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

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

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

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

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

Clara Manfredi, PhD, Kathleen S. Crittenden, PhD, Young Ik Cho, PhD,Julie Engler, MPH, and Richard Warnecke, PhD The Effect of a Structured SmokingCessation Program, Independent ofExposure to Existing Interventions May 2000, Vol. 90, No. 5 In this report we discuss findings fromthe evaluation of a smoking cessation pro-gram offered in public health clinics 1 in lightof the varied degree of implementation of ex-isting interventions in the control group. Thisissue is important because the study was con-ducted in a public health practice context(i.e., where both experimental and usual andcustomary interventions were to be initiatedand delivered to patients by clinic personnelas part of routine medical visits). 2 Underthese conditions, implementation of interven-tions is likely to be a variable rather than agiven. While the structure of the experimentalprogram allowed for the selection of smokersto whom the program was at least offered, nosuch selection was feasible in the control con-dition. The difference in outcomes betweenthe experimental and control groups couldthen be affected not only by the intrinsic effi-cacy of the new interventions when com-pared with existing interventions, but also bythe degree to which the latter were deliveredto patients.Several controlled studies have estab-lished the effectiveness of minimal smokingcessation interventions in prenatal clinics

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

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

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

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

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

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

Amid increased concerns about the adverse consequences of low health literacy, it remains unclear how health literacy affects health status and health service utilization. With a sample of 489 elderly Medicare patients in a Midwestern city in the USA, we explored the intermediate factors that may link health literacy to health status and utilization of health services such as hospitalization and emergency care. We expected to find that individuals with higher health literacy would have better health status and less frequent use of emergency room and hospital services due to (1) greater disease knowledge, (2) healthier behaviors, (3) greater use of preventive care, and (4) a higher degree of compliance with medication. Using path analysis, we found, however, that health literacy had direct effects on health outcomes and that none of these variables of interest was a significant intermediate factor through which health literacy affected use of hospital services. Our findings suggest that improving health literacy may be an effective strategy to improve health status and to reduce the use of expensive hospital and emergency room services among elderly patients.

Mild traumatic brain injury, commonly known as concussion, occurs frequently in children while playing sports. Whereas the negative impact of sport-related concussions on cognitive function is well known, the effects of concussions on sensorimotor function, especially in children, remain largely unknown. In this observational/case study, we investigated the association between neurocognitive function, assessed using a trail making test, and sensorimotor function, assessed using a visuomotor adaptation task, in three children who suffered from a concussion while playing sports. For the trail making test, children drew lines to connect numbers and letters alternately on a page. For the visuomotor adaptation task, children performed targeted reaching movements repeatedly under a novel visuomotor condition in which the visual display of reaching movements was rotated 30 degrees about the start position. Their neurocognitive and visuomotor performances were compared to those obtained from three children without a concussion. Results showed that only one of the three concussed children showed a score from the trail making test that was worse than the scores obtained from control subjects. However, the pattern of visuomotor adaptation observed in the concussed children was different from that observed in the control subjects in several ways. These data indicate that the concussed children may have some deficits in terms of their sensorimotor function as compared to the control subjects. Our findings provide preliminary data that suggest that children with concussion may have sensorimotor impairments even when they do not seem to have neurocognitive impairments.

This study examines what midlife and older (age 45 to 74) Korean American men who are current or former cigarette smokers think cause symptoms or health problems that may be related to smoking cigarettes. The study also examines how those perceptions influence attitudes and behaviors regarding smoking cessation. Separate focus groups were conducted with seven current smokers and nine former smokers in the Korean language in a Korean American. Current smokers experienced few symptoms or health problems that they attribute to smoking, and they generally do not regard smoking as a cause of symptoms or health problems. Former smokers generally quit smoking in response to experiencing a wide range of symptoms or health problems that they attribute to smoking or that they believe smoking exacerbates. A pervasive theme among both groups is that health is a function of a person’s physical constitution. The perception is that those born with a strong or special physical constitution are able to smoke and be healthy; persons with a weak physical constitution or who are predisposed to be ill should not smoke or should quit smoking. Smoking-cessation interventions for midlife and older Korean American men should take these findings into account.

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

Amid increased concerns about the adverse consequences of low health literacy, it remains unclear how health literacy affects health status and health service utilization. Moreover, studies have shown significant variation in individual adaptation to health literacy problems. This article proposes research hypotheses to address two questions: (1) What are the causal pathways or intermediate steps that link low health literacy to poor health status and high utilization of expensive services such as hospitalization and emergency care? (2) What impact does social support have on the relationships between health literacy and health service utilization? Empirical studies of health literacy are reviewed to indicate the limitations of current literature and to highlight the importance of the proposed research agenda. In particular, we note the individualistic premise of current literature in which individuals are treated as isolated and passive actors. Thus, low health literacy is considered simply as an individual trait independent of support and resources in an individual's social environment. To remedy this, research needs to take into account social support that people can draw on when problems arise due to their health literacy limitations. Examination of the proposed agenda will make two main contributions. First, we will gain a better understanding of the causal effects of health literacy and identify missing links in the delivery of care for patients with low health literacy. Second, if social support buffers the adverse effects of low health literacy, more effective interventions can be designed to address differences in individuals' social support system in addition to individual differences in reading and comprehension. More targeted and more cost-efficient efforts could also be taken to identify and reach those who not only have low health literacy but also lack the resources and support to bridge the unmet literacy demands of their health conditions.

Relatively little is known about the substance abuse treatment need patterns and experiences of youth incarcerated in the United States juvenile justice system. To address this issue, four analytic questions concerned with understanding the predictors of treatment need and utilization patterns among adolescents entering the juvenile corrections system are examined. Data analyzed were collected as part of a face-to-face survey of 401 youth who entered the Illinois juvenile correctional system in mid-2000. Overall, need for treatment and treatment utilization each were predicted by sets of social environmental and personal characteristics, in addition to several sociodemographic variables. Less than half of youth with an identified need for treatment reported receiving treatment. Considerable variability in the effects of demographic and social environmental indicators on treatment need and utilization across race groups also was observed. These findings underscore the need for the continual development of the cultural competence of treatment providers and the expansion of on-site provision of substance abuse treatment services to incarcerated juveniles.

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

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

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

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