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In this egocentric network study, we explored Chinese collectivism in relation to social network characteristics and sex work-related stigma among mid-age female sex workers (FSWs). Respondent-driven sampling was used to recruit 1245 mid-age FSWs from three cities in China. We found that a one standard deviation (SD) increase in FSWs’ collectivism was associated with a 0.18 SD decrease in social support (95% CI − 0.32, − 0.04), a 0.20 SD decrease in network effective size (i.e., the diversity of a social network; 95% CI − 0.30, − 0.10), and a 0.21 SD decrease in network betweenness (i.e., the “bridging potential” of egos within their networks; 95% CI − 0.33, − 0.09). Among participants who perceived more sex work stigma, the association between collectivism and FSWs' network betweenness was attenuated. In a collective culture emphasizing group values and honor, belonging to a less interconnected social network may give FSWs a structural advantage to cope with stigma and secure social support.

The aim of this study was to assess university students' knowledge and understanding about HPV and its association with their vaccination status and health literacy. A sample of 383 undergraduate university students between the ages of 18 and 26 were recruited between February 14 and March 22, 2018. An electronic survey was administered to assess knowledge and HPV awareness, vaccination status, and health literacy. Participants had moderate mean knowledge scores of 6.02 of a possible 11 (SD = 3.06). There was a positive association between health literacy and HPV knowledge and a statistically significant difference in knowledge scores between those who are vaccinated and unvaccinated p < 0.001. This study expanded available research on HPV vaccine and its uptake among university students and can be used to develop educational interventions. Continuous examination of HPV knowledge gaps and identifying factors that affect vaccine uptake is pivotal to increasing vaccination rates.

Background: Single cigarette use among urban African Americans can perpetuate smoking continuation. There are no measures on perceptions related to reducing single cigarette use. Purpose: We develo...

INTRODUCTION: Alcohol ignition interlock devices (IID) reduce rates of drinking and driving. The interlock offers an opportune time for tailoring targeted interventions to develop habits to separate drinking from driving among this high-risk population. This study identified different types of IID users upon whom targeted interventions could be developed. METHODS: Participants (N = 114) were assessed at IID installation and again six months later. Latent class analysis (LCA) was conducted using drinking environment, drinking motivation, social support, drug use, and problem drinking behaviors as indicators. Multivariate regression analyses were conducted comparing latent class assignment with impaired driving attempts. RESULTS: LCA supported a 4-class model where 14.8% of participants fell into the low use/high awareness class; 30.6% fell into the heavy use/high awareness class; 30.6% fell into the mixed use/high awareness class; and 24.0% fell into the moderate use/low awareness class. Drivers in the moderate use/low awareness condition had increased early morning BAC lockouts. CONCLUSIONS: These typologies demonstrate important differences within high risk drivers. Indeed, drivers who fell into the moderate use/low awareness class may not have considered their alcohol-related behaviors problematic. This information could lend itself to the development of targeted interventions to address subgroups of drinking drivers.

OBJECTIVES: Adherence to most evidence-based cancer screenings is lower among African Americans due to system- and individual-level factors that contribute to persistent disparities. Given the recommendation for low-dose computed tomography (LDCT) screening among individuals at high risk for lung cancer, we sought to describe aspects of decision-making for LDCT among African Americans and to examine associations between select components of decision-making and screening-related intentions. DESIGN: African Americans (N=119) with a long-term smoking history, aged 55 to 80 years, and without lung cancer were recruited to participate in a cross-sectional survey. We measured knowledge, awareness, decisional conflict, preferences, and values related to lung cancer screening. RESULTS: The majority of the study population was of lower socioeconomic status (67.2% had an annual income of ≤$20,000) and long-term current (79%) smokers. Participants had a median 20 pack-years smoking history. Most participants (65.8%) had not heard of LDCT and the total lung cancer screening knowledge score was M=7.1/15.0 (SD=1.8). Participants with higher scores on the importance of the pros and cons of screening expressed greater likelihood of talking with a doctor, family, and friends about screening (p’s

OBJECTIVE: The purpose of this investigation was to examine the relationships among alcohol use, driving behavior, and indicators of health among older adults. METHODS: A sample of 818 adults ages 65 and older were recruited through the state motor vehicle administration and completed an online survey. Regression models were used to assess the associations between alcohol use, driving behaviors, and 6 health indicators. RESULTS: Whereas more frequent alcohol use was associated with fewer health conditions, higher quantity alcohol use was associated with increased likelihood of having at least one health condition. Participants who drove several days a week and those who drove every day had higher perceived health status, a lower number of past-year health conditions, and a lower number of past-year health events when compared to less frequent drivers. Persons who had at least one past-year negative driving behavior or event were significantly less likely to have positive health status, had lower perceived health status, and had a higher number of past-year health conditions and events. CONCLUSIONS: High quantity alcohol use and risky driving behavior among older adults are indicative of poorer health. Continued efforts are needed to educate older adults on the relationships among alcohol use, driving behavior, and health.

Recent research indicates that perceived behavioral control is the strongest predictor of drowsy driving intention and willingness in young adult university students. This research also suggests that elevated perceived behavioral control concerning drowsy driving may impact a person’s perceptions of risk regarding drowsy driving, which subsequently may impact drowsy driving intention and willingness. Questionnaire data on drowsy driving beliefs and perceptions previously collected from 497 students at a university in the United States was used to investigate the relationship between perceived behavioral control, risk perception, intention, and willingness related to drowsy driving behavior. Regression analyses and Sobel tests revealed that drowsy driving risk perception partially mediates the relationship between perceived behavioral control and willingness to drive drowsy: greater perceived control over drowsy driving behavior decreases perceived risk concerning drowsy driving, which in turn increases willingness to engage in drowsy driving behavior. Limited evidence also was produced indicating that drowsy driving risk perception partially mediates the relationship between perceived behavioral control and intention to drive drowsy. These findings suggest important theory-based messaging strategies that can be developed to alter perceptions and subsequent behavior related to drowsy driving in young adult U.S. drivers.

OBJECTIVES. The purpose of this investigation was to determine what older adults find most concerning about driving as they age and how these concerns are related to driving skill, behaviors, and experiences. METHODS. In partnership with the Maryland Motor Vehicle Administration, a sample of 751 older adults ages 65 and older completed an online survey between October 2017 and May 2018. A content analysis was used to code open-ended responses about driver concerns, and multivariate logistic regression models were used to analyze the associations between driving concerns and driving skill, behavior, and experiences. RESULTS. Eighty-four percent of participants reported at least one driving concern, with 44% concerned about others’ driving, 34% concerned about their own driving, and 24% concerned about driving conditions. The most frequently mentioned driving concerns were other drivers in general, driving at night, visual ability and awareness, and other drivers being aggressive or reckless. Being concerned with their own driving was significantly associated with decreased perceived driving skill and increased odds of experiencing negative driving experiences in the past year. Being concerned about others’ driving was associated with increased odds of wearing a seatbelt (AOR = 2.67; 95% CI = 1.02, 7.00), having high perceived driving skills in emergency situations (AOR = 1.56; 95% CI = 1.14, 2.12), and getting in a near crash or collision in the past year (AOR = 1.50; 95% CI = 1.04, 2.18). CONCLUSIONS. Older adult drivers are frequently concerned about their own driving as well as the driving of others. Implications for future research and health practice are discussed.

OBJECTIVES: The purpose of this investigation was to compare the drinking patterns and experiences (both positive and negative) among DUI offenders who had installed an ignition interlock. The association between those experiences and interlock performance as measured by the number of times they had a lockout, was also assessed. METHODS: Over 300 DUI offenders who installed an interlocks in the State of Florida were recruited and completed an on-line survey at the beginning and end of their interlock restriction. A record of the interlock performance data from each was downloaded and used to determine how many lockouts they experienced during their interlock restriction period. Offenders were defined into two groups; successful cases (having 0 or 1 lockout) or poor performers (have 2 or more lockouts). Chi-square and binary regressions were used to assess differences between groups. RESULTS: Poor performers reported significantly more drinking and were more likely to drink in a context of emotional comfort, yet they were more likely to report positive experiences with the interlock, especially as to its ability to remind them to avoid another DUI by reducing their drinking and driving. No difference was found between these two groups for the interlock’s ability to reduce drinking. CONCLUSIONS: People with a more serious drinking pattern and who may be most at risk for recidivating may be more inclined to recognize the potential benefits of the interlock as a DUI preventive countermeasure. More research is needed to identify and influence high risk DUI offenders while on the interlock to increase its effectiveness once the interlock is removed.

Lung cancer screening via low-dose computed tomography (LDCT) has been underutilized by high-risk current and former smokers since its approval in 2013. Further, lower use of other evidence-based cancer screening tests (e.g., colorectal cancer, breast cancer) has been noted among African Americans when compared with other racial and ethnic groups. Reasons for low uptake are multilayered but include the need for consideration of patients' personal values about the screening decision. The goal of the present study was to (1) identify positive and negative factors specific to lung cancer screening via LDCT and (2) develop statements to capture values about the screening test for use in a new measure of decisional values. Key informant interviews (n = 9) identified several benefits and risks of lung cancer screening that may be important to African American smokers. Based on these interviews, a pool of items with the values statements was administered to a convenience sample of 119 African Americans [aged 55-80years, current or former smokers (who quit

Texting while driving is prevalent among college-aged students, despite distracted driving laws. Social Norms Theory suggests that individuals are influenced by perceptions of how their social groups act. Proximal sources of social influence, such as significant others (S.O.) may be more likely to effect college-aged students than distal sources (e.g. people they know in their friend or peer group, but don’t identify as people with whom they have a particularly important or meaningful relationship). We investigated whether perceived S.O. texting behaviors mediated the relationship between perceived risk of texting while driving and reported texting while driving among college-aged students. A sample of 835 undergraduate licensed drivers were surveyed about the influence of perceived risk of texting while driving on texting while driving within the past month. We examined whether seeing one’s S.O. (versus their friends) texting while driving mediated this effect. Two groups of drivers were considered: low-risk drivers, who never received a traffic citation nor got into a crash, and high-risk drivers, who had ever received traffic citation and been involved in a crash. We also examined gender differences within low-risk and high-risk groups. A series of logistic regressions, adjusting for gender and ethnicity, were conducted along with Sobel Tests to evaluate the significance of the mediation effect. Results showed that perceptions of the S.O. partially mediated the relationship between perceived risk of texting while driving and texting while driving. This effect was also observed for low risk (female only) and high risk drivers. There was no mediation effect for distal sources. These findings bolster the limited research on the importance of proximal sources of social influence and suggest prevention efforts should focus on proximal social networks of college-aged students as opposed to distal social influences when targeting young adults distracted driving.

to examine associations between childhood maltreatment and adulthood obesity, and mediating effects of adolescent depressive symptoms and BMI, using the U.S. National Longitudinal Study of Adolescent to Adult Health (n = 10,894). Individuals who reported sexual maltreatment were 27% more likely to be obese (BMI≥30; AOR = 1.27, 95% CI: 0.98-1.63) and 72% more likely to be extremely obese (BMI≥40) in adulthood (AOR = 1.72, 1.18-2.51) than those who did not. Individuals who reported physical maltreatment were 37% more likely to be extremely obese than those who did not (AOR = 1.37, 1.11-1.70). These relationships were true for males and females, and interaction terms by sex were not statistically significant. Adolescent depressive symptoms and BMI were statistically significant mediators between sexual and physical maltreatment and extreme obesity (p .05), and between physical maltreatment and self-rated obesity (p .05). Therefore, adolescent characteristics are mechanisms on the causal pathway between maltreatment and obesity in adulthood. Further research should explore these mechanisms.

Background Previous studies have shown increased precipitation to be associated with higher frequency of traffic collisions. However, data regarding how extreme weather events, projected to grow in frequency, intensity, and duration in response to a changing climate, might affect the risk of motor vehicle collisions is particularly limited. We investigated the association between frequency of extreme heat and precipitation events and risk of motor vehicle collision in Maryland between 2000 and 2012. Methods Motor vehicle collision data was obtained from the Maryland Automated Accident Reporting System. Each observation in the data set corresponded to a unique collision event. This data was linked to extreme heat and precipitation events that were calculated using location and calendar day specific thresholds. A time-stratified case-crossover analysis was utilized to assess the association between exposure to extreme heat and precipitation events and risk of motor vehicle collision. Additional stratified analyses examined risk by road condition, season, and collisions involving only one vehicle. Results Overall, there were over 1.28 million motor vehicle collisions recorded in Maryland between 2000 and 2012, of which 461,009 involved injuries or death. There was a 23% increase in risk of collision for every 1-day increase in extreme precipitation event (Odds Ratios (OR) 1.23, 95% Confidence Interval (CI): 1.22, 1.27). This risk was considerably higher for collisions on roads with a defect or obstruction (OR: 1.46, 95% CI: 1.40, 1.52) and those involving a single vehicle (OR: 1.41, 95% CI: 1.39, 1.43). Change in risk associated with extreme heat events was marginal at best. Conclusion Extreme precipitation events are associated with an increased risk of motor vehicle collisions in Maryland.

BACKGROUND: Substance use is prevalent and is associated with academic performance among adolescents. Few studies have examined the association between abstinence from all substances and academic achievement. METHODS: Data from a nationally representative sample of 9,578 twelfth graders from the 2015 Monitoring the Future survey were analyzed to examine relationships between abstinence from substance use and four academic variables: skipping school, grades, academic self-efficacy, and emotional academic engagement. Participants were categorized as lifetime non-users, former users, and past-year users based on the use of 14 substances. RESULTS: Approximately one-quarter of participants had never used cigarettes, alcohol, or other drugs during their lifetime, and 8%(wt) used at least one substance during their lifetime but not during the past year. Adjusting for demographic variables, past-year substance users had 2.71 greater odds of skipping school during the past month than lifetime non-users and 1.74 greater odds of having low grades. Lifetime non-users reported greater academic self-efficacy and emotional academic engagement than past-year users. CONCLUSIONS: Many twelfth graders have abstained from all substance use during their lifetime, and these adolescents experience better academic outcomes than their substance-using peers. Substance use prevention programs should be evaluated as a way to promote academic achievement.

Introduction Texting while driving is a significant risk factor for automobile collisions. The use of cell phones is prevalent among young people and commonly reported when they drive. Method A web-based survey of 861 college student drivers determined how texting was associated with other forms of risky driving, perceptions of risk, and their driving and texting interactions with a significant other. Results Texting drivers were more likely to engage in other risky driving behaviors, perceived less risk in texting and driving, felt more immune to traffic risks, and had friends who text and drive. Logistic regression analyses showed that even after adjusting for risky driving behaviors and perceived risk, texting drivers were significantly more likely to do so if they saw their significant other text and drive. Conclusions Traffic safety campaigns need to address important social influences on this behavior.

Extensive research has examined alcohol use context and motives among undergraduates, but less is known about where, when, and why graduate students drink. The current study aimed to describe the motives and situational context of graduate student alcohol use, identify demographic and program characteristics associated with alcohol use motives and context, and assess how alcohol use motives and context are associated with alcohol use behavior. A sample of master’s and doctoral-level students who drank during the past month (n = 2091; 63% female) completed an online survey. An exploratory factor analysis yielded two situational context factors: drinking in social situations (e.g., with friends, at a bar) and non-social situations (e.g., alone, at home). Graduate students most frequently endorsed social and enhancement drinking motives. Results of multivariate linear regression models showed that age, sex, race/ethnicity, and international student, marital, parental, and employment status were all associated with motives and context. Drinking for enhancement and drinking to cope were the motives most strongly associated with increased alcohol quantity and frequency, respectively. Drinking in social contexts was positively associated with alcohol quantity and frequency, and drinking in non-social contexts was positively associated with alcohol use frequency but inversely related to alcohol quantity. Graduate students who drink for enhancement reasons and in social situations might be at increased risk for higher quantity alcohol use, or graduate students who drink for coping reasons and in non-social situations might be at increased risk for more frequent alcohol use. Future longitudinal research is needed to explore whether drinking in certain contexts and with certain motivations is predictive of alcohol problems during and after graduate school.

Sleep disturbances can accompany alcohol use disorders during various phases of the disease. This analysis utilized a mixed methods approach to assess whether sleep-related beliefs and/or behavior of individuals who are alcohol dependent were associated with sleep quality both pre- and postdischarge from a clinical research facility providing inpatient alcohol rehabilitation treatment. Individuals with higher self-efficacy for sleep (SE-S) reported better sleep quality at both time points. Individuals with fewer dysfunctional beliefs about sleep had poorer sleep quality at both time points. Individuals with higher unhealthy sleep-related safety behaviors had poorer sleep quality at both time points. In a linear regression model, only the difference in SE-S scores from pre- to postdischarge (β = −.396, p = .01) and the postdischarge Penn Alcohol Craving Score (β = .283, p = .019) significantly predicted the change in sleep quality. Thus, those whose SE-S scores increased and those with lower postdischarge craving scores were more likely to experience a decrease on Pittsburgh Sleep Quality Index scores from pre- to postdischarge even after controlling for covariates. References to behavior or personal factors were often discussed during the qualitative interviews in tandem with the environment. Participants reported both (1) self-medicating anxiety with alcohol and (2) self-medicating the inability to fall asleep with alcohol. Given the success of behavioral sleep interventions in various populations and the unique potential contributions of mixed methods approaches to examine sleep and alcohol use, assessing sleep-related cognitions and behaviors of individuals with severe alcohol use disorders may be important in understanding sleep quality and subsequent relapse.

Objective: Alcohol-impaired driving is a significant factor in fatal and serious injury-producing crashes in the United States and many other countries. In 2013, the State of Maryland implemented an anti-driving under the influence (DUI) enforcement program, called the State Police Impaired Driving Reduction Effort (SPIDRE). This enforcement effort consisted of a select team of 7 police officers from the Maryland State Police who engaged in high-intensity driving under the influence (DUI) enforcement. The purpose of this evaluation was to determine the impact of the SPIDRE program on impaired-driving crashes, DUI arrests, DUI adjudicative outcomes, and public perceptions of DUI enforcement. Methods: Data from alcohol-related crashes, arrests, and adjudicative outcomes of those arrests were used, along with data obtained from public opinion and bar patron surveys, to compare counties where the SPIDRE program operated and non-SPIDRE counties where it did not. The evaluation period extended from 2010 to 2016 in monthly intervals. Autoregressive integrated moving average (ARIMA) methods were used for the data analyses of crashes and arrests. Results: There was no significant reduction in alcohol-related crashes as reported by the police associated with the SPIDRE program. However, there was a statistically significant decrease in the ratio of single-vehicle nighttime to multiple-vehicle daytime crashes in the SPIDRE counties but not in any other counties, suggesting a positive effect using this surrogate measure of impaired-driving crashes. The specific comparison counties as well as the other non-SPIDRE counties in Maryland experienced a statistically significant decrease in DUI arrests during the evaluation period, whereas the SPIDRE counties did not show such a decrease. Further, the arrests made by the SPIDRE team resulted in a significantly higher rate of positive adjudicative outcomes than arrests made by non-SPIDRE officers in those counties where the SPIDRE team operated. There was no evidence that the public was more aware of DUI enforcement efforts in the SPIDRE counties than in the non-SPIDRE counties. Conclusions: The SPIDRE program appeared able to prevent a downward trend in DUI arrests, experienced by the rest of the state, and achieved higher quality arrests resulting in more positive adjudicative outcomes. The way in which the SPIDRE team was deployed may have lacked sufficient duration and intensity (e.g., only 2–3 months of activity in any given county) to achieve a reduction in alcohol-impaired-driving crashes as reported by the police. It is recommended that the SPIDRE team increase its enforcement activities for at least 9–12 consecutive months in the county where they are employed.

The purpose of this study was to determine how frequent permanent change of station moves and turnover in primary care providers are associated with continuity of care and patient satisfaction in military spouses. These domains have been studied extensively in civilian populations, but this study seeks to begin filling a gap in the literature surrounding military spouses and their experiences with the military health system.Spouses were recruited via social media to complete a brief online questionnaire to examine factors related to continuity of care and satisfaction with military health care. Results were analyzed using analysis of variance and χContinuity of care scores were significantly lower as the number of moves and providers increased. Patient satisfaction was also significantly associated with continuity. In logistic regression analyses, patient-provider relationship and health status were the only significant predictors across two measures of patient satisfaction. Respondents with higher relationship scores were nearly two times more likely to report being satisfied than those with lower scores. Qualitative results indicated that the majority of dissatisfied spouses were unhappy with their military providers, which supported quantitative findings related to patient-provider relationship.No studies have previously been conducted to determine why military health system beneficiaries are less satisfied with care than their civilian counterparts. Discontinuous care is an ongoing issue for military families, which can impact satisfaction and potentially lead to poorer health outcomes. Although the military culture may not allow for fewer relocations, these results indicate that taking steps to promote enduring, trusting relationships with primary care providers may improve patient satisfaction.

Objectives This qualitative investigation sought to identify the motivational factors that contribute to drowsy driving in college students and to discover important messaging strategies that may help prevent or reduce this behavior in this population. Design Four focus groups of college students. Setting A large university in the Washington, DC, metropolitan area during the Fall 2016 term. Participants Twenty-six undergraduate students between the ages of 18 and 25 years. Measurements Notes and transcripts from the focus group sessions were analyzed to identify recurring themes regarding attitudes, motivations, experiences, influences, and potential preventive messaging strategies related to drowsy driving. Results Although most participants had heard of drowsy driving and were concerned about it, they did not associate it with legal risks and were more concerned about alcohol-impaired and distracted driving as crash risks. Participants viewed drowsy driving as a normal and unavoidable part of their lives over which they had little control. For potential anti–drowsy driving messaging strategies, participants preferred messages delivered via audiovisual or social media that featured graphic and emotional portrayals of crashes and their consequences. Participants also voiced strong support for preventive messaging strategies equating various degrees of sleep deprivation to known impairing levels of alcohol, as well as messages providing cues to action to actual drowsy drivers on roadways. Conclusions Increased enforcement, education, and public messaging campaigns are needed to increase knowledge and influence attitudes and opinions among young drivers about the dangers and social unacceptability of drowsy driving.

Being a hurried driver is associated with a variety of risky driving behaviors, yet the mechanisms underlying this behavior remain unknown. Distress tolerance, defined as an individual's capability to experience and endure negative emotional states, was examined as a predictor of hurried driving among 769 college students. Results indicate that after controlling for age, gender, race, ethnicity, the student's year in school, their grade point average, driving frequency, angry driving, aggressive driving as well as other forms of self-reported risky driving; hurried driving was significantly associated with lower levels of distress tolerance. Hurried drivers also reported greater levels of frustration and impatience with other drivers, suggesting that they have difficulty in withstanding or coping with negative psychological states when driving. Traditional traffic safety campaigns that emphasize enforcement may be less successful with these drivers. The need to develop campaigns that address the affective coping abilities that contribute to this behavioral pattern is discussed.

OBJECTIVE: To examine the relationship of driver dispositions with traffic safety behaviors and beliefs. METHODS: A random digit-dial telephone survey was conducted of 796 licensed drivers. RESULTS: Binary and multivariate logistic regression analyses compared hurried and nonhurried drivers and found that hurried drivers were more likely to admit to a variety of risky behaviors. They were also less likely to believe they would be ticketed for speeding and to report wearing their seat belt than were nonhurried drivers. CONCLUSIONS: More research is needed into identifying the underlying motivational factors of hurried drivers and what countermeasures will be most effective for them. Language: en

The National Highway Traffic Safety Administration suggests that given the changing demographics of the United States it is important to examine motor vehicle statistics by race and ethnicity. The current study sought to explore differences in traffic safety concerns and driving behaviors between black and white drivers.An annual, anonymous, random-digit-dial telephone survey was used to collect data between 2003 and 2009 from Maryland drivers. Drivers (N = 5503) were assessed regarding their driving behaviors and perceived risk of receiving a traffic violation.Results showed that black drivers perceived a greater likelihood of being stopped for driving under the influence (DUI), for not wearing a seat belt and for speeding than white drivers. These differences were found among drivers with or without a history of being ticketed. Black drivers were also more likely to report a variety of risky driving behaviors than white drivers. However, black drivers were not more likely to report receiving a ticket or citation in the last month after controlling for demographic factors, risky driving behaviors, and geographic region of the state, where traffic enforcement may vary.Findings indicate that black drivers are not more likely to be ticketed, despite perceptual biases that may exist among some drivers. These differences appear to be explained by demographic as well as regional factors. These results highlight the need for more research to understand the potential differences in driving behaviors between racial and ethnic groups. More research is also needed to develop countermeasures for racial and ethnic groups most at risk for motor vehicle violations and crashes.

INTRODUCTION: The purpose of this investigation was to compare the results of a web-based and a telephone interview survey measuring driver concerns about a variety of traffic safety issues, their beliefs, and specific driving behaviors. METHOD: State-wide, annual random digit-dial telephone surveys and web-based surveys were conducted in Maryland. A total of 1,700 drivers were surveyed by telephone and 6,806 took a web survey. RESULTS: Telephone respondents were more likely to be female and older. Web respondents were more likely to be white and not Latino/Hispanic. After controlling for demographic differences, telephone survey respondents were more likely to be concerned about traffic safety. They were more likely to believe that sobriety checkpoints reduce drunk driving (OR=2.18, 95% CI 1.94, 2.45), they would be ticketed for not wearing a seat belt (OR=1.26, 95% CI 1.12, 1.43), and they would be stopped by the police if they drove after drinking too much (OR=1.17, 95% CI 1.03, 1.32). They were less likely to report a variety of risky behaviors including using a cell phone while driving (OR=.54, 95% CI .48, .61) and driving 10+ mph over the speed limit (OR=.81, 95% CI .72, .91), but were more likely to report having been ticketed for a moving violation in the last month (OR=2.22, 95% CI 1.70, 2.90). Suggestions are offered for overcoming potential sources of sampling bias. IMPACT ON INDUSTRY: Web-based surveys produce substantially different results than random-digit-dial telephone surveys, when used for public assessments of traffic safety concerns and behaviors. Language: en

Few studies have investigated the association between the social context of cannabis use and cannabis use disorder (CUD). This longitudinal study of college students aimed to: develop a social context measure of cannabis use; examine the degree to which social context is associated with the transition from non-problematic cannabis use to CUD; and, examine the association between social context of cannabis use and depressive symptoms. The analytic sample consisted of 322 past-year cannabis users at baseline. Four distinct and internally consistent social context scales were found (i.e., social facilitation, emotional pain, sex-seeking, and peer acceptance). Persistent CUD (meeting DSM-IV criteria for CUD at baseline and twelve months later) was associated with using cannabis in social facilitation or emotional pain contexts, controlling for frequency of cannabis use and alcohol use quantity. Students with higher levels of depressive symptoms were more likely to use cannabis in an emotional pain or sex-seeking context. These findings highlight the importance of examining the social contextual factors relating to substance use among college students.

Introduction The purpose of this investigation was to identify risky driving behaviors and dispositions that distinguish drivers who use a cell phone while operating a motor vehicle from non-cell phone using drivers. Method Annual telephone surveys were used to identify drivers who reported using a cell phone while driving in the last month (n = 1803) and were compared to those who said they did not use cell phones while driving (n = 1578). Results Cell phone using drivers were more likely to report driving while drowsy, going 20 mph over the speed limit, driving aggressively, running a stop sign or red light, and driving after having had several drinks. They were also more likely to have had a prior history of citation and crash involvement than non-cell phone using drivers. Cell phone using drivers also reported they were less careful and more in a hurry when they drive than non-cell phone using drivers. Conclusion Cell phone using drivers report engaging in many behaviors that place them at risk for a traffic crash, independent of the specific driving impairments that cell phone usage may produce. Strategies that combine coordinated and sustained enforcement activities along with widespread public awareness campaigns hold promise as effective countermeasures for these drivers, who resemble aggressive drivers in many respects.

A web-based questionnaire was used to assess the utility of constructs from the Theory of Planned Behavior (TPB) and the Prototype Willingness Model (PWM) to predict intentions and willingness to engage in drowsy driving in a sample of 450 university students. Those students who reported more favorable attitudes and subjective norm and greater perceived control and willingness in relation to drowsy driving behavior were more likely to report stronger intentions to engage in drowsy driving behavior. Augmenting the TPB constructs with the PWM construct of willingness significantly explained up to an additional 8 percent of the variance in drowsy driving intention. Perceived behavioral control and willingness were consistently the strongest predictors of drowsy driving intention in the augmented model, which together with the control (personal) variables explained up to 70 percent of the variance in intention. Thus, the Theory of Planned Behavior and the Prototype Willingness Model may be useful for understanding motivational influences on drowsy driving behavior in young people and present promising theoretical frameworks for designing more effective interventions against drowsy driving in this population.

Young adults and teens are documented as the riskiest drivers on the road, and newer issues such as texting and driving are a growing concern. This study sought to determine the risk perceptions of young adults regarding various driving behaviors, their past experiences, how their social circles are structured, and how this might affect their driving.This study conducted qualitative research with 25 college undergraduate students to determine their peer and social influences regarding distracted driving. Data were analyzed and related to the health belief model and past research on social influence.Though most participants felt that their behaviors were set after learning to drive, they were, in fact, quite susceptible to the influence of those in their social circles (e.g., fear of judgment and accountability) and, more broadly, to social norms. Texting and driving was the largest and most topical distracted driving issue and was also identified as very difficult to stop due to perceived barriers and the idea that intervening is rude. Participants identified low perceived susceptibility and severity (perceived threat) for a number of risky driving behaviors, including texting and driving.Training is needed to encourage people to intervene and speak up regarding behaviors other than drinking and driving, and cues to action and campaigns should target intervention to increase self-efficacy, as well as norms, susceptibility, and common rationalizations for risky behavior.

The purpose of this study was to determine the extent to which parents intend to place driving limits on adolescents approaching unsupervised driving. A total of 658 parents and their 16-year-old adolescents were recruited from a local Maryland Motor Vehicle Administration site as adolescents successfully tested for provisional licenses. Parents completed written surveys about parent-adolescent relations and anticipated adolescent unsupervised driving. The results indicated that parents reported high levels of intended limits on adolescents’ unsupervised driving, especially for trip conditions (e.g., getting permission) when compared with risk conditions (e.g., at night). Almost one third of parents reported completing driving agreements. Overall, intended driving limits and completed driving agreements were more likely when parents reported high levels of parental monitoring (2 times more likely), discussion of driving rules (2 to 4 times more likely), risk perception (2 times more likely), and vehicle access (2 to 3 times more likely). Completed driving agreements were not related to intended driving limits.

To compare drivers who were: (1) exposed to Maryland's sobriety "Checkpoint Strikeforce" campaign; (2) not exposed but were aware of it; and (3) neither exposed nor aware of it. This six-month campaign involved periodic road-side sobriety checkpoints, in which police attempted to detect and arrest drunk drivers and a series of radio Public Service Announcements (PSAs) that promoted public awareness.A statewide sample of 1725 drivers were interviewed by telephone to determine their exposure to and awareness of this campaign, as well as their beliefs and behaviors concerning drunk driving and seat belt usage.Relatively few people (9.6%) were exposed in any way to the campaign; however almost 30% were aware of it. Significant increases in perceived vulnerability to arrest for drinking and driving were found among those who were exposed. There were no differences in reported drinking and driving, but seat belt usage in the last 30 days was higher among those who were exposed. There were no differences among those people who had been directly exposed to the campaign (i.e., personally gone through a sobriety checkpoint) and those who were indirectly exposed (i.e., knew a family member or someone else who went through a checkpoint).Exposure to a sobriety checkpoint was associated with increased perceptions of drink-driving risk (i.e., likelihood of getting caught by the police), which was not dependent upon having personally experienced it. Awareness without exposure appears to be insufficient to change perceived risk. The need to increase the reach and frequency of the sobriety "Checkpoint Strikeforce" campaign is indicated.

OBJECTIVE To examine the relationship between parental monitoring and adolescent drinking over time. METHODS Adolescents completed a baseline survey regarding their involvement with alcohol and parental monitoring. They were interviewed 12 months later, to obtain follow-up measures of drinking and involvement in alcohol-risk situations. RESULTS Highly monitored adolescents were less likely to report that they were drinking 12 months later. This relationship remained when controlling for age, gender, drinking at baseline, and being in various high-risk situations. CONCLUSIONS The longer term protective relationship between parental monitoring and alcohol involvement was demonstrated. The need to establish frequent parental monitoring is indicated.

Objective: To explore the relations between familial factors and behavioral outcomes in Latino adolescents using a youth development framework. Methods: A convenience sample of Latino youth (n=446) completed an anonymous survey. Multiple linear regression was used to examine the associations between levels of family involvement and problem and prosocial behavior outcomes. Results: Higher levels of parental monitoring and familial connectedness were consistently associated with less problem-behavior involvement. Sociocultural encouragement was consistently associated with more prosocial-behavior involvement. Conclusion: The family context is critical the prevention of problem behaviors and the promotion of prosocial behaviors among Latino adolescents. (authors)

OBJECTIVES To assess the association between parental monitoring and adolescent alcohol risk. METHODS Adolescent managed-care patients completed a survey of their involvement with alcohol and their perceptions of monitoring and other forms of parental influence. RESULTS Frequent monitoring was associated with less likelihood that adolescents had engaged in a variety of alcohol-risk behaviors or had been in a variety of risk situations. Choosing to share alcohol-related concerns with other adults and placing importance on parents' opinions were not as consistently related to alcohol risk. CONCLUSIONS The need to enhance parental monitoring as a proactive protective parental response is indicated.

An analysis is presented of adolescent driving risk, the advantages of graduated licensing programs, and the potential for parent-based programs to moderate teen driving risks. Risk factors associated with youthful driving illustrate the potential importance and benefits of limiting the amount and conditions under which teens can drive. State policies, such as graduated driver licensing systems that formalize restrictions on youthful driving, have been shown to be effective. However, teen driving risks remain elevated. Parents are in a prime position to extend the benefits of state restrictions by developing and implementing their own tailored family policies on adolescent driving. Unfortunately, parents of adolescent drivers are often under-aware of the need to do so and fail to impose effective driving restrictions. An ongoing parent-based intervention to increase parental restriction on teen driving is described, and issues involved in implementing and evaluating family-centered approaches to reduce teen driving risk are raised.

The purpose of this study was to compare driving under the influence (DUI) offenders on an alcohol ignition interlock program who had or had not changed their primary drinking context from a bar/restaurant where they might be required to drive after drinking before the interlock was installed to drinking at home where driving would not be likely to be required following interlock installation.A total of 171 DUI offenders who were on an ignition interlock program completed a web-based survey. All of these offenders reported that they drank primarily in a bar/restaurant before the interlock was installed. These offenders were classified into 2 groups: adapters who said they currently drink at home and nonadapters who said they still drink in a bar/restaurant. Measures were made of their reported drinking, driving patterns, perceptions of the likely outcomes of being on the interlock, perceived effectiveness of various prevention strategies, and demographic characteristics. Chi-square and t-test analyses were used to compare these 2 groups.Adapters and nonadapters did not differ with regard to any of the demographic characteristics, whether they were a first-time DUI offender, the length of time in the interlock program, number of lockouts (being blocked from starting their cars) they had experienced, miles driven per week, or current driving patterns since being on the interlock program. Adapters were more likely to report changing their drinking plans and habits. Currently they reported fewer drinks per occasion than nonadapters. They were more likely to report reducing the amount they drink, solo drinking or only drinking with a spouse/significant other, and changing their drinking plans and habits. They were also more likely to say that the interlock reminded them to limit their drinking after it is removed and that it might have longer term benefits in preventing future DUIs. They were also more receptive to interventions that might help them separate their drinking from their driving.Interlock clients who report that they have altered their drinking context and a willingness to receive programs that help them separate their drinking from their driving may be more receptive to and benefit from ignition interlock programs.

OBJECTIVES: To examine the physical, social and temporal contexts of physical activity, as well as sex variations of the associations among 314 urban adolescents. METHODS: Three-day physical activity recall measured contextual information of physical activities. Logistic regressions and generalized estimating equation models examined associations among physical activity types and contexts, and sex differences. RESULTS: Active transportation was the most common physical activity. Home/neighborhood and school were the most common physical activity locations. School was the main location for organized physical activity. Boys spent more time on recreational physical activity, regardless of the social context, compared to girls. The average physical activity level was significantly lower for girls than for boys after school. CONCLUSIONS: Physical activity promotion interventions need to target physical activity environments and social contexts in a sex-specific manner. Language: en

Objective: The purpose of this investigation was to determine the relationship between distress tolerance and risky and aggressive driving. Distress tolerance, defined as an individual's capability to experience and endure negative emotional states, was hypothesized to be related negatively to aggressive driving and risky driving. Methods: An anonymous, web-based survey of 769 college students was conducted at a large East Coast university. Results: After controlling for age, gender, race, ethnicity, year in school, grade point average, and driving frequency, distress tolerance was significantly inversely related to reported risky driving and aggressive driving. Conclusion: College drivers who have a diminished capacity to endure frustration without experiencing negative emotional states (i.e., low distress tolerance) tend to drive aggressively and in a risky manner. Traditional deterrence-based approaches to highway safety may benefit from inclusion of a wider array of prevention strategies that focus on...

OBJECTIVES: To determine the nature and prevalence of parental involvement with teen driving and its relationship to teen driving risk. METHODS: A statewide sample of 424 Maryland parents and their provisionally licensed teenagers were interviewed. RESULTS: Parents were unaware of the extent to which their teens had engaged in high-risk traffic events, such as being distracted by friends or driving too fast. Teens who were allowed unsupervised access to a car at least several times a week were 3 times as likely to have driven too fast than were those who had access once a month or less. The frequency of parental teaching of driving skills was not strongly related to teen risk taking. CONCLUSION: The need to increase parents' capacity to impose and enforce driving restrictions on provisionally licensed teen drivers is indicated. Language: en

Driving under the influence (DUI) enforcement practices and sanctions contribute differentially to the certainty, swiftness, and severity of punishment, which are the key components of general deterrence theory. This study used a conjoint experiment to understand the decision-making process of potential DUI offenders and tested how variation in enforcement and legal punishment affects drinking and driving decisions. It sought to verify and quantify the unique deterrent effects of certainty, severity, and swiftness and to predict the rates of drinking and driving in different legal environments.One hundred twenty-one college seniors and graduate students at the University of Maryland participated in the Web-based conjoint experiment. They were randomly assigned to 4 blocks, each of which included 9 hypothetical scenarios composed of different levels of DUI enforcement and penalties. Respondents were asked to state their likelihood of drinking and driving under each scenario, as well as their estimated chance of being caught by the police for DUI.Intensified enforcement, harsh jail penalty, and immediate long license suspension were found to be the strongest deterrents to drinking and driving. Alternative ways to get home were also important in reducing people's willingness to drive. These factors accounted for most of the attribute effect on the DUI decision, whereas delayed punishment due to judicial processing, fine penalty, and legal blood alcohol concentration (BAC) limit had negligible effects. For the personal characteristics, college seniors and those who had previously driven after drinking were more likely to choose to drink and drive, whereas those who expect a jail penalty for a DUI offense were less likely to drive.Our research confirmed and quantified certainty of punishment as the greatest deterrent to DUI, but it also indicated the equally important effect of a severe jail penalty. It provides evidence on the feasibility of using a conjoint experiment in future studies to understand the general driver population and, with the help of a simulation tool, to predict DUI decisions in different legal environments. Such predictions can be used to better inform policy decisions on developing targeted general deterrence programs in different communities.

In a statewide random telephone survey of 454 parents and their 14- to 19-year-old adolescents, we examined the associations between various parenting strategies and self-reported teen drinking. Less teen drinking was associated with parents' reports of checking to see if other parents would be present at teen parties, particularly among White parents. Parents' monitoring of teens' activities was associated with feelings of competence at doing so. There was, however, no difference in drinking between teens with parents who did or did not report restricting their teens due to teen misbehavior. These findings suggest that a proactive parental monitoring approach may be associated with less adolescent drinking. Prospective research is needed to clarify the causal relationship between parental monitoring, efficacy and teen alcohol-related behavior.

OBJECTIVES To establish reliability/validity of the Glover-Nilsson Smoking Behavioral Questionnaire (GN-SBQ). METHODS The GN-SBQ and the Fagerstrom Test for Nicotine Dependence (FTND) were completed by 100 smokers. The number of cigarettes smoked, smoking duration, and craving were obtained. RESULTS The GN-SBQ was internally consistent (Cronbach α = .82), temporally stable (r = .86), and uncorrelated with FTND. There was a significant main effect for craving, F(3, 73) = 14.68, p < .001; and the GN-SBQ was a significant predictor of craving levels (β = .476, p < .001). CONCLUSIONS The GN-SBQ shows promise as a tool for distinguishing behavioral from physical nicotine dependence.

Objective: To develop an instrument that measures the social context of hookah use among college students. Participants: A pool of 50 potential items, based on 44 in-depth interviews with regular college hookah smokers, was administered to a sample of 274 hookah users between October and December 2011. Methods: Participants were approached in hookah bars and asked to complete the survey. Results: A principle components analysis revealed 3 reliable factors: social facilitation, family/cultural influence, and alternative to smoking cigarettes and drinking. These were examined across different categories of hookah use: Weekly hookah users were more likely to smoke in a context of social facilitation than the other 2 groups. Similar effects were observed for family/cultural influence. Asians were more likely to smoke in a context of family and cultural influence than non-Asians. Conclusions: This scale has potential for identifying situation-specific contexts of hookah use that may help in designing ...

To compare offenders with high versus low perceptions of risk for being stopped by police for drinking and driving using measures of beliefs, behaviors, social context of drinking, and perceived influence from a significant other in their social network.Telephone interviews were conducted with 161 individuals who received a first-time driving under the influence (DUI) citation in Maryland. They were divided into 2 groups: those who felt that it was almost certain or very likely that they would be stopped by the police if they drove after having too much to drink (n = 56) and those who felt that it was only somewhat likely or unlikely (n = 105).The 2 groups did not differ in terms of age, gender, race/ethnicity, education, employment, or marital status. Offenders with a low perceived risk of being stopped were less likely to believe that they would be convicted if they were stopped and arrested. They were more likely to report having an encounter with an aggressive driver, running through a stop sign or traffic light, drinking in a context of social facilitation, knowing someone in their social network who had received a DUI citation, and having a member of their social network suggest that they had had too much to drink and could not drive safely.The social context of drinking and the relationship they have to their social network have important implications for influencing first DUI offenders and preventing them from recidivating.

A random telephone survey of attitudes toward underage drinking was conducted in the Washington, DC, metropolitan area. The results revealed that alcohol use, especially alcohol-impaired driving, among youth were seen as serious problems by a majority (>80%) of the respondents. Strong support (>80%) was detected for imposing suffer penalties on bars and restaurants that sell alcohol to minors, older peers who purchase alcohol for minors, and driver's license restrictions for minors who possess and use alcohol. Over 50% favored stiffer penalties for parents who provide alcohol to minors. Respondents who were parents of teenage children were more likely to believe their teen's friends drink and drive (37%) than they were to believe their own teen drives drunk (10%). These parents were also unlikely to believe their teen had ever come home intoxicated (19%) despite the fact that almost 60% believed their teen has been to parties where there is drinking. These findings, and others from this survey, indicate that parents (especially whites) are unaware of the nature of teen drinking and are reluctant to accept the fact that their teens are involved with alcohol and high-risk alcohol-related behaviors. The implications of these findings for prevention programs are discussed.

An anonymous questionnaire was administered to students at two universities. The questionnaire contained the Social Context of Drinking Scales, the Sensation Seeking Scale, and measures of alcohol use intensity, frequency of alcohol-impaired driving, as well as frequency of riding with an impaired driver. The results revealed significant gender differences in the social context of drinking as well as sensation seeking. High intensity drinkers of each gender were more likely to drink in a context of Social Facilitation and score higher on the sensation seeking subscale--Disinhibition. High intensity men drinkers were more likely to drink in a context of Sex Seeking, whereas high intensity women drinkers tended to drink in a context of Emotional Pain. In general, the Social Context of Drinking Scales were superior to the Sensation Seeking Scales at being able to discriminate high from low intensity drinkers. The implications for targeted prevention programs on college campuses are discussed.