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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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

BACKGROUND: Trait aggression has been linked to alcohol-related problems among college students. However, the individual conditions underlying this association are unknown. Empirical evidence and theory suggest the importance of distress tolerance, defined as an individual's ability to withstand negative affective states, in the relationship between trait aggression and alcohol use. Therefore, the purpose of the current study was to examine whether distress tolerance moderates the relationship between trait aggression and problematic alcohol use. METHODS: Participants were 646 undergraduate students in a large university, who reported any lifetime alcohol use. The dependent variable, problematic alcohol use, was measured using the Alcohol Use Disorders Identification Test total score. The main independent variable, trait aggression, was assessed on the negative emotionality scale of the Multidimensional Personality Questionnaire, and the moderator, distress tolerance, was determined using the Distress Tolerance Scale. RESULTS: Hierarchical linear regression analyses indicated a significant interaction between trait aggression and distress tolerance in predicting problematic alcohol use, adjusting for demographic variables, regular substance use, depressive symptoms, and anxiety symptoms. Specifically, a significant positive relationship between trait aggression and problematic alcohol use was present among those with low, but not high, distress tolerance. CONCLUSIONS: Results provide evidence that college students with high levels of trait aggression are more likely to engage in problematic alcohol use if they also evidence an inability to tolerate negative affective states. Study implications are discussed, including the development of prevention and intervention programs that target distress tolerance skills. Language: en

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

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

Background: Previous research has suggested important contextual factors that can differentiate problem and nonproblem drinkers. Objectives: To evaluate the strength of the prospective association between social contexts of drinking and subsequent alcohol use disorder and drunk driving 2-3 years later. Methods: The sample consisted of 652 individuals who were originally recruited at college entry, had complete data on at least one social context subscale, met the minimum criteria for Year 1 drinking, and had nonmissing data on at least one of the outcome variables in Years 3 and/or 4. Social contexts of drinking were assessed in Year 1 by using previously validated scales measuring six different situational and motivational contexts in which alcohol is consumed. DSM-IV criteria for alcohol abuse and dependence and drunk driving were assessed annually. Results: Holding constant gender, race/ethnicity, and baseline drinking frequency, the frequency of drinking in a context of social facilitation, sex-seeking, or in a motor vehicle during Year 1 was significantly related to a greater likelihood of alcohol abuse, alcohol dependence, and drunk driving in Years 3 and/or 4. Drinking in a context of emotional pain was related to alcohol dependence and drunk driving but not to alcohol abuse. Conclusions: The Social Context of Drinking Scales have utility for identifying students who are at risk for developing alcohol-related problems. Scientific Significance: Identifying college students who might develop alcohol dependence requires an assessment of both situational and motivational factors that influence drinking, especially drinking in a motor vehicle. Language: en

An anonymous questionnaire was administered to more than 1,200 seventh to 12th grade students in four rural public schools in western New York State. The questionnaire measured alcohol use, the social contexts of drinking, and the personality trait known as "sensation seeking." A majority (57%) were drinkers, and discriminant function analyses were performed on their scores on these measures to determine if they could distinguish between different levels of alcohol use intensity, alcohol-impaired driving, and riding with an impaired driver. Results indicated social context measure were effective in distinguishing among levels on each indicant of abuse. In particular, high-intensity drinkers, impaired drivers, and riders of impaired drivers were more likely to drink in a context of social facilitation, stress control, and defiance of school and adult authority. The drinking context of peer acceptance was important only in distinguishing teen-agers who ride with drunk drivers from those who do not. Overall, the sensation seeking trait was of moderate importance in distinguishing among different alcohol abuse practices. Implications of these findings for assessment as well as school-based prevention programs are discussed.

A series of items that measure the social context of alcohol consumption among adolescents was administered in a questionnaire survey to over 1,300 high school students. Emerging from a factor analysis were five factors which suggested that drinking occurs in the following social contexts: drinking for social facilitation where adults are not present, drinking at school or during school-related activities, drinking for stress control, drinking for conformity or to be part of a group, and drinking under parental supervision at home. Scales based on these factors appeared to be reliable, free from social desirability bias, and able to discriminate problem drinkers from nonproblem drinkers. The most important of these factors was drinking for social facilitation that is not restrained by the presence of adults. These findings reinforce the validity of examining the social context of drinking (which involves situational as well as motivational reasons for drinking) to uncover important etiological contributors of alcohol abuse in an adolescent population.

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

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.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).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.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.

This study examined the association between dating violence victimization and psychosocial risk and protective factors among Latino early adolescents. An anonymous, cross-sectional, self-reported survey was administered to a convenience sample of Latino youth ( n = 322) aged 11 to 13 residing in suburban Washington, D.C. The dependent variable was physical dating violence; the independent variables included violence, substance use, emotional well-being, prosocial behaviors, and parenting practices. Multivariate logistic regression models were constructed and adjusted odds ratio and 95% confidence interval were examined. Overall, 13.5% ( n = 43) of Latino early adolescents reported being a victim of physical dating violence within the past year. The prevalence was 14.4% for girls and 12.9% for boys. Among the girls, binge drinking was the sole risk behavior associated with dating violence. Gun carrying, alcohol consumption, and having considered suicide were associated with dating violence among the boys. Physical dating violence appears to affect a small but significant proportion of Latino early adolescents and is associated with other risk behaviors. Healthy dating relationship programs are warranted for middle school youth with some tailoring to reflect gender differences in risk profiles.

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.

To determine the pathways to alcohol use among adolescents.A cross-sectional study of risk and protective factors among a sample of Latino youth (aged 11-13) was conducted.Peer norms and school connectedness had direct pathways to alcohol use. Self-concept was related to peer norms. Youth who were less acculturated were more likely to believe that their peers drank. Family monitoring, connectedness, and academic support did not have direct pathways to alcohol use.Peer norms appear critical in shaping adolescent involvement with alcohol. The protective influence of family and academic support appear to be indirect.

The evidence concerning Maryland's anti-drunk driving program, Checkpoint Strikeforce, is reviewed. To date, there is no evidence to indicate that this campaign, which involves a number of sobriety checkpoints and media activities to promote these efforts, has had any impact on public perceptions, driver behaviors, or alcohol-related motor vehicle crashes and injuries. This conclusion is drawn after examining statistics for alcohol-related crashes, police citations for impaired driving, and public perceptions of alcohol-impaired driving risk. Comparisons are also made with other states in the mid-Atlantic region, where similar campaign activities have occurred. Reasons for this failure in Maryland include insufficient levels of enforcement (e.g., too few sobriety checkpoints and vehicle contacts occurred to raise public perceptions of risk pertaining to impaired driving) and inadequate publicity surrounding this campaign. Suggestions for overcoming these problems are offered.

To determine the relations among parent-teen discordance for restrictions on driving conditions, driving rules, and consequences for rule violations at licensure and subsequent risky teen driving.Parents and teens completed telephone interviews at 1, 4, and 9 months after teens became licensed.At each time interval, the degree of disagreement with parent restrictions on driving conditions was positively associated with teen risky driving.These results demonstrate a positive association between parent-teen discordance for driving conditions and teen risky driving. Initial establishment of restrictions and agreement with them may have longer term protective effects against teen driving risk.

To determine if the type of exposure to roadside sobriety checkpoints is related to vulnerability of being stopped by the police for drinking and driving.Random household telephone surveys were conducted over 3 years.Personally exposed drivers had lower perceptions of vulnerability than did drivers who knew a family member who had been stopped. Exposed drivers who also had a family member and an acquaintance that had been stopped had higher perceptions of vulnerability.Direct exposure to a checkpoint appears to lower perceptions of risk than if one has had only indirect exposure (ie, family or friends).

To establish and disseminate the position of the American Academy of Health Behavior (The Academy) on doctoral research training.A collaborative process involving the Work Group on Doctoral Research Training with input from The Academy membership led to the development of the guidelines described herein.A set of guidelines is provided that describe the process of learning to be a scholar/researcher and the outcomes of learning the practice of health behavior research.The doctoral students who are to become the stewards of our field should be prepared to engage in scholarship that creates new knowledge, uses research to transform practice, and effectively communicates research findings.