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Purpose: The aim of this study was to determine changes in human papillomavirus (HPV) prevalence among young men from a Midwest metropolitan area over the six years after vaccine introduction, including HPV prevalence in men overall, in vaccinated men to examine vaccine impact and in unvaccinated men to examine herd protection. An exploratory aim was to examine associations between number of vaccine doses and HPV prevalence., Methods: Men aged 14-26 years reporting male-female and/or male-male sexual contact were recruited from a primary care clinic, sexually transmitted disease clinic, and community setting during two waves of data collection: 2013-2014 (N = 400) and 2016-2017 (N = 347). Participants completed a questionnaire and were tested for penile, scrotal and anal HPV. Changes in prevalence of any (≥1 type) and vaccine-type HPV (HPV6, 11, 16, and/or 18) were examined using propensity score weighted logistic regression. Associations between number of doses and HPV infection were determined using chi-square tests and logistic regression., Results: The proportion of men with a history of ≥1 HPV vaccine doses increased from 23% to 44% (p < 0.001) from waves 1 to 2. After propensity score weighting, infection with ≥1 vaccine-type HPV significantly decreased among all men (29% to 20%; 31% decrease; odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.44-0.88) and unvaccinated men (32% to 21%; 36% decrease; OR = 0.56, 95%CI = 0.34-0.86); there was a non-significant decrease (21%) among vaccinated men. Associations between number of doses and HPV prevalence were not statistically significant., Conclusions: Prevalence of vaccine-type HPV decreased among all, vaccinated, and unvaccinated men six years after HPV vaccine recommendation, supporting vaccine impact and herd protection. Decreases in vaccine-type HPV in all men appear to be due to decreases in unvaccinated men, suggesting that the full impact of vaccination has yet to be realized. Continued monitoring and efforts to vaccinate men prior to sexual initiation are warranted., (Copyright © 2019. Published by Elsevier Ltd.)

Men's alcohol consumption and casual sexual behavior peak in early adulthood. Although there is a strong positive association between these behaviors, most studies have utilized a between-subjects approach rather than a person-centered approach to assess this relationship. A person-centered approach allows for an examination of subgroups of drinkers that may differ in their casual sexual behaviors. To address this gap, secondary data analyses were conducted with two independent samples totaling 906 men between the ages of 18 and 29 from the Midwestern United States. In both studies, participants reported their alcohol expectancies and consumption, sexual behaviors, and sexual attitudes. Multiple group latent profile similarity analyses were conducted using the alcohol-related variables. Four similar profiles emerged in both samples; thus, the data were combined. Casual sex-related variables were then examined in relation to the profiles. The two lighter drinking groups differed from one another in their alcohol consumption and sexual attitudes; however, they did not differ in their alcohol expectancies or number of sex partners. The two heavier drinking groups differed from one another in their liquid courage expectancies, alcohol consumption, one-time-only partners, and sexual attitudes; however, they did not differ from each other in their sex-drive expectancies or lifetime partners. Person-centered approaches can be used to develop more tailored interventions, particularly for those at greater risk for the negative health consequences of engaging in sexual behavior with multiple one-time-only partners., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Polytobacco use and experimentation is common among young adults. Additional research is needed to determine how these patterns of use impact perceptions of tobacco-related harm and risk. The current study examined whether a relationship exists between an increased number of tobacco products used and decreases in perceptions of harmfulness and health risk., Method: Participants (N = 792) completed a survey assessing current/lifetime tobacco use, perceived absolute harmfulness of tobacco/nicotine products and perceived health risk of smoking. For some analyses, participants were grouped by polytobacco use status., Results: Among participants who ever tried a tobacco product, a greater number of products tried was associated with lower perceptions of harm (all p < .05). For e-cigarettes and hookah, nonusers rated tobacco products as more harmful compared to single product, dual, and poly users (all p < .05). Number of products tried predicted perceived harmfulness above and beyond demographic characteristics and polytobacco use status across all products. Similarly, number of products tried predicted perceived health risk above and beyond demographic characteristics and polytobacco use status for both lung cancer and heart disease risk., Discussion: Trying a greater number of tobacco products is associated with lower perceived harmfulness of tobacco products. Prospective studies are needed to determine if experimentation with more tobacco products leads to reductions in perceived risk of tobacco use and subsequent sustained use of tobacco., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Hepatitis D virus (HDV) infection may accompany acute or chronic hepatitis B virus infection. While HDV infection in the United States is thought to be uncommon, there are limited data regarding frequency of testing, and prevalence of HDV antibody and HDV RNA. We evaluated the use of HDV antibody testing using electronic medical record (EMR) data. Among 1007 HBsAg positive patients, only 121 had been tested for HDV antibody. Testing was performed primarily by gastroenterologists/hepatologists and limited testing was performed in identifiable high risk groups including those with HBV/HIV coinfection. Overall, HDV antibody was detected in 3.3% (95% C.I. = 0.9%-8.2%) An HDV RNA assay was developed and validated and 138 HBV or HBV/HIV coinfected patients were tested. The prevalence of HDV among the HBV/HIV coinfected subjects was 2.2% (95% C.I. = 0-5.3%). In a U.S. Midwestern population of HBV infected patients, HDV testing is under-employed. Overall prevalence exceeds 2% whether testing by antibody or HDV RNA and more comprehensive HDV surveillance may be indicated., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Introduction: Smoking tobacco via a waterpipe (WP) is on the rise, particularly among college students. One reason for this may be normative perceptions of WP tobacco smoking (WTS) among this population. The current study examined the perceived and actual descriptive and injunctive norms of WTS among a college student sample., Methods: Participants were 894 college students enrolled at a large, Midwestern university. Participants completed measures of WTS frequency and quantity and perceived/actual descriptive and injunctive norms of WTS., Results: Over one-third of the sample reported ever trying WTS, while only 2% reported current (past month) use. When comparing ever and never WP smokers, ever smokers reported greater perceived peer approval of WTS. Both males and females overestimated WTS frequency of same-sex students at their university., Discussion: The current study is one of the first to investigate descriptive and injunctive norms of WTS among college students. Students who report WTS are more likely to overestimate descriptive norms of WTS among their peers, suggesting corrective normative feedback regarding actual use by peers may be an important target for WTS intervention among college students. Future research should investigate the temporal association between normative perceptions and WTS behaviors among college students., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Though abundant research suggests that Native Americans report high rates of alcohol use and related consequences, little research has examined drinking patterns among Native American college students. It is possible that drinking rates for this group may differ from their non-college counterparts and also from those of Caucasian college students. The aim of this study was to examine whether alcohol use differs between Native American and Caucasian college students, and specifically whether alcohol expectancy effects mediate the relationship between race and drinking., Method: Participants were 43 Native American and 87 Caucasian college students who reported on their positive and negative expectancy effects and past-6-month drinking., Results: Caucasians reported drinking significantly more alcohol and holding stronger positive expectancies. Bootstrapping mediational analysis with 95% confidence intervals indicated that positive but not negative expectancy effects mediated the relationship between race and past-6-month drinking., Conclusions: This preliminary research is the first to examine expectancy effects as mediators of the relationship between Native American and Caucasian race and drinking. Further understanding of the differences in positive expectancy effects between groups may have important implications for prevention and treatment of alcohol use among Native American college students., (Copyright © 2017. Published by Elsevier Ltd.)

Research indicates 10% of college student drinkers report deliberately training to increase alcohol tolerance (a diagnostic criterion for alcohol use disorder) to avoid passing out early or to keep up with peers. Given that tolerance training may be considered a harm reduction technique designed to reduce acute aversive consequences, we examined the associations between tolerance training and the use of protective behavioral strategies (PBS) more generally. A cross-sectional survey of 1080 lifetime drinkers was conducted at a large Midwestern university. Of this sample, 5.6% (n=60) reported training to increase their tolerance. Drinkers who endorsed having trained to increase tolerance reported notably more alcohol-related problems than those who reported never training (M adj =51.80 versus M adj =39.30; p<0.0001). Further, participants who endorsed tolerance training reported utilizing significantly fewer PBS (e.g., avoid drinking games) on the Protective Behavioral Strategies Scale (PBSS, Martens et al., 2005) than participants who had never trained (M adj =16.89 versus M adj =18.90; p<0.01). An exception was that drinkers who trained to avoid passing out early used significantly more PBS (e.g., using a designated driver, knowing where your drink is at all times). Despite this, these trainers consumed more alcohol and experienced more alcohol-related harms. The present findings support previous research demonstrating that trainers consume more alcohol than non-trainers, and provide further evidence that deliberately training to increase tolerance is indicative of problematic drinking behavior. Prevention efforts might aim to inform drinkers of the problems associated with deliberately inducing alcohol tolerance, and focus on developing alternative strategies for minimizing acute harm from drinking., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Heavy drinking is highly comorbid with nicotine and marijuana use among young adults. Yet, our knowledge about the longitudinal effects of nicotine and marijuana use (including onset timing and quantity/frequency) on heavy drinking and whether the effects vary by gender is very limited. This study aims to characterize gender-specific developmental trajectories of multiple substance use and to examine gender differences in the effects of nicotine and marijuana use on heavy drinking., Methods: We conducted secondary analysis on 8 waves of data from 850 high-risk youth who were recruited as ninth graders with low GPA in an economically disadvantaged school district in the Midwest and were followed up annually to young adulthood. Onset ages and quantity/frequency of multiple substance use were assessed by a self-report questionnaire at each wave. The time-varying effect model and linear mixed model were adopted for statistical analysis., Results: Males' levels of heavy drinking, nicotine use, and marijuana use tended to grow persistently from adolescence to emerging adulthood. Females, on the other hand, only gradually increased their nicotine use across time while maintaining low levels of heavy drinking and marijuana use. Controlling for the early onset status of alcohol use, early onset statuses of nicotine use and marijuana use both added additional risk for heavy drinking; late onset marijuana users were also at higher risk for heavy drinking than nonusers of marijuana. Controlling for substance use onset statuses, higher quantity/frequency of nicotine and marijuana use both contributed to more involvement in heavy drinking. We also found that the effect of nicotine use quantity on heavy drinking was greater among males., Conclusions: Our study demonstrates the longitudinal effects of onset timing and quantity/frequency of nicotine and marijuana use on heavy drinking. Our analysis of gender differences also identifies female youth's nicotine use and male youth's co-use of nicotine and alcohol as two important areas for future prevention and intervention work., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The center of origin theory predicts that genetic diversity will be greatest near a specie's geographic origin because of the length of time for evolution. By corollary, diversity will decrease with distance from the origin; furthermore, invasion and colonization are frequently associated with founder effects that reduce genetic variation in incipient populations. The blacklegged tick, Ixodes scapularis, harbors a suite of zoonotic pathogens, and the geographic range of the tick is expanding in the upper Midwestern United States. Therefore, we posited that diversity of I. scapularis-borne pathogens across its Midwestern range should correlate with the rate of the range expansion of this tick as well as subsequent disease emergence. Analysis of 1565 adult I. scapularis ticks from 13 sites across five Midwestern states revealed that tick infection prevalence with multiple microbial agents (Borrelia burgdorferi, Borrelia miyamotoi, Babesia odocoilei, Babesia microti, and Anaplasma phagocytophilum), coinfections, and molecular genetic diversity of B. burgdorferi all were positively correlated with the duration of establishment of tick populations, and therefore generally support the center of origin - pathogen diversity hypothesis. The observed differences across the gradient of establishment, however, were not strong and were nuanced by the high frequency of coinfections in tick populations at both established and recently-invaded tick populations. These results suggest that the invasion of ticks and their associated pathogens likely involve multiple means of pathogen introduction, rather than the conventionally presented scenario whereby infected, invading ticks are solely responsible for introducing pathogens to naïve host populations., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: To examine trends in the lifetime and past-year prevalence of medical use, diversion, and nonmedical use of four prescription medication classes (i.e., sedative/anxiety, opioid, sleeping, and stimulant) among college students between 2003 and 2013; and to identify demographic and background characteristics associated with trends in past-year nonmedical use of prescription medications., Methods: A self-administered, cross-sectional Web survey was conducted in 2003, 2005, 2007, 2009, 2011, and 2013 at a large public four-year university in the Midwest United States., Results: Approximately one in every five individuals reported nonmedical use of at least one prescription medication class in their lifetime. The past-year prevalence of medical use, diversion and nonmedical use of prescription stimulants increased significantly between 2003 and 2013 while the past-year prevalence of medical use, diversion and nonmedical use of prescription opioids decreased significantly over this same time period. The odds of past-year nonmedical use of each prescription medication class were generally greater among males, Whites, members of social fraternities and sororities, and those with a lifetime history of medical use of prescription medications or a past-year history of being approached to divert their prescription medications., Conclusions: The present study represents the first investigation to demonstrate that trends in medical use of controlled medications parallel changes in diversion and nonmedical use of the same medication class among college students. The findings reinforce the importance of continued monitoring of prescription medication use at colleges to help guide prevention and intervention efforts., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Posttraumatic stress disorder (PTSD) and alcohol-use disorders (AUD) frequently present comorbidity in veteran populations. Traditionally those with alcohol dependence have been excluded from PTSD treatment outcome studies, thus we do not know how those with alcohol dependence may tolerate or respond to PTSD-specific interventions; no studies to date have examined the extent to which cognitive PTSD interventions are tolerated or effective for those with comorbid PTSD/AUD. The present study examines the extent to which CPT is tolerated by and effective in treating PTSD symptoms for veterans with PTSD and AUD, as compared to veterans with PTSD only in an outpatient treatment setting. Data were obtained through chart review of 536 veterans diagnosed with PTSD who had received at least 1 session of CPT at a Midwestern US Veterans Affairs hospital. Nearly half (n=264, 49.3%) of the veterans in the study exhibited a current or past AUD diagnosis. Participants were grouped into the following diagnostic groups: current AUD (past 12 months), past AUD (prior to 12 months), and no AUD. Participants completed an average of 9 sessions of CPT with no significant difference between AUD diagnostic groups on the number of CPT sessions completed. Individuals with past AUD had higher initial symptoms of self-reported PTSD symptoms than those with no AUD. All groups reported significant reductions in PTSD symptoms and depression over time. Overall, the results suggest that CPT appears well tolerated among veterans with comorbid AUD and is associated with significant reductions in symptoms of PTSD and depression in an outpatient treatment setting., (© 2013.)

Purpose: Many young adult smokers routinely smoke less than daily. Prospective, longitudinal data are needed to describe and predict the influences on smoking patterns among nondaily young adult smokers., Methods: Latent class growth analysis was used to examine developmental trajectories and predictors of nondaily cigarette smoking among young adults aged 18 to 21 in the Upper Midwestern United States., Results: There were three distinct groups of nondaily smokers during young adulthood (n=519). College status, previous quit attempts, attitudes toward the meanings of cigarettes, and situational factors influencing smoking were significant predictors of group membership., Conclusions: Nondaily smoking in young adulthood may result in several discrete patterns of smoking between age 18 and 21. Predictors that differentiate smoking trajectories may be useful to promote cessation or reduction in young adult smoking., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Young adults have the highest rate of smoking among any age group., Purpose: The purpose of this study is to assess the short-term effects of Minnesota's comprehensive statewide smokefree law on young adult smoking perceptions and behavior., Methods: Telephone surveys were conducted before and up to 18 months after Minnesota's statewide smokefree law went into effect on October 1, 2007 (data analyzed 2010-2011). Participants included young adults from a population-based cohort in Minnesota (n=1458) and from five other upper Midwest states that serve as a comparison (n=248). Differences in perceptions and smoking behavior were examined between Minnesota participants who lived with and without a local smokefree law prior to Minnesota's statewide law, and participants who lived in the comparison states., Results: The majority of youth in Minnesota were aware of the smoking restrictions in restaurants and bars following the law. After implementation of the law, Minnesota participants who previously lived without a local law (versus comparison) were more likely to perceive fewer adult and peer smokers and less likely to report leaving social events early because it was too smoky. No changes in smoking behaviors were observed before and after the law. Minnesota participants, however, who lived without a prior law (versus participants with a prior law) were more likely to attribute a quit attempt after the law to smoking restrictions in restaurant and bars., Conclusions: Results suggest that Minnesota's law has changed perceptions of the tobacco environment. Longer-term follow-up may be needed to observe changes in smoking behavior., (Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The goal of the current study is to examine how urgency, drinking motives, and risk/benefit perception concurrently influence problematic alcohol consumption in young adults., Method: Participants were 281 young adults enrolled in large, public US mid-western university. The mean age of the sample was 19.81 (SD=1.82) and 79.7% of the sample was female and 84.7% of the sample was Caucasian., Results: A series of moderated-mediation analyses indicated the following: The relationship between negative urgency and alcohol use was mediated through coping motives, and this relationship between coping motives and alcohol use was moderated by benefit perception. The relationship between positive urgency and alcohol use was mediated through enhancement motives, and this relationship between enhancement motives and alcohol use was moderated by benefit perception., Conclusions: This study suggests that modifying perceptions about the benefits of alcohol and drinking motives could be viable prevention and/or treatment strategy in this population, especially among those who exhibit urgent behaviors., (Published by Elsevier Ltd.)

The increased prevalence and negative impact of bullying and substance use among youth has been established independently in the literature; however, few researchers have examined the association between involvement in bullying and substance use across middle and high school youth. Thus, the aim of this study was to examine the self-reported prevalence of bullying and substance use (alcohol, cigarettes, and marijuana) among youth in middle and high school. Middle and high school students from 16 school districts across a large metropolitan area (N=78,333) completed a school-based survey. Scales were created to examine involvement in bullying, victimization, and substance use. A link between involvement in bullying and substance use was evident. Youth involved in bullying were more likely than students not involved in bullying to use substances, with bully-victims reporting the greatest levels of substance use. Differences at the school level and across status (i.e., bullies, victims, and bully-victims) are discussed. Implications for practice and prevention and intervention programs are offered. Findings support the need for continued research into risky behaviors, such as substance use, that are correlated with bullying behavior and may contribute to an increase in negative outcomes., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The present research focuses on the party related drinking behaviors of college students and explores the differences in these behaviors based on students' host status (i.e. party host vs. party attendee). Furthermore, we examine if the differences in party hosts and attendees' drinking behaviors vary as a function of the party location (on-campus vs. off-campus). Multiple regression analyses were conducted using data from 3796 undergraduates at a Midwestern University. Findings revealed a significant interaction between host status and party location, such that student party hosts reported significantly greater drink consumption and related consequences as compared to party attendees, only when the party was organized off-campus. For parties organized on-campus, student hosts reported lower drink consumption as compared to attendees. College-based preventive interventions should target students likely to host off-campus parties due to their high risk for involvement in heavy drinking., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Aim: To examine the relation of changes in Five-Factor personality traits (i.e., extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience; Costa & McCrae, 1985), drinking motives, and problematic alcohol involvement in a cohort of college students (N=467) at varying risk for alcohol use disorders from ages 21 to 35., Method: Parallel process latent growth models were estimated to determine the extent that prospective changes in personality and alcohol problems covaried as well as the extent to which drinking motives appeared to mediate these relations., Results: Changes in neuroticism and conscientiousness covaried with changes in problematic alcohol involvement. Specifically, increases in conscientiousness and decreases in neuroticism were related to decreases in alcohol from ages 21 to 35, even after accounting for marriage and/or parenthood. Change in coping (but not enhancement) motives specifically mediated the relation between changes in conscientiousness and alcohol problems in addition to the relation between changes in neuroticism and alcohol problems., Discussion: Personality changes, as assessed by a Five-Factor model of personality, are associated with "maturing out" of alcohol problems. Of equal importance, change in coping motives may be an important mediator of the relation between personality change and the "maturing out" of alcohol problems., (Published by Elsevier Ltd.)

A quasi-experimental design was used to test a modified Project Towards No Tobacco (TNT) use program on cigarette smoking in 380 Arab American and 236 non-Arab American 9th graders in the Midwest. Tenth grade Non-Arab American students given the intervention as 9th graders were 23% less likely to experiment (Odds Ratio=1.31, 95% CI: 1.05, 1.64) or to have smoked cigarettes in the past 30 days (Odd Ratio=1.43 times, 95% CI: 1.03, 2.01) compared to Arab American youth. Arab American students reported greater experimentation with water pipe smoking than cigarettes (38% vs. 22%), and more current (16% vs. 6%) and regular (7% vs. 3%) use of water pipes than cigarettes, respectively. The intervention designed to focus on cigarette smoking had non-significant effects on water pipe smoking. These findings provide support for a school-based intervention revised to focus on prevention as well as cessation and to be culturally consistent. They also call for further research and intervention tailoring to address the problem of water pipe smoking in a growing Arab American adolescent population.

This study reports findings from two-level growth curve modeling of cigarette smoking and depressive symptoms based on the first three waves of data from a longitudinal study of Indigenous adolescents and their parents/caretakers in the northern Midwest and Canada. The 743 adolescents were aged 10-13 years at Wave 1 and 12-15 years at Wave 3. Over the three years of the study the overall retention rate was 93%. By Wave 3, 39% of the adolescent girls and 25% of the boys had smoked cigarettes in the past 12 months. The growth curve results indicated that smoking increased for both adolescent boys and girls across time. Depressive symptoms were associated with an increase in cigarette smoking for girls but not boys.

Purpose: To describe demographics, clinical course, treatment, and visual prognosis of uveitis in pediatric patients with Behçet disease, and to compare childhood-onset with adult-onset Behçet uveitis., Design: Retrospective, observational case series., Methods: setting: Uveitis service, University of Illinois at Chicago and private office of one of the authors (H.H.T.). study population: Patients diagnosed with Behçet uveitis using International Study Group criteria between January 1, 1973 to December 31, 2007. main outcome measures: Demographics, symptoms, clinical course, management, laboratory tests, complications, and visual prognoses were recorded., Results: Thirty-three patients had available records with at least one month follow-up; four were children and 29 were adults. All children and 19 adults were male. The most common initial symptom was oral ulcers and the most common uveitis type was panuveitis with retinal vasculitis in both groups. There was an average delay of one year among children and 1.8 years among adults between onset of uveitis and disease diagnosis. Immunosuppressive therapy was employed in all children and 23 of 29 adults. Treatment response was variable in both groups. Maculopathy was the most common cause of permanent visual impairment, both in children and in adults. Six of eight pediatric eyes (75%) and 13 of 25 adult eyes (52%) retained a visual acuity better than 20/200 at three years., Conclusions: Behçet disease is an uncommon cause of uveitis in the United States, with a male predominance. Although the clinical picture of Behçet uveitis was similar among both groups, the visual prognosis appeared worse in adults. Awareness of this disease should be increased in nonendemic areas to prevent blindness resulting from delays in diagnosis.

Background: Water-pipe smoking is a rapidly growing form of tobacco use worldwide. Building on an earlier report of experimentation with cigarette and water-pipe smoking in a U.S. community sample of Arab-American youth aged 14-18 years, this article examines water-pipe smoking in more detail (e.g., smoking history, belief in harmfulness compared to cigarettes, family members in home who smoke water pipes) and compares the water-pipe-smoking behaviors of Arab-American youth with non-Arab-American youth in the same community., Methods: A convenience sample of 1872 Arab-American and non-Arab-American high school students from the Midwest completed a 24-item tobacco survey. Data were collected in 2004-2005 and analyzed in 2007-2008., Results: Arab-American youth reported lower percentages of ever cigarette smoking (20% vs 39%); current cigarette smoking (7% vs 22%); and regular cigarette smoking (3% vs 15%) than non-Arab-American youth. In contrast, Arab-American youth reported significantly higher percentages of ever water-pipe smoking (38% vs 21%) and current water-pipe smoking (17% vs 11%) than non-Arab-American youth. Seventy-seven percent perceived water-pipe smoking to be as harmful as or more harmful than cigarette smoking. Logistic regression showed that youth were 11.0 times more likely to be currently smoking cigarettes if they currently smoked water pipes. Youth were also 11.0 times more likely to be current water-pipe smokers if they currently smoked cigarettes. If one or more family members smoked water pipes in the home, youth were 6.3 times more likely to be current water-pipe smokers. The effects of ethnicity were reduced as a result of the explanatory value of family smoking., Conclusions: Further research is needed to determine the percentages, patterns, and health risks of water-pipe smoking and its relationship to cigarette smoking among all youth. Additionally, youth tobacco prevention/cessation programs need to focus attention on water-pipe smoking in order to further dispel the myth that water-pipe smoking is a safe alternative to cigarette smoking.

Background: Manipulating the physical environment may be an efficacious way to promote physical activity. This study examined the relationships between features of the neighborhood environment and walking in the neighborhood by U.S. adults., Methods: A random sample of women (n =266) and men (n =208) aged >18 years participated. Door-to-door interviews were conducted in 2003 to collect information about demographics, walking behavior, and features of the neighborhood environment., Results: The analyses conducted in 2004 revealed that women were more likely to walk for exercise (odds ratio [OR]=4.6, 95% confidence interval [CI]=1.01-20.72) or walk a dog (OR=3.3, 95% CI=1.01-11.08) in the neighborhood if neighborhood safety was average as opposed to below average (p <0.05). Women with an average number of neighborhood destinations were more likely to walk for transportation in the neighborhood (OR=5.7, 95% CI=1.63-19.73) than women with a below average number of neighborhood destinations (p <0.01). In men, none of the neighborhood features were significantly associated with walking for exercise or walking a dog. Men were less likely to walk for transportation in the neighborhood if the functional (OR=0.22, 95% CI=0.06-0.89) or aesthetic (OR=0.17, 95% CI=0.03-0.89) features of the neighborhood were average versus below average., Conclusions: Prospective studies are needed to determine if changes in neighborhood safety and awareness of neighborhood destinations promote increases in walking by women. Evaluations of the relationships between other environmental features and walking behavior in men are warranted.

We examined the smoking relapse curves for African-American smokers by level of smoking to characterize nicotine dependence in this population of smokers. This analysis was conducted from data originally collected to study differences in level of smoking among African-Americans at an inner-city health center in Midwest. Relatively little research has been conducted to clarify smoking and quitting patterns among African-American smokers. The median number of cigarettes smoked currently was 7 cigarettes per day (cpd) for light smokers and 20 cpd for the moderate to heavy smokers. The heavier smokers reported smoking at this rate longer than light smokers, 11 and 5 years, respectively. The major finding in this study is that African-American light smokers have abstinence rates very similar to heavier smokers and the median length of their most recent quit attempts were also similar. Therefore, stable light smokers may also need smoking cessation interventions similar to those used for heavier smokers in order to successfully stop smoking.

Background: Whereas much is known about single lifestyle-related health risk factor prevalence and covariates, more research is needed to elucidate the interactions among multiple healthy lifestyle factors and variables that may predict adherence to these factors. Such data may guide both clinical and health policy decision making and person-centered approaches to population health improvement., Methods: We document the prevalence and cluster patterns of multiple healthy lifestyle factors among a random sample of adolescents (n =616), adults (n =585), and seniors (n =685) from a large Midwestern health plan. Modifiable, lifestyle-related health factors assessed included physical activity, nonsmoking, high-quality diet, and healthy weight for all subjects; adults and seniors were also asked about their alcohol consumption. Second, we sought to identify characteristics associated with the likelihood of meeting recommendations for healthy lifestyle factors. The healthy lifestyle factors sum score was categorized into three levels, that is, 0 to 2, 3, or 4 to 5 healthy lifestyle factors (4 for adolescents), and we used ordinal logistic regression to estimate the odds of meeting each of these criteria from several demographic characteristics and disease states., Results: Overall, only 14.5% of adolescent, adult, and senior health plan members meet recommended guidelines for four common healthy lifestyle factors. Only 10.8% of adults and 12.8% of seniors met all five behavior-related factors. For adolescents, only being nondepressed was associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors (odds ratio [OR]=2.15; p <0.05). For adults, being in the 50- to 64-year-old cohort (OR=1.46, p<0.05), having a college degree (OR=1.65; p <0.05), and having no chronic disease (OR=1.92; p <0.05) were all associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors. For seniors, having a college degree (OR=1.61; p <0.05), was the only variable associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors., Conclusions: A small proportion of health plan members meet multiple recommended healthy lifestyle guidelines at once. This analysis identifies population subgroups of specific interest and importance based on adherence to multiple healthy lifestyle factors, and predictors for increased likelihood to be in adherence to multiple healthy lifestyle factors. It presents a potentially useful summary measure based on person-centered measures of healthy lifestyle factors. Clinicians may derive meaningful information from analyses that address adherence to multiple healthy lifestyle factors. Health systems administrators may use this information to influence health policy and resource allocation decisions. Further studies are needed to assess the usefulness of this comprehensive lifestyle-related health measure as a metric of progress toward public health goals, or as a clinical metric that conveys information on future health status and directs interventions at the individual level.

Background: Latinas (Latino women) are at higher risk than non-Latina white women of cardiovascular disease and stroke, primarily because of higher rates of obesity and type-2 diabetes mellitus. Increases in physical activity help control these cardiovascular risk factors, but a higher percentage of Latinas than white women are inactive. The study goals were to identify personal, social environmental, and physical environmental correlates of physical activity of urban-dwelling, Midwestern Latinas and to obtain their recommendations for increasing exercise in their communities., Methods: A face-to-face interview (Women and Physical Activity Survey) that covered personal, social environmental, and physical environmental correlates of physical activity was performed with 300 volunteer Latinas (242 in Spanish, 58 in English), aged 20 to 50 years, living in Chicago. Physical activity was measured with questions on lifestyle and planned leisure activity (exercise) from the Behavioral Risk Factor Surveillance System survey., Results: The sample consisted of urban-dwelling Latinas who were primarily from Mexico and who spoke predominantly Spanish. The breakdown was as follows: 36% met current recommendations for moderate or vigorous physical activity, 52.3% were insufficiently active, and 11.7% were inactive. Physical activity was higher among younger women, married women, and women with the following characteristics: had some confidence about becoming more active, saw people exercising in the neighborhood, attended religious services, or lived in areas with heavy traffic., Conclusions: Interventions need to focus on encouraging Latinas, especially those who are older, to reach the level of physical activity recommended to benefit health. The church may be a suitable community setting for initiating programs that provide women with the knowledge, skills, and motivation to become more active so that they can bring back to the larger Latina community.

Background: Physical activity is a promising component of cardiovascular disease prevention among women. Research in this area is expanding, but much needs to be done to assess subgroups of the population (e.g., people living in rural environments). The study goal was to determine personal, social environmental, and physical environmental correlates of physical activity among rural white women aged 20 to 50 years., Methods: A survey was conducted by using randomly selected numbers in rural areas in Missouri and Illinois. The Women and Physical Activity Survey was administered to assess physical activity status and personal, social environmental, and physical environmental factors. Physical activity status was the dependent variable in analyses comparing inactive women with women who performed any activity and comparing women who met current recommendations for moderate or vigorous physical activity with those women did not meet recommendations., Results: Of the 1000 women in the study, 52% met recommendations for physical activity, 40.1% were insufficiently active, and 7.9% were inactive. Younger women (20-29 years) were more likely than the oldest age (40-50 years) category to perform some activity than to be inactive. Women in excellent or very good general health were much more likely to perform some physical activity than to be inactive. Higher income and employment were factors in meeting the recommendations. Attending religious services and a higher social roles score were significant factors. Having street lighting was the only physical environmental factor that emerged as statistically significant., Conclusions: More research is needed on the assessment of important issues regarding physical activity in women. Interventions should use assessment information to tailor programs and to address personal, social environmental, and physical environmental components.

Background: African-American women are at higher risk than white women of cardiovascular disease and stroke. In addition, fewer African-American women reap the cardiovascular benefits of exercise, because of low physical activity. The study goals were to identify personal, social environmental, and physical environmental correlates of physical activity of urban-dwelling, Midwestern, African-American women and to obtain their recommendations for increasing exercise in their communities., Methods: A face-to-face interview (Women and Physical Activity Survey) covering personal, social environmental, and physical environmental correlates of physical activity was administered to 399 volunteer African-American women aged 20 to 50 years, living in Chicago. Physical activity was measured with questions on lifestyle and planned leisure-time activity (exercise) from the Behavioral Risk Factor Surveillance System., Results: The women were from a wide socioeconomic spectrum of education and income. Forty-two percent of the women met current recommendations for moderate or vigorous physical activity; 48% were insufficiently active; and 9% were inactive. The following groups of women were more likely to be physically active: women with at least a high school education; women with perceived good health; women who knew people who exercise; and women who viewed the neighborhood as safe. These findings were statistically significant., Conclusions: Interventions that target urban African-American women must address the safety of the physical environment and personal and social environmental correlates of physical activity, and they should focus especially on inactive women who have less than a high school education or perceive themselves to be in poor health.

Although considerable research has investigated the use of cigarette smoking for weight management, the potential role of smokeless tobacco (ST) use in dieting behavior has not been explored. Several measures designed to assess dieting behavior, attitudes toward eating, and tobacco use were administered to adult women using ST (n = 18), cigarettes (n = 20), and no tobacco (n = 20). Use of tobacco for weight loss was prevalent among the women smoking cigarettes. Nearly half the women in the cigarette-smoking group (45%) reported use of cigarettes to assist in weight loss, and only three (16.6%) of the women in the ST groups indicated use of ST for such purposes. No significant differences were observed across groups on measures of dietary restraint or attitudes toward eating. Issues of dieting and weight control may not be important factors in prompting ST use. Implications and areas for further research are discussed.