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Purpose: This study is a formative evaluation of an adolescent online e-cigarette prevention program (Clearing the Vapor) giving attention to identifying higher risk adolescent populations, confirming the theory of change, and assessing short-term outcomes. Design/methodology/approach: The evaluation was conducted using online pre-test and post-test survey data collected from adolescent program participants age 10-18 from 2019 to 2021. Analyses included risk ratios on perceived risk, self-efficacy, and behavioral intentions across demographic variables. Pre-test and post-test comparisons were conducted with analysis involving the t-test and the McNemar test. Findings: Prevalence of e-cigarette use was higher among males, older adolescents, and in racial/ethnic groups other than Whites and Asians. Adolescents with lower confidence to say "no" were more likely to use e-cigarettes. Greater perception of harm by using e-cigarettes increased the likelihood of adolescents feeling competent to explain to peers the harmful effects of e-cigarettes. Mean change in commitment levels to not use e-cigarettes increased for males and females, all ages, and racial/ethnic groups other than non-Hispanic Blacks and American Indians. Improvement in non-Hispanic Whites was significantly greater than for non-Hispanic Blacks, American Indians, and Hispanics. Originality/value: Improvement in programming should give careful attention to the incorporation of more prevention activities and to materials tailored specifically to racial/ethnic participants. As a theory of change, findings support the utility of the Clearing the Vape prevention programming to address perceptions of harm that e-cigarettes are safe, confidence in explaining the harmful effects of use, and the development of skills to resist use.

Purpose: The aims of this study were: (1) to quantify variability in voice production (as measured acoustically) within and across consecutive days in vocally healthy female speakers; (2) to identify which acoustic measures are sensitive to this variability; and (3) to identify participant characteristics related to such voice variability. Method: Participants included 45 young women with normal voices who were stratified by age, specifically 18-23, 24-29, and 30-35 years. Following an initial acoustic and auditory-perceptual voice assessment, participants performed standardized field voice recordings 3 times daily across a 7-day period. Acoustic analyses involved 32 cepstral-, spectral-, and time-based measures of connected speech and sustained vowels. Relationships among acoustic data and select demographic, health, and lifestyle (i.e., participant-based) factors were also examined. Results: Significant time-of-day effects were observed for acoustic analyses within speakers (p < 0.05), with voices generally being worse in the morning. No significant differences were observed across consecutive days. Variations in voice production were associated with several participant factors, including improved voice with increased voice use; self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality; and worse voice with regular or current menstruation, depression, and anxiety. Conclusions: This acoustic study provides essential information regarding the nature and extent to which healthy voices vary throughout the day and week. Participant-based factors that were associated with improved voice over time included increased voice use, self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality. Factors associated with worse voice production over time included regular or current menstruation, and depression and anxiety.

Purpose: The primary aim of this study was to obtain high-quality acoustic normative data in natural field environments for female voices. A secondary aim was to examine acoustic measurement variability in field environments. Method: This study employed a within-subject repeated-measures experimental design that included 45 young female adults with normal voices. Participants were stratified by age (18-23, 24-29, and 30-35 years). After initial evaluation and instruction, participants completed voice recordings during seven consecutive days using a standard protocol, including both connected speech and sustained vowels. Thirty-two cepstral-, spectral-, and time-based acoustic measures were acquired using Praat and the Analysis of Dysphonia in Speech and Voice. Results: Among the 958 total recordings, greater than 90% satisfied inclusion criteria based on protocol compliance, peak clipping, and signal-to-noise ratio. Significant differences were observed for age (p < 0.05). For 19 acoustic measures, values improved significantly as signal-to-noise ratio increased. Cepstral- and spectral-based measures demonstrated less measurement variability as compared with time-based measures. Conclusions: With adequate training, field audio recordings represent a viable option for clinical voice management. The significant age effects observed in this study support the need for more specific criteria when collecting and applying normative data. Cepstral- and spectral-based measures demonstrated the least measurement variability. This study provides additional evidence for multiparameter acoustic voice measurement, specifically toward ecologically valid sampling in natural environments. Future studies should expand on these findings in other populations with normal and disordered voices.

Objective: Differentiating adductor laryngeal dystonia (ADLD) and primary muscle tension dysphonia (pMTD) can be challenging. Unlike pMTD, ADLD is described as "task-dependent" with voiced phonemes purportedly provoking greater sign expression than voiceless phonemes. We evaluated the ability of two automated acoustic measures, the Cepstral Spectral Index of Dysphonia (CSID) and creak, to detect task dependency and to discriminate ADLD and pMTD. Method: CSID, % creak, and listener ratings of dysphonia severity were obtained from audio recordings of patients with ADLD (n = 29) or pMTD (n = 33) reading two sentences loaded with either voiced or voiceless phonemes. Results: Group × Sentence Type interaction effects confirmed that both "normalized" CSID and % creak detected task-dependent sign expression in ADLD (i.e., worse symptoms on the voiced- vs. voiceless-loaded sentence). However, a stepwise binary logistic regression analysis with group (ADLD vs. pMTD) as the dependent variable and % creak and normalized CSID variables (voiced, voiceless, and voiced vs. voiceless difference) as covariates revealed that the normalized CSID voiceless-laden sentence z score was the only significant predictor of group membership. Estimates of diagnostic precision from the normalized CSID voiceless sentence z scores were superior to % creak or listener ratings. Finally, the CSID possessed the strongest correlations with listener severity ratings regardless of group or sentence type. Conclusions: Although both normalized CSID and % creak detected taskdependent performance as a distinguishing feature of ADLD, a CSID profile wherein (a) the voiceless sentence z score was less severe than the voiced sentence and (b) the normalized voiceless sentence z score was within approximately 2 SDs (or less) of typical expectations provided the best estimates of diagnostic precision. Automated acoustic measures such as the CSID and creak provide useful information to objectively discriminate ADLD and pMTD. [ABSTRACT FROM AUTHOR]

This study examined physician attitudes and practices pertaining to patient counseling about smoking in Belgrade, Serbia. Data were collected using a cross-sectional survey of 86 physicians at multiple health care facilities. Approximately 74% of physicians agreed that they should routinely ask patients about their smoking habits and 79% agreed that physicians should routinely advise their smoking patients to quit smoking. However, only 35% of the physicians regularly counseled with their patients about smoking. Previous tobacco-cessation counseling training and being female both directly increased the likelihood of physicians regularly counseling patients about smoking, but age and smoking status did not significantly influence physician counseling about smoking. Physicians who received previous training were 3.3 (95% CI = 1.7-6.4) times more likely to regularly counsel their patients about smoking than those who had not received training; and female physicians were 6.8 (95% CI = 2.2-20.7) times more likely than male physicians to regularly counsel their patients about smoking. Previous tobacco-cessation counseling training was associated with a greater likelihood of feeling well-prepared to assist patients to quit smoking (49% vs. 20%; P less than 0.0001). In turn, the likelihood of regularly counseling their patients about smoking was 81% for those who felt well-prepared, 39% for those who felt somewhat prepared, and 2% for those who felt unprepared (P less than 0.0001). Hence, tobacco-cessation counseling training increases confidence, which, in turn, increases patient counseling about smoking. (Contains 2 tables.)

Background: The Coronary Health Improvement Project (CHIP) is designed to lower cardiovascular risk factors among a group of generally healthy individuals through health education. Purpose: This study will evaluate the efficacy of the CHIP intervention at improving eating, sleep, stress, and depressive disorders. Methods: A health education randomized experimental study was used, with 348 participants, ages 24 to 81 years, from metropolitan Rockford, Illinois. Results: Higher Beck Depression Inventory (BDI) scores at baseline were significantly associated with being overweight, being physically inactive, eating little or no breakfast, eating fast, sleeping less than six hours per night, restless sleep, insomnia, very few vacations, feeling under pressure, being easily emotionally upset, feeling muscular tension, and feeling fearful or depressed. Each of these items showed a significantly greater improvement through six weeks and six months among those in the intervention group compared with the control group. BDI scores through six weeks and six months of follow-up were also significantly lower among those in the intervention group compared with the control group. Discussion: Selected eating and sleep practices were associated with depression. Eating little or no breakfast has been associated with health-compromising behaviors that may increase stress and depression. The health education intervention designed to reduce cardiovascular risk improved eating and sleep practices and reduced stress and depression. Translation to Health Education Practice: Lifestyle change programs such as CHIP aimed at improving physical health behaviors can likewise have a profound influence on mental health. (Contains 3 tables and 1 figure.)

Background: There is some debate over the efficacy of alcohol industry parenting manuals. Purpose: This study compares the content and focus of alcohol industry and non-industry "talk to your child about drinking" parenting manuals. Methods: Parenting manuals from Anheuser-Busch and Miller Brewing Company were compared to federal government and private health agency manuals (e.g., the National Council on Alcoholism and Drug Dependence and a joint project by the Department of Health and Human Services and the Ad Council). Independent reviewers read each page from the manuals and coded how frequently alcohol-related problems and potentially sensitive public health perspectives were mentioned. Tabulations were converted in rates of mentions per 1000 words. Results: Although the industry parenting manuals analyzed in this study advised parents to "get the facts," they provided substantially fewer reasons why teens should not drink and showed significantly lower rates of mention for most problems compared to non-industry manuals. They also avoided potentially sensitive public health perspectives on underage drinking, whereas the non-industry manuals devoted considerable attention to these issues. Discussion: This preliminary study suggests that when alcohol companies control the alcohol education agenda, major omissions are made, only selected risks are communicated, and the public health dimensions of the problem are minimized. Translation to Health Education Practice: Health educators should be aware of the vast range of topic coverage and focus available in parenting manuals on underage drinking when considering use of such material. (Contains 2 tables and 1 figure.)

UNICEF data indicates that Iraqi women have lower rates of breastfeeding than other Middle East countries and that breastfeeding rates are usually even lower among refugee women. This low rate of breastfeeding may be a result of refugee women's lack of public and social support and access to health professionals. This study identifies Iraqi refugee women's barriers to breastfeeding, as well as the amount of breastfeeding education and support they received. Analyses are based on a cross-sectional survey of 80 Iraqi refugee women, currently residing in Amman, Jordan, ages 18 years of age and older who had given birth within the last year. Results indicated that the majority of these women did not receive education or assistance about breastfeeding from health professionals, family or friends before or after giving childbirth. Furthermore, relatives and friends not healthcare professionals were identified as having largest influence on the decision to breastfeed. In view of these women's unique situation, the development of a peer counseling program to meet the educational, health and social needs is recommended. Further investigation into how peer counseling programs can be used to help women in refugee situations is needed. (Contains 6 tables.)

This study explored the effectiveness of selected statistical measures at motivating or maintaining regular exercise among college students. The study also considered whether ease in understanding these statistical measures was associated with perceived effectiveness at motivating or maintaining regular exercise. Analyses were based on a cross-sectional survey of 546 students. Students identified the total number of disease cases as the most effective measure for motivating behavior change, followed by the risk ratio of developing disease, percentage of disease cases, ratio lifetime risk of developing disease, percentage lifetime risk of developing disease, and then lethality. The ordering of these statistical measures in terms of ease in understanding was total number of disease cases, risk ratio, percentage of disease cases, ratio lifetime risk, lethality, and finally percentage lifetime risk. Students who identified total number of disease cases as the best statistical measure for motivating behavior change were also significantly more likely to identify that measure as the easiest, of those considered, to understand. Likewise, students tended to consider the statistical measure they perceived as being easiest to understand as the best measure for motivating behavior change. (Contains 5 tables.)

This study identifies the extent that knowledge of selected study designs and elementary statistical techniques may assist readers in understanding the statistical component of articles in the "American Journal of Health Education." The frequency of and trend in use of selected statistical research designs and statistical methods is reported, based on 366 research and review articles in Volumes 25 to 34, covering 1994 to 2003, of the "Journal." Almost 85% of the articles employed a descriptive study design. An increase in cross-sectional surveys which was offset by a decrease in review articles over the study period characterized almost all of the descriptive study designs. Analytic study designs were represented primarily by clinical trials and quasi-experiments. Their use did not significantly increase over the study period. While descriptive statistics were present in over 83% of the articles, many other articles relied on statistics beyond the descriptive statistics, such as statistics associated with model validation (33.1%), the chi-square test (25.4%), ANOVA (17.2%), T-test/Z-test (16.9%), the Pearson correlation coefficient (15.3%), and the F-test (13.1%). Beyond these, no other statistical methods stand out from the rest as being favored among the authors of the "Journal." Epidemiologic statistical methods were less frequently used. The estimated annual percent change in the percentage of studies not employing statistical methods was -12.71 (95% CI: -23.23, -0.76). A significant increase in use was observed for measures of central tendency/dispersion, ANOVA, Pearson correlation coefficient, and the use of validity/reliability statistics for instrument validation. (Contains 2 figures and 3 tables.)

This study compares the rate of selected types of mental illnesses (stress, anxiety, depression) and sleep disorders (insomnia, sleep apnea) according to the status of eight male genital problems. Analyses utilize medical claims data for male employees aged 18 to 64 years of a large corporation, 2017 to 2021. Approximately 1,076 (7.3%) men per year have one or more genital problems. The most common being benign prostatic hyperplasia (BPH; 3.8%) and then erectile dysfunction (ED; 1.7%). For BPH patients, the rate experiencing stress, anxiety, depression, or a combination of these is 0.96%, 6.2%, 5.3%, and 5.1%, respectively. Corresponding rates for ED are 1.5%, 7.2%, 5.9%, and 7.5%. For BPH patients, the rate experiencing insomnia, sleep apnea, or both is 3.1%, 22.7%, and 2.0%, respectively. Corresponding rates for ED are 1.2%, 20.6%, and 2.2%. Male genital problems positively associate with having one or more mental illnesses (stress, anxiety, depression), except for hydrocele, with ED and penis disorder having the strongest associations. Male genital problems also positively associate with having insomnia and/or sleep apnea, except for infertility and orchitis, with BPH and ED having the strongest associations. The positive associations involving BPH and ED with mental illnesses are each more pronounced in the younger age group (18-49 vs. 50-64). Similar results are seen in the models involving sleep disorders. Thus, comorbid male genital problems, mental illnesses, and sleep disorders exist, with the strength of associations unique to the male genital problem and sometimes modified by age. [ABSTRACT FROM AUTHOR]

Purpose: Vocal hyperfunction, related to abnormal laryngeal muscle activity, is considered the proximal cause of primary muscle tension dysphonia (pMTD). Relative fundamental frequency (RFF) has been proposed as an objective acoustic marker of vocal hyperfunction. This study examined (a) the ability of RFF to track changes in vocal hyperfunction after treatment for pMTD and (b) the influence of dysphonia severity, among other factors, on the feasibility of RFF computation. Method: RFF calculations and dysphonia severity ratings were derived from pre- and posttreatment recordings from 111 women with pMTD and 20 healthy controls. Three vowel-voiceless consonant-vowel stimuli were analyzed. Results: RFF onset slope consistently varied as a function of group (pMTD vs. controls) and time (pretherapy vs. posttherapy). Significant correlations between RFF onset cycle 1 and dysphonia severity were observed. However, in many samples, RFF could not be computed, and adjusted odds ratios revealed that these unanalyzable data were linked to dysphonia severity, phonetic (vowel-voiceless consonant-vowel) context, and group (pMTD vs. control). Conclusions: RFF onset appears to be sensitive to the presence and degree of suspected vocal hyperfunction before and after therapy. The large number of unanalyzable samples (related especially to dysphonia severity in the pMTD group) represents an important limitation.

Background: Bullying is a global problem among children and adolescents. The purpose of this study was to explore bully victimization in Peru and to identify potential adverse mental health and social outcomes resulting from bully victimization. Methods: This study analyzed data from an ongoing prospective cohort of children taking part in the Young Lives study. This study assessed bullying consequences on mental and emotional health in the 3 rounds of data collected among Peruvian adolescents at ages 8, 12, and 15. Results: Bullying by peers was negatively related with age. A factor analysis showed that boys were significantly less likely than girls to suffer emotional and relational problems due to victimization. Additionally, bullying in rounds 2 and 3 of the cohort were significantly correlated with adverse emotional and mental health outcomes in round 3. Lastly, emotional status was positively associated with violent incidences in the schools and at home. Conclusions: This study shows significant problems with emotional and mental stress as early outcomes associated with victimization in Peru. The findings have implications for treating adolescent health issues like peer victimization. Steps should be taken to address bullying and mental/emotional health in Peru in order to combat subsequent mental health problems.

Objectives: This study examined the effects of a combination corticosteroid plus long‐acting beta2‐adrenergic agonist inhaler (IC) on rabbit phonation. Methods: White New Zealand male rabbits were assigned randomly to experimental and control groups (n = 11 per group). The experimental group received twice‐daily doses of Advair HFA™ (fluticasone propionate 45 mcg and salmeterol 21 mcg) via a veterinary facemask with 1‐way valve and spacer; the control group received aerosolized saline. After 8 weeks, animals were euthanized, larynges excised, frozen, and subsequently thawed and mounted on a standard bench apparatus. Phonation was elicited during 15 successive trials, and phonation threshold pressure (PTP; cmH2O) and flow (PTF; L/min) were quantified. Results: Repeated measures analysis of variance indicated significant differences between the experimental and control groups (p < 0.05). Mean PTP and PTF values were higher (worse) for rabbits that received Advair HFA™. Conclusion: Following 8‐week exposure to ICs, rabbit larynges required greater air pressure and flow to initiate phonation. Because even modest phonation onset differences can have a meaningful clinical impact on voice function, these findings suggest that LABA ICs may put patients at risk for voice disorders. Furthermore, these voice disorders may occur within a relatively short timeframe. The results from this study have important clinical implications for voice care in those who use ICs. Level of Evidence: NA Laryngoscope, 133:2680–2686, 2023 [ABSTRACT FROM AUTHOR]