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Despite recent declines, Latinas bear a disproportionate burden of teen births. Understanding social, cultural, and demographic factors underlying pregnancy desire among Latino adolescents is needed to design effective teen pregnancy prevention interventions.A questionnaire was completed by 794 Latino youth including a “pregnancy wantedness scale” (PWS) to assess attitudes toward an early pregnancy and socio-demographic variables. Regression analyses examined the association between these variables and PWS score. PWS scores for all groups were below but near the midpoint, suggesting ambivalence toward an early pregnancy. Being female, older, acculturated, using hormonal contraception, living with parents, and having an educated mother were significantly associated with lower PWS scores, but impacted youth differently depending on their sex and sexual experience. Multi-component Latino teen pregnancy prevention strategies should address behavioral and attitudinal differences based on sex and sexual experie...

OBJECTIVES To identify and compare key features of independent comprehensive state health surveys (SHS) with those of the Behavioral Risk Factor Surveillance System (BRFSS) for addressing the need for statewide and local population health data. METHODS We developed inclusion criteria, systematically collected information about federal and SHS that met these criteria, and obtained supplemental information from SHS leaders. RESULTS We identified comprehensive independent SHS in 11 states and BRFSS surveys in all 50 states. The independent SHS meet important statewide and local data needs, filling 3 key health data gaps in the BRFSS: lack of adequate data on special populations such as children, lack of data on specific localities, and limited depth and scope of health topics surveyed on key issues such as health insurance coverage. Unlike BRFSS, independent SHS have limited comparability with each other. CONCLUSIONS The BRFSS and independent SHS each meet some key state and local data needs but result in data gaps and inefficient use of resources. Surveys could more effectively and efficiently meet future needs for comparable data to monitor health care reform and address health disparities if they were coordinated across states and at the national, state, and local levels.

To determine the psychometric properties of a theoretically based continuing medical education (CME) evaluation instrument examining attitudinal determinants of physicians' changes in medical practices after a CME intervention. The instrument's scales represented constructs from the theory of planned behavior.The authors based the template instrument on educational objectives of the CME intervention and adapted it to the clinical domain of preoperative breast cancer therapy. Development of the initial survey involved cognitive testing, pilot tests, and expert reviews. The authors asked 269 clinicians to complete the 35-item instrument before the CME intervention. Factor analysis and item analysis guided the development of the final six subscales: positive behavioral beliefs, negative behavioral beliefs, attitude toward the behavior, perceived behavior control (self-efficacy), subjective norms, and behavioral intention.Cognitive testing and pilot tests ensured the accuracy and clarity of the language and a reasonable survey length. Of the 269 clinicians, 168 (134 physicians) responded. Scales clustered according to the theoretical constructs. Items not loading in any subscales were eliminated. The final 25 items loaded on six subscales with loadings0.54. Reliability for the subscales ranged from 0.73 to 0.93 (good for the scale development stage). The authors revised the instrument template and protocol after this initial study to increase the possibility of use in future CME evaluations.The levels of content and construct validity and reliability of the CME evaluation instrument are acceptable for evaluation of CME activities targeting physicians. Instruments adapted from this template could potentially evaluate future CME activities.

Objectives:The National Institutes of Health (NIH) Consensus Development Conference (CDC) was instituted to provide evidence-based guidance on controversial medical issues to researchers, health practitioners, and the public; however, the degree of impact this activity has on stimulating relevant research is unclear. This study examines the impact of CDC statements on the initiation of related NIH-funded research projects.Methods:Six CDCs from 1998 to 2001 were examined. Research initiatives related to the Conferences' topics were collected through two discrete methods: (i) the overall number of relevant pre- and postconference research activities was compiled using NIH's Information for Management, Planning, Analysis, and Coordination II (IMPAC II) and the Department of Health and Human Services' (DHHS) Computer Retrieval of Information on Scientific Projects (CRISP) grant application and award databases; (ii) for each CDC, the sponsoring institute's conference coordinator and other identified Program Directors were queried for their knowledge of new conference-specific research initiatives sponsored by their institute. The main outcome measure was the total number of requests for applications, requests for proposals, program announcements, broad agency announcements, notices, and funded investigator-initiated research program grants (RO1s) for a given Consensus topic in the 3 years before (baseline measure) and following (measure of impact) a CDC.Results:As identified through NIH's IMPAC II and DHHS' CRISP grants and announcements databases, the total number of relevant postconference research initiatives increased for five of six CDCs when compared with baseline activity levels; research activities remained constant for the sixth. When inclusion criteria were restricted to institute-identified research initiatives, two of six CDC topics had overall increases in relevant research activity in the postconference period.Conclusions:CDCs appear to have a positive impact on the stimulation of related NIH-funded research initiatives. Future outcomes evaluations using prospective data collection methods and more robust participation by sponsoring and cosponsoring institutes should strengthen the reliability of the association between new research initiatives on a given topic and their causal relationship to a given CDC.

To examine obstetrician-gynecologists' knowledge, opinions, and practice patterns related to cesarean delivery on maternal request.Questionnaires were mailed to 1,031 American College of Obstetricians and Gynecologists Fellows in February 2006, with a response rate of 68%. The questionnaire queried respondents' demographic characteristics, practices and attitudes surrounding vaginal and cesarean deliveries, knowledge and beliefs regarding the risks and benefits of elective and nonelective cesarean delivery, and counseling practices and department policies for cesarean delivery on maternal request.About half of respondents believe women have the right to cesarean delivery on maternal request, and a similar percentage acknowledge having performed at least one cesarean delivery on maternal request. Fifty-eight percent of respondents note an increase in patient inquiries regarding cesarean delivery over the past year, yet most of their practices do not have a policy regarding this procedure. Respondents attribute the increase in inquiries to the increase of information from the media and to convenience. Respondents cited more risks than benefits of cesarean delivery on maternal request, and nearly all discuss these risks with patients who are considering one. Females were more negative toward cesarean delivery on maternal request than males and endorsed more risks and fewer benefits. There were no relationships between assessment of risks and benefits or practice with clinician age or patient characteristics.Most obstetrician-gynecologists in this study recognized an increased demand for cesarean delivery on maternal request within their practices, while believing that the risks of this procedure outweigh the benefits. Clinicians would benefit from strong evidence regarding risks and benefits, evidence that is crucial to guiding policy making with regard to cesarean delivery on maternal request.III.

As the nation’s premier biomedical research agency, the National Institutes of Health (NIH) has supported most of the research that underlies the prevention services that are provided to citizens in the United States and around the world. Within the NIH, the Office of Disease Prevention (ODP) has as its mission to improve the public health by increasing the scope, quality, dissemination, and effect of prevention research supported by the NIH. In today’s environment, the ODP needs to focus its efforts to address this mission. To do so, the ODP has developed a strategic plan for 2014 to 2018. We provide background on the ODP and key points from the strategic plan.

CONTEXT There is high demand for local-level population health data. A national system of state and local data collection would help improve both population health and health care delivery. The primary source of state-level population health data for adults is the Behavioral Risk Factor Surveillance System. However, many states need data on children and adolescents, racial and ethnic subpopulations, consistent estimates for localities, or more in-depth information on key topics than the Behavioral Risk Factor Surveillance System provides. Eleven state health surveys (SHSs) have emerged in an effort to address these gaps. DESIGN Semistructured telephone interviews were conducted in 2009 with representatives of 9 SHSs. The interviews were recorded, and data were transcribed, organized, and analyzed according to the query structure. This analysis identified (1) the core elements of SHS that have been successful in meeting needs for local data and (2) the processes and strategies used by state officials in creating these surveys. RESULTS Key findings include the following: (1) SHSs provide concrete data on local health issues that meet the needs of policy makers who wish to adopt evidence-based public health policies; (2) data from SHSs allow researchers to identify issues, apply for grants, and evaluate, assess, and track health indicators; (3) a "champion" is required to build the case for a survey and push through barriers to obtain funding and stakeholder buy-in; and (4) SHSs face challenges such as inconsistent funding and lack of uniform standards. CONCLUSION Opportunities to support SHSs include (1) identifying sustained funding sources; (2) providing technical assistance and facilitating training to foster best practices, quality standards, and comparability across states; and (3) supporting an organization for SHS researchers to share resources, information, and experiences.

Snacking has long been considered a chief characteristic of the adolescent lifestyle. Studies have shown that between 60% and 87% of all U.S. adolescents consume at least one snack per day, with a range of one to seven snacks daily. 1-3 According to a national survey, 4 the top snacks selected by teens include potato chips, ice cream, candy, cookies, breakfast cereal, popcorn, crackers, soup, cake, and carbonated beverages. Fruits and vegetables are chosen less often at snack time than are other food categories? In general for adolescents, meals have been found to have greater nutrient density for key nutrients compared with snacks. Studies have also shown between one fourth and one third of the energy intake of adolescents comes from snacks. Recently, comparison of periodic national surveys has suggested that foods eaten between meals are making an increasing contribution to total food intake among all age groups. 1’2 Concern has been expressed about the quality of the teenage diet. Dietary excesses of fat, sugar, cholesterol, and sodium are common among U.S. adolescents and are found in all income and ethnic groups and both sexes. ~,6 In addition, inadequate dietary intakes of certain vitamins (folate, A, E, B6) and minerals (calcium, magnesium, zinc

OBJECTIVES. The results of an evaluation of "Eat for Health," a supermarket nutrition intervention, are presented. The study tested whether such a program could be successfully carried out and whether it could effect changes in knowledge, attitudes, and food purchasing behavior in line with nutrition and cancer risk reduction guidelines. METHODS. The evaluation consisted of an in-store monitoring element, an in-store and telephone consumer survey, and an analysis of sales data on selected foods. A matched-pair design, using a total of 40 stores in the intervention and comparison groups, was used. RESULTS. The intervention was successfully implemented and had limited success in changing some food purchasing behaviors. There appeared to be no effect on knowledge and attitudes except for increased awareness of a link between diet and cancer and of the program itself. CONCLUSIONS. Despite the intervention's success, limitations of the consumer survey and sales data analyses and the continuing diffusion of nutrition messages throughout society make it difficult to specify the impact of this program on consumer nutrition knowledge and behaviors.

To determine obstetrician-gynecologists' practice patterns of cesarean delivery on maternal request (CDMR) following the 2006 National Institutes of Health (NIH) State-of-the-Science conference on this topic, and compare them with those in their practice prior to the conference.Questionnaires were mailed to 612 American College of Obstetricians and Gynecologists fellows who participated in a 2006 preconference survey, with 59% responding. The survey assessed demographic characteristics, practice, attitudes, knowledge regarding potential risks and benefits, counseling practices, and department policies with regards to CDMR.The majority of obstetrician-gynecologists in our sample continues to believe that a woman has the right to CDMR, but fewer than in 2006 would agree to perform this procedure. In general, obstetrician-gynecologists associate more risks and fewer benefits with CDMR than in 2006.Some physicians have shifted their perception of CDMR risks and benefits since the NIH State-of-the-Science conference; however, practice patterns have not changed significantly.

A 2-year supermarket intervention in 20 pair-matched stores tested whether a nutrition education program could produce changes in food purchasing behavior. Food sales data for 2 intervention years were compared with baseline year data. The evaluation presented challenges related to the quasi-experimental study design and to the high variability and auto- and cross-sectional correlations in the data. A complex time series model was used to take these factors into account and to test for intervention effects.

Introduction: Physicians spend a considerable amount of time in Continuing Medical Education (CME) to main- tain their medical licenses. CME evaluation studies vary greatly in evaluation methods, levels of evaluation, and length of follow-up. Standards for CME evaluation are needed to enable comparison among different studies and to detect factors influencing CME evaluation. Methods: A review of the CME evaluation literature was conducted on primary research studies published from January 2000 to January 2006. Studies assessing only satisfaction with CME were excluded, as were studies where fewer than 50% of the participants were practicing physicians. Thirty-two studies were included in the analy- ses. Determinations were made about evaluation methods, outcome measures, and follow-up assessment. Results: Only 2 of 32 reviewed studies addressed all evaluation levels: physician changes in knowledge and atti- tudes (level 2), practices (level 3), and improved patient health status (level 4). None of the studies using self- developed instruments (n = 10) provided reliability and validity information. Only 6 studies used validated scales. Twenty studies had a follow-up period of 6 months or less, and 11 had a follow-up period between 1 and 2 years. Discussion: A gold standard for evaluating the effectiveness of CME would include assessment of all 4 levels of evaluation. A valid, reliable, and adaptable CME evaluation questionnaire addressing variables in the second level is needed to allow comparison of effectiveness across CME interventions. A minimum 1-year postintervention fol- low-up period may also be indicated to investigate the sustainability of intervention outcomes.

The National Adolescent Student Health Survey (NASHS) provides information on student knowledge, attitudes, and self-reported practices of eighth and 10th grade students in eight health areas. Data from the NASHS were reviewed relative to cancer risk factors, specifically, smoking, smokeless tobacco use, and nutrition. About 21% of 10th grade students reported smoking and a large percentage of both eighth and 10th grade students reported eating foods high in fat. The data indicate youth may be at increased risk for cancer and that much of that risk can be reduced by eliminating smoking and lowering dietary fat.

Clinical trials using interferon to treat human malignancies are currently hampered by limited supplies of the compound. We have utilized a human tumor cloning system as an assay for the antitumor effects of human leukocyte interferon. Interferon was tested against 62 patients' tumors growing in this soft agar system. A dose-dependent cytotoxic effect of interferon was noted against only five of the patients' tumors. A greater than or equal to 70% decrease in tumor colony-forming units (TCFUs) was noted with one lymphosarcoma cell leukemia, one small cell lung cancer, one adenocarcinoma of the lung, one breast cancer, and a pancreatic cancer. One patient had his tumor cultured in vitro and had a clinical trial with interferon. This patient whose tumor demonstrated in vitro sensitivity had a clinical antitumor effect with interferon therapy. The in vitro results in this study suggest that the human leukocyte interferon currently available has a low level of activity in a human tumor cloning system. Additional testing is needed to determine whether the cloning system can identify the patient(s) who might have an antitumor effect from the interferon.

The American Cancer Society (ACS) Plan for Youth Education for the Year 2000 is discussed in consideration of other health initiatives such as the U.S. Dept. of Health and Human Services' Objectives for the Nation and the National Cancer Institutes' Cancer Control Objectives for the Year 2000. Objectives of the ACS Plan are detailed with corresponding data sources to monitor progress. The Plan is designed to serve as a framework for ACS program planning, implementation, and evaluation in substance use, nutrition and eating patterns, cancer — early detection, cancer — the disease, and the environment. Justification for selecting the priority program areas also is described.

The purpose of this study was to determine the effects that a controlled-usage alcohol education program had on a university population. The program was developed incorporating factors of the Health Belief Model (HBM) and persuasive communication strategies. Observation in the form of a questionnaire occurred during the second, fourth, and ninth weeks of the academic quarter. The results of the multivariate analysis of variance demonstrated the overall effectiveness of the program. Univariate comparisons between experimental and control groups demonstrating statistical significance (p < .05) were behavioral intention towards responsible alcohol use and knowledge about alcohol. Discussion of the results and recommendations for further research are reported.

Though implementing health education in schools has numerous advantages, many barriers impede adoption of effective curricula. Diffusion theory provides a framework for understanding why some school systems do not implement comprehensive, sequential, and behaviorally oriented curricula. Reasons for failure to provide optimal health education include competition for time, unawareness of resources and research results, political considerations, long-range planning difficulties, lack of teacher training, lack of testing, other academic priorities, uncertainty about responsibility for health education, and costs. Health educators can overcome such difficulties by working within existing curricular agendas, political interests, and budgets, and by organizing interventions through school health councils, while recognizing local programs, conditions, and resources.

The total resting plasma catecholamine concentration from 13 drugfree, depressed patients was found to be significantly elevated over concentrations from 47 normal controls. Differential determinations of epinephrine and norepinephrine revealed that both catecholamine components were elevated in the Patients. The literature on norepinephrine concentrations in brain, spinal fluid, and urinary excretion was reviewed and indicated that rather than being decreased, norepinephrine has been found to be either unchanged or increased in depressed patients.

A sensitive and specific double-isotope dilution method for assaying norepinephrine and epinephrine separately is described. The method is based on enzymatic conversion of these two catecholamines to their respective metanephrines and was applied successfully to measurement of resting plasma concentrations of norepinephrine and epinephrine in normal subjects with the finding that norepinephrine (0.20 ± 0.08 µg/liter) normally constitutes approximately 80% of the plasma catecholamine content and epinephrine (0.05 ± 0.03 µg/liter) 20%.