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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.

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.

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

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.

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.

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

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.

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.

Asthma is a common chronic disease among adolescent students, and was one of the 5 most common reasons for pediatric treat-and-release for emergency department visits among 5- to 14-year-old children in 2010.1 In 2013, 26.3% of high school and 23.5% of middle school students in Maryland reported ever having been told by a doctor or nurse that they had asthma.2 Avoidance of smoking and exposure to secondhand smoke has been recommended for people with asthma,3 because persons with asthma who smoke experience higher rates of hospitalization and reduced quality of life when compared with non-smokers with asthma.4 Previous studies have found that adolescents with current asthma smoke as many or more cigarettes than adolescents without asthma.5-8 For example, adolescents reporting having had an asthma episode or attack are more likely than other adolescents to report lifetime daily cigarette use and current frequent cigarette use.5 In addition, a recent study has shown that high school students with asthma have a higher prevalence of hookah smoking than other students.9 Despite the large number of studies identifying relationships between peers, school programs, family members, and media for adolescent smokers,10-13 our understanding of the role of these factors for asthmatic adolescent smokers remains limited. Previous studies of asthmatic adolescent smoking have examined environmental smoking exposure, alcohol, communication with parents, as well as intrapersonal factors such as autonomy, depression, smoking prevalence, asthma management.6,14,15 Sex has an impact on adolescents’ school social networks including peer selection, patterning of peer ties, and peer influence making.16 Research is needed to explore whether and to what extent exposure to smoking in mass media has a similar influence on adolescent tobacco use and variations by sex.17 This study aims to determine whether exposure to mass media and school social networks’ influence are associated with current smoking status among asthmatic adolescent students by sex and if these associations vary by sex.

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.

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.

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.

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...

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.

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 ...

Focus group interviews were conducted with Hispanic teenagers to explore their patterns of alcohol consumption, influences on drinking and possible intervention strategies. The findings revealed that drinking and alcohol-impaired driving are common. Conviviality and social facilitation are the predominant contexts for alcohol consumption in this population. The strong influence of peers was detected where drinking to 'fit in' and be part of the crowd was observed. Parents were also noted to have influence. Some parents actively promoted drinking among their sons as it is often seen as a sign of masculinity or 'machismo'. Suggestions for effective prevention strategies included a preference for messages which vividly portray the harmful consequences of alcohol consumption and the use of testimonials from people who have suffered some form of impairment due to alcohol abuse. Teens, especially those who speak Spanish and understand the Hispanic culture, were seen as the most credible spokespersons for prevention campaigns. Language: en

Background: Alcohol-impaired driving is a major public health problem. National studies indicate that about 25% of college students have driven while intoxicated in the past month and an even greater percentage drive after drinking any alcohol and/or ride with an intoxicated driver. The purpose of this investigation was to examine the change in these various alcohol-related traffic risk behaviors as students progressed through their college experience. Methods: A cohort of 1,253 first-time first-year students attending a large, mid-Atlantic university were interviewed annually for 4 years. Repeated measures analyses were performed using generalized estimating equations to evaluate age-related changes in prevalence and frequency of each behavior (i.e., ages 19 to 22). Results: At age 19, 17%(wt) of students drove while intoxicated, 42%(wt) drove after drinking any alcohol, and 38%(wt) rode with an intoxicated driver. For all 3 driving behaviors, prevalence and frequency increased significantly at age 21. Males were more likely to engage in these behaviors than females. To understand the possible relationship of these behaviors to changes in drinking patterns, a post hoc analysis was conducted and revealed that while drinking frequency increased every year, frequency of drunkenness was stable for females, but increased for males. Conclusions: Alcohol-related traffic risk behaviors are quite common among college students and take a significant upturn when students reach the age of 21. Prevention strategies targeted to the college population are needed to prevent serious consequences of these alcohol-related traffic risk behaviors. Language: en

The purpose of this investigation was to examine the relationship between impaired driving crashes and public beliefs and concerns about impaired driving across each of Maryland's twenty-four counties (including Baltimore City). It was hypothesized that residents of counties that experience higher impaired driving crashes would express more concerns about impaired driving and perceive more risks about driving impaired than residents of counties that have lower rates of impaired driving.Data for alcohol impaired driving crashes were obtained for the years 2004-2006. These data were compared to public opinion data that was obtained annually by random-digit-dial telephone surveys from 2004 to 2007.Concerns about drunk driving as well as perceptions of the likelihood of being stopped by the police if one were to drive after having too much to drink were related to counties with higher serious impaired driving crash rates, as were perceptions that the police and the legal system were too lenient. Perceptions about the likelihood of being stopped by the police were higher in those counties with more impaired driving enforcement activity.Perceptions of concern appear to be shaped more by crash exposure than enforcement activity. Campaigns that address impaired driving prevention should substantially increase enforcement, strengthen the adjudication process of impaired drivers, and emphasize the potential seriousness of drinking-driving crashes in their promotional activities.

Three hundred and seven nurses at a large military medical centre were sent and completed an anonymous questionnaire which measured their smoking status along with job stress, job satisfaction and social support, as well as a variety of demographic factors. Three groups of nurses were defined on the basis of their response to the smoking status questions: those who have never smoked (54%), former smokers (23%) and current smokers (22%). The results revealed that the current smokers reported significantly (P less than 0.05) more job stress, job dissatisfaction and less social support than either former smokers or those who had never smoked. Further, the former smokers reported significantly less social support, defined from a variety of perspectives, than those who had never smoked. These were not as important in predicting amount smoked (number of cigarettes per day) among the current smoker group as they were in predicting differences between the different smoking status groups. The results suggest the need to incorporate the issues of social support and to a lesser extent job stress/satisfaction issues into smoking cessation programmes aimed at this population.

An anonymous survey questionnaire was administered in school to over 1,100 White and close to 400 Black middle class, suburban high school students. The questionnaire included questions about the source of information and influence about drugs and alcohol. Results revealed that while both groups rated the mass media as their best source of information, Whites were more likely to report this than Blacks. Blacks reported more frequently than Whites that they would go to their family if they had a question about alcohol or drugs, if they thought they had a problem with and needed help with a drug problem, and would most likely believe their family if they were told that they had a problem with alcohol or drugs. Whites were more likely to use their friends for these sources of information. Results are discussed in terms of the need to empower parents to be more influential at preventing alcohol and drug abuse among adolescents and for the need to research whether middle class Black families employ in...

The purpose of the investigation was to determine if parent-teen discordance for parent-imposed restrictions on driving conditions, driving rules, and the consequences for driving rule violations were related to risky teen driving. A total of 579 parents and their newly licensed teens were interviewed by telephone, 1 month after teens obtained provisional licenses. In multiple regression analyses, the degree of disagreement with parent restrictions on driving conditions and parent-imposed consequences for driving rule violations were negatively associated with a composite measure of teen risky driving. Female parents were negatively associated and male teens were positively associated with risky driving, but discordance with restricted driving conditions was the most important predictor. Discordance may reflect poor parent-teen relations or inadequate communication about parental expectations. The findings suggest that increasing parent-teen concordance on parent-imposed driving restrictions may help reduce risky teen driving.

The purpose of this study was to determine whether parent-imposed limits on 16-year-old high-risk driving are stricter in Maryland (MD), a state with graduated driver licensing (GDL) than in Connecticut (CT), a non-GDL state. In both states, parents and adolescents completed telephone surveys about the restrictions that parents placed on their adolescents' driving at night, with adolescent passengers, and at high speeds. In Maryland, surveys took place 1 month (294 parent-adolescent pairs) and 4 months (292 parent-adolescent pairs) after provisional licensure. In Connecticut, surveys took place the first month (132 pairs) and the third month (108 pairs) after adolescent licensure. The findings indicated that after controlling for demographic characteristics, Maryland parents and adolescents reported stricter parent-imposed limits for adolescent passengers, high-speed roads, weekend night driving, and overall limits. Parents in GDL states appear better able to establish and enforce adolescent driving restrictions when the licensing state stipulates, favors, and supports regulated adolescent driving.

Introduction: With a growing interest in increasing parental involvement in teen driving, it is important to find out what parents are already doing. Method This study assessed the content, delivery, rigidity, and consequences of 143 driving rules reported by 24 parent-teen dyads. Results: Strengths included that driving rules covered the full range of concerns, especially night driving limits and passenger limits, and most parents and teens reported that violations would be followed by consequences, especially talk/warn or no driving. Weaknesses included that many rules were not very strict and only half showed parent-teen agreement on content. Conclusions: These findings suggest that teen driving rules are not clearly defined.

Objective: The purpose of this study was to determine the extent to which effects of exposure to a brief intervention designed to increase parental restrictions on teen driving privileges persisted over time. Design: A total of 658 parents and their 16 year old adolescents were recruited from a local motor vehicle administration (MVA) site as adolescents successfully tested for provisional licenses. At the MVA, parents completed written surveys about expected teen driving during the first month of provisional licensure. Afterwards, on weeks assigned as intervention, parents watched a video and were given the video and a driving agreement to take home. Both parents and teens completed follow up telephone interviews about communication, amounts, and limits on teen driving at one month (579 dyads), four months (529 dyads), and nine months (528 dyads). Results: The results indicated that both intervention parents and teens were much more likely to report using a driving agreement at each follow up during the nine month period. Significant treatment group differences persisted for communication about driving, but effects related to limits on teen driving that were evident at one month declined over time. Reports for passenger, road, and overall limits remained significant at four months; fewer were present at nine months. There were no differences in amounts of teen driving at four or nine months. Conclusions: It is possible to reach parents through brief interventions at the MVA and successfully promote increases in initial parental restrictions on teen driving with modest persistence for at least four months.

OBJECTIVES: This investigation sought to test the effectiveness of a statewide ignition interlock license restriction program for drivers with multiple alcohol-related traffic offenses. METHODS: A total of 1387 multiple offenders eligible for license reinstatement were randomly assigned to participate in an ignition interlock program (experimental group) or in the conventional postlicensing treatment program (control group). The arrest rates of these 2 groups for alcohol traffic offenses were compared for 1 year during the ignition interlock license restriction program and for 1 year after unrestricted driving privileges were returned. RESULTS: Participation in the interlock program reduced offenders' risk of committing an alcohol traffic violation within the first year by about 65%. The alcohol traffic violation rate during the first year was significantly less for participants in the interlock program (2.4%) than for those in the control group (6.7%). However, there was no statistically significant difference between these groups in the second year, after the interlock license restriction was lifted. CONCLUSIONS: Ignition interlock license restriction programs are effective at reducing recidivism among drivers with multiple alcohol offenses, at least while the restriction is in effect.

The high risk of fire death and injury among elderly people is well documented. To be effective, fire safety education must reach older adults in the settings in which they reside: nursing homes and other long-term care institutions, board and care homes, and independent living facilities including the person's own home. Training must also be targeted at the people who are responsible for fire safety. In the case of the nursing home or board and care home, the responsible people are the staff and owners. In the case of the majority of older adults who live independently in their homes, it is either the individual or family members. These programs must also be comprehensive. A fire safety education curriculum was developed by a group of experts in a variety of related fields including fire safety, gerontology, health care industry, developmental disabilities, research, and instructional design. Older adults were included in each planning session. Based on that curriculum, workshops and workshop materials were developed for each of the three target populations: staff of health care facilities, staff and owners of board and care homes, and elderly people living independently in their homes. Materials included both print and audiovisuals. A pilot test of each workshop was conducted to test the short-term effects of the programs. Results indicated significant gains in knowledge for all groups and a significant improvement in positive attitudes toward fire safety for most participants. Measures of effects of the programs on intentions to change fire safety practices indicated a potential for change. Results also showed that the measured traits, knowledge of fire safety and attitudes toward fire safety, were relatively stable.

A national survey of cardiopulmonary resuscitation (CPR) training services for deaf individuals was conducted by contacting regional directors of the American Heart Association, the American National Red Cross, and continuing education programs for the deaf. The results revealed that very little is being done in the way of a CPR training for the deaf. The American National Red Cross appears to be more active in this area than the other two organizations. Communication barriers and lack of adequate training resources (e.g., captioned films and sign interpreters) were identified as the major reasons why so few deaf people are being given CPR instruction. Cardiopulmonary resuscitation (CPR) has been shown to be an extremely important skill for people to possess in order to reduce the chances of death in a cardiac arrest victim (Copley, Mantle, Rogers, RA¼ssel, & Rackely, 1977; Crampton, Aldrich, Stillerman, Gascho, & Miles, 1975; Eisenberg, Bergner, & Hallstrom, 1979; Stephenson, 1974). The relationship between effective CPR training and increased survival of heart attack victims has resulted in a burgeoning interest in receiving CPR instruction. In the last 10 years training efforts have spread from what was the sole province of physicians and paramedical professionals to the lay public in community programs. While the research literature is rampant with training and outcome evaluations of CPR training for the general public, the deaf population has been virtually ignored. Current estimates indicate that there are approximately 1,968,000 deaf people in this country1. This is a sizeable population to be excluded from CPR training efforts. In an innovative study by Tomasetti, Beck

Deaf college students were randomly assigned to three separate instructional conditions for a cardiopulmonary resuscitation (CPR) course. One group received the standard course presented through signed instruction. A second group received the same instruction with the addition of a captioned vidA©ocassette, "The New Pulse of Life—Revised." The third group received the standard instruction and viewed the uncaptioned vidA©ocassette, signed by an interpreter. These groups were compared with a non-deaf group who received the standard 4-hour course. The results revealed that the deaf group which viewed the uncaptioned vidA©ocassette signed by an interpreter retained a significantly greater amount of performance skills than the other groups. The prompt and effective administration of cardiopulmonary resuscitation (CPR) significantly increases a cardiac arrest victim's chances of survival (Copley, Mantle, Rogers, Russell, & Rackley, 1977; Crampton, Aldrich, Stillerman, Gascho, & Miles, 1975; Eisenberg, Bergner, & Hallstrom, 1979; Stephenson, 1974). This fact underscores the importance of training the lay public to initiate CPR before advanced cardiac care is provided in an emergency medical care facility. However, additional effort is needed to train all segments of the population, including the handicapped. This investigation focused upon the deaf segment of the handicapped population. There is little information on CPR instruction and retention ability of the deaf learner, although many studies indicate that nondeaf trainees show significant decreases in retention as early as three months following instruction (Barrick, 1977; Vanderschmidt, 1976; Vanderschmidt, Burnap, & Thwaites, 1975). A need exists to provide CPR programs for deaf individuals and to improve the retention of these abilities. The use of inadequate visual aids in CPR

Eighty dental patients were pretested with a scale measuring health locus of control and then exposed to a persuasive communication designed to manipulate their beliefs about the seriousness of periodontal disease and their susceptibility to it. The high seriousness condition increased feelings of fear, concern, and threat as well as intentions and reported compliance with recommended oral hygiene procedures. However, patient's perceived personal efficacy in performing the recommended behavior was the most important predictor of subsequent behavior. The implications of the results for Roger's protection motivation theory are discussed.

The use of a multivariate procedure is demonstrated in the analysis of a survey of various firesafety actions and beliefs in a college student population. A canonical correlation analysis identified three significant factors and revealed that performing a safety inspection of one's residence for potential hazards was associated with beliefs in one's personal efficacy in handling fire situations, whereas engaging in more emergency-related actions such as checking to see if one's smoke detector was working properly, knowing the emergency telephone number, having it posted by the telephone, and knowing two exits out of each area of the home was related to beliefs of susceptibility and seriousness concerning fires. A third factor revealed an association between having a sprinkler system (but not a fire extinguisher) present in the place of residence, vacuuming the dust from a smoke detector, and having ever practiced an emergency escape with beliefs reflecting susceptibility to future (but not present) fire hazards, adequacy of firesafety knowledge, and beliefs in the effectiveness of firesafety inspections. It is shown that the results of this analysis can be quite useful in guiding the development of firesafety education materials; also, the need to differentiate the specific motivational approach depending upon the type of firesafety action being promoted with this particular population is revealed.

This study was designed to determine what factors might contribute to possible pregnancy and birth control usage among a sample of college women. The obtained sample was comprised of 140 college women who sought pregnancy tests at the health center at the University of Maryland. Of the 140 pregnancy tests performed 40 (28.6%) were positive. Over 40% of the women in this study were not using any type of birth control at the time of their possible pregnancy and over 15% of women whose tests proved positive had been pregnant before. The reasons given for non-use seem to reflect a tendency to deny ones sexuality. In addition over 1/3 of the non-users listed their concern over the health risks of birth control methods as a reason for non-use. Denial and health risk appear to be critical barriers for effective contraceptive usage and these issues need to be addressed in birth control education programs for this population. Not surprisingly a strong relationship was detected between sporadic or non-use of birth control and pregnancy. Also contraceptive behavior at the onset of sexual activity appears to be related consistently to use in later years. Those women who reported that they had used some method of contraception the 1st time they had intercourse were more likely to use contraception "always." Methods that supposedly had failed for those women who had positive pregnancy tests tended to be the diaphragm and the sponge. These same women were more likely to have used the diaphragm or sponge the 1st time they had intercourse. The women with negative pregnancy tests were more likely to have used condoms in both initial and subsequent sexual activity. Because lack of knowledge has not played a major role in unintended pregnancy health educators must concentrate more on the psychosocial factors of non-contraceptive use including denial and guilt over sexuality in general (particularly in women) lack of communication between the sexes a coming to terms with sexuality in general and assertiveness training.

The effects of different types of risk information in a simulated decision-making task were investigated to test the predictions of protection motivation theory. In accordance with predictions, outcome severity, efficacy of protection, and access to protection were related to protective decisions. The results are discussed in terms of general utility of this model for a variety of decision-making situations. The aspect of manageability, which is seen as a combination of efficacy of protection and access to protection, was discussed as an essential component for risk decision making.

A national survey of information seeking about work-related safety and health matters was conducted among 574 safety and health managers from the U.S. Department of Agriculture, Science and Education Administration. Specific beliefs about the seriousness, likelihood, and effectiveness of present work hazards as well as the need for additional information were used to predict self-reported information-seeking activities. The results revealed that the beliefs of how well the managers protect themselves from hazards, the seriousness of needing information, the likelihood of needing additional information, and the usefulness of this information were significant predictors of safety and health information seeking. Manager beliefs of how well coworkers protect themselves from hazards and felt need for additional information were not related to information seeking. Manager perceptions of coworkers as less careful and informed concerning safety are discussed.

In a survey of over 2300 high school students, an examination was made of their social context of alcohol consumption and their sources of information about alcohol and drugs. Students were classified as alcohol abusers by three different methods and were asked to indicate among a series of choices how often they consumed alcohol in various situations and for various motivations or reasons. These two sets of items comprised the measure of social context. The students were also asked to indicate their best source of information about alcohol and drugs, and to what source they would go first if they had a question about alcohol and drugs. A discriminant analysis of the social context items revealed that in contrast to non-problem drinkers, students classified as alcohol abusers consistently demonstrated a distinct social context pattern of alcohol consumption. They more frequently drink to get drunk, to get rid of depression, at a bar, to get along better on dates, etc. than their non-problem drinker counterparts. Abusers also consistently indicated that their own experience was their best source of information about alcohol and drugs, and if they had a question they would seek information first from their friends. Non-drinkers and non-problem drinkers both said that mass media (newspapers, books, T.V., and movies) was their best source of information and if they had a question they would go first to their family for information. These findings are consistent with previous research on social context of drinking which show that alcohol abusers, even in older age groups, possess different social patterns of drinking than non-abusers and suggest that different ways of communicating information about alcohol with this group be considered apart from traditional information dissemination strategies in school/community programs.