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Objective: The authors examined the secondhand effects among college freshmen of others' alcohol use and related student characteristics, and perceptions about residence hallmates. Participants: The authors surveyed 509 incoming freshmen residing in predominantly freshman residence halls. Methods: The authors administered a Web-based survey 2 months into the 2006 fall academic semester. Results: Most (80%) students experienced at least 1 secondhand effect. Participants' perceptions of wingmates' acceptance and expectation of alcohol use and participants' perceived inability to protect themselves against alcohol problems were related to experiencing secondhand effects, as were being a female and a drinker. Conclusions: Incoming college freshmen frequently experienced secondhand effects of alcohol use. Involving residence halls in norms-based interventions aimed at reducing secondhand effects warrants evaluation. Further research is also needed to examine skill building among college students to avoid and intervene into others' drinking and to examine resident advisor roles as both engenderers of trust and cooperation as well as enforcers of alcohol rules. Keywords: Adolescents, alcohol, college, freshman, peers, secondhand effects, Researchers have not adequately examined the effects that college drinkers have on other college students, particularly those with whom they live. Heavy alcohol consumption is common on college campuses; recent [...]

Objective: In this qualitative study, the authors examined how students attempt to minimize harm to themselves and others when drinking. Participants: The authors recruited freshmen at a large, mid-Atlantic US public university during the fall semester of 2005 to participate in 8 focus groups. Methods: The moderator's guide was developed through an iterative process that included input from experts and pilot testing. The researchers audiotaped focus group conversations, transcribed them, and subjected them to an interrater reliability check. Analysis was based on the framework of Information-Motivation-Behavioral Skills Model and a phenomenological approach. Results: College students have a repertoire of coping strategies they use in an attempt to safeguard themselves and their friends from harm when drinking. Strategies encompass planning a safe context for drinking, using safety measures to minimize harm when drinking, and taking care of someone who has consumed too much alcohol. Conclusions: A harm-reduction focus that acknowledges and builds on existing protective strategies may be a promising avenue for alcohol interventions. Keywords: alcohol, college health, gender, health education, More than 20 years after US federal law raised the minimum age for the purchase and public possession of alcohol from age 18 to 21 years, alcohol consumption remains prevalent [...]

There is a paucity of research investigating the impact that parents may have on college drinking. In this study, the authors investigated the relationship between students' perceptions of parent approval of drinking and problem drinking occurrence. They conducted a Web-based survey of 265 first-year students living on campus during their second semester. The authors used logistic regression to examine the relationship between students' perceptions of their mothers' and fathers' attitudes toward their drinking, their mothers' and fathers' drinking habits, and problem drinking since they had begun college. Sixty-nine percent of respondents reported experiencing at least 1 drinking problem. Over one third of students perceived that their parents would approve of them drinking occasionally. Students perceiving more parental approval for their drinking were more likely to report at least 1 drinking problem. Student perceptions of parental approval of drinking warrant further investigation as a potentially mutable correlate of problem drinking. Key Words: alcohol, college students, parents, The 1995 National College Health Risk Behavior Survey (NCHRBS) found that 68% of college students had at least 1 drink of alcohol during the 30 days preceding the survey and [...]

Objective: To identify factors associated with young adolescents' sense of comfort about discussing sexual problems with their physician. Design: Confidential, assisted self-report questionnaires on physician-adolescent communication developed by the investigators and completed by participants at visits for general health examinations. Setting: Five primary care pediatric practices at health maintenance organizations in Washington, DC. Patients: A consecutive sample of all adolescents 12 to 15 years old who received a general health examination. Of 412 eligible patients, 221 received parental consent and participated. Main Outcome Measure: Adoslescents' sense of comfort about talking to their physician about a sexually transmitted disease or some other sexual problem. This outcome was chosen for a substudy of a larger longitudinal prevention trial. Results: Most adolescents valued their physicians' opinions about sex (89%) and said it was easy to talk to the physician during their visit (99%) , but about half said they would be uncomfortable talking to the physician if they had a sexually transmitted disease or some other sexual problem (57%). Adolescents' sense of comfort was greater when physicians discussed sexual issues in the general health examination, adolescents perceived their personal risk of sexually transmitted disease to be high, adolescents had high self-esteem, and physicians were adolescents' usual physicians. Conclusions: This study emphasizes the need for physicians to discuss sexual risks with young adolescents and suggests ways physicians can help young adolescents feel more comfortable talking with them about sexual concerns., Young adolescents may be receptive to talking about sexual concerns with their doctors. Researchers evaluated questionnaires completed by 221 adolescents aged 12 to 15 after they had met with their primary care doctors for a general health examination. Many (89%) adolescents said they respected their doctor's opinions about sex and found they could talk to their doctors (99%). Adolescents said they were more comfortable talking with their doctors about sex when the doctor initiated discussion about ways to reduce sexual risks, although most doctors did not do this. Older teens were more concerned about confidentiality.

* Objective: To determine whether office-based interventions increase primary care physicians' risk assessment of and counseling practices for patients regarding sexually transmitted diseases and the human immunodeficiency virus (HIV). * Design: Randomized controlled clinical trial. * Setting: Washington, D.C., Metropolitan Statistical Area. * Study Participants: Office-based primary care physicians (family or general practice, internal medicine, and obstetrics-gynecology). * Intervention: Mailed educational materials alone or coupled with a simulated patient instructor office visit. * Measurements: Self-reported and observed frequency of assessing and counseling patients regarding their risk factors for sexually transmitted diseases and HIV infection. Participants were interviewed by telephone before and after the intervention (n = 757). A subset of participants (n = 194) was also observed after the intervention by simulated patient evaluators in blinded office visits. * Results: 89% of physicians who received both educational materials and a simulated patient instructor visit reported that they reviewed the educational materials compared with 53% of those who only received the educational materials (P [less than or equal to] 0.001). Physicians in the combined intervention group had higher self-reported and observed rates for several risk assessment questions and counseling recommendations than did physicians in the control group or the group that only received educational materials. Seventy-three percent of physicians of the combined intervention group reported an increase in counseling patients about reducing risky sexual behavior compared with 53% of the group receiving only educational materials and 42% of the control group (P [less than or equal to] 0.001). * Conclusions: Mailed educational materials combined with an office visit by a simulated patient instructor for role-play and feedback on clinical performance increased the frequency of office-based physicians' risk assessment and risk reduction counseling of patients for sexually transmitted diseases and HIV infection., Physicians may increase their rate of counseling patients about sexually transmitted disease (STD) risks if they receive educational materials and practice with a simulated patient. In a study of 757 office-based primary care physicians, 256 received no intervention (control group), 253 received educational materials and 248 received the educational materials and had a session of role-playing with an instructor simulating a patient at risk for STDs. The educational materials included an audiotape, a book, brochures, a resource directory and a wall chart. The physicians were interviewed by telephone before and three to five months after the intervention, and 194 of them were also evaluated by another simulated patient. Physicians who had simulated patient instruction were more likely to review the educational materials than those who just received the materials. More STD counseling was reported by physicians who received materials and had instruction (73%) than by physicians who just received educational materials (53%) and by physicians in the control group (42%).

* Background.--Simulated patients are used with increased frequency for medical students and residents, but have not been used very often with practicing physicians. We hypothesized that educational materials could improve primary care physicians sexual practices history taking and counseling as assessed by a simulated patient in the physician's office. Methods.--Simulated patient (SP) visits were made to 232 (75% of eligible) primary care physicians. The patient simulated was a sexually active young woman with vaginitis and sexually transmitted disease/human immunodeficiency virus risk behaviors. In advance of the visit, physicians were provided educational materials (monograph, pamphlet, and audiotape) developed for the study, including a risk assessment questionnaire that could be used with patients. Results.--Most physicians randomly allocated to the intervention participated. Twenty-one percent of physicians refused to schedule an SP visit. Physicians who received an SP rated the experience highly. Physicians who prepared for the visit with the educational materials performed significantly better than those who did not. About two thirds of physicians reviewed the materials, many for the second time, after the SP visit. Physicians who used the study risk assessment questionnaire performed better. Many physicians (24.9% to 39.8%) did not meet each of the four goals for the visit, as assessed subjectively by the SP. Physician performance was better for measures of general patient interaction than for measures of sexual practices history taking and counseling techniques. Conclusion.--The SP visit was acceptable to most physicians practicing in a community and was evaluated by them as an appealing and an effective educational experience. The SP, however, has limited feasibility because of cost. The SP led to review of materials by nearly all physicians either before or after the visit. Physicians who prepared before the visit performed better on every dimension, eliciting more information, displaying better patient interaction skills, and meeting more of the educational goals. Even with educational preparation, however, many physicians were not perceived as being effective counselors. (Arch Intern Med. 1992;152:1823-1828)

Goal: To determine chlamydia screening practices and the resulting positive test results for adolescents enrolled in a large nonprofit managed care organization. Study Design: The electronic medical records of all 12- to 19-year-olds enrolled in a large nonprofit managed care organization serving a demographically diverse patient population from January 1998 through December 1999 were reviewed retrospectively. Results: Among the 43,205 female and 44,133 male managed care organization members, ages 12 to 19 years in 1998-1999, 7575 adolescents (8.7%) (6914 females [16%] and 661 males [1.5%]) were tested for chlamydia. Among the members tested, chlamydia was diagnosed in 1109 adolescents (14.6%) (983 females [14.2] and 126 males [19.1%]); 761 (68.6%) adolescents were retested for chlamydia; and 182 (16.4%) had repeat positive test results. The median time to diagnosis of a repeat infection was 6 months. Conclusions: Chlamydia imposes a large disease burden in the private, organized healthcare sector. Managed care organizations can use operational data to enhance chlamydia prevention services by defining testing practices and local disease prevalence.