention efforts. (PsycINFO Database Record

Factors Associated with Self-Estimated Breath Alcohol Concentration Among Bar Patrons.

BACKGROUND: Few studies have examined the context in which drinkers underestimate their breath alcohol concentration (BrAC) in natural drinking environments. This study examined factors associated with bar patrons' self-estimated BrAC in high-risk college town settings. METHODS: Guided interview and BrAC data were collected from 510 participants recruited as they exited bars located close to large universities: 1 in Florida and 1 in Texas. RESULTS: Participants with the highest measured BrACs underestimated their BrAC levels the most. Findings from multivariable linear regression analysis indicated that BrAC (std ß = 0.014, p < 0.001), number of alcoholic drinks consumed (std ß = 0.006, p < 0.01), and perceived drunkenness (std ß = 0.024, p < 0.001) had significant positive associations with BrAC self-estimates, where the regression coefficients were scaled by values approximately equal to each variable's interquartile range. Among the 321 participants with BrAC levels ≥ 0.08 g/dl, 21.2% believed their BrAC was below the legal per se driving limit of 0.08 g/dl. Results from a logistic regression analysis indicated that higher levels of perceived drunkenness were associated with better self-recognition that one's BrAC level exceeded the legal driving threshold (OR = 3.312, p < 0.001). Further, participants under 26 years of age had reduced odds of recognizing that their BrAC was greater than 0.079 g/dl (OR = 0.245, p < 0.05). CONCLUSIONS: These findings highlight the inaccuracy of self-estimated BrAC when drinking, particularly among younger drinkers. Adjusting for BrAC, situational factors were strongly associated with self-estimated BrAC. Future research is needed to better understand how altering drinking environments may improve accuracy of BrAC self-estimates and deter driving after drinking.

Extreme Weight-Control Behaviors and Suicide Risk Among High School Students.

BACKGROUND: Suicide is the third leading cause of death for people ages 15-19. Research has established an association across numerous risk factors and suicide, including depression, substance abuse, bullying victimization, and feelings of alienation. However, the connection between disordered eating as manifested in extreme weight-control behaviors (EWCB), and suicidal thoughts, ideation, and attempts among adolescents is less understood. Given the prevalence of adolescent suicide, this investigation examined associations between EWCB and suicide risk among high school students. METHODS: Data were collected from a convenience sample of 4178 students in grades 9-12 attending 5 public high schools using the Youth Risk Behavior Survey (YRBS) questionnaire. Logistic regressions were used to estimate associations between EWCB and suicide controlling for grade level and race, reported separately by sex. RESULTS: Students who reported seriously considering suicide had higher odds of exhibiting all 3 EWCBs [adjusted odds ratio (AOR)(male) = 3.0 (confidence interval (CI): 1.4, 6.5); AOR(female) = 4.5 (CI: 2.5, 8.3)]. Moreover, students who reported they made plans about suicide were also more likely to exhibit all EWCBs [AOR(male) = 3.7 (CI: 1.7, 7.9); AOR(female) = 4.2 (CI: 2.3, 7.7)]. CONCLUSIONS: EWCBs were significantly associated with suicide risk, furthering the evidence suggesting a link between disordered eating and suicide. Findings demonstrated the need for school health services that address disordered eating in the effort to reduce adolescent suicide.

Alcohol mixed with energy drink: Use may be a consequence of heavy drinking.

AIMS: In recent years, studies have indicated that consumers of alcohol mixed with energy drink (AmED) are more likely to drink heavily and experience more negative consequences than consumers who avoid these beverages. Although researchers have identified a number of plausible hypotheses that explain how alcohol-energy drink co-ingestion could cause greater alcohol consumption, there has been no postulation about reverse causal relations. This paper identifies several plausible hypotheses for the observed associations between AmED consumption and greater alcohol consumption, and provides initial evidence for one such hypothesis suggesting that heavy drinking may be a determinant of AmED use. METHOD: Data collected from 511bar patrons were used to examine the plausibility of one of the proposed hypotheses, i.e., AmED is an artifact of heavy drinking. Associations between the consumption of an assortment of alcoholic beverage types and total alcohol consumption were examined at the event-level, to assess whether AmED is uniquely related with greater alcohol consumption. RESULTS: Increased alcohol consumption was associated with greater odds of consuming most alcoholic beverage types; this association was not unique to AmED. CONCLUSIONS: Results support the overlooked hypothesis that AmED use is an artifact of heavy drinking. Thus, AmED consumption may be a consequence or marker of heavier drinking. Much of the existing research on alcoholic beverage types is limited in its ability to implicate any specific type of drink, including AmED, as a cause of increased alcohol consumption and related harm. More rigorous study designs are needed to examine causal relationships.

Health concerns of adolescents in Tehran, Iran.

BACKGROUND: Adolescent health concerns are an important source of information that should be considered when planning school and community health promotion policies, programs and services. Adolescence is a critical period of human development and the health concerns of adolescents can point to important issues that may be eclipsed by epidemiologic and other clinical sources of information. This study aimed to assess the health concerns of adolescents living in Tehran, Iran and to examine associations between selected demographics and the health concerns reported by participants. METHODS: This study was a population-based cross-sectional survey in 2011. Data were collected from a stratified random cluster sample of 915 adolescents, aged 14-18 years, living in Tehran, using the Persian version of the Adolescent Health Concern Inventory (AHCI-P). The data were analyzed using the χ2, Mann-Whitney and Kruskal-Wallis tests and logistic regression analysis. RESULTS: The mean numbers of health concerns in girls and boys were 48 (±27.6) and 44.5 (±27.4) respectively. The highest ranking health concern subscale for both girls and boys was The Future, and "being successful" was endorsed as the most prominent concern in the subscale. Female (OR: 1.42, CI 95%: 1.08-1.87), mother's educational level (OR: 2.23, CI 95%: 1.07-4.65) and living in northern (OR: 1.76, CI 95%: 1.13-2.74) and western (OR: 2.02, CI 95%: 1.30-3.16) regions of Tehran were significant predictors of a higher level of health concerns. CONCLUSION: Findings can be used to inform school and public health promotion policies, programs and supportive services designed to improve the overall health and well-being of adolescents.

Adolescent Nonmedical Use of Prescription Pain Relievers, Stimulants, and Depressants, and Suicide Risk.

BACKGROUND: Although the link between drug abuse and suicide risk is established, few studies have examined the relationship between the nonmedical use of prescription drugs (NMUPD) and suicide risk, particularly among adolescents. OBJECTIVES: To explore the relationship between NMUPD and suicide risk among 4,148 adolescents in grades 9-12 enrolled in five public high schools. METHODS: Logistic regression models were constructed for the nonmedical use of prescription pain relievers, depressants, stimulants, and a composite measure for any NMUPD. Models were estimated before and after controlling for key covariates. RESULTS: About 21% of respondents reported lifetime NMUPD. After covariate adjustment, students who had reported any NMUPD were between 1.7 and 2.3 times more likely to report suicidal ideation, but not a suicide attempt (p < .0001). When stratified by sex and drug, nonmedical use of pain relievers, stimulants, and depressants were significantly associated with greater odds of suicidal ideation and behavior for both males and females (p < .05). However, NMUPD of pain relievers were not associated with greater odds of suicide attempts for males or females or among males who reported nonmedical use of stimulants. Nonmedical use of depressants was associated with greater odds of suicide attempts for both males and females (OR = 1.61 and 2.25, respectively) and among females who reported nonmedical use of stimulants (OR = 2.06, p < .01). CONCLUSIONS/IMPORTANCE: Results suggest that some adolescents may be inappropriately self-medicating psychological distress with prescription medications or NMUPD may promote suicide risk, especially for males and females who use depressants and females who use stimulants.

Designing and Testing an Inventory for Measuring Social Media Competency of Certified Health Education Specialists.

BACKGROUND: Social media can promote healthy behaviors by facilitating engagement and collaboration among health professionals and the public. Thus, social media is quickly becoming a vital tool for health promotion. While guidelines and trainings exist for public health professionals, there are currently no standardized measures to assess individual social media competency among Certified Health Education Specialists (CHES) and Master Certified Health Education Specialists (MCHES). OBJECTIVE: The aim of this study was to design, develop, and test the Social Media Competency Inventory (SMCI) for CHES and MCHES. METHODS: The SMCI was designed in three sequential phases: (1) Conceptualization and Domain Specifications, (2) Item Development, and (3) Inventory Testing and Finalization. Phase 1 consisted of a literature review, concept operationalization, and expert reviews. Phase 2 involved an expert panel (n=4) review, think-aloud sessions with a small representative sample of CHES/MCHES (n=10), a pilot test (n=36), and classical test theory analyses to develop the initial version of the SMCI. Phase 3 included a field test of the SMCI with a random sample of CHES and MCHES (n=353), factor and Rasch analyses, and development of SMCI administration and interpretation guidelines. RESULTS: Six constructs adapted from the unified theory of acceptance and use of technology and the integrated behavioral model were identified for assessing social media competency: (1) Social Media Self-Efficacy, (2) Social Media Experience, (3) Effort Expectancy, (4) Performance Expectancy, (5) Facilitating Conditions, and (6) Social Influence. The initial item pool included 148 items. After the pilot test, 16 items were removed or revised because of low item discrimination (r<.30), high interitem correlations (Ρ>.90), or based on feedback received from pilot participants. During the psychometric analysis of the field test data, 52 items were removed due to low discrimination, evidence of content redundancy, low R-squared value, or poor item infit or outfit. Psychometric analyses of the data revealed acceptable reliability evidence for the following scales: Social Media Self-Efficacy (alpha=.98, item reliability=.98, item separation=6.76), Social Media Experience (alpha=.98, item reliability=.98, item separation=6.24), Effort Expectancy(alpha =.74, item reliability=.95, item separation=4.15), Performance Expectancy (alpha =.81, item reliability=.99, item separation=10.09), Facilitating Conditions (alpha =.66, item reliability=.99, item separation=16.04), and Social Influence (alpha =.66, item reliability=.93, item separation=3.77). There was some evidence of local dependence among the scales, with several observed residual correlations above |.20|. CONCLUSIONS: Through the multistage instrument-development process, sufficient reliability and validity evidence was collected in support of the purpose and intended use of the SMCI. The SMCI can be used to assess the readiness of health education specialists to effectively use social media for health promotion research and practice. Future research should explore associations across constructs within the SMCI and evaluate the ability of SMCI scores to predict social media use and performance among CHES and MCHES.

Hookah and Alcohol Use among Young Adult Hookah Smokers: A Mixed Methods Study.

OBJECTIVES: Hookah tobacco smoking has grown steadily in popularity among young adults in the United States. Little attention has been given to the relationship between hookah smoking and another behavior that is common among young adults - alcohol use. The purpose of this study was to examine hookah and alcohol use among young adults. METHODS: Forty young adult hookah smokers (55% female) participated in focus group sessions on hookah use beliefs and a brief survey examining hookah and alcohol use including drinking alcohol before, during, or after smoking hookah. RESULTS: Quotes from the focus groups indicated that alcohol use may promote hookah use among individuals who have little or no hookah smoking experience. Alcohol use, binge drinking, and alcohol use before, during, and after hookah use were common among the participants regardless of legal drinking age status. Nearly half of the participants preferred to drink alcohol while smoking hookah due to the improved physical and social effects they associated with combining the 2 behaviors. CONCLUSIONS: For some young adult hookah smokers, alcohol appears to enhance the hookah smoking experience and may play a role in hookah smoking initiation. Future research and interventions should address the association between hookah and alcohol use.

Self-Efficacy to Drive While Intoxicated: Insights into the Persistence of Alcohol-Impaired Driving.

BACKGROUND: Scant research has examined event-level risk factors for impaired driving in natural drinking settings. This study assessed driving self-efficacy among intoxicated individuals to better understand decision-making about alcohol-impaired driving at night after exiting on-premise drinking establishments. METHODS: Interview and breath test data were collected from bar patrons (n = 512) exiting 2 college bar districts in Florida and Texas. RESULTS: Results from a multivariable linear regression model indicated that self-efficacy to drive while intoxicated was more strongly associated with situational variables, that is, perceived drunkenness and self-estimated blood alcohol concentration than patron traits, that is, past-year history of drinking, risk proneness, and sex. A large proportion of bar patrons, particularly men, expressed confidence in their ability to drive, despite being highly intoxicated. Moreover, the majority of legally intoxicated patrons who were confident in their ability to drive were aware of their high level of intoxication. CONCLUSIONS: Emphasis should be placed on the enactment and enforcement of policies and laws to prevent alcohol-impaired driving.

Pharmacists' perspective on providing care when patients engage in unhealthy behaviors.

OBJECTIVE To assess the association between unhealthy lifestyle-related behaviors in patients and the pharmacist's professional obligation for providing care. DESIGN Repeated measures ANOVA was used to examine the effect of severity of lifestyle disease on professional obligation. SETTING Four live continuing education programs on law and management conducted in the state of Florida. PARTICIPANTS 488 Florida pharmacists were surveyed with 65% completing the survey. MAIN OUTCOME MEASURES Pharmacists' opinions based on lifestyle-related diseases classified as follows: low lifestyle-related disease (low LD): nonsmoker with asthma who is adherent with asthma medications; moderate (mod) LD: nonsmoker with asthma who is nonadherent with asthma medications; high LD: smoker with asthma who is adherent with asthma medications. RESULTS The difference between the scales for measuring professional obligation for low and mod LD was significant, with pharmacists reporting greater professional obligation for low versus mod LD. The difference between professional obligation for low and high LD was significant, with pharmacists reporting greater professional obligation for low than high LD. The difference between professional obligation for mod and high LD was significant, with pharmacists reporting a higher professional obligation for mod than high LD. CONCLUSION The differences in professional obligation between the three patient scenarios were small but statistically significant. The findings suggest that certain patient behaviors, such as smoking or medication nonadherence, can have a negative effect on pharmacists' sense of professional obligation to the patient.

Reliability and validity for the measurement of moral disengagement in pharmacists.

BACKGROUND: Social cognitive theory describes a process in which behavior can be disengaged from moral self control through eight different mechanisms. These mechanisms were used for the development of a new scale for measuring moral disengagement (Moral Disengagement Inventory, or MDI) in pharmacists. OBJECTIVES: The objectives of this study were to assess the reliability and validation of a scale to measure pharmacists' moral disengagement toward patients who exhibit behaviors directly or indirectly leading to their disease condition, such as an asthmatic patient who smokes or a non-compliant asthmatic patient. METHODS: A self-administered survey called the Moral Disengagement Instrument (MDI) was developed for this study. Once the MDI was designed, the items were evaluated for content validity, readability and face validity. The reliability of the developed measures was assessed. The convergent and discriminant validity of the moral disengagement constructs were tested using confirmatory factor analysis. RESULTS: The reliability coefficient for the MDI for the asthmatic smoker was 0.814 and reliability coefficient for the MDI for the non-compliant asthmatic patient was 0.782. Evidence supporting validity of the MDI was provided in a confirmatory factor analysis. CONCLUSIONS: The Moral Disengagement Instrument (MDI), developed as a tool for measuring pharmacists' disengagement beliefs for a smoker asthmatic patient and a non-compliant asthmatic patient, was found to be reliable and valid.

Psychometric properties of the adolescent health concern inventory: the persian version.

OBJECTIVE: It is important to consider the health concerns of adolescents before developing and implementing public health promotion or health education curriculum programs aimed at ameliorating priority health problems experienced by adolescents. The aim of this study was to test the psychometric properties of the original Adolescent Health Concern Inventory (AHCI) for use with an Iranian population. METHODS: This was a methodological study in which 50 adolescents with age range of 14-18 years were selected using convenience sampling. The translation and cultural adaptation process of The AHCI followed recognized and established guidelines. The face and content validity was established by analyzing feedback solicited from teenagers and professionals with expertise in health, sociology and psychology. Reliability was examined using test-retest and Cronbach's alpha for internal consistency reliability. Kappa and McNemar tests were used to examine test-retest reliability for each item. RESULTS: Minor cultural differences were identified and resolved during the translation process and determining the validity of the checklist. Results from Kappa and McNemar tests indicate a high degree of test-retest reliability. Internal consistency reliability as measured by Cronbach's alpha for the subscales were between 0.68 and 0.87 with total instrument reliability of 0.96 indicating considerable overall reliability. CONCLUSION: The Persian version of the AHCI appears valid and reliable. Hence, it can be used for filling a gap in identifying the adolescents' health concerns in the research and community settings and school health education programs in Iran to design appropriate interventions.

Is there a misplaced focus on AmED? Associations between caffeine mixers and bar patron intoxication.

BACKGROUND: Previous research on alcohol mixed with energy drinks (AmED) suffers from measurement problems. Missing from the research literature are studies that assess caffeine-alcohol co-ingestion in natural drinking environments. METHODS: This field study collected data in a U.S. college bar district from 328 randomly selected patrons. Anonymous data were obtained from face-to-face interviews and self-administered surveys, and from breath tests. RESULTS: Cola-caffeinated alcoholic beverage consumers left bars in a more highly intoxicated state than those who consumed alcohol only. There was no significant difference between the intoxication level of the AmED group and the cola-caffeinated alcoholic beverage group. Results from a multivariate regression model indicated that quantity of caffeinated alcoholic beverage consumption had a significant, positive association with bar patron intoxication after adjusting for potential confounders. CONCLUSIONS: Findings indicate that caffeine may have a dose-dependent relationship with alcohol intoxication in the bar/nightclub setting. In addition, results revealed that cola-caffeinated alcoholic drinks may pose similar levels of risk to bar patrons as those associated with AmED beverage consumption. Product labeling requirements about alcohol risks may need to be extended not only to energy drinks, but to caffeinated soft drinks as well.

Brief integrative multiple behavior intervention effects and mediators for adolescents.

This study evaluated the efficacy of a brief integrative multiple behavior intervention and assessed risk factors as mediators of behavioral outcomes among older adolescents. A randomized controlled trial was conducted with participants randomly assigned to either a brief intervention or standard care control with 3-month follow-up. A total of 479 students attending two public high schools participated. Participants receiving the intervention showed a significant reduction in quantity × frequency of alcohol use, and increases in fruit and vegetable consumption and frequency of relaxation activities, compared to those receiving the control, P's = .01. No effects were found on cigarette and marijuana use, exercise and sleep. Effect sizes were small with alcohol use cessation effects reaching medium size. Intervention effects were mediated by changes in peer influenceability for alcohol use, and self-efficacy and self-image for health promoting behaviors. Findings suggest that the brief intervention resulted in health risk and promoting behavior improvements for adolescents, with outcomes mediated by several risk factors.

5-HTTLPR genotype and associations with intoxication and intention to drive: results from a field study of bar patrons.

The serotonin transporter promoter polymorphism (5-HTTLPR) has been linked to a number of human behavioral traits and disorders. The variants of 5-HTTLPR are commonly reported in three forms, L/L, S/L and S/S, with the latter most often associated with emotional distress and/or behavioral dysfunction. Missing from the research literature are investigations that assess event-level associations between 5-HTTLPR genotype and specific incidents of risk behavior in natural drinking settings. This study reports associations between 5-HTTLPR, alcohol intoxication and intention to drive among young adult patrons exiting on-premise drinking establishments (i.e. bars) at night. Self-report measures, breath alcohol concentration (BrAC) readings and saliva samples for DNA analysis were collected from 477 bar patrons. Analyses were performed on 225 patrons likely to be near their peak intoxication level for the night. Results from a linear regression revealed that the 5-HTTLPR genotype was associated with exiting patron BrAC, after adjusting for random and fixed effects of other variables. An interaction effect involving 5-HTTLPR and bar-sponsored drink specials also had an independent association with BrAC, suggesting that selection of price-discounted alcoholic beverages increased intoxication in patrons with an L allele. In addition, results from logistic regression indicated that patrons with the S/S genotype were three times more likely to intend to drive a motor vehicle (after drinking on the night of study participation) compared with those with the L/L genotype. The 5-HTTLPR genotype may play an important role in the etiology of problems associated with on-premise drinking establishments.

Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons.

AIM: To assess event-level associations between energy drink consumption, alcohol intoxication, and intention to drive a motor vehicle in patrons exiting bars at night. METHOD: Alcohol field study. Data collected in a U.S. college bar district from 802 randomly selected and self-selected patrons. Anonymous interview and survey data were obtained as well as breath alcohol concentration (BrAC) readings. RESULTS: Results from logistic regression models revealed that patrons who had consumed alcohol mixed with energy drinks were at a 3-fold increased risk of leaving a bar highly intoxicated (BrAC> or =0.08g/210L), as well as a 4-fold increased risk of intending to drive upon leaving the bar district, compared to other drinking patrons who did not consume alcoholic beverages mixed with energy drinks. DISCUSSION: These event-level associations provide additional evidence that energy drink consumption by young adults at bars is a marker for elevated involvement in nighttime risk-taking behavior. Further field research is needed to develop sound regulatory policy on alcohol/energy drink sales practices of on-premise establishments.