AIDS risk among students attending Seventh-day Adventist school, in North America.

In 1995, a survey was conducted among students attending 69 Seventh-day Adventist (SDA) high schools within the United States and Canada. The survey assessed the extent that these students practiced sexual and drug-use behaviors which place them at risk for contracting or transmitting the human immunodeficiency virus (HIV). A total of 1,748 respondents enrolled in grades 9 through 12 completed questionnaires similar to the instrument used in the 1993 Youth Risk Behavior Survey (YRBS). Data were collected and compared to results from the 1993 YRBS. Students who attended SDA parochial schools reported lower rates of sexual intercourse compared to YRBS school counterparts (16.3% vs. 53.1%) and lower rates of all substances measured. Furthermore, respondents were more likely to engage in substance use and sexual intercourse if they had at least one parent who used tobacco, alcohol, or marijuana, as reported by the students.

The impact of including incentives and competition in a workplace smoking cessation program on quit rates.

PURPOSE: To determine the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition. DESIGN: A quasi-experimental design was employed to compare the effectiveness of three different smoking cessation programs, each assigned to separate worksite. SETTING: The study was conducted from 1990 to 1991 at three aerospace industry worksites in California. SUBJECTS: All employees who were current, regular tobacco users were eligible to participate in the program offered at their site. INTERVENTION: The multicomponent program included a self-help package, telephone counseling, and other elements. The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 months of the program. The traditional program offered a standard smoking cessation program. MEASURES: Self-reported questionnaires and carbon monoxide tests of tobacco use or abstinence were used over a 12-month period. RESULTS: The incentive-competition program had an abstinence rate of 41% at 6 months (n = 68), which was significantly better than the multicomponent program (23%, n = 81) or the traditional program (8%, n = 36). At 12 months, the quit rates for the incentive and multicomponent-programs were statistically indistinguishable (37% vs. 30%), but remained higher than the traditional program (11%). Chi-square tests, t-tests, and logistic regression were used to compare smoking abstinence across the three programs. CONCLUSIONS: Offering a multicomponent program with telephone counseling may be just as effective for long-term smoking cessation as such a program plus incentives and competition, and more effective than a traditional program.

The impact of caffeine use on tobacco cessation and withdrawal.

Continuous caffeine consumption with smoking cessation has been associated with more than doubled caffeine plasma levels. Such concentrations may be sufficient to produce caffeine toxicity symptoms in smoking abstinence conditions. To test whether caffeine abstinence influences smoking cessation, 162 caffeine-using smokers were enlisted from American Lung Association smoking cessation programs. Volunteers were randomly assigned by clinic to caffeine-use and caffeine-abstinence conditions and measured for 3 weeks post-smoking cessation, at 6 months and one year. Results showed a significant linear increase in caffeine sputum levels across 3 weeks post cessation for those who quit smoking and continued using caffeine. Three weeks after cessation, concentrations reached 203% of baseline for the caffeine user. Typical nicotine withdrawal symptoms occurred during the first 16 days of cessation. The caffeine abstainers, but not continued users of caffeine, reported increased fatigue during the first 3 days of cessation. Among complete caffeine abstainers, compared with caffeine users, there was a significant increase in fatigue, a decrease in stimulation, and a marginal increase in caffeine craving immediately following tobacco cessation. There were no differences between the groups on other withdrawal symptoms or in cessation success at 16 days, 6 months, or 12 months.

Caffeine and nicotine: a review of their joint use and possible interactive effects in tobacco withdrawal.

There is a strong, significant relationship between coffee consumption and smoking. In six epidemiological studies reviewed and analyzed here, 86.4% of smokers consumed coffee versus 77.2% of nonsmokers. Exsmokers use more coffee than nonsmokers but somewhat less than smokers. Seventeen experimental studies suggest that the pharmacologic effect of caffeine in coffee may be partially but not totally responsible for the relationship. Conditioning, a reciprocal interaction (caffeine intake increases anxiety/arousal--nicotine decreases it), or joint effect of a third variable (e.g., stress, alcohol) may account for the relationship. In abstinent smokers, blood caffeine levels increase and remain elevated for as long as 6 months. These higher caffeine plasma levels may be sufficient to produce caffeine toxicity syndrome. A review of 86 studies of nicotine withdrawal, caffeine withdrawal, and caffeine toxicity suggests that the symptoms are similar enough to be confused, and that reported nicotine withdrawal symptoms may be a mixture of nicotine withdrawal and caffeine toxicity.

The impact of incentives and competitions on participation and quit rates in worksite smoking cessation programs.

PURPOSE: The purpose of this review is to determine whether incentive-based programs conducted at worksites increase participation and long-term smoking cessation rates. METHODS: Published studies of workplace smoking cessation programs involving incentives and competition were identified through all available years up to winter of 1992 in MEDLINE (1966-1992), Psychlit (1967-1992), Smoking and Health (1960-1992), and Combined Health Information (1973-1992) computer databases and article reference lists. Programs were considered incentive programs when they involved either cash or other prizes paid to the participant for quitting smoking. Incentive competition programs typically involve groups contesting for prizes by having the greatest smoking cessation rates. Thirty studies were found, out of which 15 quasi-experimental and experimental studies are reviewed. The 15 studies that did not have comparison groups were excluded from this report. RESULTS: Only eight studies had a comparison group in which the effects of incentives and competition were separated from the effects of other interventions. Only one study separated the effects of competition from incentives. Five of these studies evaluated smoking rates after six months, and three after 12 months from the program start. Three of these studies showed that incentives increased participation rates, and five enhanced smoking reduction. No study showed, however, that incentives and/or competition enhanced smoking cessation past six months. CONCLUSIONS: It appears that incentives/competition may be useful for increasing participation and smoking reduction. Further research needs to be conducted to determine whether incentives and/or competition enhance long-term quit rates, and what are the most effective types of incentive procedures.

A perspective on international school health education research.

The scope and content of school health education research conducted from 1984-1987 in countries outside the U.S. are examined. Both published and unpublished research were requested from sources identified by the American School Health Association's Council on International Health. One hundred eighty-eight studies from 31 countries were reviewed and categorized. Countries that publish journals devoted to school health offer more opportunities for publishing research. Analysis of the studies revealed that individuals involved in school health face similar problems regardless of country. Cross-country comparative studies serve as models for future research.

Determining patient education needs.

Patients will learn more readily if you teach them what they want to know, in a way suited to their style of learning. The current emphasis in education is on the learner: What is that learner like? What are his or her beliefs, values, attitudes, and behaviors? What is his or her level of knowledge? You need to know all these things--and more--when you embark on a program of patient education. This article offers a step-by-step guide in determining your patients' educational needs.

Hypertension in a Caribbean population.

This cross-sectional study presents an assessment of factors associated with elevated blood pressure in Seventh-Day Adventists in the Caribbean. Four-hundred-thirty-three subjects were randomly selected from the English-speaking Caribbean population. Subjects ranged in age from twenty-one to sixty; 150 were males and 283 females. Eighty percent were Negroes of African descent, 12 percent mixed, 8 percent Indians of East Indian descent, and 3 percent of Spanish background. The study utilized the PRECEDE model developed by Green and associates to examine factors for hypertension. A positive correlation was found between body mass index (weight in Kg/height in M2) and hypertension in both sexes. Age was also significantly associated with hypertension. Normotensive females had a slightly higher intake of potassium than hypertensives, while hypertensive males tended to have higher levels of calcium. Other factors, such as parental history of blood pressure, vegetarian diet, sugar and fat intake, or Type A/B personality showed no relationship to hypertension. The vast majority of participants were Type B. This study provides baseline information for use in selecting those features which will be emphasized in a health education program, as well as baseline data for evaluation of health education in the Caribbean.

Making an educational diagnosis to improve patient education.

The health professional needs to make an educational diagnosis before he selects a specific approach to patient education. Tailoring a patient education program to the patient's belief regarding his health and the patient's expectations regarding his diagnosis and care is useful. Other factors that influence the pulmonary rehabilitation team's selection of educational methodology are the patient's age, sex, educational level, cultural background, and prior experience with his disease. An educational program oriented to patients who rely on self-motivation or self-reward should provide choice of treatment, involvement of the patient in making choices, information-giving, and strong emphasis on individual responsibility. An educational program oriented to patients who demonstrate success when group strategies and support are used should encourage them to believe that their health can be controlled, even if it is dependent upon powerful others. Values clarification and behavior modification are also helpful in patient education.

Values clarification and the cardiac patient.

This exploratory study tested the feasibility and potential of values-clarification methods in patient education with 20 chronic heart patients participating in the cardiac classes of a university medical center. Strengths and limitations of the methods were identified, with greater feasibility and responsiveness demonstrated in patients between 51 and 60 years of age, those who had accepted their cardiac problem, and in home visits rather than clinical settings.