Gender and ethnic differences in rates of immune reconstitution, AIDS diagnosis, and survival.

In this work, we use 2011-2013 Texas HIV surveillance data (N=2,175) and apply hierarchical linear and Cox regression modeling to characterize the association of gender and race/ethnicity with rate of immune recovery and determine whether immune recovery contributes to gender and racial/ethnic disparities in AIDS diagnosis and survival. The associations between gender and rate of immune recovery and between race/ethnicity and rate of immune recovery were not statistically significant (p > 0.05). In the multivariate survival analyses, there was no statistically significant association between gender and AIDS diagnosis (Adjusted Hazard Ratio (AHR) = 1.06, p = 0.61, 95%=0.85-1.32) and between race/ethnicity and AIDS diagnosis (Blacks vs Whites: AHR = 1.10, p = 0.24, 95% CI = 0.94-1.30; Hispanics vs Whites: AHR = 1.06, p = 0.46, 95% CI = 0.91-1.24). Similarly, there were no statistically significant associations with death (males vs females: AHR = 0.88, p = 0.73, 95% CI = 0.43-1.81; Blacks vs Whites: AHR = 0.68 p = 0.25, 95% CI = 0.36-1.30; Hispanics vs Whites: AHR = 0.96, p = 0.88, 95% CI = 0.55-1.67). However, the direction of the point estimates were in the reverse direction when compared to the rate of immune recovery or the AIDS diagnosis models. Our findings suggest that differences in rate of immune recovery may better explain disparities in AIDS diagnosis than disparities in survival. Future studies with longer follow-up may potentially generate statistically significant results.

Efavirenz versus Protease Inhibitors in Patients with HIV: A Systematic Review and Meta-Analysis

Efavirenz- and protease inhibitor (PI)-based regimens remain viable options across the globe. We conducted a meta-analysis to compare the effectiveness of efavirenz-based regimens relative to PI-based regimens. EMBASE, PubMed, Cochrane, and clinicaltrials.gov were searched for randomized controlled trials conducted between 1987 and 2018 comparing efavirenz- with PI-based regimens. This was followed by title, abstract, and full-text screens. The quality of selected studies was assessed using the Cochrane risk of bias tool. Meta-analysis of the odds of virological suppression was conducted using the robust variance estimation approach. Fifteen studies met the inclusion criteria and totaled 6712 patients (efavirenz arm = 3339; PI arm = 3373), of which 1610 (24.0%) were females. Follow-up ranged from 24 to 144 weeks. Mean/median age ranged from 33 to 44 years. Mean/median baseline CD4 count ranged from 32 to 557 cells/mL while mean/median baseline viral load ranged from log10 4.5 to log10 5.5 copies/mL. Meta-analysis showed that patients receiving efavirenz-based regimens had 37% higher odds of virological suppression compared to PI-based regimens (odds ratio = 1.37, 95% confidence interval = 1.06-1.77, p = 0.02). The Egger test suggested the presence of publication bias (B = 0.927, t = 2.214, p = 0.033). The main threat to the quality of evidence was attrition bias. Regarding virological suppression, efavirenzbased regimens were more effective than PI-based regimens and, therefore, might be ideal for the management of treatment naïve patients with HIV in settings where NNRTIs and PIs are used.

Identifying subgroups within at-risk populations that drive late HIV diagnosis in a Southern U.S. state.

We aimed to identify subgroups within age, racial/ethnic, and transmission categories that drive increased risk for late HIV diagnosis (LHD).A 1996-2013 retrospective study of HIV-diagnosed individuals (N = 77,844) was conducted. The proportion of individuals with LHD (AIDS diagnosis within 365 days of HIV diagnosis) was determined, stratified by age, race/ethnicity, and transmission category. Logistic regression with interaction terms was used to identify groups/subgroups at risk for LHD during 1996-2001, 2002-2007, and 2008-2013.Respectively, 78%, 27%, 38%, and 31% were male, White, Black, and Hispanic. Overall, 39% had LHD with a 6.7% reduction for each year increase (OR = 0.93, 95% CI = 0.93-0.94, p < 0.01). Older age was significantly associated with increased odds of LHD (OR range = 1.90-4.55). Compared to their White counterparts, all Hispanic transmission categories (OR range = 1.31-2.58) and only Black female heterosexuals and men who have sex with men (MSM) (OR range = 1.14-1.33) had significantly higher odds of LHD during 1996-2001 and/or 2002-2007. Significance was limited to Hispanic MSM (all age categories), MSM/IDUs (30-59 years), and heterosexuals (18-29 years) and Black MSM (30-39 years) during 2008-2013.Older individuals and Hispanics (driven by MSM) are at increased risk for LHD. HIV testing interventions directed at seniors and Hispanic MSM can further reduce rates of LHD.

Willingness to Seek Help for Depression in Young African American Adults: Study Protocol.

BACKGROUND: In the United States, among those living with mental illness, 81% of African American (AA) young adults do not seek treatment compared with 66% of their white counterparts. Although the literature has identified unique culturally related factors that impact help seeking among AAs, limited information exists regarding the development and evaluation of interventions that incorporate these unique factors. OBJECTIVE: This study aims to describe a study protocol designed to develop a culturally relevant, theory-based, psychoeducational intervention for AA young adults; to determine if exposure to the intervention impacts AA young adults' willingness to seek help; and to determine whether cultural factors and stigma add to the prediction of willingness to seek help. METHODS: The Theory of Planned Behavior (TPB) and Barrera and Castro's framework for cultural adaptation of interventions were used as guiding frameworks. In stage 1 (information gathering), a literature review and three focus groups were conducted to identify salient cultural beliefs. Using stage 1 results, the intervention was designed in stage 2 (preliminary adaptation design), and in stage 3 (preliminary adaptation tests), the intervention was tested using pretest, posttest, and 3-month follow-up surveys. An experimental, mixed methods, prospective one-group intervention design was employed, and the primary outcomes were participants' willingness and intention to seek help for depression and actual help-seeking behavior. RESULTS: This study was funded in May 2016 and approved by the University of Texas at Austin institutional review board. Data were collected from November 2016 to March 2016. Of the 103 students who signed up to participate in the study, 70 (67.9%) completed the pre- and posttest surveys. The findings are expected to be submitted for publication in 2020. CONCLUSIONS: The findings from this research are expected to improve clinical practice by providing empirical evidence as to whether a culturally relevant psychoeducational intervention is useful for improving help seeking among young AAs. It will also inform future research and intervention development involving the TPB and willingness to seek help by identifying the important factors related to willingness to seek help. Advancing this field of research may facilitate improvements in help-seeking behavior among AA young people and reduce the associated mental health disparities that apparently manifest early on. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/16267.

Association between quality-of-care indicators for HIV infection and healthcare resource utilization and costs.

OBJECTIVES: Multiple care quality indicators for HIV infection exist but few studies examine their impact on health outcomes. This study assessed which HIV care quality indicators were associated with healthcare resource utilization and costs. DESIGN: Retrospective analysis of Texas Medicaid claims data (01 January 2012 to 31 September 2016). METHODS: Included patients had at least two HIV-related medical claims during the identification period (01 July 2012 to 31 August 2014) (index = date of first HIV claim), were 18-62 years at index, and were continuously enrolled in the 6-month pre-index and 1-year post-index periods. Dependent variables included emergency department (ED) visits, inpatient hospitalizations, prescription count, and all-cause healthcare costs. Independent variables included CD4 cell count monitoring, syphilis, chlamydia, gonorrhea, hepatitis B, hepatitis C, and tuberculosis screenings, influenza and pneumococcal vaccinations, retention in care, and HAART initiation. Covariates included age, chronic hepatitis C virus infection, AIDS diagnosis, sex, and baseline healthcare cost. The study objective was addressed using generalized linear modeling. RESULTS: CD4 cell count monitoring and HAART initiation were significantly associated with reduced emergency department visits (P < 0.0001 for each). Influenza vaccination was significantly associated with reduced inpatient hospitalization (P < 0.0001). CD4 cell count monitoring (P < 0.0001), TB screening (P = 0.0006), influenza vaccination (P < 0.0001), and HAART initiation (P < 0.0001) were significantly associated with increase prescription claims. CD4 cell count monitoring, TB screening, and HAART initiation (P < 0.0001 for each) were significantly associated with all-cause healthcare costs. CONCLUSION: HAART may reduce use of emergency care services as early as 1 year following initiation.

The Role of Physical Activity in the Association Between Smoking Status and Quality of Life.

OBJECTIVES: Nonsmoking status and physical activity have, individually, been shown to be associated with health-related quality of life (HRQoL). The objective of this study was to assess whether the relationship between smoking status and HRQoL is modified or influenced by physical activity. METHODS: Data were extracted from the 2014 Behavioral Risk Factor Surveillance Survey dataset (N = 332680) in 2015. Logistic regression models were used to address study objectives. Health-related quality of life (HRQoL), measured using eight domains (general health, physical health, mental health, activity limitations, pain, depressive symptoms, anxiety, and vitality), was regressed on smoking status without and with adjustment for age, race, gender, education, marital status, income, employment, healthcare coverage, comorbidity, body mass index, flu vaccination, alcohol use, and physical activity. Smoking status by physical activity interaction term was added to the adjusted model and evaluated for significance. RESULTS: There were significant smoking status by physical activity interaction effects on general health, physical health, activity limitations, and depressive symptoms domains. Among those who exercised, relative differences in the odds of a high HRQoL was smaller between former smokers and nonsmokers and larger between current smokers and nonsmokers when compared to those who did not exercise. Similarly, there were sharper relative differences between those who exercised and those who did not exercise among former smokers than among current smokers. CONCLUSIONS: Smokers who successfully quit smoking (former smokers) may benefit from enhanced HRQoL that tends towards that of nonsmokers if they adopt physical activity in their daily routine. IMPLICATIONS: Behavioral interventions that combine smoking cessation and physical activity may be more effective than either smoking cessation or physical activity alone in improving the quality of life measures such as overall, physical and mental health, and degree of limitation to activities due to poor health. Health care providers can support patients who successfully quit smoking to add exercise to their daily routine with the expectation of enhanced HRQoL.

A pilot study assessing the addition of a Quit and Win program to pharmacist-led intensive smoking cessation therapy in a predominantly underserved, minority population.

INTRODUCTION: Quit and Win programs (Q&W) have been shown to improve smoking cessation rates by offering potential rewards to encourage smoking cessation. However, few studies have combined Q&W with intensive smoking cessation programs including behavioral counseling and pharmacotherapy, or studied Q&W in underserved, minority populations. This study was conducted to assess the impact on smoking cessation rates of adding a Q&W to intensive smoking cessation therapy in a largely underserved, minority population. METHODS: This was a single-center, prospective, open-label controlled study. Current smokers received pharmacist-led behavioral counseling and smoking cessation pharmacotherapy. Intervention group patients who successfully quit (verified by self-report and exhaled carbon monoxide) at 1 month and 3 months post-quit date were entered into a draw for $1000. The control group received the same smoking cessation services, but without a monetary incentive. RESULTS: Enrollment was 111 patients (N=85 in the intervention group), made up of predominantly underserved (82% had annual household income <$25000), minority (69.1%), and female (58%) patients. Groups were similar except the intervention group had lower educational and income levels, while the control group was more likely to smoke more than 1 pack per day. Quit rates at 3 months were 27% and 19% in the intervention and control groups, respectively (p=0.22). Female gender (OR=2.84; p=0.04) and Fagerström score (OR=0.71; p<0.01) were significant predictors of quitting. CONCLUSIONS: The addition of Q&W to intensive smoking cessation services increased clinic referrals and numerically improved cessation rates, although this difference was not statistically significant, possibly due to high attrition of the study.

Comparison of pharmacy students' self-efficacy to address cessation counseling needs for traditional and electronic cigarette use.

BACKGROUND AND PURPOSE: This study assessed pharmacy students' self-rated ability to provide cessation counseling for e-cigarette use and traditional cigarette smoking. EDUCATIONAL ACTIVITY AND SETTING: A cross-sectional study was conducted in spring 2014 at The University of Texas at Austin. Participants included first through fourth year (P1-P4) doctor of pharmacy (PharmD) students. Perceived confidence and knowledge to counsel on cigarette smoking cessation and e-cigarette cessation were self-rated and based on the Ask-Advise-Assess-Assist-and Arrange (5 A's) follow-up model as well as general counseling skills for recreational nicotine product use cessation. Comparisons were made between students' confidence to counsel patients on traditional cigarette smoking cessation and e-cigarette cessation and by class level. FINDINGS: Compared to cigarette smoking cessation counseling, students were less confident in their ability to counsel on e-cigarette cessation using the 5 A's model and general counseling skills. Students perceived themselves to be less knowledgeable about the harmful effects of e-cigarettes, pharmacists' role in counseling on e-cigarette cessation, and how patients can benefit from e-cigarette cessation counseling. A higher proportion of students reported having no training on e-cigarette cessation compared to cigarette smoking cessation (59% vs 9%). SUMMARY: Targeted training on how to counsel patients on e-cigarette cessation should be included in pharmacy curricula. Such training is expected to increase the confidence of pharmacists-in-training to address the needs of patients who use e-cigarettes.

Trends in Racial/Ethnic Disparities Among Patients Living with HIV in Texas, 1996 to 2013.

National studies show that Blacks with HIV have higher mortality rates compared to Whites. This study aimed to identify trends in Black racial disparities among Texas residents living with HIV. Using HIV surveillance data from the Texas Department of State Health Services, a cohort of HIV-diagnosed patients (N = 70,996) were identified and grouped according to year of diagnosis, 1996-1997 (T1), 1998-2006 (T2), 2007-2010 (T3), and 2011-2013 (T4). Survival analysis was used to examine racial differences in death rate (analysis 1) and clinical progression to AIDS (analysis 2) for each subcohort, using Blacks as the reference group. In analysis 1, Whites (hazard ratio, HR = 0.80, 95% confidence interval, CI = 0.74-0.87, p < 0.001; HR = 0.82, 95% CI = 0.78-0.87, p < 0.001; respectively) and Hispanics (HR = 0.72, 95% CI = 0.66-0.79, p < 0.001; HR = 0.77, 95% CI = 0.74-0.81, p < 0.001, respectively) had lower death rates in T1 and T2. This remained significant after adjusting for covariates. In T3, death rate was higher for Hispanics after adjustment (HR = 1.13, 95% CI = 1.00-1.28, p < 0.05). In T4, death rate was higher for Whites (HR = 1.66, 95% CI = 1.30-2.13, p < 0.001) and Hispanics (HR = 1.66, 95% CI = 1.34-2.06, p < 0.001). These relationships became non-significant after adjusting for covariates. In analysis 2, the rate of clinical progression to AIDS was higher for Hispanics in all subcohorts. The significance remained after adjusting for covariates. The rate of clinical progression to AIDS was lower for Whites after adjustments in T2 and T3. Additional studies are needed to understand factors that may explain this unexpected finding of improved survival for Blacks over time. Such studies may inform decision-making in HIV care to reduce Black HIV disparities.

Comparison of pharmacy students' knowledge and self-efficacy to provide cessation counseling for hookah and cigarette use.

OBJECTIVES: We aimed to assess pharmacy students' self-efficacy to provide cessation counseling for commercial cigarette and hookah tobacco use. METHODS: A cross-sectional study including PharmD students at a College of Pharmacy was conducted in Spring 2014. Confidence in counseling and perception of knowledge were self-rated and based on the Ask-Advise-Assess-Assist-Arrange follow-up (5A's) model and general tobacco cessation counseling skills. Comparisons were made between cigarettes and hookahs and by program level using t-tests, Wilcoxon signed-rank test, analyses of variance, and Tukey-Kramer tests. RESULTS: Overall, 82% and 16% of the students, respectively, reported receiving training on cigarette smoking and hookah tobacco use cessation. Students were moderately confident in their ability to counsel. Compared to hookah tobacco use cessation counseling, students were more confident in their general counseling skills and ability to counsel on cigarette smoking cessation using the 5A's (p < 0.001 in each case). Students perceived themselves to be more knowledgeable about cigarette smoking cessation than about hookah tobacco use cessation. Almost half of the students (42.0%) thought hookah tobacco was less harmful than traditional cigarettes. CONCLUSIONS: Pharmacy students need further training to address hookah and other alternative tobacco products to support patients' cessation needs, decrease risks for tobacco-related morbidity and mortality, and increase medication effectiveness.

Evaluating the Impact of an Anti-stigma Intervention on Pharmacy Students' Willingness to Counsel People Living with Mental Illness.

Third-year pharmacy students (n = 88) participated in an anti-stigma intervention program consisting of presentations, videos, discussion and active-learning exercises. Willingness to counsel (WTC) people with mental illness (MI) was evaluated using immediate pre and post-tests comparing diabetes, depression and schizophrenia. At pre-test, WTC diabetes was highest (higher = increased WTC) while schizophrenia was the lowest. There were no statistically significant differences between pre/post-test WTC for diabetes and depression, while schizophrenia WTC increased significantly (p < 0.05). At post-test, diabetes WTC was significantly higher than depression and schizophrenia (p < 0.0001). Regression results for WTC depression showed that comfortability and gender were significant (p < 0.05) predictors. Regression results for WTC schizophrenia showed that comfortability was a significant (p < 0.05) predictor. As highly accessible healthcare providers, pharmacists have the potential to positively impact healthcare, but this depends on WTC. Colleges of pharmacy may consider instituting policies that support experiential education involving counseling people living with MI, as this may increase comfortability.

Impact of a Mental Illness Stigma Awareness Intervention on Pharmacy Student Attitudes and Knowledge.

Objective. To determine if exposure to an intervention course impacts pharmacy students' mental health stigma (MHS) and mental health knowledge (MHK). Methods. A one-group pre/posttest intervention study of third-year pharmacy students (N=120) was conducted. Dependent variables were subdomains of MHS (recovery, safety, disclosure, separation, comfort) which were measured on a 5-point Likert scale (1=strongly disagree; 5=strongly agree). Mental health knowledge was measured with 10 true/false questions. The 2.5-hour intervention included presentations, videos, discussions, and active-learning exercises. Pre/posttests were administered, and data were analyzed using paired t tests and McNemar's tests. Results. Among responding students (n=88; 73.3% response rate), the following stigma subdomains significantly decreased after the intervention for depression and schizophrenia: recovery, safety, separation, and comfort. Mental health knowledge scores significantly increased from 5.9 (1.5) to 6.8 (1.5). Conclusion. Pharmacy students' MHS and MHK related to depression and schizophrenia can be improved through a brief and interactive anti-stigma intervention.

Little Cigar and Cigarillo Beliefs and Behaviors among African-American Young Adults.

OBJECTIVES: To inform the development of future research and culturally-targeted interventions to address little cigar and cigarillo (LCC) use among an at-risk population: African-American (AA) young adults. Additionally, this project assesses LCC use and perception differences between college- and non-college attending AA young adults who use LCCs. METHODS: Separate focus groups with college and non-college attending AA young adult LCC users assessed participants' attitudes, norms, and perceived behavioral controls regarding LCC use, which was guided by the Theory of Planned Behavior. A thematic analysis following standard qualitative methods procedures revealed 5 themes. RESULTS: Participants shared overwhelmingly positive attitudes toward LCC use, ubiquitous use in their communities, and limited barriers to use. Additionally, participants had difficulty separating LCC and marijuana use practices because LCCs often served as carriers for marijuana. There were no substantive differences between the college and non-college samples with respect to overall themes. CONCLUSIONS: Future research should assess LCC intended versus altered use and create culturally relevant intervention measures.

Scales of smoking-related self-efficacy, beliefs, and intention: assessing measurement invariance among intermittent and daily high school smokers.

PURPOSE: To examine the factorial validity and measurement invariance of scales that measure smoking-related self-efficacy, beliefs, and intention between daily and intermittent adolescent smokers. DESIGN: Cross-sectional survey design. SETTING: Selected high schools in eastern Texas. SUBJECTS: Subjects were 2888 high school current smokers; mean age 16.2 years; 53.5% male; 67.4% White, 17.8% Hispanic, 6.2% Black, 8.6% "other." Daily smokers comprised 37.9% of the sample (i.e., smoked at least one cigarette every day 30 days prior to the survey). MEASURES: Smoking-related self-efficacy and intention were measured by three items; beliefs were measured by four items. ANALYSIS: Confirmatory factor analyses were conducted to test the invariance of the measures between daily and intermittent smokers. Fit indices included comparative fit index (CFI), nonnormed fix index (NNFI), and root mean square error of approximation (RMSEA). RESULTS: The three-factor measurement model had good fit for daily (CFI = .97, NNFI = .95, RMSEA = .09) and intermittent (CFI = .96, NNFI = .95, RMSEA = .09) smokers. Evidence of strong factorial invariance was found for the factors between the smoking subgroups (CFI = .96, NNFI = .96, RMSEA = .08). CONCLUSION: These measures may be used to capture and compare scores on self-efficacy to resist smoking, beliefs about benefits of smoking, and intention to smoke between daily and intermittent adolescent smokers.

Exposure to celebrity-endorsed small cigar promotions and susceptibility to use among young adult cigarette smokers.

Small cigar smoking among young adult cigarette smokers may be attributed to their exposure to its advertisements and promotions. We examined the association between exposure to a celebrity music artist's endorsement of a specific brand of small cigars and young adult cigarette smokers' susceptibility to smoking that brand. Venue-based sampling procedures were used to select and survey a random sample of 121 young adult cigarette smokers, aged 18-35. Fourteen percent reported exposure to the artist's endorsement of the small cigar and 45.4% reported an intention to smoke the product in the future. The odds of small cigar smoking susceptibility increased threefold for those who reported exposure to the endorsement compared to those not exposed (OR = 3.64, 95% CI 1.06 to 12.54). Past 30-day small cigar use (OR = 3.30, 95% CI 1.24 to 8.74) and past 30-day cigar use (OR = 5.08, 95% CI 1.23, 21.08) were also associated with susceptibility to smoke a small cigar. An association between young adult cigarette smokers' exposure to the music artist's small cigar endorsement and their susceptibility to smoke small cigars was found. This association underscores the importance of monitoring small cigar promotions geared toward young people and their impact on small cigar product smoking.

Assessing the psychometric properties of smoking-related attitudes, self-efficacy, and intention among a diverse population of middle school students.

Large-scale surveys frequently assess smoking-related attitudes, self-efficacy and intention to understand differences in smoking behavior. However, a critical assumption is that measures of these determinants should be equivalent across different subgroups of a target population. The current study examined the factorial invariance of measures of smoking-related attitudes, self-efficacy, and intention with a large sample (N=13,733) of middle school students from 25 schools in Texas. We examined five levels of factorial invariance using a sequential process, in which increasingly constrained models assess the equivalence of a measure across subgroups. Strong factorial invariance provided a good fit for the model across all of the subgroups: race/ethnicity (CFI=.93), gender (CFI=.96), age (CFI=.95), and grade level (CFI=.95). Invariance results provide strong empirical support for the validity of smoking-related attitudes, self-efficacy, and intention measures across race/ethnicity, gender, age, and grade level for middle school students.

Engaging physicians and pharmacists in providing smoking cessation counseling.

BACKGROUND: Health professionals have a proven, positive impact on patients' ability to quit smoking, yet few integrate cessation counseling into routine practice.The aim of this study was to evaluate the impact of continuing education training on physicians' and pharmacists' cessation counseling. METHODS: A group-randomized trial of health care providers (87 physicians and 83 pharmacists) from 16 Texas communities compared smoking cessation training (intervention group) with skin cancer prevention training (control group). Pretraining, posttraining, and extended follow-up surveys were collected from providers. Perceived ability, confidence, and intention (ACI) to address smoking with patients were assessed with a composite ACI index. Patient exit interviews (at baseline, 1452 patients completed interviews; after 12 months, 1303 completed interviews) assessed counseling practices. RESULTS: There was a significant increase in the percentage of physicians with a high ACI index in the intervention group from pretraining to posttraining (27% to 73%; P < .001) vs the control group (27% to 34%; P = .42) and for pharmacists (4% to 60%; P < .001) vs the control group (10% to 14%; P = .99). Similar results were seen from pretraining to extended follow-up. At baseline, fewer pharmacy patients reported being asked about smoking compared with patients seen by physicians (7% vs 33%; P = .001). There was an increase in assisting patients to quit (6% to 36%; P = .002) by physicians (baseline vs 12 months) in the intervention group, but not in the control group. CONCLUSIONS: Training led to significant and lasting improvement in counseling among physicians. Low levels of counseling were seen among pharmacists.

Project ASPIRE: an Interactive, Multimedia Smoking Prevention and Cessation curriculum for culturally diverse high school students.

A Smoking Prevention Interactive Experience (ASPIRE) is an innovative, computer-based smoking prevention and cessation intervention delivered to a culturally diverse population of high school students. Founded in the Transtheoretical Model of Change, five main and two "booster" sessions comprise the interactive intervention. Here we describe the intervention and the baseline characteristics from our study sample of 1,574 10th graders from 16 high schools in Houston, Texas. Environmental and behavioral smoking risk factors were assessed, and the two intervention groups were comparable with respect to most measured variables. The intervention program holds considerable promise in its ability to reduce smoking among teens.

Validation of scales measuring attitudes, self-efficacy, and intention related to smoking among middle school students.

Attitudes toward smoking, self-efficacy to avoid smoking, and smoking intention, widely cited correlates of youth smoking prevention, are often measured in large-scale youth tobacco surveys. The psychometric properties of these scales have not been well studied among middle school youth. We examined the factorial, discriminate, and convergent validity of these scales among sixth to eighth graders from a convenience sample of 22 Texas middle schools (51.2% female; 51.21% White, 32.1% Hispanic, 16.9% African American, and 8.8% Other; 67.8% nonsmokers, 21.9% experimental smokers; 3.3% former smokers; and 7.6% current smokers). Confirmatory factor analysis and invariance testing suggest that smoking attitudes, self-efficacy, and intention have evidence of construct validity in this multiethnic sample, and the scales are appropriate to assess these constructs among middle school adolescents. Additional studies are needed to establish additional evidence of validity of these constructs in other middle school samples and other subgroups (e.g. current, experimental, and former smokers).

Impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive, multimedia smoking prevention and cessation curriculum for culturally diverse high-school students.

Few studies have examined the long-term efficacy of computer-based smoking prevention and cessation programs. We analyzed the long-term impact of A Smoking Prevention Interactive Experience (ASPIRE), a theoretically sound computer-based smoking prevention and cessation curriculum for high school students. Sixteen predominantly minority, inner-city high schools were randomly assigned to receive the ASPIRE curriculum or standard care (receipt of the National Cancer Institute's Clearing the Air self-help booklet). A total of 1160 students, 1098 of whom were nonsmokers and 62 smokers at baseline, were included. At 18-month follow-up, among baseline nonsmokers, smoking initiation rates were significantly lower in the ASPIRE condition (1.9% vs. 5.8%, p < .05). Students receiving ASPIRE also demonstrated significantly higher decisional balance against smoking and decreased temptations to smoke. Differences between groups in self-efficacy and resistance skills were not significant. There was a nonsignificant trend toward improved smoking cessation with ASPIRE, but low recruitment of smokers precluded conclusions with respect to cessation. ASPIRE demonstrated the potential for an interactive multimedia program to promote smoking prevention. Further studies are required to determine ASPIRE's effects on cessation.