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Mortality prediction models, which this author prefers to call outcome-risk assignment models, are ubiquitous in critical care practice. They are designed to assess the risk of dying for any given patient by assigning risk based on indices of physiological derangement, high-risk diagnoses or diagnostic categories, or the need for therapeutic intervention to support organ function. It is important to recognise that predictive models derived to date are not accurate enough to allow reliable prediction of individual patient outcome, and therefore cannot be used as criteria for admission to intensive care. Patients identified as high risk for mortality must be flagged for appropriate intensive intervention and close monitoring in order to reduce the risk of dying due to the current illness. [ABSTRACT FROM AUTHOR]

Background. Paediatric Index of Mortality (PIM) and PIM 2 scores have been shown to be valid predictors of outcome among paediatric intensive care unit populations in the UK, New Zealand, Australia and Europe, but have never been evaluated in the South African context. Objective. To evaluate the PIM and PIM 2 as mortality risk assessment models. Method. A retrospective audit of case records and prospectively collected patient data from all admissions to the Paediatric Intensive Care Unit (PICU) of Red Cross War Memorial Children's Hospital, Cape Town, during the years 2000 (PIM) and 2006 (PIM 2), excluding premature infants, children who died within 2 hours of admission, or children transferred to other PICUs. Results. For PIM and PIM 2 there were 128/962 (13.3%) and 123/1113 (11.05%) PICU deaths with expected mean mortality rates of 12.14% and 12.39%, yielding standardised mortality risk ratios (SMRs) of 1.1 (95% confidence interval (CI) 0.93 - 1.34) and 0.9 (95% CI 0.74 - 1.06), respectively. Receiver operating characteristic analysis revealed area under the curve of 0.849 (PIM) and 0.841 (PIM 2). 2 2 Hosmer-Lemeshow goodness of fit revealed poor calibration for PIM (? =19.74; p=0.02) and acceptable calibration for PIM 2 (χ² =10.06; p=0.35). SMR for age and diagnostic subgroups for both scores fell within wide confidence intervals. Conclusion. Both scores showed good overall discrimination. PIM showed poor calibration. For PIM 2 both discrimination and calibration were comparable to the score derivation units, at the time of data collection for each. Calibration in terms of age and diagnostic categories was not validated by this study. [ABSTRACT FROM AUTHOR]

Abstract The incidence of new AIDS diagnoses among gay males indicates that risk reduction in smaller communities may be lagging behind that reported in larger cities. Contradictory evidence exists, largely from urban areas, concerning the utility of HIV testing as a means of promoting behavioural change. This study examined the relationship between HIV antibody testing and subsequent high-risk sexual behaviours among gay men in cities of 180,000 or fewer inhabitants. In February and March of 1992, male gay bar patrons in sixteen small US cities were administered an anonymous questionnaire concerning recent sexual behaviour and HIV testing history. Of the 1820 respondents, 28.1 % had recently engaged in unprotected anal intercourse and 60.7% had been tested for HIV antibodies. Those who had been tested were more sexually active and reported more protected and safer sexual activities. Analyses at the individual and city levels converged to demonstrate that communities as well as individuals evidence increased self-protection in association with HIV antibody testing. [ABSTRACT FROM AUTHOR]

Background: Community-level interventions may be helpful in population-focused HIV prevention. If members of populations at risk of HIV infection who are popular with other members can be engaged to advocate the benefits of behaviour change to peers, decreases in risk behaviour may be possible. We assessed a community-level intervention to lower the risk of HIV infection, focusing on men patronising gay bars in eight small US cities.Methods: We used a randomised community-level field design. Four cities received the intervention and four control cities did not. Participants were men from each city who went to gay bars. Men completed surveys about their sexual behaviour on entering the bars during 3-night periods at baseline and at 1-year follow-up. In the control cities, HIV educational materials were placed in the bars. In the intervention cities, we recruited popular homosexual men in the community and trained them to spread behaviour-change endorsements and recommendations to their peers through conversation.Findings: Population-level of risk behaviour decreased significantly in the intervention cities compared with the control cities at 1-year follow-up, after exclusion of surveys completed by transients and men with exclusive sexual partners in a city-level analysis, in the intervention cities we found a reduction in the mean frequency of unprotected anal intercourse during the previous 2 months (baseline 1.68 occasions; follow-up 0.59: p = 0.04) and an increase in the mean percentage of occasions of anal intercourse protected by condoms (baseline 44.7%; follow-up 66.8%, p = 0.02). Increased numbers of condoms taken from dispensers in intervention-city bars corroborated risk-behaviour self-reports.Interpretation: Popular and well-liked members of a community who systematically endorse and recommend risk-reduction behaviour can influence the sexual-risk practices of others in their social networks. Natural styles of communication, such as conversations, brought about population-level changes in risk behaviour. [ABSTRACT FROM AUTHOR]

Purpose: This study examined factors associated with fecal occult blood test (FOBT) and sigmoidoscopy screening use among Chinese-American women age 60 years and older., Description of Study: One hundred women were recruited from senior centers in two metropolitan areas on the east coast of the United States. Participants completed a questionnaire that included sections on demographics, health history, health insurance coverage, FOBT and sigmoidoscopy use, common and cultural barriers to colorectal cancer screening, and acculturation., Results: Logistic regression models found greater acculturation to be a significant predictor of having had a FOBT at least once, and found both greater acculturation and physician recommendation to be significant predictors of having had a sigmoidoscopy at least once. No significant predictors were found for regular adherence to colorectal screening guidelines, which include having undergone an FOBT in the past year and sigmoidoscopy in the past 5 years., Clinical Implications: This study found that older Chinese-American women underuse FOBT and sigmoidoscopy screening, as is recommended by the American Cancer Society colorectal cancer screening guidelines. These findings suggest that cultural factors may influence the initiation of colorectal cancer screening for Chinese-American women but are not predictive of adherence to screening over time. Outreach efforts to promote colorectal cancer screening in this population might target women who are less acculturated to facilitate an initial entry into the Western healthcare system to obtain screening.

An adaptation of Andersen's behavioral model of health services utilization is used to examine the psychosocial and socio-demographic factors that directly and indirectly influence the likelihood of undergoing genetic susceptibility testing for cancer, and the amount of money that individuals would be willing to pay out-of-pocket for such a test. Apart from willingness and likelihood, the model also included perceived benefits and barriers, perceived susceptibility, dispositional optimism, information seeking, family history of cancer, socioeconomic status (SES), and age, and explained 30.3% of the variation in willingness. We found as hypothesized that likelihood of undergoing such tests was central to understanding willingness to pay. Being aware of genetic susceptibility testing for cancer, and talking and seeking information about it was directly associated with an increased chance of being willing to pay more, independent of other indirect associations (effects). Interventions targeting those with a family history of cancer and those with a higher SES should generate more awareness about the potential positive and negative consequences to one's family of testing, and the interface between family history of cancer and perceived susceptibility. Interventions should also motivate people to talk and seek more information about genetic testing for cancer risk to enable them take well-informed decisions.

Objective: To assess level of endorsement and expected consequences of worksite smoking restriction policies among correctional employees., Design: Mailed survey to Vermont state correctional employees., Main Outcome Measures: Support for various policy alternatives for both staff and inmate smoking; expected consequences of restrictive smoking policies and smoking behaviour., Participants: 321 of 640 (50%) state correctional employees responded., Results: Employees were somewhat receptive to smoking restrictions for inmates, but less supportive of staff smoking restrictions. A complete ban on inmate smoking both indoors and outdoors was supported by 56% and 49% of never and ex-smokers, respectively, but only 15% of current smokers (p < 0.01). A similar ban on employee smoking was supported by 38% of never and ex-smokers, but only 3% of current smokers (p < 0.01). Overall, employees were most supportive (52%) of a policy for themselves that banned indoor smoking and restricted it to certain areas outdoors. Current smokers were more likely to expect negative consequences as a result of further restrictions than were never or ex-smokers., Conclusions: Although our findings are limited by a low response rate, most employees support an indoor ban, but not a total ban on smoking. Employees generally favoured a policy that was slightly more restrictive than the current policy, but were less supportive of tighter smoking restrictions for themselves. However, a more restrictive smoking policy is likely to result in some degree of resistance among current smoking employees, who may require specific attention to address their opposition.

The use of hormone replacement therapy (HRT) is a controversial decision for many women, yet few studies have evaluated the socio-demographic, psychological, and behavioral correlates of HRT use. This cross-sectional, mailed survey evaluated the associations of socioeconomic status, preventive health behaviors, knowledge and perceptions about HRT-related risks and benefits with HRT use among 428 women 50-70 years old in Vermont. The overall prevalence of HRT use was 40%. Women of moderate to high income were three times more likely than those of low income to use HRT. HRT use was significantly higher among women whose physician had encouraged use (58%) than among those who received ambivalent recommendations from their physicians (20%). Hysterectomy, higher income, younger age, regular adherence to cervical cancer screening, and recommendation by a provider were significantly associated with HRT use in multivariate analyses. There were no differences in HRT use according to level of concern about heart disease, osteoporosis, or breast cancer. A recommendation by a health care provider is a powerful predictor of HRT use, but disparities in use exist by socioeconomic status. Future research should examine why lower income women are less likely to use HRT and whether the discrepancy is due to inconsistent recommendations by health care providers.

Background: This study examined screening utilization at least once and regular adherence to mammography, clinical breast exam, and breast self-exam among older Chinese-American women., Method: One hundred women were recruited from senior centers in two metropolitan cities. Participants completed a questionnaire that included sections on demographics, health history, health insurance coverage, breast cancer screening, common and cultural barriers to screening, and acculturation., Results: Logistic regression models found insurance coverage for mammography and acculturation to be significant predictors of having had a mammogram at least once. Low perceived need/lack of physician recommendation and recency of physical examination were significant predictors of having had a mammogram in the past year. Acculturation and modesty were significant predictors of having had a clinical breast exam at least once, while recency of physical examination was a significant predictor of having had a clinical breast exam in the past year. Reliance on medial professionals for screening and forgetting were significant predictors of having performed breast self-exam at least once, and forgetting was a significant predictor of regular performance of breast self-exam., Conclusions: These findings suggest that both common and cultural barriers play a role in breast cancer screening among older Chinese-American women, with cultural factors being more influential in the initiation of cancer screening behavior., (Copyright 2000 American Health Foundation and Academic Press.)

Background: This study tested the impact of free nicotine patches plus proactive telephone peer support to help low-income women stop smoking., Methods: A total of 214 Medicaid-eligible women smokers of childbearing age were randomized to receive free nicotine patches through the mail or free nicotine patches through the mail plus the provision of proactive support by telephone from a woman ex-smoker for up to 3 months. Assessments were conducted by telephone at baseline, 10 days, and 3 and 6 months after enrollment., Results: At the 3-month follow-up, significantly more women in the patch plus proactive telephone support condition were abstinent (42%) compared to the patch only condition (28%) (P = 0.03). Similarly, more women in the experimental condition were abstinent at both the 10-day and 3-month assessments (32 v 19%, P = 0.02). However, differences were not found at the 6-month follow-up, suggesting that the addition of proactive telephone peer support enhanced short-term, but not long-term cessation., Conclusions: This is the first study to demonstrate a beneficial effect for the addition of proactive telephone support as an adjunct to free nicotine replacement in a low-income population., (Copyright 2000 American Health Foundation and Academic Press.)

Objectives: This intervention was implemented to reduce the prevalence of cigarette smoking among women., Methods: We used community organization approaches to create coalitions and task forces to develop and implement a multicomponent intervention in 2 counties in Vermont and New Hampshire, with a special focus on providing support to help women quit smoking. Evaluation was by pre-intervention and post-intervention random-digit-dialed telephone surveys in the intervention counties and the 2 matched comparison counties., Results: In the intervention counties, compared with the comparison counties, the odds of a woman being a smoker after 4 years of program activities were 0.88 (95% confidence interval = 0.78, 1.00) (P = .02, 1-tailed); women smokers' perceptions of community norms about women smoking were significantly more negative (P = .002, 1-tailed); and the quit rate in the past 5 years was significantly greater (25.4% vs 21.4%; P = .02, 1-tailed). Quit rates were significantly higher in the intervention counties among younger women (aged 18 to 44 years); among women with household annual incomes of $25,000 or less; and among heavier smokers (those who smoked 25 or more cigarettes daily)., Conclusions: In these rural counties, community participation in planning and implementing interventions was accompanied by favorable changes in women's smoking behavior.

Background: Health professionals are credible sources of smoking cessation advice. This study describes changes in health professionals' reported provision of smoking cessation counseling activities for women during a community health education project that took place in two intervention counties (I) and compares these to reports from health professionals in two similar comparison counties (C)., Methods: Specific smoking cessation activities reported by physicians (I n = 73, C n = 73), dentists (I n = 51, C n = 46), dental hygienists (I n = 38, C n = 44), family planning and WIC (Special Supplemental Food Program for Women, Infants and Children) counselors (I n = 14 C n = 16), and community mental health counselors (I n = 57, C n = 23) were assessed by mailed surveys at baseline, after 4 years of countywide interventions, and 2 years later., Results: Compared with health professionals in the comparison counties, significant increases in smoking cessation training (P < 0.01) and in reported referral of women to stop smoking groups, support groups, and one-to-one support were noted for physicians, family planning, and WIC counselors (P < 0.001); in training and referral to stop smoking groups and support groups by dentists and dental hygienists (P < 0.05); and in referral to support groups by community mental health counselors (P < 0.05). Significant increases in setting quit dates (P < 0.05) and providing self-help materials (P < 0.01) were also noted for family planning and WIC counselors. These effects were no longer demonstrable 2 years after external support for the countywide interventions was withdrawn., Conclusions: We suggest that an important aspect of facilitating consistent smoking cessation advice and counseling from health professionals in the future will be the provision of a broader range of regularly available smoking cessation support systems within communities than is generally available at this time in the United States., (Copyright 2000 American Health Foundation and Academic Press.)

Background: Studies on public perceptions of genetic susceptibility testing for cancer risks are few and tend to focus on specific cancer risks of higher-risk populations, ignoring the general population and their perceived risk of getting any cancers. This study develops and tests a psychosocial model of the proximal and distal influences on likelihood of undergoing genetic susceptibility testing for cancer risk among a population-based sample., Methods: The sample consisted of 622 adults aged 18-75 interviewed by telephone. The survey instrument included measures derived from the Health Belief Model and adaptations of existing measures from the literature. Data were analyzed using structural equation modeling techniques., Results: The model suggested independent main effects for perceived benefits, perceived barriers, perceived susceptibility, and pessimism while simultaneously accounting for the effects of age, socioeconomic status, family history of cancer, and awareness of the existence of genetic susceptibility testing for cancer risk. The model explained 34% of the variance in likelihood., Conclusions: While perceived benefits, perceived barriers, perceived susceptibility, and pessimism may directly impact likelihood, they may also mediate the effects of age, socioeconomic status, family history of cancer, and awareness of cancer genetic susceptibility testing, on likelihood., (Copyright 2000 American Health Foundation and Academic Press.)

Objective: To determine baseline variables associated with low intentions of stopping smoking early in pregnancy., Design: Cross sectional survey., Participants: Pregnant smokers pooled across seven Smoke-Free Families trials (n = 1314)., Results: 36% of pregnant smokers had low intentions of stopping smoking within the next 30 days. In contrast to pregnant smokers with higher intentions of quitting, pregnant smokers with low intentions were less confident in their ability to quit, less likely to have private health insurance, and less likely to agree that smoking harms the unborn child. They were more likely to smoke heavily, more likely to have fewer years of education, and more likely to have friends and family members who smoke., Conclusions: Three options to smoking cessation assistance are proposed for pregnant smokers with low intentions of quitting: targeting, triage, and tailoring. Further research is needed to determine which approach is most appropriate.

Objectives: Women in impoverished inner-city neighborhoods are at high risk for contracting HIV. A randomized, multisite community-level HIV prevention trial was undertaken with women living in 18 low-income housing developments in 5 US cities., Methods: Baseline and 12-month follow-up population risk characteristics were assessed by surveying 690 women at both time points. In the 9 intervention condition housing developments, a community-level intervention was undertaken that included HIV risk reduction workshops and community HIV prevention events implemented by women who were popular opinion leaders among their peers., Results: The proportion of women in the intervention developments who had any unprotected intercourse in the past 2 months declined from 50% to 37.6%, and the percentage of women's acts of intercourse protected by condoms increased from 30.2% to 47.2%. Among women exposed to intervention activities, the mean frequency of unprotected acts of intercourse in the past 2 months tended to be lower at follow-up (mean = 4.0) than at baseline (mean = 6.0). These changes were corroborated by changes in other risk indicators., Conclusions: Community-level interventions that involve and engage women in neighborhood-based HIV prevention activities can bring about reductions in high-risk sexual behaviors.

Objective: To describe and apply a process evaluation model (PEM) for patient education programs for pregnant smokers., Methods: The preparation of a process evaluation plan required each program to define its essential "new" patient assessment and intervention procedures for each episode (visit) of patient-staff contact. Following specification of these core implementation procedures (p) by each patient education program, the PEM, developed by the Smoke-Free Families (SFF) National Program Office, was applied. The PEM consists of five steps: (1) definition of the eligible patient sample (a); (2) documentation of patient exposure to each procedure (b); (3) computation of procedure exposure rate (b/a = c); (4) specification of a practice performance standard for each procedure (d); (5) computation of an implementation index (c/d = e) for each procedure. The aggregate of all indexes (e) divided by the number of procedures (P(n)) produced a program implementation index (PII = Sigmae/P(n))., Participants and Settings: Data from four SFF studies that represent different settings were used to illustrate the application of the PEM., Results: All four projects encountered moderate to significant difficulty in program implementation. As the number and complexity of procedures increased, the implementation index decreased. From initial procedures that included patient recruitment, delivery of the intervention components, and conducting patient follow ups, a variety of problems were encountered and lessons learned., Conclusion: This process evaluation provided specific insight about the difficulty of routine delivery of any new methods into diverse maternity care setting. The importance of pilot testing all procedures is emphasised. The application of the PEM to monitor program progress is recommended and revisions to improve program delivery are suggested.

This study examined cultural factors as predictors of breast self-examination (BSE) and participation in cervical cancer screening in young Asian and Caucasian women in the United States. Comparisons between Asian and Caucasian samples revealed significant differences in ever performing BSE and obtaining a pap test; the Caucasian women reported higher participation in both behaviors. Factor analysis of cultural barriers to screening revealed four factors: communication with mother, openness around sexuality, prevention orientation, and utilization of Western medicine. Logistic regression predicting BSE performance from demographics, acculturation, and cultural barriers revealed openness around sexuality to be a significant predictor. Pap test participation was predicted by year in college, ever having engaged in sexual intercourse, prevention orientation, and global acculturation. Cultural factors should be considered in programs to enhance participation in cancer screening.

Small Group Education (SGE) to promote breast cancer screening was implemented in a community-wide program. Based on diffusion of innovations theory, SGE initially was directed toward women at higher occupation and education levels and then progressively shifted toward more vulnerable populations of women at risk of not getting screening. During the four-year intervention, 116 volunteers led SGE presentations, with 8,184 women participating in 740 groups at work sites, organizations, residences, and churches. High participation in SGE and positive participant responses suggest that delivery of SGE using a social diffusion model was an effective method for reaching women throughout the community.

Background: This study prospectively examined rates of adherence to mammography, clinical breast examination (CBE), and breast self-examination (BSE) in a cohort of women over 3 years to determine whether participation in BSE influenced participation in the other two screening modalities., Methods: Women ages 51 and older (n = 450) who attended a small group educational session to learn BSE and to hear about CBE and mammography guidelines were assessed annually by telephone for 3 consecutive years to determine their subsequent breast cancer screening behavior., Results: Annual CBE and mammography screening are highly positively associated. Regular performance of BSE has a modest positive association with both CBE and mammography adherence over time., Conclusions: Women who perform BSE regularly over time may be more likely to adhere to the other breast cancer screening guidelines.

Background: Physicians' advice to help pregnant women quit smoking during prenatal care has had mixed results. Training and prompting physicians to provide consistent advice and referral to on-site support might improve cessation rates., Methods: Pregnant women who smoked were randomly assigned to receive structured advice from their physician and referral to individual behavior change counseling during prenatal care or to receive brief advice to stop smoking and a quit smoking booklet at their first visit. Smoking status was measured by self-report, exhaled carbon monoxide, and urinary cotinine., Results: Compared with usual care, greater proportions of intervention group women reported not smoking at the 36th-week visit (14% vs 10%) and at 1 year postpartum (18% vs 11%), but these differences were not significant. However, significantly greater proportions of intervention group women reported either not smoking or reducing their cigarette consumption by 50% or more at their second visit (43% vs 29%, P = 0.02), at their 36th-week visit (40% vs 25%, P < 0.01), and at 1 year postpartum (26% vs 14%, P = 0.02)., Conclusions: Physician training on how to gain a pregnant smoker's commitment to change her smoking behavior, an office prompt system, and individualized smoking behavior change counseling show promise in reducing smoking during pregnancy and postpartum, but practical methods to assist pregnant smokers between regular prenatal visits, as they attempt to quit, need to be developed.

Background: This study analyzed influences on state legislators' decisions about cigarette tax increase votes using a research strategy based on political science and social-psychological models., Methods: Legislators from three states representing a spectrum of tobacco interests participated in personal interviews concerned with tobacco control legislation (n = 444). Measures of potential predictors of voting intention were based on the consensus model of legislative decision-making and the theory of planned behavior. Multiple logistic regression methods were used to identify social-psychological and other predictors of intention to vote for cigarette tax increases., Results: General attitudes and norms concerning cigarette tax increases predicted legislators' intention to vote for cigarette tax increases. More specific predictors included perceptions of public health impact and retail sales impact of cigarette tax increases. Constituent pressure was the strongest perceived social influence. Political party and state also were strong predictors of intention. Results were consistent with related research based on political science models., Conclusions: Legislators' votes on cigarette tax increases may be influenced by their perceptions of positive and negative outcomes of a cigarette tax increase and by perceived constituent pressures. This research model provides useful insights for theory and practice and should be refined in future tobacco control research.

This study examined the relative impact of different self-reward strategies on maintenance of breast self-examination (BSE) practice among 1649 women trained to do BSE. Training groups were randomized into four conditions: (a) self-reward instructions and materials delivered at the end of the BSE training session; (b) self-reward suggestions delivered through the mail each month, contingent upon the BSE performance; (c) external monetary rewards and self-reward suggestions delivered through the mail each month on an intermittent schedule, contingent upon BSE practice; and (d) a no-reward control condition. Follow-up assessments 12 months following training revealed a pattern of evidence in support of the benefits of external monetary rewards and self-reward prompts on BSE frequency and quality; however, it is likely that the value of that condition lies in the external reward component.

The predictive validity of state legislators' behavioral intentions in relation to their votes on tobacco control legislation was assessed by using the theory of planned behavior (I. Ajzen, 1991). Intentions to vote for cigarette tax increases were measured through interviews in the summer of 1994. A bill containing cigarette tax increases was considered about 8 months later. Votes were compared with intentions and were found to be consistent for 78% of these legislators (N = 120). Multiple logistic regression analyses showed a strong independent relationship between intentions and voting and a similar effect of political party; results suggested but did not confirm that votes were predicted by interactions between intentions and perceived control. Legislator surveys that use this conceptual model can provide results relevant to understanding tobacco policy development.

This exploratory study examined the acceptability and efficacy of a videotape modeling smoking cessation as an adjunct to smoking cessation advice delivered during prenatal care. In a randomized controlled trial involving 60 women, we compared the delivery of brief smoking cessation advice and a tipsheet to the same advice and tipsheet plus provision of the videotape. Outcomes included opinions about content and acceptability of the videotape, and smoking behavior change during pregnancy. The most highly endorsed features of the videotape were seeing other women quitting smoking (77%), dealing with stress and bad feelings (69%), talking about what to do with urges to smoke (69%), and discussing ways to get support from families and friends (54%). The reported quit rate in the last month of pregnancy, validated by exhaled carbon monoxide levels, and including women lost to follow-up as smokers, was 19.2% in the intervention group and 0% in the comparison group (p = .02). This study suggests that the use of videotapes modeling smoking behavior change may increase the effectiveness of the assistance in quitting smoking that is generally available in obstetric and family practices or public maternity clinics.

This article describes the development of a mass media smoking prevention intervention targeted primarily toward adolescent girls at increased risk for smoking and assesses its outcomes. A cohort of 5,458 students was surveyed at baseline in Grades 4-6 and annually for 4 years. Through diagnostic and formative research, media messages were created to appeal especially to girls. Students beginning in Grades 5-7 received the 4-year media intervention and a school program in two communities, while students in two matched communities received the school program alone. Media targeting techniques resulted in high levels of message appeal and exposure consistent with effects on mediating variables and 40% lower weekly smoking at Grades 8-10 for girls receiving the media and school interventions compared to school alone. Smoking behavior effects were maintained at Grades 10-12. These results indicate that mass media interventions targeting specific audience segments can reduce substance use behavior for those segments.

Background and Objectives: To examine prevalence and predictors of condom use and human immunodeficiency virus (HIV) test seeking among women living in inner-city housing developments., Study Design: Between April and June 1994, 671 women living in low-income housing developments in five cities in the United States completed an anonymous self-report questionnaire eliciting information on acquired immune deficiency syndrome (AIDS) risk behavior and characteristics indicative of risk., Results: Most participants were women of color who were economically disadvantaged. Fifteen percent reported multiple sex partners, and 30% of women with one sex partner believed he had sex with someone else in the past year. Predictors of condom use included increased rates of safe-sex negotiation, stronger risk reduction intentions, absence of condom barrier beliefs, and multiple sex partners. Women tested for HIV in the past year were younger, perceived themselves to be at risk for HIV infection, reported more conversations with other women about AIDS concerns, and had condoms readily available., Conclusions: HIV public health prevention interventions are urgently needed for women who live in low-income urban housing developments.

Introduction: Our objectives were (1) to examine the relationship between women's intention of stopping smoking in the next month and a broad range of mediating variables and (2) to assess the implications of these relationships for intervention components of a comprehensive community-wide health education program to help women quit smoking., Methods: In preparation for the community-wide program to help women quit smoking, baseline data were collected through a random digit dialing telephone survey of 6,324 adult women, 18-64 years of age., Results: At baseline, smoking prevalence, defined as smoking an average of one or more cigarettes per day, was 25.8% and showed clear relationships with age and income, but most strikingly with education, indicating the need for programs for women of childbearing age with low incomes and fewer years of schooling. Among female smokers, knowledge of the health effects of smoking; motivations toward quitting; confidence in controlling weight, or handling stress, anger or boredom; number of strategies named to cope when upset of angry; number of community smoking cessation resources named; perceptions of support for quitting; and perceptions of norms concerning women smoking varied significantly with level of intention to quit smoking in the next month., Conclusions: These relationships provided support for the broad range of health behavior change strategies proposed for this community-based program to help women quit smoking.

This study examined the effects of a smoking cessation intervention on stages of change in 349 low-income, pregnant women. At first prenatal visit, women were randomized into experimental or usual care condition and classified by stage of change: precontemplation, contemplation, preparation, or action. For each stage of change at the first prenatal visit, the stage distributions of the experimental and usual care groups were compared at the second and 36-week prenatal visits. Kruskal-Wallis tests revealed significant differences at the second visit in the stage distributions by condition for subjects who were initially in precontemplation or in preparation. In each case, a greater proportion of experimental than usual care subjects advanced through the stages. The shift was not maintained at the 36-week visit.

Research investigating HIV-risk sexual behaviors of men who have sex with men usually combines gay and bisexual men, treating them as a single, homogeneous group. However, gay and bisexual men may differ in their HIV risk behavior and in psychological characteristics indicative of risk. Exclusively gay (N = 1,180) and bisexual men (N = 136) completed anonymous surveys at gay bars. The surveys assessed demographic, psychological, and behavioral data related to sexual behavior and HIV risk. Relative to exclusively gay men, bisexual men had lower intentions to use condoms in their next intercourse occasion, reported a greater frequency of oral sex with men and more oral-sex partners, knew fewer people who were HIV positive, and perceived weaker peer norms favoring safer sex and risk avoidance. One-third of bisexual men reported engaging in unprotected anal intercourse, and 17% of bisexual men had multiple unprotected anal sex partners in the past two months. Interventions tailored to the needs of bisexual men are urgently needed and should focus on increasing intentions to use condoms, increasing HIV-risk sensitization, and fostering norms favoring safer sex and risk avoidance.

A sample of 671 predominantly single, young black women living in 10 low-income housing developments in five cities completed an anonymous questionnaire assessing factors related to their risk of contracting the human immunodeficiency virus, including their sexual behavior and condom use, and their partners' risk-related behaviors. In the two months before the 1994 survey, 17% of the women had sex with multiple partners and 22% had an exclusive partner who either had had other sexual partners in the past year or had a history of injection drug use; 40% had an exclusive partner who they believed had not engaged in these risky behaviors. During the same interval, 26% of women who had multiple partners received treatment for a sexually transmitted disease, compared with 9-11% of those who had an exclusive relationship. Condom use at last intercourse and communications about condom use were less frequent among women with an exclusive, risky partner than among those with multiple partners; attitudinal barriers to condom use did not vary, however, by the characteristics of women's relationships.

The authors used a questionnaire to assess gender differences in barriers to condom use among 198 female and 89 male heterosexual undergraduate college students. Participants were divided into three groups--consistent users, inconsistent users, and nonusers--based on their reported condom use. Factor analyses on each gender revealed similar barrier factor structures, but the barriers explained more of the variance in condom use among women than among men. Of the 9 or 10 predictors assessed, the low perceived need barrier was the most powerful predictor of condom use for both genders. Male and female participants who were nonusers, in a current monogamous relationship, and using oral contraceptives were more likely to report a low perceived need to use condoms. Implications for future research are discussed.

Six hundred and thirty smokers who intended to quit smoking themselves completed pre-cessation measures of self-efficacy, partner support, daily stresses and demographics. Subjects were contacted at 2, 7, 14, 30, 90 and 180 days post-cessation to determine smoking status and to re-administer the measures at 7, 14 and 30 days post-cessation. A series of logistic regression examined which prospective factors best predicted relapse between 0-2 days, 3-7 days, 8-14 days, 15-30 days, 31-90 days and 91-180 days. Relapse was predicted by different variables at different times; however, self-efficacy was a consistent predictor of relapse over time.

Our objective was to examine the efficacy of the added effect of individualized smoking relapse prevention counseling on obstetricians' and nurse midwives' usual advice during prenatal care. One hundred and seventy-five pregnant women who were smoking early in their pregnancy, but had quit by first prenatal visit, were randomly assigned to receive the usual advice from their obstetrician or nurse midwife, or usual advice plus individual relapse prevention counseling. Smoking status was measured by self-report, by urinary cotinine/creatinine ratio at the 36-week visit, and by self-report at long-term postpartum follow-up. We found that a smaller percentage of women in the intervention group (8.8%) reported smoking at the thirty-sixth-week visit than those in the usual care group (16.9%), a nonsignificant difference. No significant difference in relapse rates during pregnancy was observed based on urinary cotinine/creatinine ratios, but these rates, 29.5% and 27.9% respectively, were substantially higher than those based on self-report. The average number of days abstinent reported by women in the intervention group was significantly longer than that in the usual care group, 199 days versus 166 days respectively (P < .01). Logistic regression analysis indicated that longest time abstaining before first visit, level of belief in smoking's harm to the fetus, and motivation to smoke were independently related to the probability of relapsing to smoking by the 36-week visit. Long-term relapse rates were not significantly different: intervention group, 50.9%, usual care group, 50.0%.(ABSTRACT TRUNCATED AT 250 WORDS)

Nearly 6,000 men entering gay bars in 16 small American cities were anonymously surveyed to assess their sexual behavior and to determine predictors of risky sexual practices. Excluding individuals in long-term exclusive relationships, 27% of the men reported engaging in unprotected anal intercourse in the past 2 months. Factors strongly predictive of risk included having a large number of different male partners, estimating oneself to be at greater risk, having weak intentions to use condoms at next intercourse, believing that safer sex is not an expected norm within one's peer reference group, being of younger age, and having less education. These findings indicate that HIV prevention efforts are urgently needed for gay men in smaller cities, with efforts particularly focused on young and less educated men sexually active with multiple partners. Prevention should focus on strengthening intentions to change behavior and on changing social norms to foster safer sex.

Assessed condom use, barriers to condom use, oral contraceptive use, partnership status and STD history in 457 15-30 year-old women attending four family planning clinics. Subjects were classified into three condom use groups: Non Users (37%); Current Users (33%); and Past Users (30%). Factor analysis revealed five barriers to condom use: Partner's Perception, Peer's Perception, Pleasure/Intimacy, Communication, and Low Perceived Need. Multivariate analyses revealed significant group differences on only two barrier factors: Pleasure/Intimacy and Low Perceived Need. Low Perceived Need accounted for 13.5% of the variance in condom use. Women with low perceived need to use condoms were more likely to use oral contraceptives.