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Social media platforms are home to large volumes of ambiguous hashtag-based claims about the health, modified-risk, and cessation benefits of electronic cigarette products (e.g., #Vapingsavedmylife). The objective of this study was to qualitatively explore how young adults interpret these hashtags on the popular platform Instagram. Specifically, we sought to identify if they view these hashtags as making health-related claims, and if they find these claims to be credible and valid. We conducted 12 focus groups in 2018 with non–tobacco users, smokers, dual users, and vapers between the ages of 18 and 24 ( n = 69). Using real Instagram posts to guide discussion, participants reflected on the meaning of potentially claims-making hashtags. Participants interpreted the majority of the hashtags as making health-related claims. However, many participants felt that the claims were too exaggerated to be entirely valid. Some participants, including dual users and vapers, argued that smoking and vaping were largely equivalent. Smokers were particularly skeptical of claims. Findings suggest that the U. S. Food and Drug Administration should consider hashtag-based claims in their regulatory efforts. However, further research is needed on how to pragmatically address claims taking the form of hashtags given legal and practical constraints.

Poor health outcomes of chronically ill low-income adults are costly in both fiscal and human terms. One-third of Americans have hypertension and 43%) with high rates of exacerbations and complications [28, 10]. Low-income African American adults face life situations complicated by limited resources, high environmental and social risks, a high burden of stress and limited access to healthcare, all of which contribute to a substantial risk for multiple chronic conditions [10, 11, 19]. These factors may also contribute to a low sense of trust in the healthcare system, low self-efficacy regarding self-management behaviors to control hypertension, poor chronic disease management and costly sequelae [6, 19]. Thus, new intervention models and systems of care that are consumer-driven must be developed to improve outcomes. Client self-management of chronic diseases has emerged as a key factor in improved health outcomes [8]. We tested the effect of an innovative Ecological Nurse Case Management (ENCM) intervention on perceived stress, self-efficacy, self-management behaviors (SMB), and health status of low-income, chronically ill, African American adults. We hypothesized ENCM would reduce stress and increase self-efficacy and positively impact health status. We expected that that clients receiving this intervention would show decreased blood pressure (B/P), body mass index (BMI) and waist circumference (WC).

Introduction This study examined the relationships between experiences of childhood and adulthood victimization and current smoking among heterosexual and sexual minority women. The main hypothesis was that victimization experiences would predict current smoking status. Further, we hypothesized that the effect of childhood victimization on self-reported smoker status would be mediated by adult victimization. Methods Data are from two studies conducted in the United States that used similar methods and questionnaires in order to conduct a comparative analysis of women based on sexual orientation. Data from Wave 1 (2000-2001) of the Chicago Health and Life Experiences of Women (CHLEW) study and from Wave 5 (2001) of the National Study of Health and Life Experiences of Women (NSHLEW) study were used in these analyses. Results Twenty-eight percent of the sample reported current smoking. Victimization experiences were common, with 63.4% of participants reporting at least one type of victimization in childhood and 40.2% reporting at least one type in adulthood. Women who identified as heterosexual were less likely to be victimized during childhood than were women who identified as lesbian or bisexual. Adult victimization had a significant effect on current smoker status, and the effect of childhood victimization on smoker status was mediated by adult victimization. When examined by sexual orientation, this indirect relationship remained significant only among bisexual women in the sample. Conclusions Study findings make a valuable contribution to the literature on victimization and health risk behaviors such as smoking. Given the negative and long-term impact of victimization on women, strategies are needed that reduce the likelihood of victimization and subsequent engagement in health risk behaviors such as smoking. Implications The study findings make a valuable contribution to the literature on sexual minority women's health on the influence of victimization on health risk behaviors. With the goal of reducing the likelihood of adult victimization and subsequent engagement in health risk behaviors, programs and policies aimed at preventing victimization of women are warranted. Providers and community health agencies should assess and target physically and sexually abused sexual minority youth for mental health intervention with the goal of interrupting the progression from childhood victimization to adult victimization and subsequent engagement in health risk behaviors.

Background While marketing for electronic cigarette refill liquids (e-liquids) is widespread on Instagram, little is known about the post elements that create appeal among young adult Instagram users. Further information is needed to help shape regulatory strategies appropriate for social media. Objective This study examined young adult Instagram user perceptions of actual e-liquid marketing posts and US Food and Drug Administration (FDA)–mandated nicotine addiction warning statements on Instagram. Methods A series of 12 focus groups (n=69) were held with non–tobacco users, vapers, smokers, and dual users in Wisconsin between September and December 2018. Participants discussed the elements of posts that they found appealing or unappealing, in addition to completing a survey about each post and e-liquid. Focus group transcripts were analyzed by smoking status using a framework analysis approach. Results Although willingness to try e-liquids was highest among nicotine users, focus group discussions indicated that Instagram posts promoting e-liquids held appeal for individuals across smoking statuses. The primary elements that created appeal were the perceived trustworthiness of the Instagram account, attractive design and flavor visuals, and promotion of flavors and nicotine levels that met personal preferences. Post appeal was reduced by references to vaping subcultures, indicators that the post creator did not take nicotine addiction seriously, and FDA-mandated nicotine warning statements. Non–tobacco users were particularly drawn to posts featuring nicotine-free e-liquids with attractive visual designs and flavors known from foods. Conclusions Young adults consider a broad range of elements in assessing the appeal of e-liquid marketing on Instagram, with minor but notable distinctions by smoking status. Non–tobacco users are uniquely drawn to nicotine-free e-liquids and are more deterred by the FDA’s mandated nicotine addiction warning statements than those from other smoking statuses. This suggests that it may be possible to tailor policy interventions in a manner that helps to reduce novel uptake of vaping without significantly diminishing its potential harm-reduction benefits.

Background Patient-delivered partner therapy (PDPT) is an evidence-based method of partner treatment, but further research was needed to understand theoretical underpinnings of potential PDPT use. Purpose We sought to develop and test a theoretical framework to understand PDPT intentions. Methods A Midwestern sample of sexually transmitted infection clinic patients were recruited to participate in a three-phase study incorporating semi-structured interviews (n = 20, total), cognitive interviews (n = 5), and surveys (n = 197; Mage = 31.3, 61% male, 91% Black or African-American). Thematic analysis was conducted to identify major themes, which guided development and testing of a theoretical framework on PDPT intentions using structural equation modeling. Results We identified themes of information (knowledge); motivation (individual and partner protection beliefs, partner and provider motivation-to-comply); social support (sexual health and general); and behavioral skills (partner notification, medication delivery, and communication skills self-efficacy) in thematic analysis. The developed Interpersonal-Behavior model demonstrated good model fit in structural equation modeling [χ2(36) = 95.56, p

This article examined differences in condom use during anal intercourse among men who have sex with men (MSM) and male-to-female transgender women in Jakarta, Indonesia. A cross-sectional design, structured interviews, and hierarchical linear modeling were used to examine condom use among MSM recruited from entertainment places (EPs; e.g., discotheques/dance clubs/karaoke bars), massage parlors (MPs), and among transgender women who congregated and/or sought sexual partners on streets/parks (S/P). The sample consisted of 91, 97, and 114 of MSM-EP, MSM-MP, and transgender-S/P, respectively. Respondents reported on 641 unique sexual partner encounters, which were “nested” within 302 respondents. Reported condom use was high, 66%, 84%, and 83% for MSM-EP, MSM-MP, and transgender-S/P, respectively, and varied across type of respondent. At the individual level, depressive symptoms and history of physical abuse during childhood and adulthood were associated with lower condom use ( p < .05). By contrast, having a higher level of education was associated with more condom use ( p < .05). At the partner level, condom use was associated with type of partners and the use of club drugs before sex. HIV-prevention efforts should take into account the multilevel determinants of condom use within these populations.

Sexual-minority women are at heightened risk for a number of mental health problems, including hazardous alcohol consumption, depression, and anxiety. We examined self-medication and impaired-functioning models of the associations among these variables and interpreted results within a life course framework that considered the unique social stressors experienced by sexual-minority women.Data were from a sample of 384 women interviewed during the first two waves of the Chicago Health and Life Experiences of Women (CHLEW) study.Covariance structure modeling revealed that (a) consistent with a self-medication process, anxiety was prospectively associated with hazardous drinking and (b) consistent with an impaired-functioning process, hazardous drinking was prospectively associated with depression.Our findings support a life course perspective that interprets the mental health of adult sexual-minority women as influenced by adverse childhood experiences, age at drinking onset, first heterosexual intercourse, and first sexual identity disclosure, as well as by processes associated with self-medication and impaired functioning during adulthood.

Women with breast or cervical cancer abnormalities can experience barriers to timely follow-up care, resulting in delays in cancer diagnosis. Patient navigation programs that identify and remove barriers to ensure timely receipt of care are proliferating nationally. The study used a systematic framework to describe barriers, including differences between African American and Latina women; to determine recurrence of barriers; and to examine factors associated with barriers to follow-up care.Data originated from 250 women in the intervention arm of the Chicago Patient Navigation Research Program (PNRP). The women had abnormal cancer screening findings and navigator encounters. Women were recruited from a community health center and a publicly owned medical center. After describing proportions of African American and Latina women experiencing particular barriers, logistic regression was used to explore associations between patient characteristics, such as race/ethnicity, and type of barriers.The most frequent barriers occurred at the intrapersonal level (e.g., insurance issues and fear), while institutional-level barriers such as system problems with scheduling care were the most commonly recurring over time (29%). The majority of barriers (58%) were reported in the first navigator encounter. Latinas (81%) reported barriers more often than African American women (19%). Differences in race/ethnicity and employment status were associated with types of barriers. Compared to African American women, Latinas were more likely to report an intrapersonal level barrier. Unemployed women were more likely to report an institutional level barrier.In a sample of highly vulnerable women, there is no single characteristic (e.g., uninsured) that predicts what kinds of barriers a woman is likely to have. Nevertheless, navigators appear able to easily resolve intrapersonal-level barriers, but ongoing navigation is needed to address system-level barriers. Patient navigation programs can adopt the PNRP barriers framework to assist their efforts in assuring timely follow-up care.

Background Among women in the general population, childhood physical abuse (CPA) is associated with poor adult health status and engagement in health risk behaviors. Sexual minority women (SMW) are at elevated risk of CPA, have higher rates of smoking, and may be at higher risk for poorer general health. In this study, we examined the influences of CPA on health status in a diverse sample of SMW. We hypothesized that SMW with a history of CPA would report poorer health than those without such histories and that early onset of smoking—an important health risk behavior—would mediate the relationship between CPA and current health status. Methods Structural equation modeling was used to evaluate the influence of CPA on early health risk behavior (i.e., age of smoking onset) and current perceived health status in a community based sample of 368 SMW. Results More than one fifth of the sample (21.5%) reported a history of CPA. One fourth of the sample was current smokers; the average age of smoking onset was 19 to 20 years old. The mean level of self-rated health status was between “fair” and “good.” When relationships were simultaneously estimated, the effect of CPA on health status was mediated by two sequential smoking factors: CPA was associated with earlier age of smoking onset, and age of smoking onset was associated with current smoker status. Being a current smoker had a negative effect on perceived health status. Implications for Practice and/or Policy These results suggest that tobacco use is an important pathway by which CPA influences current health status. Prevention and early intervention initiatives should focus on the reduction of CPA among SMW to eliminate the long-term health consequences of adverse childhood events among SMW.

Patient-delivered partner therapy (PDPT) is the practice of providing patients diagnosed with a bacterial sexually transmitted infection (STI) medication to give directly to their partner for treatment without requiring the partner to participate in diagnostic testing and counseling. Despite a growing body of evidence in support of PDPT, literature is limited to date on the influence of perceived risk of intimate partner violence (IPV) on PDPT use. We analyzed mixed-method data from 196 quantitative surveys (61% male, M age = 31.2, 92% Black or African-American) and 25 qualitative interviews to better understand the barriers and facilitators associated with PDPT delivery for patients attending a Midwestern, publicly funded STI clinic in the U.S. Nearly a third of surveyed patients (29; 34% of women, 26% of men) expressed worry about IPV when delivering PDPT. Patients had concerns about infidelity worry, embarrassment, and anxiety (referred to as IWEA hereafter) associated with partner notification and PDPT delivery. We found IWEA was highly correlated with IPV concerns in a fully adjusted logistic regression model. Women had 2.43 (95% CI = 1.09–5.42) times greater odds of worrying about IPV than men; other significant factors associated with IPV worry included higher condom use, no prior STI diagnosis, and being uninsured (as compared to having Medicare/Medicaid insurance). Encouraging communication between healthcare providers and their patients about the potential for IPV could facilitate patient triaging that results in the consideration of alternative partner referral mechanisms for patients or partners at risk of harm and better outcomes for patients and their partners.

Although research has documented cultural variability in respondent comprehension and interpretation of survey questions, little information is currently available on the role that acculturation might play in minimizing cross-cultural differences in the comprehension or interpretation of survey questions. To investigate this problem, we examine the potential effects of acculturation to host culture on respondent comprehension of a set of health survey questions among two distinct Latino populations on the US mainland: Mexican-Americans and Puerto Ricans. Specifically, comprehension-related respondent behaviors coded from 345 face-to-face interviews conducted with Mexican-American, Puerto Rican, African American, and non-Latino White adults living in Chicago are examined. Findings indicate that Latino respondents who were born outside of the US and who have a preference for communicating in Spanish, relative to English, were more likely to express comprehension difficulties. These findings suggest that pretest survey instruments with immigrant populations may be a useful strategy for identifying problematic questions.

Introduction Physical activity is known to significantly impact cardiometabolic health. Accelerometer data, as a measure of physical activity, can be used to objectively identify a disparity in movement (movement discordance) between healthy and unhealthy adults. The purpose of this study was to examine the Movement Discordance between healthy and unhealthy adults in a large US population sample. Methods Demographic, health and accelerometer data from the National Health and Nutrition Examination Study (NHANES) 2003–2004 and 2005–2006 cohorts were used for this study. Participants were classified as either having a “normal” or “abnormal” value for each cardiometabolic health parameter examined, based on published criteria. Linear regression analyses were performed to determine significance of each abnormal health parameter (risk factor) in its unique effect on the accelerometer counts, controlling for age and gender. Average accelerometer counts per minute (cpm) by gender and age categories were estimated separately for the groups of normal and abnormal cardiometabolic risk. Results Average cpm for those with healthy levels of each individual cardiometabolic health parameter range from 296 cpm (for C reactive protein) to 337 cpm (for waist circumference), while average cpm for those with abnormal levels of each individual cardiometabolic health parameter range from 216 cpm (for insulin) to 291 cpm (for LDL-cholesterol). After controlling for age and gender, waist circumference, HbA1c, Insulin, Homocysteine, and HDL-Cholesterol were the cardiometabolic health parameters that showed significant, unique and independent effects on cpm. Overall, individuals who have abnormal values for all significant cardiometabolic health parameters (“unhealthy”) averaged 267 cpm (SE = 15 cpm), while the healthy sample of this study averaged 428 cpm (SE = 10 cpm). The difference in cpm between the unhealthy and healthy groups is similar between males and females. Further, for both males and females, the cpm gap between unhealthy and healthy is largest in the 30s (males: 183 cpm; females 144 cpm) and lessens as age increases, with the lowest gap seen in those 80+ years (males, 81 cpm; females, 85 cpm). Conclusion This Movement Discordance between healthy and unhealthy adults represents a gap in movement that needs to be closed to improve the health of individuals with, or at risk for cardiometabolic disease.

Background Nonresponse is a potentially serious source of error in epidemiologic surveys concerned with injury control and risk. This study presents the findings of a records-matching approach to investigating the degree to which survey nonresponse may bias indicators of violence-related and unintentional injuries in a random-digit-dialed (RDD) telephone survey. Methods Data from a statewide RDD survey of 4155 individuals aged 16 years and older conducted in Illinois in 2003 were merged with ZIP code–level data from the 2000 Census. Using hierarchical linear models, ZIP code–level indicators were used to predict survey response propensity at the individual level. Additional models used the same ZIP code measures to predict a set of injury-risk indicators. Results Several ZIP code measures were found to be predictive of both response propensity and the likelihood of reporting partner violence. For example, people residing in high-income areas were less likely to participate in the survey and less likely to report forced sex by partner, processes that suggest an over-estimation of this form of violence. In contrast, estimates of partner isolation may be under-estimated, as those residing in geographic areas with smaller-sized housing were less likely to participate in the survey but more likely to report partner isolation. No ZIP code–level correlates of survey response propensity, however, were found also to be associated with driving-under-the-influence (DUI) indicators. Conclusions There is evidence of a linkage between survey response propensity and one variety of injury prevention measure (partner violence) but not another (DUI). The approach described in this paper provides an effective and inexpensive tool for evaluating nonresponse error in surveys of injury prevention and other health-related conditions.

The goals of this study were to (i) determine how factors commonly implicated in smoking cessation processes influenced smoking cessation in low socio-economic status (SES) women and (ii) elucidate the pathways through which these factors may lead to quitting smoking. Secondary analysis was conducted on data from 644 women smokers aged 18-45 years who had participated in an earlier experimental evaluation of a smoking cessation program, were still smokers at the 2-month post-intervention survey and completed an interview 6 months later. Path analysis (LISREL 8) was used to test a conceptual model in which (i) factors considered as precursors to quitting (motivation, self-efficacy, confidence, action and intention to quit) directly predicted subsequent quitting and (ii) health concerns, social pressure to quit and daily stress influenced quitting indirectly through their effects on the precursor factors and (iii) mediated the effects of background characteristics (race, education, single motherhood, pregnancy and exposure to the earlier smoking cessation intervention) on quitting. Overall, results supported this conceptual model and its applicability to low-SES women smokers and indicated significant pathways among specific factors. In particular, (i) only plans to quit, confidence and social pressure to quit directly predicted quitting; (ii) both health concerns and social pressure increased motivation to quit and (iii) the negative effect of daily stress on quitting was mediated through decreased self-efficacy.

Background. We conducted longitudinal analysis of long-term outcomes of a motivational smoking cessation program. The program consisted of clinic-based minimal interventions delivered to women smokers in public health clinics by clinic personnel, a reminder letter, and an optional brief telephone counseling. Methods. Subjects seen in six intervention ( N = 541) and six control clinics ( N = 527) were interviewed by telephone 2, 6, 12, and 18 months later. At each measurement point, unadjusted percent abstinence and mean action, motivation, and readiness scores by study group were compared with standard bivariate comparisons tests. Hierarchical linear modeling that adjusted for clustering of subjects within clinics and clustering of results over 18 months (four waves) within individuals was used to compare outcomes by study group. Results. Number of actions toward quitting, motivation, and stage of readiness to quit remained better in the intervention than in the control group up to 18 months. The program effect on abstinence was still significant at 12 months, but not at 18 months. Conclusions. Exposure to one-time, brief interventions in public health clinics appears sufficient to enhance abstinence up to 12 months, and action toward quitting and motivation and readiness to quit up to 18 months.

This study examined the prevalence of alcohol-and substance-related disorders in a random sample of 627 adult probationers in Illinois. The investigation also explored the prevalence of major psychiatric disorders and their co-occurrences with alcohol and substance use disorders. To detect the presence of psychiatric disorders, researchers employed standardized assessment tools based on Diagnostic and Statistical Manual of Mental Disorders criteria. Overall, results showed that probationers had significantly higher rates of psychiatric disorders, substance use disorders, and co-occurring disorders compared with persons in the general population. In light of these findings, probation administrators are urged to invest more resources in treating drug use, mental illness, and codisorders, the latter of which is associated with a higher risk of violent behaviors.

Introduction The objective of this study was to assess change in sitting and physical activity behavior in response to a workplace intervention to disrupt prolonged sitting time. Methods Sixty office workers were randomized to either a Stand group (n = 29), which received hourly prompts (computer-based and wrist-worn) to stand up, or a Step group (n = 31), which received the same hourly prompts and an additional prompt to walk 100 steps or more upon standing. An ActivPAL monitor was used to assess sitting and physical activity behavior on the same 3 consecutive workdays during baseline and intervention periods. Mixed-effect models with random intercepts and random slopes for time were performed to assess change between groups and across time. Results Both groups significantly reduced duration of average sitting bouts (Stand group, by 16%; Step group, by 19%) and the number of sitting bouts of 60 minutes or more (Step group, by 36%; Stand group, by 54%). The Stand group significantly reduced total sitting time (by 6.6%), duration of the longest sitting bout (by 29%), and number of sitting bouts of 30 minutes or more (by 13%) and increased the number of sit-to-stand transitions (by 15%) and standing time (by 23%). Stepping time significantly increased in the Stand (by 14%) and Step (by 29%) groups, but only the Step group significantly increased (by 35%) the number of steps per workday. Differences in changes from baseline to intervention between groups were not significant for any outcome. Conclusion Interventions that focus on disrupting sitting time only in the workplace may result in less sitting. When sitting time disruptions are paired with a physical activity prompt, people may be more likely to increase their workday physical activity, but the effect on sitting time may be attenuated.

Purpose/objectivesTo assess the efficacy of Korean Immigrants and Mammography-Culture-Specific Health Intervention (KIM-CHI), an educational program for Korean American (KA) couples designed to improve mammography uptake among KA women.DesignA two-group cluster randomized, longitudinal, controlled design.Setting50 KA religious organizations in the Chicago area.Sample428 married KA women 40 years of age or older who had not had a mammogram in the past year. The women and their husbands were recruited from 50 KA religious organizations.MethodsCouples were randomly assigned to intervention or attention control groups. Those in the KIM-CHI program (n = 211 couples) were compared to an attention control group (n = 217 couples) at baseline, as well as at 6 and 15 months postintervention on mammogram uptake.Main research variablesSociodemographic variables and mammography uptake were measured. Level of acculturation was measured using the Suinn-Lew Asian Self-Identity Acculturation Scale. Researchers asked questions about healthcare resources and use, health insurance status, usual source of care, physical examinations in the past two years, family history of breast cancer, and history of mammography.FindingsThe KIM-CHI group showed statistically significant increases in mammography uptake compared to the attention control group at 6 months and 15 months postintervention.ConclusionsThe culturally targeted KIM-CHI program was effective in increasing mammogram uptake among nonadherent KA women.Implications for nursingNurses and healthcare providers should consider specific health beliefs as well as inclusion of husbands or significant others. They also should target education to be culturally relevant for KA women to effectively improve frequency of breast cancer screening.

This study examines monthly variation in reports of recent alcohol consumption behavior.Telephone survey data collected by the Behavioral Risk Factor Surveillance System were used to measure self-reports of drinking and heavy episodic drinking in the 30 days before the interview. The sample (N = 57,758) comprised cases collected in six states in 5 selected years. Monthly variability in self-reported alcohol consumption was evaluated by logistic regression analysis, using "deviation from means coding" for the month of interview, with background variables and year of interview controlled and state-level clustering adjusted.Adults were significantly more likely to report past 30-day alcohol consumption when interviewed during the month of January and less likely to report consumption when interviewed during March. Respondents were also more likely to report heavy episodic drinking during the month of July. Despite large differences in alcohol consumption between male and female participants, these seasonal patterns were essentially the same for both genders.The findings suggest that assessments of alcohol consumption that do not consider seasonal variation may be biased. In order to minimize this bias, it is recommended that researchers avoid collecting data only during these particular times of the year or extend the data collection interval and control for seasonal variability.

Background. A multicomponent motivational smoking cessation intervention was evaluated in 33 prenatal, family planning, and pediatric services in 12 public health clinics. Clinic-based intervention components were implemented by clinic personnel as part of routine medical visits. Methods. The evaluation design included pre- and postintervention measurements of multiple study outcomes in a baseline (all clinics prior to the start of the intervention) and an experimental period (matched-pair random assignment of clinics to intervention or control conditions). Subjects were 683 (baseline) and 1,064 (experimental) smokers with measurements of smoking outcomes at both times. Mixed-effects regressions analyzed individual outcomes clustered within clinics and services. Results. Control and intervention clinics had similar outcomes in the baseline period. In the experiment, outcomes improved in the intervention but not in the control clinics. Compared to controls, smokers exposed to the intervention were more likely to have quit (14.5 versus 7.7%) or take actions toward quitting and had higher mean action, stage of readiness, and motivation to quit scores. These positive effects persisted when clustering within clinics and services was controlled. Conclusions. This intervention, implemented by clinic personnel as part of routine medical visits, was effective under these natural conditions across different types of clinic service.

This study examined the influence of demographic characteristics, sexual identity, hazardous drinking, and sexuality/intimacy enhancement alcohol expectancies on rates of risky sexual behaviors in a community sample of women who self-identified as lesbian, mostly lesbian, and bisexual ( N = 349). Structured interview data were collected as part of a larger longitudinal study of sexual minority women’s health, the Chicago Health and Life Experiences of Women study. We used structural equation modeling, controlling for demographic characteristics, to evaluate the influence of sexual identity, hazardous drinking, and alcohol-related sexuality/intimacy enhancement expectancies on sexual risk behaviors. Controlling for demographic characteristics and for sexual identity, higher levels of both hazardous drinking and sexuality/intimacy enhancement alcohol expectancies were associated with higher sexual risk scores. The final model predicted 36% of the variance in risky sexual behavior scores. Our findings regarding the central role of alcohol use and sexuality/intimacy enhancement expectancies in sexual risk behaviors among sexual minority women are consistent with previous research focusing on predominantly heterosexual women. Future efforts at sexual risk reduction in sexual minority women will need to address the influences of alcohol use and drinking-related expectancies on sexual behaviors and decision making.

We report results from an experimental study that tested the effectiveness of dissemination interventions to improve implementation of smoking cessation guidelines in maternal and child public health clinics. We additionally examine individual clinic results for contextual explanations not apparent from the experimental findings alone. Twelve clinics in Illinois were randomized to three dissemination strategies: (i) core dissemination (provision of the 2000 Public Health System Clinical Practice Guideline and a tested smoking cessation program, including program supplies and training), (ii) core dissemination and access to telephone counseling and (iii) core dissemination, telephone counseling access and outreach visits to clinics. Implementation outcomes were post-dissemination improvements over baseline in the percent of smokers reporting receipt/exposure to (i) provider advice, (ii) self-help booklet, (iii) videos, (iv) posters and (v) an adjunct intervention. Results showed significant increases in the percent of smokers receiving a booklet (overall) and an adjunct intervention (Groups 2 and 3). There were no increases in smoker-reported provider advice or videos and poster exposure. Examination of individual clinic findings showed that seven clinics accounted for all the experimental effectiveness. Smoker-reported provider advice to quit also increased in these clinics. Type of clinic and the absence of disruptive events distinguished clinics with and without effective dissemination outcomes.

Immigrant women are at greater risk for late stage breast cancer diagnosis. The rapid increase in the US foreign-born population and new immigration patterns lead us to investigate the association between changes in immigrant population and the likelihood of distant metastasis stage at diagnosis of breast cancer among women in Cook County, Illinois. Analyses employed Illinois State Cancer Registry data for 42,714 breast cancer cases diagnosed between 1994 and 2003 in conjunction with 1990 and 2000 Census tract data. We find that concentration of and increases in immigrant populations within neighborhoods contributed to the risk of late stage breast cancer diagnosis. These findings suggest that, although some health indicators for immigrant populations have improved in recent years, important health disparities in breast cancer diagnosis still remain at the neighborhood level. They further suggest that cancer screening and follow-up resources should be directed to areas experiencing rapid increases in immigrant populations.

Aims Although research shows that sexual minority women report high rates of lifetime sexual victimization and high rates of hazardous drinking, investigators have yet to explore the relationships between sexual victimization and hazardous drinking in this population. In addition, because the rates of these problems may vary within the sexual minority population, we examined and compared relationships between sexual victimization and hazardous drinking in exclusively heterosexual and sexual minority (mostly heterosexual, bisexual, mostly lesbian and exclusively lesbian) women. Method Data from 548 participants in the National Study of Health and Life Experiences of Women and 405 participants in the Chicago Health and Life Experiences of Women study were pooled to address these relationships. We compared hazardous drinking, childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization (both CSA and ASA) across the five sexual identity subgroups. We then fit a multilevel general linear model to examine group differences in the relationships between hazardous drinking and sexual victimization and to test for potential interactions between victimization and identity on hazardous drinking. Results Sexual minority women reported higher levels of hazardous drinking and higher rates of CSA and sexual revictimization than did exclusively heterosexual women. Revictimization was the strongest predictor of hazardous drinking among women who identified as mostly heterosexual and mostly lesbian. Conclusions This study extends previous research by examining associations between sexual victimization and hazardous drinking in heterosexual and sexual minority women and by exploring within-group variations in these associations among sexual minority women. Higher rates of lifetime sexual victimization and revictimization may help to explain sexual minority women's heightened risk for hazardous drinking. The findings highlight the need for additional research that examines the meanings of sexual identity labels to more fully understand differences in risk within groups of sexual minority women as well as how sexual identity may affect responses to and interpretations of sexual victimization.

Purpose To test whether upward socioeconomic neighborhood change has an effect on probability of distant metastasis at diagnosis of breast cancer among women who live there. Methods Census tract data (N = 1,137) from Cook County. IL, from 1990 and 2000 and cancer registry data for female breast cancer cases for these census tracts from 1994–2000 (N = 21,516) were used. A multilevel model of 1990 baseline socioeconomic status (SES) of neighborhoods and degree of neighborhood change 1990–2000 (compositional characteristics) and patient's age and race/Hispanic status (individual characteristics) was constructed to predict distant metastasis (vs. local and regional stage) at diagnosis. Results While residence in a census tract with lower baseline SES in 1990 (higher concentrated disadvantage and immigration and lower concentrated affluence) and being African American were associated with increased odds of distant metastasis at diagnosis, residence in an improving census tract was also associated with increased odds of distant metastasis at diagnosis. Conclusions Paradoxically, both measures of initial neighborhood disadvantage and upward neighborhood socioeconomic change were independently associated with greater odds of distant metastasis at diagnosis of breast cancer. Neighborhood social and economic change can affect health.

Objective. The study was intended to develop and validate a health literacy test, termed theShortAssessmentofHealthLiteracyforSpanish-speakingAdults (SAHLSA), for the Spanish-speaking population. Study Design. The design of SAHLSA was based on the Rapid Estimate of Adult Literacy in Medicine (REALM), known as the most easily administered tool for assessing health literacy in English. In addition to the word recognition test in REALM, SAHLSA incorporates a comprehension test using multiple-choice questions designed by an expert panel. Data Collection. Validation of SAHLSA involved testing and comparing the tool with other health literacy instruments in a sample of 201 Spanish-speaking and 202 English-speaking subjects recruited from the Ambulatory Care Center at UNC Health Care. Principal Findings. With only the word recognition test, REALM could not differentiate the level of health literacy in Spanish. The SAHLSA significantly improved the differentiation. Item response theory analysis was performed to calibrate the SAHLSA and reduce the instrument to 50 items. The resulting instrument, SAHLSA-50, was correlated with the Test of Functional Health Literacy in Adults, another health literacy instrument, at r 5 0.65. The SAHLSA-50 score was significantly and positively associated with the physical health status of Spanish-speaking subjects (po.05), holding constant age and years of education. The instrument displayed good internal reliability (Cronbach’s a 5 0.92) and test–retest reliability (Pearson’s r 5 0.86). Conclusions. The new instrument, SAHLSA-50, has good reliability and validity. It could be used in the clinical or community setting to screen for low health literacy among Spanish speakers.

Representative data from the U.S. National Health Interview Survey are used to investigate the substance use patterns of immigrants and compare them to those of the native born populations. The information examined is from the 1991 supplementary Drug and Alcohol Use Data File, which examined the self-reported substance use behaviors of approximately 21,000 adults aged 18-44. Findings indicate that immigrants to the U.S. in the late twentieth century are less likely to use alcohol and other drugs than are native born citizens. Additional findings suggest assimilation processes by which exposure to mainstream American society leads to patterns of alcohol and illicit drug use among long term immigrants that approximates that of the native born population. The patterns of substance use observed among immigrants, however, are not consistent with acculturative stress mechanisms. These findings provide an important and representative profile of the substance use patterns of one of the largest international migration streams of the past one hundred years.

OBJECTIVES: This study assessed the prevalence and effectiveness of smoking cessation interventions for women of childbearing age in public health clinics. METHODS: Smokers in prenatal, family planning, and well-child services in 10 public health clinics (n = 1021) were interviewed 5 to 8 weeks after a medical visit to assess their exposure to smoking cessation interventions and smoking cessation outcomes. RESULTS: Depending on clinic service and intervention component (poster, video segment, provider advice, booklet), 16% to 63% of women reported exposure to an intervention component during their visit. Women in prenatal services received more interventions and had better outcomes than those in the other services. CONCLUSIONS: Exposure to more interventions increased readiness and motivation to quit and the number of actions taken toward quitting.

We conducted an independent pilot test of the internal consistency, stability, and predictive validity of the instrument presented by Crittenden, Manfredi, Lacey, Warnecke, and Parsons (1994) using a two-wave panel of female smokers in 12 public health clinics. This instrument subdivides the precontemplation stage proposed by Prochaska and DiClemente into three more distinct stages: not contemplating quitting or cutting down, not contemplating quitting, and not contemplating quitting within 6 months. Findings confirm that the instrument is useful for evaluating movement toward quitting for populations that are largely concentrated in the precontemplative stage. The concurrent and predictive validity of the elaborated stages and the reliability and stability of smoking motivation and confidence indicate that the instrument is sensitive enough to track changes in readiness and motivation across the full readiness continuum.

Ethnographic research has occasionally reported the presence (or absence) of the disease concept of alcoholism in non-Western cultures. But the problem of differences in the nature of the concept of alcoholism between cultures in which it exists has not been seriously investigated. This study contrasts beliefs about alcoholism among samples of Koreans and Americans at a university in the United States. The findings suggest that the concept of alcoholism is present in both cultures, but Koreans tend to restrict their disease to the physiological consequences of long-term alcohol use, while Americans accept a definition which is couched largely in social and behavioral terms. It thus appears that, in contrast to America, alcohol consumption in Korea is relatively high, but alcoholism is rare. The implications of these findings for drinking behaviors, and the diagnosis and treatment of alcoholism, are discussed.