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Aggressive behavior (AB) in persons with dementia is defined historically as destructive actions directed toward persons, objects, or self; AB is most commonly directed toward caregivers (Cohen-Mansfield, Marx, & Rosenthal, 1989; Ryden, Bossenmaier, & McLachlan, 1991). Aggression has been identified as one of the most challenging aspects of such care (Leonard, Tinetti, Allore, & Drickamer, 2006; Sloane et al., 2004). AB negatively affects the quality of life for both persons with dementia as well as their caregivers, and it contributes greatly to caregiver burden and burnout (Talerico, Evans, & Strumpf, 2002). Recent investigations concerning AB in dementia have addressed the following: techniques to decrease aggression and other problematic aspects of dementia during bathing (Sloane et al., 2004); correlates of aggression among nursing home residents with dementia (Boustani et al., 2005; Eustace et al., 2001; Talerico et al.); and associations between AB, depression, delusions, hallucinations, and constipation in this population (Leonard et al., 2006). These studies and others have added significantly to the body of knowledge concerning aggression in dementia, addressing the problem from a multiplicity of viewpoints and a variety of techniques. Our study is guided by the Need-Driven Dementia-Compromised Behavior model (NDB model; Algase et al., 1996). In part the NDB model is built on findings from earlier studies, including those by Swearer, Drachman, O’Donnell, and Mitchell (1988); Teri, Larson, and Reifler (1988); Cohen-Mansfield and associates (1989); Evans and colleagues (1989); Meddaugh (1991); Beck, Rossley, and Baldwin (1991); Ryden and associates (1991); Werley, Devine, Zorn, Ryan, and Westra (1991); and Burgener, Jirovec, Murrell, & Barton (1992). Subsequent studies examining aspects of the NDB model include those by Kolanowski, Strand, and Whall (1997); Whall (1999, 2002); Kolanowski, Buettner, Costa, and Litaker (2001); Kolanowski, Litaker, and Bauman (2002, 2005); Algase, Whall, and Beck (2003); Kolanowski, Algase, Whall, Richards, and Beck (2004); Kolanowski and Litaker (2006); Yao and Algase (2006); Algase and colleagues (2007); Kovach and colleagues (2004); and Kim and Whall (2006).

Background Various factors in hospitals can adversely affect patients’ outcomes, including faulty communication between nurses and physicians. Whether specific communication elements (timeliness, accuracy, openness, understanding) can influence adverse outcomes is unknown. Objectives To determine the relationships between patients’ outcomes and (1) nurses’ perceptions of elements of communication between nurses and physicians and (2) characteristics of the practice environment. Methods A cross-sectional survey design was used. Information on ventilator-associated pneumonia, bloodstream infection associated with a central catheter, and pressure ulcers was collected from 25 intensive care units in southeastern Michigan. Simultaneously, 462 nurses in those units (response rate, 53.3%) were anonymously surveyed. The Conditions for Work Effectiveness Questionnaire-II and the Practice Environment Scale of the Nursing Work Index were used to measure characteristics of the practice environment. The Intensive Care Unit Nurse-Physician Questionnaire was used to measure communication between nurses and physicians. Statistical tests included correlation and multiple regression. Analyses were conducted at the unit level. Results Unit response rates varied from 6% to 100%. Together, variability in understanding communication and capacity utilization were predictive of 27% of the variance in ventilator-associated pneumonia. Timeliness of communication was inversely related to pressure ulcers (r= −0.38; P=.06), and workplace empowerment and scores on the Acute Physiology and Chronic Health Evaluation III were positive predictors of ventilator-associated pneumonia (R2=0.36; P=.005). Conclusions Not all elements of communication were related to the selected adverse outcomes. The connection between characteristics of the practice environment at the unit level and adverse outcomes remains elusive.

This article reports results of a randomized controlled trial designed to test an intervention to increase parent-adolescent sexual risk communication among Mexican parents. Data were analyzed from parents (n = 791) randomly assigned to an HIV risk reduction or health promotion intervention. Measures were administered at pretest, posttest, and 6- and 12-month follow-ups. Generalized estimation equation (GEE) analysis indicates parents in the HIV risk reduction intervention reported significantly more general communication (p < .005), more sexual risk communication (p < .001) and more comfort with communication (p < .001) than parents in the control intervention. Behavioral, normative, and control beliefs significantly mediated the effect of the intervention on all communication outcomes. This study demonstrates the efficacy of an intervention to increase the quality and quantity of parent-adolescent communication related to general and sex-specific communication.

Smoking negatively affects serum carotenoid levels, and it is a negative prognostic factor for head and neck cancer. In this study, micronutrient levels were examined in 60 smoking and non-smoking head and neck cancer patients. The goal was to determine if oxidation of the carotenoid lycopene would occur to a greater extent in smokers. Subjects were drawn from a prospective cohort study and matched on seven demographic factors. Serum levels of alpha-carotene, zeaxanthin, and 2,6-cyclolycopene-1,5-diol A, an oxidation product of lycopene, were all lower in smokers versus non-smokers (18%, 22%, and 8%, respectively) while beta-carotene, beta-cryptoxanthin, and lutein were about the same in the two groups. Levels of lycopene, gamma-tocopherol, and alpha-tocopherol were higher in smokers, and notably serum alpha-tocopherol was 48% higher in smokers. The majority of vitamin E intake was from supplements. The higher levels of alpha-tocopherol in smokers were interesting in that higher alpha-tocopherol levels have been associated with higher mortality in head and neck cancer. Although this was a pilot investigation, there was no evidence that 2,6-cyclolycopene-1,5-diol A formation was appreciably affected by smoking status, but alpha-tocopherol levels were higher in smokers.

To characterize and compare quality of life (QOL) in patients with head and neck cancer shortly before initial treatment and 1 year later and to study the predictors of changes in QOL over 1 year.Prospective cohort study.Three otolaryngology clinics.Three hundred sixteen patients having newly diagnosed squamous cell head and neck cancer.Health-related QOL was assessed using the 36-item Short-Form Health Survey and a head and neck cancer-specific QOL scale.Over 1 year, QOL decreased for physical functioning measures and eating but improved for mental health QOL. Depression and smoking were major predictors of poor QOL at baseline. Major predictors of change in QOL from baseline to 1 year were treatment factors, especially feeding tube placement (9 scales), chemotherapy (3 scales), and radiation therapy (3 scales). Baseline smoking and depressive symptoms also remained significant predictors of several QOL scales at 1 year.Health-related physical QOL tended to decline over 1 year and mental health QOL improved. The major predictors of change in QOL were treatment factors, smoking, and depressive symptoms. Physicians should alert patients to the relative effects on QOL one may experience with different treatments.

To determine differences in quality of life (QOL) between patients with head and neck cancer who receive chemoradiation versus chemoradiation and neck dissection.A prospective cohort study was conducted at two tertiary otolaryngology clinics and a Veterans Administration hospital.103 oropharyngeal patients with Stage IV squamous cell carcinoma treated via chemoradiation +/- neck dissection.self-administered health survey to collect health, demographic, and QOL information pretreatment and 1 year later.QOL via SF-36 and HNQoL. Descriptive statistics were calculated for health/clinical characteristics, demographics, and QOL scores. t tests evaluated changes in QOL over time.Sixty-five patients underwent chemoradiation and 38 patients underwent chemoradiation and neck dissection. Only the pain index of the SF-36 showed a significant difference between groups (P0.05) with the neck dissection group reporting greater pain.After post-treatment neck dissection, patients experience statistically significant decrement in bodily pain domain scores, but other QOL scores are similar to those of patients who underwent chemoradiation alone.

A study was conducted to assess the reliability and validity of the Appropriateness Evaluation Protocol (AEP), the Standardized Medreview Instrument (SMI) and the Intensity-Severity-Discharge criteria set (ISD), three utilization review instruments used to determine whether inpatient care is required. Reliability and validity were assessed for retrospective application of these instruments to charts of a sample of 119 medical cases from 21 hospitals in the state of Michigan. The reliability of each instrument was determined by having the instrument applied by two different nurse reviewers to each hospital record. Results indicated that the AEP and ISD were moderately reliable, while the SMI had low reliability. The validity of each instrument was tested by comparing the judgments of nurse reviewers using the instruments with the judgment of a panel of physicians. The AEP and ISD were found to be moderately valid and the SMI was found to have low validity. Results suggested that the SMI should not be used. The modest level of validity of the other two instruments suggests that payment should never be denied on the basis of the instrument alone. Payment should be denied only if a physician confirms the judgment based on the instrument that inpatient care was not required.

There is limited research on how aspects of Latino culture affect condom use among Latino adolescents. In this study, the authors examined the effects of familialism, gender roles, and religiosity on condom use intentions and past condom use. Results showed only religiosity predicted past condom use; no other cultural variable had either a direct or an indirect effect on condom use intentions or past condom use. These findings represent an important effort in promoting safer sex behaviors among sexually active Latino adolescents.

Background. This prospective, cohort study is the first to describe 5 health behaviors of head and neck cancer patients the first year after diagnosis. Methods. Patients (N ¼ 283) were recruited in otolaryngol- ogy clinic waiting rooms and asked to complete written surveys. A medical record audit was also conducted. Descriptive statis- tics and multivariate analyses were conducted to determine which variables were associated with the 5 health behaviors. Results. Half of the patients smoked and 25% were problem drinkers. Over half of the smokers and drinkers quit 1 year post- diagnosis. Smoking and problem drinking were highly associ- ated and both were associated with lower body mass index (BMI) (p < .01). Moreover, physical activity and sleep were associated with each other (p < .01). Low SLEEP (Medical Out- comes Study Sleep Scale) scores were common and highly associated with depression (p < .01). Conclusion. The health behaviors of head and neck cancer patients are interrelated, and assessing and treating these behaviors together may be beneficial. V C 2007 Wiley Periodi

To test the efficacy of a behavioral intervention designed to decrease risk sexual behaviors for HIV/AIDS and unplanned pregnancies in Mexican adolescents.Randomized controlled trial with four follow ups; 832 adolescents recruited from high schools, age 14-17, were randomly assigned to the experimental or control group. The six hour intervention used active learning strategies, and was delivered in two sessions on two consecutive Saturdays. The study was carried out in Monterrey, Mexico, 2002-2005.GEE analysis indicated no differences in sexual relationships intentions between the two conditions, however, the experimental group had higher intentions to use condoms and contraceptives (mean differences 0.15 and 0.16, CI 95%) in the next three months, as compared with the control group. Theoretical variables, such as control beliefs, were significant mediators of the intervention.The behavioral intervention represents an important effort in promoting safe sexual behaviors among Mexican adolescents.

Advances in computer technology and accessibility enable researchers to provide individually tailored interventions for behavioral change. Using multimedia technology, this study developed and tested a computer-based hearing test and a tailored intervention. The purpose of this study was to evaluate, using a randomized experimental design, the efficacy of the intervention to increase workers’ use of hearing protection. The tailored intervention developed by the research team showed more significant short-term effect measured immediately after the intervention than the control intervention. For the long-term effect measured 1 year after the intervention, both tailored and control groups showed significant increase in their reported use (7% vs. 6%) from preintervention to postintervention, but no significant difference between the two groups. The change accomplished in this study was small progress toward the desired level of 100% use of hearing protection to prevent noise-induced hearing loss. This finding showed that changing workers’ hearing protection behavior is difficult.

Investigators conducting focus groups on end-of-life preferences noted that veterans voiced opinions that strongly differed from those of nonveterans.The objective of this study was to further explore differences between veterans' and nonveterans' end-of-life preferences.Ten focus groups and a pilot survey were conducted.The focus groups consisted of Arab Muslims, Arab Christians, Hispanics, blacks, and whites stratified by gender (n = 73). Fifteen male veterans were included across all five racial groups.A moderator discussion guide was used to lead the focus groups and a pilot survey asked about demographic information and end-of-life preferences.Veterans were more likely to be married (p0.05) and less connected to their cultural group (p0.05) than nonveterans. The focus group results indicated that veterans in this study were more likely to oppose the use of heroic measures compared to nonveterans. More so than nonveterans, veterans felt that their doctors should be frank and open (p0.05) were strongly in favor of do-not-resuscitate (DNR) orders (p0.10), yet were less likely to have a proxy (p0.10) or durable power of attorney p0.01). Comparing end-of-life preferences, veterans felt less strongly than nonveterans about remembering personal accomplishments (p0.05), being listened to (p0.05), being with friends (p0.01), or being comfortable with their nurse (p0.05), but did want to be around their pets at the end of life p0.10).The Department of Veterans Affairs is in a unique position to improve endof- life care for veterans. Providing end-of-life care that is congruent with the veteran's wishes can improve satisfaction and increase cost effectiveness by eliminating unacceptable services.

To determine the accuracy of self-reported comorbidities compared with medical record review and the clinical and sociodemographic characteristics associated with accuracy of self-reported comorbidities.We conducted a prospective study of 458 newly diagnosed head and neck cancer patients using self-administered questionnaire and medical chart review data. Overall and itemwise consistency between self-report and chart review was evaluated. Social, clinical, and demographic characteristics of consistent versus inconsistent responders were analyzed.Seventy-four percent of patients had at least one comorbidity. There was good overall consistency between self-report and chart review (kappa = 0.50). Compared with consistent responders, inconsistent responders were found to be older (P0.05), have lower sleep (P0.05) and physical activity scores (P0.05), be more depressed (P0.05), and have more severe comorbidities (P0.05).Self-report may be considered as an alternative to chart review for comorbidity assessment in head and neck cancer patients. Younger patients, those with good general health, fewer depressive symptoms, and mild comorbidities, are more likely to give responses consistent with chart review.

This study investigated racial/ethnic preferences, sex preferences, and perceived discrimination related to end-of-life care. Ten focus groups and a follow-up survey were conducted to obtain in-depth information on end-of-life preferences across five racial/ethnic groups in Michigan stratified by sex. There were 73 focus group participants, including Arab Muslims, Arab Christians, Hispanics, blacks, and whites. The mean age+/-standard deviation was 67+/-8.5 (range 50-83). A focus group screener was used to recruit participants. A moderator discussion guide was used to guide the focus groups. A take-home questionnaire asked about demographic information and end-of-life issues. Arab Americans were in favor of making peace on earth and were against assisted suicide, extending life artificially, nursing homes, and telling the patient "bad news." Hispanic and black women were against assisted suicide and in favor of extending life, whereas the men in these groups felt the opposite. Hispanic women spoke of not wanting a feeding tube and would consider alternative medicine. Blacks were least opposed to nursing homes. For whites, it was important to have choices. When asked about discrimination related to end-of-life care, Muslim women spoke of cultural barriers, blacks spoke of inequities in the past, and whites spoke of age discrimination and abandonment when dying. As the population becomes more diverse and continues to age, it will be important to provide culturally and sex-sensitive end-of-life interventions to increase patient/family satisfaction and allocate resources appropriately.

Pender's health promotion model (HPM) has been revised, including substantial changes in its structure. The purpose of this study was to compare the fit and predictive usefulness of the original and revised structures of the HPM as applied to the use of hearing protection devices by 703 construction workers. Structural equation modeling was used to evaluate the two alternative forms of the model. Both forms of the model fit well, with the revised structure having a better fit and explaining more of the variance in use of hearing protection (28% vs. 18%). Results support the revised structure of the health promotion model (HPM) over the original form, and indicate it may be useful in understanding and predicting use of hearing protection.

Tobacco exposure is a key risk factor for head and neck cancer, and continued smoking after diagnosis negatively affects outcomes. The present study examined tobacco smoking, nicotine dependence, alcohol use, and depression in survivors of head and neck cancer. Subjects at least 6 months post-initial diagnosis of head and neck cancer (N=694) drawn from three VA otolaryngology clinics (n=309, VA patients) and a university-based otolaryngology clinic (n=385, non-VA patients) were administered questionnaires and standardized rating instruments for nicotine and alcohol dependence and for depression. Additional clinical information was extracted from chart reviews. Despite high rates of prior smoking, less than one-quarter of all subjects continued to smoke. After controlling for significant confounding variables, we found that VA patients were more likely to be current smokers (OR=1.9, 95% CI=1.3-3.0), but current VA smokers did not differ significantly from non-VA smokers on the Fagerstrom Test for Nicotine Dependence criterion (p=.69). The VA patients were more likely to screen positive for problem drinking on the Alcohol Use Disorder Identification Test (OR=2.1, 95% CI=1.3-3.7). After adjusting for other variables, we found no statistical difference between the groups in depression scores on the Geriatric Depression Scale-Short Form. The study provides data on smoking, alcohol use, and depression in head and neck cancer survivors indicating that VA patients are at increased risk for continued smoking and problem drinking relative to non-VA patients. Head and neck cancer patients benefit from aggressive smoking cessation efforts by the VA, but many patients need specialized services that integrate smoking interventions with treatment of comorbid alcoholism.

The purpose of the study is to determine whether there are ethnic differences in predictors of hearing protection behavior between Black and White workers. The Predictors of Use of Hearing Protection Model (PUHPM) derived from Pender's Health Promotion Model (Pender, 1987) was used as a conceptual model. A total of 2,119 (297 Blacks, 1,822 Whites) were included in the analysis. Internal consistency of instrument items was assessed using theta reliability estimates. Significant predictors of the use of hearing protective devices (HPDs) for Black and White workers and differences in predictors between the two groups were examined using multiple regression with interaction terms. Ethnic differences in scale or individual item scores were assessed using chi-square and f-test analyses. Different factors influenced hearing protection behavior among Black and White workers. The model was much less predictive of Blacks' hearing protection behavior than Whites' (R^sup 2^ = .12 vs. .36). Since the PUHPM was not as effective in predicting hearing protection behavior for Blacks as for Whites, future studies are needed to expand the PUHPM through qualitative study and to develop culturally appropriate models to identify factors that better predict hearing protection behavior as a basis for developing effective interventions. Keywords: hearing protection; Blacks; moderated regression; Whites; ethnic disparity; noise-induced hearing loss Noise-induced hearing loss (NIHL) is an irreversible sensorineural hearing impairment caused by prolonged exposure to noise. It causes communication interference that can substantially affect social integration, self-image, and quality of life (National Institutes of Health, 1990). NIHL ranks among the most important occupational health problems in many countries (Chew & Lin, 1991; Hong, Chen, & Conrad, 1997; Kahan & Ross, 1994; National Institute for Occupational Safety and Health [NIOSH], 1996). Considering its serious impact on the quality of life among workers, NIHL should be prevented. Although it is ideal to reduce hazardous noise exposure through engineering controls, it is often impractical, costly, or scientifically impossible to eliminate all harmful noise. Hearing protective devices, assuming they are correctly used, are the best means of reducing hearing damage. The solution for NIHL is, therefore, a relatively simple and inexpensive preventive measure, the consistent and proper use of the HPDs (Sataloff & Sataloff, 1993). While the prevention is simple, the problem is noncompliance. Workers do not consistently wear HPDs (Hong, Wilber, & Furner, 1998; Lusk et al, 1999; Lusk et al., 2003; Melamed, Rabinowitz, Feiner, Weisberg, & Ribak, 1996). Promoting the use of HPDs is essential to preventing NIHL in workers. Therefore, it is important to identify factors predicting workers' use of HPDs to develop the most effective ways to assist them in adopting this behavior. As minority populations increase, the United States is increasingly becoming a multiethnic and multicultural society. The 2000 U.S. Census showed minority groups including Asians (72.0%), Hispanics (52.9%), and Blacks (21.5%) increased faster than the total population (13.2%) between 1990 and 2000 (U.S. Census Bureau, 2000). According to projections by the U.S. Department of Labor (USDL) Bureau of Labor Statistics (BLS), by 2025, minorities will increase to almost one-half of the population (USDL, BLS, 1994). Considering these changes, it is necessary to understand the factors influencing hearing protection behaviors among minority workers. Several studies investigated predictors of HPD use among farmers (McCullagh, Lusk, & Ronis, 2002), factory workers (Lusk, Ronis, Kerr, & Atwood, 1994), and construction workers (Lusk, Ronis, & Hogan, 1997). However, these studies included mainly White workers. Little is known about the predictors of HPD use among minority worker populations. …

Background: Patients with head and neck cancer often experience debilitating speech, eating, and respiratory problems as well as the psychological effects of loss of function and change in body image. These patients often become unemployed as a result of their disease process, which adds financial burden to their already stressful lives. Yet the specific factors associated with unemployment have not been systematically studied. Methods: This multisite study used survey and chart data to determine the predictors of work-related disability. Results: Of the 384 patients who were working prior to their diagnosis of head and neck cancer, 52% (n=201) were disabled by their cancer treatment. Multivariate analysis demonstrated significant links between disability and chemotherapy (odds ratio [OR], 3.4; P.001), neck dissection status (OR, 2.3;P=.01), pain scores (OR, 1.2; P=.01), and time since diagnosis (OR, 0.9; P=.04). Conclusions: More than half of the patients in this study were disabled by their head and neck cancer or treatment. Patients with head and neck cancer who have undergone chemotherapy or neck dissection or have high pain scores are at increased risk for disability from their cancer or their treatment. Efforts to prevent (if possible), better assess, and treat pain and other adverse effects of head and neck cancer treatments may also have the potential to reduce patient disability.

To identify clinical predictors of quality of life (QoL) in a head and neck cancer patient population.A convenience sample of 570 patients with upper aerodigestive tract cancers were surveyed at a tertiary care oncology clinic and Veterans Affairs otolaryngology clinic.A self-administered health survey was constructed to collect demographic, health, smoking, alcohol, depression symptom, and QoL information. Tumor site and tumor stage, clinical, and treatment data were abstracted from the patient medical records.Quality of life was assessed using the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and the Head and Neck QoL (HNQoL) instrument.Of the 570 eligible respondents, the presence of a feeding tube had the most negative impact on QoL, with significant decrements in 6 of the 8 SF-36 scales and all 4 HNQoL scales (P.01). In descending order of severity, medical comorbid conditions, presence of a tracheotomy tube, chemotherapy, and neck dissection were also associated with significant (P.05) decrements in QoL domains. Patients who took the survey more than 1 year after diagnosis had improved QoL in 7 of 12 domains. Hospital site, age, education level, sex, race, and marital status were also significant predictors of QoL.There are at least 13 demographic and clinical characteristics that are significant predictors of QoL in patients with head and neck cancer, which should be considered when treating patients and conducting QoL studies in the future.

" Background: In the United States it is estimated that more than 30 million workers are exposed to harmful levels of noise on the job. When engineering or administrative controls cannot be used to reduce noise, workers should always use hearing protection devices (HPDs) when exposed to loud noise to prevent noise-induced hearing loss (NIHL). Previous research has shown that workers do not always use HPDs when required; therefore, it is essential that workers assume personal responsibility for preventing NIHL by increasing their use of HPDs. " Objectives: This study tested the effectiveness of an individually tailored multimedia intervention to increase use of HPDs by factory workers. " Methods: A randomized controlled design was used to compare the effects of a tailored intervention (n = 446) with two other interventions (a nontailored predictor-based intervention (n = 447) and a control intervention (n = 432)) on workers' self-reported use of HPDs 6 to 18 months following the intervention. " Results: Only those workers receiving the tailored intervention significantly increased their use of HPDs from pretest to posttest. However, this increase significantly differed from the nontailored group but not from the control group. " Conclusions: Individually-tailored interventions offer promise for changing behavior. In light of the similarity between the results for the tailored intervention and the control intervention groups, further research is needed to understand barriers to HPD use and how to maximize the benefits of individually tailored interventions in this setting.

Background. Although a number of studies have investigated perceived self-efficacy, perceived benefits, and perceived barriers and their relationship to adolescents' participation in physical activity, the validity and reliability of the instruments used have not been consistently examined. The purpose of the present study was to develop culturally sensitive, reliable, and valid instruments to measure physical activity cognitions among Taiwanese adolescents. Methods. The items generated for the instruments were drawn from a comprehensive literature review and a focus group interview. The instruments were translated using the back-translation technique and evaluated by a panel of experts. Psychometric testing was performed and confirmed with convenience samples of 110 and 969 Taiwanese adolescents. Results. Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for this group of Taiwanese adolescents. Cronbach's α's ranged from 0.79 to 0.90. Construct validity was supported by exploring the factor structure of the instrument using confirmatory factor analysis and correlation with the outcome variable of physical activity. Conclusions. The study identified culturally sensitive items to measure physical activity cognitions in urban Taiwanese students in their early adolescence. Clinicians or practitioners can use the instruments developed and tested in this study for clinical assessment to identify risk factors for inactivity as well as for further research in similar populations.

This pilot study examined the relationship between smoking, alcohol intake, depressive symptoms and quality of life (QoL) in head and neck cancer patients. A questionnaire on smoking, alcohol, depressive symptoms and QoL was distributed to head and neck cancer patients (N=81). Over one-third (35%) of the respondents had smoked within the last 6 months, 46% had drunk alcohol within the last 6 months and 44% screened positive for significant depressive symptoms. About one-third (32%) of smokers were interested in smoking cessation services and 37% of patients with depressive symptoms were interested in depression services. However, only 9% of those who drank alcohol expressed interest in alcohol services. Smoking was negatively associated with five scales of the SF-36V including Physical Functioning, General Health, Vitality, Social Functioning, and Role-Emotional Health. Depressive symptoms were negatively associated with all eight scales on the SF-36V and all four scales of the Head and Neck Quality of Life instrument. Surprisingly, alcohol was not found to be associated with any of the QoL scales. While smoking, alcohol intake and depression may be episodically treated, standardized protocols and aggressive intervention strategies for systematically addressing these highly prevalent disorders are needed in this population.

BACKGROUND: Most farmers are exposed to potentially hazardous noise levels through many of their work activities, such as operating tractors, grain dryers, and chain saws. Rates of noise-induced hearing loss in this group are high. Although this condition is preventable through the use of hearing protection, rates of protective device use are low. Understanding factors influencing the use of hearing protection devices will provide direction for programs to increase their use and decrease risk of noise-induced hearing loss. OBJECTIVES: A study was designed using the Pender Health Promotion Model to identify factors affecting farmers' use of hearing protection devices. METHOD: Model testing was conducted with a convenience sample of 139 farmers. Prior to model testing, existing instruments designed to measure concepts from the Health Promotion Model were modified for use with farmers through interviews, validity testing with an expert panel, and reliability testing with first a small (n = 36) then a second larger (n = 139) convenience sample of farmers. Instruments measuring cognitive and affective factors related to hearing protection device use were administered to farmers at a regional farm show in the Midwest. RESULTS: A logistic regression analysis identified interpersonal support, barriers, and situational influences as statistically significant predictors of this health behavior, correctly predicting 78% of the cases. Results of model testing were consistent with results of previous studies of Health Promotion Model variables with other worker groups' use of hearing protection. CONCLUSIONS: Information from this study can be used to design and evaluate interventions to promote hearing protection device use among farmers and reduce the level of noise-induced hearing loss in this high-risk and underserved worker group.

The purpose was to determine the effectiveness of the Tobacco Tactics program in three Veterans Affairs hospitals. In this effectiveness trial, inpatient nurses were educated to provide the Tobacco Tactics intervention in Ann Arbor and Detroit, while Indianapolis was the control site (N = 1,070). Smokers were surveyed and given cotinine tests. The components of the intervention included nurse counseling, brochure, DVD, manual, pharmaceuticals, 1-800-QUIT-NOW card, and post-discharge telephone calls. There were significant improvements in 6-month quit rates in the pre- to post-intervention time periods in Ann Arbor (p = 0.004) and Detroit (p

BACKGROUND The cognitive capacity to direct attention (CDA) is essential for self-care and independent functioning. Older women may be more vulnerable to fatigue-related losses in CDA following surgery for breast cancer. Normal functional variations in CDA associated with aging might affect attentional responses in older women newly diagnosed with breast cancer, and factors such as extent of surgery or symptom distress might influence CDA over time. OBJECTIVES To examine (a) differences in CDA and symptom distress in older women newly diagnosed with breast cancer as compared to a control group of older women without breast cancer; (b) the pattern of change in CDA and symptom distress from the pretreatment period to 3 months after surgery; and (c) to examine the relationship of CDA with symptom distress and extent of surgery over time. METHODS Women, 55 to 79 years of age, newly diagnosed with breast cancer (N = 47), were assessed with measures of CDA and symptom distress: (a) before surgery, (b) at 2 weeks postsurgery, and (c) 3 months postsurgery. To account for normal variations associated with aging, 48 women of similar age without breast cancer were assessed following a routine screening mammogram and 3 months later. RESULTS Before treatment, the breast cancer group scored significantly lower than the control group (p < .05) on measures of CDA and higher on symptom distress. Repeated measures ANOVA showed significant main effects of group, but not time, for the measures of CDA and symptom distress with the breast cancer group having worse status than the control group. For CDA only, there was a significant group by time interaction effect (p = .005) so that the breast cancer group showed a gradual gain in CDA over time. CONCLUSIONS Reduced performance in a cognitive function was observed before treatment and found to persist over an extended interval in older women newly diagnosed with breast cancer.

In this project we tested the effectiveness of a theory-based intervention (video, pamphlets, and guided practice session) to increase the use of hearing protection devices (HPDs) among Midwestern construction workers and a national group of plumber/pipefitter trainers. Posttest measures were collected 10--12 months following this intervention. Pender's Health Promotion Model (1987) provided the conceptual basis for development of the training program. A total of 837 highnoise- exposed workers were included in the analysis: 652 regional Midwestern construction workers and 185 national plumber/pipefitter trainers. Effectiveness of the intervention was determined through the sequence of analyses recommended by Braver and Braver (1988) for the Solomon Four-Group Design. Analysis of variance and covariance of postintervention use and intention to use HPDs and a meta-analytic test were done. These analyses indicated that the intervention significantly increased use of HPDs but had no effect on intention to use HPDs in the future. Pretesting had no effect on use. Actual or potential applications of this research include guidance in the development of successful theorybased interventions to increase use of HPDs.

Objective: This study compared the preventive oral health behaviors of African-Americans and whites. Methods: Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits. Results: More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically. Conclusion: African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.

This study assessed dental anxiety in adults living in the Detroit tricounty area and identified factors associated with it. The prevalence of dental anxiety was 10.0 percent. Regression analysis revealed six factors associated with dental anxiety: unfavorable attitudes toward dentists, infrequent checkups, dissatisfaction with one's mouth, small numbers of filled surfaces, being female and lower income. Dentists should be aware of these factors when assessing dental anxiety in their patient populations.

This study examined gender and developmental differences in exercise-related beliefs and exercise behaviors of 286 racially diverse youth and explored factors predictive of exercise. Compared to males, females reported less prior and current exercise, lower self-esteem, poorer health status, and lower exercise self-schema. Adolescents, in contrast to pre-adolescents, reported less social support for exercise and fewer exercise role models. In a path model, gender, the benefits/barriers differential, and access to exercise facilities and programs directly predicted exercise. Effects of grade, perceived health status, exercise self-efficacy, social support for exercise, and social norms for exercise on exercise behavior, were mediated through the benefits/barriers differential. Effect of race on exercise was mediated by access to exercise facilities and programs. Continued exploration of gender and developmental differences in variables influencing physical activity can yield valuable information for tailoring exercise promotion interventions to the unique needs of youth.

The purpose of this study was to determine how the components of psychosocial adjustment to diabetes predict adherence to nutrition recommendations based on self-reported successful completion of contingency contracts. The relationships between the components of psychosocial adjustment and adherence to nutrition recommendations were examined in a convenience sample of patients with non-insulin- dependent diabetes mellitus participating in a contingency contracting intervention with nurses. Patients completed a standardized instrument, the Diabetes Care Profile, at the time they were enrolled into this randomized clinical trial. High and low levels of adherence to nutrition recommendations were identified by a median split of the number of contingency contracts completed for adherence to nutrition recommendations. Subjects who reported higher regimen adherence and a higher support ratio (received more diabetes-specific social support than desired) were significantly less likely to engage in contingency contracting for adherence to nutrition recommendations .

In this study, we used the conceptual Health Promotion Model to identify predictors of hearing protection use among blue-collar workers ( N = 504). The strongest predictors were self-efficacy, benefits, value, and barriers. Items in the barriers scale were most strongly correlated with use and had the greatest potential for change. Therefore, items from this scale are being used as the primary basis for development of a training intervention program.

Objectives This investigation examined current practices of brushing, flossing, and periodic dental visits and their association with periodontal health status. Methods Data were collected using face-to-face interviews and 40-minute in-home dental examinations with a probability sample of adults 18 years of age or older, having at least one tooth, and living in housing units in the Detroit tricounty area. Complete examinations were performed on 319 individuals. Results On average, subjects reported brushing their teeth about twice a day. About one-third of the population reported flossing at least once a day. Loss of periodontal attachment was related to frequency of brushing while subjects who exhibited acceptable flossing ability had less plaque and calculus, shallower pocket depths, and less attachment loss. Subjects reporting a periodic dental visit at least once a year had less plaque, gingivitis, and calculus than subjects reporting less frequent visits. In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss. Conclusions Brushing, flossing, and periodic dental visits were correlated with better periodontal health. The behaviors appeared to be indirectly related to pocket depth and attachment loss through their associations with plaque, gingivitis, and calculus levels.

The health-promoting lifestyles of blue-collar, skilled trade, and white-collar workers were examined. Specific purposes included determining differences in health-promoting behaviors, especially according to worker category, as well as ethnic identification, age, gender, education, and marital status. A convenience sample of 638 workers in a midwestern automotive components plant completed the Health-Promoting Lifestyle Profile (HPLP) and demographics questionnaire. In a multivariate analysis of variance (MANOVA) including all demographic variables, significant differences were found in the mean scores on subscales of the HPLP by job category (2 subscales), age (3), gender (2), and education (4). Prior to including education in the MANOVA, significant differences were found by job category on 5 subscales of the HPLP. The effects of education eliminated the majority of the effects of job category.

The Health Promotion Model (HPM) was tested as a causal model to predict workers' use of hearing protection (N = 645). Measures indicated an excellent fit of the theoretical model. The exploratory analyses found the same cognitive-perceptual factors most important in predicting use. However, in contrast to the theoretical model, two modifying factors (job category and situational factors) had direct effects on use. The hypothesized model accounted for 49.3% of variance and the exploratory models accounted for 50.7% to 52.7% of variance in hearing protection use. Results of testing the HPM are consistent with the recently proposed revision of the model by Pender, Walker, Frank-Stromborg, and Sechrist (1990a, 1990b). The strongest effects on behavior came from the behavior-specific influences and demographic characteristics. Situational factors had a direct effect on the health behavior.

The first author's concepts of operational and conceptual disconfirmability are revised on the basis of recent critiques appearing in this journal. Operational and conceptual disconfirmation can be conceived as alternative resolutions of the disconfirmation dilemma, which is the problem faced by a researcher when a theoretical prediction is empirically disconfirmed. Operational disconfirmation corresponds to the conclusion that the prediction failed because of invalid procedures, while conceptual disconfirmation corresponds to the conclusion that the theoretical analysis underlying the prediction was faulty. Social psychology may indeed differ from other disciplines in being more prone to the operational disconfirmation conclusion.

Fazio, Zanna, and Cooper (Dissonance and self-perception: An integrative view on each theory's proper domain of application. Journal of Experimental Social Psychology, 1977 , 13, 464–479) specified mutually exclusive domains of application for dissonance and self-perception theory and used a misattribution-of-arousal procedure to distinguish between dissonance reduction and self-perception processes. Because their proposed limitations of the domains of the two theories and their use of the misattribution procedure are not directly derivable from earlier statements of either theory, it may be best to regard their analysis as a new theory, rather than as a conciliation of the parent theories. New analyses based on the Fazio et al. results indicate that their data provide an insufficient basis for preferring their theory to earlier versions of dissonance and self-perception theories. Dissonance and self-perception: An integrative view of each theory's proper domain of application. Journal of Experimental Social Psychology, 1977, 13, 464–479.

An experiment was conducted to compare mathematical models describing how people combine information to form an impression of another person. Subjects rated how much they would like stimulus persons described by one or two adjectives. Subjects also reported their level of uncertainty about each evaluation. Models using the uncertainty measures to predict integration weights were no more successful than the equal weight averaging model. There was no evidence that extreme adjectives were given high weight. Information integration was best described by a model in which the more negative adjective in a pair is given more weight than the other adjective.

An experiment is reported in which subjects assigned probabilities to the outcomes of basketball games and to the truth of general-knowledge items. Three different methods were used for eliciting subjects' probability judgments. Subjects were more successful in selecting answers to the general-knowledge questions than they were in picking basketball game winners. The overall accuracy of their probability judgments for general-knowledge items was superior, too. On the other hand, subjects' judgments about general-knowledge questions were more overconfident, more poorly calibrated, and included greater scatter. One method of probability assessment gave subjects an irrelevant cue. This was found to increase confidence and overconfidence and to hurt calibration. Correlations between measures of performance on general-knowledge questions and basketball predictions showed substantial individual consistency in confidence, but only weak consistency in other components of judgment quality. Theoretical and practical implications are discussed.

Subjects in China, Japan, and the United States reported probability judgments. In Study 1, Chinese and American subjects indicated degrees of certainty about their answers to general-knowledge questions with discrete alternatives, e.g., whether potatoes grow better in warm or in cool climates. In Study 2, Japanese subjects made similar discrete-alternative assessments. In Study 3, subjects in China and the United States reported probability distribution judgments for various quantities, e.g., the maximum temperature on a specified day. Judgment accuracy was evaluated overall and with respect to several underlying accuracy dimensions. The overall quality of discrete-alternative judgments was indistinguishable among the subjects from the three countries. The accuracy component patterns of the Japanese and American subjects were essentially the same. However, the Chinese subjects achieved the common overall accuracy level very differently. On some accuracy dimensions, e.g., calibration, the American and Japanese subjects' judgments were superior. On others, e.g., discrimination, the assessments of the Chinese subjects excelled. Results for quantity judgments were similar to those for discrete-alternative judgments, although there were notable differences. Potential explanations and implications are discussed.

3 etudes qui verifient un modele d'apprentissage associatif dans le cas precis d'information concernant des marques de produits de consommation et agissant sur la persuasion