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Objective: Previous research has recommended education for parents, teachers, and anticipatory guidance by pediatricians regarding participation in the so-called choking game, a potentially fatal behavior. The purpose of this study was to examine possible associations between selected demographic variables and risk behaviors with youth engagement in the choking game on the basis of secondary data analysis from a general adolescent health risk behavior survey., Methods: Self-administered survey data from an adolescent needs assessment was used to assess choking game behavior between fall 2008 and fall 2009. The sample included 192 classrooms across 88 schools in a Midwestern state., Results: Of the 3598 questionnaires distributed to middle and high school students, 3408 (95%) were returned completed. Participation rate in the choking game was 9%, with male participation (11%) greater than female participation (7%), and high school students (11%) more likely than middle school students (5%) to participate. Adjusted odds ratios found that the likelihood of middle school students engaging in the choking game were higher for older students, substance users, and those having lower grades. For high school students, adjusted odds ratios found that being older, substance use, and selected mental health issues (forced sex and attempted suicide) were most associated with choking activities., Conclusions: Engaging in the choking game was highly associated with abuse of substances, suggesting that youth engage in the choking game for the thrill-seeking experience of brief euphoria, a drug-related feeling. To reduce the potentially fatal consequences associated with this behavior, pediatricians should screen youths and provide anticipatory guidance for higher-risk youths and their parents., (Copyright © 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Nearly 1 of 10 American children has asthma. Asthma is addressed in Healthy People 2010 as a public health problem. This study examined the relationship between parents'/guardians' health literacy levels and their perceived self-efficacy to manage their child's asthma. A four-page asthma questionnaire was developed to assess the self-efficacy of parents/guardians of African American children with asthma. There was a statistically significant relationship among the parents'/guardians health literacy levels and their perceived efficacy expectations to manage their child's asthma. There is evidence that high parental/guardian self-efficacy and successful asthma management contribute to a child with well-controlled asthma. It is necessary for patient educators to capitalize on physician/nurse visits and use the time for asthma education, particularly to increase the efficacy expectations of parents/guardians with limited health literacy skills., (Copyright © 2010 Elsevier Inc. All rights reserved.)

African American smokers (34% of males and 23% of females) need formal interventions to assist them in quitting smoking, a major method of preventing premature mortality from smoking-related illnesses. The purpose of this study was to examine African American primary care physicians' perceptions and practices regarding smoking cessation counseling. A national random sample (n=202) of primary care physicians was asked about their perceptions and practices regarding smoking cessation therapy. Most (89%) placed themselves in the maintenance stage for asking their patients about their smoking status and regularly documented the smoking status of their patients (70%). Most physicians did not comply with all of the components of the U.S. Public Health Services' smoking cessation guidelines (e.g., 5 A's and 5 R's). The component most often implemented of the 5 A's was to "advise" patients to quit (89%), and "arrange" followup was the least frequently (60%) used component. Perceived barriers to engaging in smoking cessation interventions were time (38%) and patients not interested in quitting (19%). Although physicians used many of the steps in the 5 A's and 5 R's, they were far less compliant in recommending nicotine replacement therapy, prescribing pharmacotherapy, and providing support and/or follow-up for patients who were willing to quit smoking. Physicians need more academic preparation in providing smoking cessation counseling since few received such training in medical school (31%) or during their residency programs (18%).

A disproportionate share of firearm suicides and homicides are committed by individuals who have a psychiatric diagnosis, many with a history of substance abuse. This study assessed whether selected variables that potentially indicate increased access to mental health care or known demographic risk factors for firearm trauma best predicted state variations in firearm homicide and suicide. Partial correlation coefficients indicated that the proportion of the population within a given state that was African American or Hispanic was significantly associated with increased state firearm homicides. The percent of the population within a given state that had earned a Baccalaureate degree was associated with decreased state firearm homicides. Additionally, increased state firearm ownership rates were significantly associated with firearm suicides, while state educational expenditures were associated with a significant reduction in firearm suicides. The findings suggest that mental health resources within a state have minimal association with firearm homicide and suicide rates. However, state levels of educational achievement and educational expenditures reduce firearm mortality.

Objective: This study identified psychiatrists' perceptions and practices regarding advising and treating obese patients., Methods: Questionnaires were mailed to a national random sample of 500 members of APA. A three-wave mailing was used to maximize the return rate. The questionnaire contained items on weight control based on the Stages of Change and Health Belief models, Self-Efficacy theory, and the 5As strategy., Results: A total of 236 psychiatrists responded to the survey. Most did not have any formal training during medical school on treating obese patients and three-quarters evaluated their training in psychiatric residency programs on weight loss/control issues as "not adequate at all" or "not very adequate." The majority regularly assisted their obese patients with weight management. Most psychiatrists felt confident to ask, advise, assess, assist, and arrange (5As) regarding weight loss issues and believed that doing so would result in significant weight loss. The majority were more likely to advise obese patients to lose weight when comorbid conditions were present. The most common barriers to aiding obese patients were time constraints, poor patient compliance, lack of clear guidelines and practice tools, limited medical training on the issue, and fear of offending patients., Conclusion: Patients can no longer afford to have their psychiatrists provide cursory assistance with obesity. Weight management training should be incorporated into psychiatric residency training and continuing education programs.

Preventive medicine plays a central role in the reducing the number of deaths due to preventable causes of premature deaths. General Preventive Medicine Residency programs have not been studied in relation to training in this area. A three-wave mail survey was conducted with email and telephone follow-ups. The outcome measures were the portion of program directors involved in training residents on firearm injury prevention issues and their perceived benefits and barriers of training residents on firearm injury prevention issues. Only 25% of the programs provided formal training on firearm injury prevention. Program directors who provided formal training perceived significantly higher number of benefits to offering such training than did directors who did not provide such training but no significant difference was found between the two for number of perceived barriers. If preventive medicine residency graduates are to play a role in reducing premature morbidity and mortality from firearms it will require more residencies to offer formal training in this area. The Association for Prevention Teaching and Research needs to develop guidelines on specific curriculum topics regarding firearm injury prevention.

Background: This was a pilot study to determine the impact of the Michigan Model (MM) Nutrition Curriculum on nutrition knowledge, efficacy expectations, and eating behaviors in middle school students., Methods: The study was conducted in a large metropolitan setting and approved by the Institutional Review Board. The participants for this study were divided into an intervention group (n = 407) and a control group (n = 169). An MM instructor trained health teachers in the use of the curriculum, and the teacher subsequently taught the curriculum to students in the intervention group. A valid and reliable questionnaire was used to determine pre-post differences. It consisted of 3 subscales assessing eating habits, nutrition knowledge, and efficacy expectations toward healthy eating. Subscale scores were analyzed using a 2 groups (intervention vs control) x 2 times (pre vs post) analysis of variance., Results: The intervention group increased their nutrition knowledge at post. There was also a significant main effect for groups in the subscales "Eating Behaviors" and "Efficacy Expectations Regarding Healthy Eating." Subsequent post hoc analysis revealed that the intervention group was significantly more likely to eat fruits and vegetables and less likely to eat junk food than the control group. Students in the intervention group also felt more confident that they could eat healthy., Conclusions: The results of this pilot study suggest that the MM Nutrition Curriculum delivered by trained professionals resulted in significant positive changes in both nutrition knowledge and behaviors in middle school children. Further research needs to be conducted to determine the long-term impact.

Background: Most suicides (60%) and homicides (67%) are committed with firearms. Additionally, 90% of homicide offenders and 80% of individuals reporting suicide behaviors meet diagnostic criteria for mental illness. Medical society guidelines support the counseling of patients regarding firearms. This study assessed psychiatrists' anticipatory guidance on firearms and their perceived roles on this topic., Method: A four-wave mail survey of adult psychiatrists in Ohio was conducted and analyzed. The outcome measures were the portion of psychiatrists involved in anticipatory guidance on firearm safety issues and their self-efficacy and perceived barriers regarding firearm counseling., Results: Two hundred and five psychiatrists of a possible 340 (60%) responded. Almost half (45%) had never thought seriously about discussing firearm safety issues with patients. They perceived firearm safety issues to be much greater (32%) or slightly greater (37%) for mental health patients than for the general population. Psychiatrists with high efficacy expectations were twice as likely (56.5% vs 28.0%) as those with low efficacy expectations to provide firearm anticipatory guidance. Those who counseled their patients were 15 times more likely to have high outcome expectations compared to those who did not counsel their patients (93.7% vs 6.3%, respectively)., Conclusions: When psychiatrists are provided with firearm information, they were significantly more likely to be involved in anticipatory guidance regarding firearms. This implies that professional societies and journals should attempt to increase the information they provide to their members regarding this topic. Psychiatrists may be in a unique position to help reduce firearm morbidity and mortality for mentally ill patients.

The purpose of this study was to examine pediatricians' use of nicotine replacement therapy (NRT) and the 5 A's counseling method with adolescent smokers. Using a mail survey, 203 randomly selected pediatricians (52% response rate) responded to a valid and reliable 37-item questionnaire regarding: perceptions of prescribing NRT, confidence in using NRT, perceived barriers to prescribing NRT, sources of information regarding NRT, and use of the 5 A's counseling method. Forty-four percent of pediatricians did not feel competent in helping adolescents quit smoking cigarettes. Less than a fifth (17%) were currently prescribing NRT. A plurality (48%) perceived NRT to be safe for adolescent use but a majority (53%) rated themselves as not confident in their ability to use NRT. Those who prescribed NRT used transdermal patches (81%), nicotine gum (53%), or bupropion (44%). Pediatricians based their decisions on using NRT on whether: the adolescent showed an openness to quitting (78%), the adolescent requested NRT (72%), and if the adolescent had a health problem exacerbated by smoking (56%). The low level of perceived competence in helping adolescents quit smoking may be due to how few pediatricians identified medical school as a major source of information on helping adolescents stop smoking. Even though ample evidence suggests that NRT is safe to use with adolescents, less than half of the responding pediatricians perceived it to be safe, possibly indicating a desire for a more definitive conclusion on its safety before adopting the products or a lack of awareness of existing studies on this topic.

This study assessed differences in response rates to a mailed health survey by adults in two neighboring rural midwestern counties with differential incentives, of dollar 2.00 and dollar 5.00. Potential respondents in each county were randomly selected from a commercial database of residents' addresses. County "F" respondents (n = 541) which were 57% female and 95% Euro-American having a mean age of 47.3 yr. (SD= 16.9), received the dollar 5 incentive. County "H" respondents (n= 514) were 63% female, 95% Euro-American, had a mean age of 49.0 yr. (SD= 14.7), and received a S2 incentive. The response rates were 71% using the dollar 2 incentive and 73% using the dollar 5 incentive. These were not significantly different by chi-square test. The more cost-effective incentive for increasing the response rate of adults in this rural midwestern sample was to code the envelopes and use a dollar 2.00 rather than dollar 5.00 incentive, a cost per returned survey of dollar 5.24 versus dollar 9.13, respectively. The findings support Dillman's principle of diminishing returns as the size of the incentive goes up.

The purpose of this study was to examine Ohio parents' perceptions of the role of schools in smoking prevention, cessation, and anti-tobacco policy for their children. A 46-item questionnaire was based on the CDC Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. Surveys (n = 800) were sent to a stratified random sample of parents of junior high and high school aged students and 57% responded. Parents were supportive of smoking prevention activities, but almost two-thirds believed their child's school should get parents' input. Furthermore, mothers/step-mothers were more likely than fathers/step-fathers to agree that the school had a role in smoking prevention activities. The majority of parents were also supportive of smoking cessation activities. However, only 8% of parent respondents supported schools providing nicotine gum or patches to students trying to quit smoking. Overall, the majority of parents were supportive of the seven recommendations developed by the CDC as guidelines for school health programs to prevent tobacco use and addiction. Schools have the opportunity to impact student smoking through prevention and cessation activities. Schools need to know that parents are supportive of these activities and want to be included in the process of implementing effective prevention or cessation programs.

The objective of this study was to assess Ohio obstetricians/ gynecologists' perceptions and use of nicotine replacement therapy (NRT) with pregnant smokers. A three-wave mailing procedure was used and 154 responded (44%) to a valid and reliable 36-item questionnaire regarding: Stage of Change in using NRT, perceptions of prescribing NRT, confidence in using NRT, barriers to prescribing NRT, and use of 5 A's counseling steps. One-fourth (26%) prescribed NRT to pregnant smokers. One-third (32%) perceived NRT as safe, yet few (14%) perceived it as effective. Respondents were most likely to prescribe NRT if the patient requested it (44%). Those most likely to prescribe NRT were more likely to: perceive use of NRT in pregnancy as safe (OR = 20.0); perceive NRT as effective in pregnancy (OR = 4.3); have high confidence in their ability to effectively prescribe NRT (OR = 3.86); and believed most or some of their colleagues prescribed NRT to pregnant smokers (OR = 6.7). The majority did not prescribe NRT possibly because few respondents received cigarette smoking cessation training in medical school or their residencies. Significant revisions in professional training and more continuing medical education are needed regarding smoking cessation and use of NRT.

Background: This national study assessed police chiefs' support for various types of firearm control measures, perceptions regarding firearms as a public health problem, and the likelihood of initiating firearm control advocacy activities., Methods: A 29-item survey instrument was developed to assess respondents' likelihood of firearm policy support, interest, exposure, involvement with firearm control advocacy, and demographic and background characteristics. The survey was sent out in spring 2005 using a three-wave mailing to a national random sample of 600 police chiefs in cities with populations greater than 25,000 in 2002 and 2003., Results: The majority of responding police chiefs supported 11 out of 14 proposed firearm control policies. Most police chiefs (62%) believed that the government should do everything it can to keep handguns out of the hands of criminals, even if it makes it more difficult for law-abiding citizens to purchase handguns. Police chiefs were not likely to participate in the majority of firearm control advocacy activities. The advocacy activities that police chiefs were most likely to participate in were meeting with state legislators (52%) and writing a letter to a legislator in relation to gun control (44%)., Conclusions: Police chiefs support several potentially important firearm control policies. This suggests the need to evaluate interventions aimed at increasing their role in shaping policy on this important public health issue.

This study examined relationships between variation in child and adolescent firearm mortality by state and the following variables: childhood poverty rate, percent single parent families, percent population that is African American, percent population that is Hispanic, percent students carrying a gun, percent students carrying a weapon, percent students feeling unsafe, percent students feeling sad/hopeless, percent students academically at-risk, percent students involved infighting, percent students engaging in binge drinking behavior, violent crime rate for youths, individual gun laws in each state, prevalence of firearm ownership, and percent residing in urban area. Stepwise regression was calculated and one independent variable, prevalence of firearm ownership in the state, emerged as a significant predictor of child and adolescent firearm mortality. This variable predicted 47% of the variance from state to state in the child and adolescent firearm mortality. Schools need to address firearm safety and advocate for elimination of firearms accessible to youth.

The purpose of this study was to examine principals' perceptions and practices regarding bullying prevention. A survey instrument was developed to assess principals' stages of change and perceived barriers regarding selected bullying prevention activities as well as the effectiveness of bullying prevention activities. Of a national random sample of 700 principals to which the survey was mailed, 55% responded. None of the school-based bullying prevention activities were being done by more than one in five schools even though principals perceived there to be no barriers regarding these activities. Characteristics that affected the offering of these activities included number of perceived barriers to implementing the activity, whether the principal had received violence/bullying prevention training, perceptions regarding the extent of bullying, and the number of bullying problems reported to them. The findings suggest that preprofessional training and continuing education are needed to educate principals regarding this area.

This study assessed differences in response rates to a series of three-wave mail surveys when amiable or insistently worded postcards were the third wave of the mailing. Three studies were conducted; one with a sample of 600 health commissioners, one with a sample of 680 vascular nurses, and one with 600 elementary school secretaries. The combined response rates for the first and second wave mailings were 65.8%, 67.6%, and 62.4%, respectively. A total of 308 amiable and 308 insistent postcards were sent randomly to nonrespondents as the third wave mailing. Overall, there were 41 amiable and 52 insistent postcards returned, not significantly different by chi-square test. However, a separate chi-square test for one of the three studies, the nurses' study, did find a significant difference in favor of the insistently worded postcards.

This study assessed elementary school secretaries' (n = 385) experiences and perceptions with student prescription medication. Sixty-nine percent (n = 246) reported dispensing student medication, and this group represents the focus of this study. One in four secretaries reported not receiving any training regarding administration of student medication. Of those who were trained, 28% received training of less than one hour, and 24% received training of one to two hours duration. Secretaries generally disliked the responsibility of dispensing medication to students, but felt prepared to do so. Most (63%) administered student medication five days per week. The most commonly administered categories included attention deficit/hyperactivity medication (92%), asthma medication (87%), and antibiotics (68%). Most (85%) reported they had made no medication errors during the past year.

This study examined a national random sample of teachers regarding their perceptions and practices concerning school bullying prevention activities. A total of 359 of 700 (52.4%) teachers responded. Most (86.3%) teachers had serious talks with both the bully and victim. Less than one-third set aside classroom time to discuss bullying (31.7%) or involved students in creating classroom rules against bullying (31.2%). Most perceived no barriers to implementing these activities. Teachers perceived post-bullying activities as the most effective means of reducing bullying problems, followed by improved student supervision, and by environmental bullying prevention activities. The findings suggest that preprofessional and continuing education are needed to improve teacher knowledge about effective classroom-based bullying prevention activities.

This study assessed differences in response rates to a three-wave mail survey when signed or unsigned postcards were the third wave of the mailing (after two mailings of the questionnaire). A total of 259 signed postcards and 259 unsigned postcards were mailed as the third-wave mailing. There were 34 signed postcards and 30 unsigned postcards returned, a not significantly different distribution by chi-square test.

In elementary schools, the prevalence of bullying ranges from 11.3% in Finland to 49.8% in Ireland. The only United States study of elementary students found that 19% were bullied. Bullying behavior declines as students progress through the grades. School bullying is associated with numerous physical, mental, and social detriments. A relationship also exists between student bullying behavior and school issues such as academic achievement, school bonding, and absenteeism. Prevention of school bullying should become a priority issue for schools. The most effective methods of bullying reduction involve a whole school approach. This method includes assessing the problem, planning school conference days, providing better supervision at recess, forming a bullying prevention coordinating group, encouraging parent-teacher meetings, establishing classroom rules against bullying, holding classroom meetings about bullying, requiring talks with the bullies and victims, and scheduling talks with the parents of involved students. Finally, this review suggests further studies needed to help ameliorate the bullying problem in US schools.

A national sample of 390 junior and senior high school-based centers were mailed an 18-item survey to assess their institutional stages of change regarding smoking cessation education, referral, and prescription nicotine replacement therapy (NRT) services and their perceived barriers and benefits regarding the provision of these services. Nearly half were in the maintenance stage for cessation education programs, one-third were in maintenance stage for referral services, and 12% were in the maintenance stage for NRT. The most frequently cited perceived benefits included an increased awareness of short- and long-term effects of smoking (education programs and referral services) and increasing student access to cessation methods (NRT). The greatest barriers cited were a lack of financial resources (education programs), problems with student transportation (referral services), and staff not having the authority to provide prescription services (NRT). School-based centers can do more to help stop adolescents from using tobacco.

Fifth- and sixth-grade elementary school teachers' (n = 277) techniques of responding to students' human sexuality-related questions were assessed. Few teachers (34%) reported receiving formal training in sexuality education. The most commonly asked student questions dealt with STDs, puberty, homosexuality, pregnancy, and abortion. Teachers' willingness to answer sexually-related questions in front of the class varied (73% to 14%) by content of the question. There were no questions on the questionnaire in which more than one in five teachers would choose not to answer. The most common questions the teachers identified they would not respond to dealt with topics such as abortion, masturbation, homosexuality, and issues about the male genitals. Finally, none of the questions was perceived by more than one in eight of the teachers as questions they would not be allowed to answer.

This study assessed urban elementary school students' experience with weapon carrying and violence, concerns for personal safety, and perceptions of passive and direct interventions in resolving fights. The survey was completed by 1,912 urban students in the fourth and fifth grades. This cross-sectional study found that one in 12 students reported weapon carrying one or more times during the past month. One-third indicated that they would hit peers back if struck by them. One-quarter of students did not feel safe going to or from school, and 23%-43% worried about being physically attacked in or around school. Adjusted odds ratios and 95% confidence intervals were calculated using logistic regression. Significant associations were found between the independent variables of age, race, gender, and academic success (grades) and the dependent variables of weapon carrying, hitting a peer back, concerns of safety, and passive solutions or direct interventions for peer fighting.

Objective: To assess whether developmental assets and risk-taking behaviors, as measured by the Search Institute instrument, were related to attempted suicide in African American, inner-city youth., Methods: Survey of 336 African American, inner-city youths., Results: Significant odds ratios were found for 4 asset questions and for 11 risk-taking behavior questions by attempted suicide behavior. The odds ratios ranged from 2.4 to 6.4 in magnitude. The percent of variation in suicide-attempt behavior explained by the asset questions (14.6% and 19.6%) was explained by the risk-taking behavior/high-risk behavior pattern questions., Conclusions: The risk-taking behavior items were better predictors of suicide behavior than were the developmental asset items for the African American youth.

A national random sample of 195 university health education faculty at graduate degree-granting programs completed a 31-item survey with regard to their perceptions of ethical issues in research and publishing. Most respondents were male (57%), tenured (75%), had graduate faculty status (92%), had presented original research at conferences (85%), and had published articles in health education journals (89%). Faculty members were requested to assess whether 21 scenarios dealing with ethical issues in research and publishing were ethical, unethical, questionable, or not an ethical issue. Of the scenarios, 3 were considered ethical and 7 unethical by the majority of respondents. The perceptions of how ethical the remaining 11 scenarios were varied considerably. Perceptions of the ethical scenarios did not differ among respondents by sex, academic rank, years taught as a faculty member, whether the department taught units/classes on research ethics, or whether the respondents were from doctoral-level versus master's-level programs.

The use of complementary and alternative medicine (CAM) is growing in the United States. Patients and their health care providers are increasingly accepting of complementary and alternative therapies. The purpose of this study was to identify physician assistants' (PAs') attitudes, beliefs, knowledge, training, recommendations for, and personal use of CAM. A random sample of 500 practicing PAs was sent a four-page, 78-item survey investigating their personal use of, recommendations for, and perceptions of the efficacy and safety of complementary and alternative therapies. Of PAs eligible to complete the survey, 50% responded. Chi-square analyses found a significant relationship between knowledge level and recommendation for CAM; status of use and belief that CAM exerts a placebo effect; status of use and recommendation for CAM; and source of information on CAM and recommendation for CAM. With the increasing prevalence of use of CAM, PAs need to be informed regarding CAM therapies.