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For the four leading causes of death in the United States (heart disease, cancer, stroke and chronic respiratory disease), tobacco use is a common risk factor. Tobacco use is responsible for almost 450,000 deaths per year and impacts the health of every member of our society. Tobacco is a gateway drug for substance abuse. That role is critical to revisit and revalidate. From 490 schools, a total of 175,460 students in grades 6-12 participated in an alcohol, tobacco and other drug use survey, the descriptive analyses of the data being stated in a 2007 technical report. The secondary analyses of the data clearly demonstrated that a dose-response relationship pattern of association existed between increasing quantity of cigarette use and the use of alcohol and other drugs. Additionally, logit analysis revealed that selected demographic and other variables were statistically significant predictors of the past month's use of cigarettes. The secondary analyses were replicated for the 2008 survey, in which 152,732 students responded to the same questionnaire. Similar results were obtained. Smoking is a major risk factor to the leading causes of death and sufficient empirical evidence establishes that tobacco is a gateway drug. To combat tobacco use, a comprehensive ecological approach, including tobacco education and cessation, enacting and enforcing smoke-free policies, and increasing taxes on tobacco products, is recommended. (Contains 3 tables and 2 figures.)

The purpose of this study was to examine prevalence of eating breakfast and associated health compromising behaviors. This study utilized a cross-sectional survey methodology. A purposive cluster sampling technique was utilized to collect data from a representative sample of college students in a Midwestern university in the U.S. A total of 1,257 college students with a response rate of 85% participated in the study. The questionnaire, consisting of 22 closed ended question was adopted from health related literature. These questions measured demographic and health compromising behaviors such as drinking, smoking, eating breakfast. Data were analyzed using descriptive statistics, chi squared and logistic regression. Place of living significantly influenced the health compromising behaviors such as number of hours sleeping, drinking, and smoking. Over one-fifth of the sample reported never eating breakfast. Logistic regression analysis indicated that sleeping less than 5.5 hours [odds ratio (OR): 2.76; 95% CI: 1.50, 5.09], drinking alcohol once a week [odds ratio (OR): 2.05; 95% CI: 1.43, 2.95], currently smoking [odds ratio (OR): 2.38; 95% CI: 1.59, 3.58], never exercising [odds ratio (OR): 3.99; 95% CI: 2.3, 6.63], and frequency of regular soda consumption [odds ratio (OR): 5.56; 95% CI: 2.91, 10.63] were associated with irregular breakfast eating. (Contains 3 tables.)

Background: We examined the longitudinal trajectory of substance use (binge drinking, marijuana use, and cocaine use) in relation to self-esteem from adolescence to young adulthood. Methods: Generalized estimating equation models were fit using SAS to investigate changes in the relation between self-esteem and each substance use (binge drinking, marijuana use, and cocaine use) from adolescence to young adulthood. Data were drawn from the 3 waves of the National Longitudinal Study of Adolescent Health, a nationally representative sample of middle and high school students in the United States (N = 6504). Results: Self-esteem was a significant predictor for the use of all 3 substances at 15 years of age (ps < 0.001). However, at age 21, self-esteem no longer predicted binge drinking and marijuana use in the controlled model. Conclusions: It appears that self-esteem loses its protective role against substance use except cocaine use as adolescents transition to young adulthood.

Since Congress passed .08 blood alcohol concentration (BAC) as the national standard for impaired driving in October 2000, 28 U.S. States including Indiana have enacted .08 BAC law. This study investigated perceived impact of the .08 law among Indiana residents and their attitudinal and perceptional changes since the enforcement of the law. The focus of this study was to examine demographic differences in these changes. Using random-digit dialing that included unpublished numbers and new listings, a representative sample of 525 adult Indiana residents ages 18 or older was interviewed. Of the total respondents, 61% (n=320) reported having 12 or more drinks in a year, 15% (n=81) reported a decrease in the number of alcohol drinking occasions compared to their drinking behavior before the passage of the .08 law and 30% advocated further reduction of the legal limit of impaired driving below .08 g/dl, which reflects the perception of increased safety. Even though 38% of the total respondents expressed that the BAC law should be enforced only when drinking and driving was a factor in an accident, 75% acknowledged that their driving skills became worse after consuming a couple of drinks. Chi-square and logistic regression analyses indicated that gender, education and income were significant predictors for the majority of attitudinal and perceptional outcome variables regarding drinking and driving or .08 BAC law whereas race/ethnicity, age, employment status, religion and political views contributed little to the prediction. (Contains 4 tables.)

This study examined emotional and perceptional changes American people had experienced 10 to 12 months after the September 11 (9-11) terrorist attacks. A nationally representative sample of 807 U.S. adults ages 18 or older was interviewed using random-digit dialing that included unpublished numbers and new listings. The results indicated that 5 to 8% of the respondents had probable posttraumatic stress disorder symptoms such as angry outbursts, trouble falling asleep, difficulty concentrating, and experiencing nightmares even 10 to 12 months after the attacks. Twenty-two percent reported more frequent life-threatening perceptions and 50% more concerns about personal safety than before the 9-11 attacks. Chi-square and logistic regression analyses indicated that gender, age, race/ethnicity, geographic region, and employment status were significant predictors for experiencing differential emotional and perceptional changes. (Contains 3 tables.)

Amaneh Mahmoudian,1 Razieh Torabi Chafjiri,2 Atefeh Alipour,3 Abbas Shamsalinia,4 Fatemeh Ghaffari5 1Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; 2Guilan University of Medical Sciences, Rudsar Shahid Ansari Hospital, Rudsar, Guilan, Iran; 3Mazandaran University of Medical Sciences, Imam Sajjad Hospital, Ramsar, Mazandaran, Iran; 4Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; 5Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Introduction: Older adults with chronic disease are more vulnerable to abuse. Early and accurate detection of the elderly abuse phenomenon can help identify health-promoting solutions for the elderly, their family, and society. The purpose of this study was to design and evaluate the psychometric properties of a questionnaire on elderly abuse by family caregivers among older adults on hemodialysis.Methods: Qualitative and quantitative research methodologies were used to develop the questionnaire. The item pool was compiled from literature reviews and the Delphi method. The literature reviews comprised 22 studies. The psychometric properties of the questionnaire were verified using face, content, and construct validity, and the reliability was tested using Cronbach’s alpha reliability.Results: A 57-item questionnaire was developed after the psychometric evaluation. The Kaiser–Meyer–Olkin index and Bartlett’s test of sphericity showed reliable results. Seven components from the exploratory content analysis including psychological misbehavior, authority deprivation, physical misbehavior, financial misbehavior, being abandoned, caring neglect, and emotional misbehavior explained 74.769% of the total variance. Cronbach’s alpha was 0.98 and the interclass correlation coefficient was r=0.91 responding to the items twice (p

Razieh Torabi Chafjiri,1 Nasrin Navabi,2 Abbas Shamsalinia,2 Fatemeh Ghaffari2 1Gilan University of Medical Sciences, Rudsar Shahid Ansari Hospital, Rudsar, Gilan, Iran; 2Ramsar Nursing Care Research Center, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Mazandaran, Iran Introduction: Stroke is a chronic condition that necessitates multidimensional and overwhelming care. The caregivers of stroke patients are faced with various stressors that can threaten different aspects of their health, especially their mental health. Spiritual attitude and being spiritually oriented contribute significantly to mental health and can be used as a strategy for adapting to the stressful events that are part of the role of caregiving. This study was therefore conducted to investigate the relationship between the spiritual attitude of the family caregivers of older patients with stroke and their burden.Methods: This descriptive cross-sectional study was conducted in 2016. The study population consisted of all the family caregivers of older patients with stroke presenting to health care centers and nursing service companies of Gilan Province in Iran. The participants were selected through convenience sampling and consisted of 407 participants. Data were collected using the Spiritual Attitude Scale and the Caregiver Burden Inventory and were then analyzed in SPSS-18 using Pearson’s correlation coefficient at a significance level of 0.05.Results: The results showed that 88.9% of the caregivers were females. The mean age of the participants was 38.3±8.8 years. The duration of caregiving was

Objective: To identify levels of moderate-intensity physical activity (MPA) and vigorous-intensity physical activity (VPA) in a representative sample of college students in six East Asian economies and examine their relationship with weight, alcohol consumption and cigarette smoking. Design: Cross-sectional survey. Setting: College students recruited from 21 different colleges in six East Asian economies. Method: Self-reported physical activity, weight, height, alcohol consumption, and smoking were assessed using already-validated instruments. Multiple logistic regression models of MPA and VPA were separately performed for each economy, controlling for age, gender, living area before college, military experience, paid employment, and religion. All the analyses were performed using SAS 9.2 with clustering effects accounted for. Results: Being a heavy drinker increased the odds of engaging in VPA in five economies (adjusted odds ratio [AOR] = 1.56 to 2.65). Cigarette smoking was not associated with MPA in any economy and was only associated with VPA in China (AOR = 1.54) and Taiwan (AOR = 1.48), indicating that smokers are more likely to engage in VPA than non-smokers. Conclusions: The relationship between college students' VPA and alcohol consumption and between MPA and cigarette smoking is similar across the East Asian economies, whereas the relationship between VPA and smoking varies substantially.

Purpose: The purpose of this study was to determine if intravenous push (IVP) administration of piperacillin-tazobactam reduced the time to antibiotic administration compared to intravenous piggyback (IVPB) in emergency department (ED) patients who present with sepsis. Methods: This was a retrospective cohort study of patients with sepsis who received piperacillin-tazobactam before and after implementation of an IVPB to IVP conversion protocol. Results: A total of 486 charts were reviewed and the final analysis included 127 patients in each group. The mean time to administration of piperacillin-tazobactam was 67 (± 48) minutes and 58 (± 36) minutes in the IVPB and IVP cohorts, respectively (P = NS). The time to administration of secondary antibiotics was reduced by 38 minutes in patients who received piperacillin-tazobactam by IVP (105 min ±69 vs 67 min ±37; P <.001). Nurse administration time was reduced by 11 min for piperacillin-tazobactam (54 min ±46 vs 43 min ±33; P =.034) and 40 min for secondary antibiotics (90 min ±67 vs 50 min ±32; P = <.001) in the IVP group. There was no difference in hypersensitivity reactions, hospital length of stay, or mortality. Conclusion: Conversion from piperacillin-tazobactam IVPB to IVP was associated with a reduction in time to piperacillin-tazobactam and secondary antibiotic administration in emergency department patients with sepsis. Further prospective research is needed to evaluate clinical outcomes associated with IVP administration. [ABSTRACT FROM AUTHOR]

Purpose: A secondary analysis of 2000 and 2004 Indiana Youth Tobacco Survey (IYTS) data was conducted to investigate salient environmental and perceptual correlates of adolescents' current and established smoking while controlling for demographic variables such as gender, grade, and race/ethnicity and to compare the pattern of significant correlates between the years. Methods: The IYTS was an anonymous school-based survey regarding tobacco use; familiarity with pro- and anti-tobacco media messages; exposure to environmental tobacco smoke (ETS); minors' access to tobacco products; and general knowledge, attitudes, and beliefs about tobacco. In 2000, a representative sample of 1416 public high school students in grades 9-12 and 1516 public middle school students in grades 6-8 (71.44% and 72.53% response rates, respectively) were surveyed. In 2004, 3433 public high school students and 1990 public middle school students (63.04% and 65.44 % response rates, respectively) were surveyed. Results: Significant predictors of adolescents' current and established smoking habits included exposure to ETS either in homes or in cars, exposure to pro-tobacco messages, perceived benefit of smoking, and perceived peer acceptance of smoking. The influence of exposure to pro-tobacco messages greatly outweighed exposure to any anti-tobacco messages. Conclusions: The findings of this study warrant that more efforts and resources be placed on preventing youth from being exposed to ETS, and to control pro-tobacco marketing and improve the tobacco counter-marketing messages. The perceived benefits of smoking found here indicate that smoking for relaxation and weight control may be major influencing factors on adolescent smoking. (Contains 6 tables.)

Background: To investigate the correlates of youth tobacco use in terms of nonsmoking adolescents' openness to future smoking, a secondary analysis of the 2000 and 2004 Indiana Youth Tobacco Survey (IYTS) was conducted. Methods: A representative sample of 1416 public high school students in grades 9-12 and 1516 public middle school students in grades 6-8 (71.44% and 72.53% response rates, respectively) were surveyed in 2000, and 3433 public high school students and 1990 public middle school students (63.04% and 65.44% response rates, respectively) were surveyed in 2004. Results: Seventy-four percent of students in 2000 were not open to future smoking and 77% were not open in 2004. The adolescent cohort in 2004 became more exposed to antitobacco messages and less exposed to protobacco messages and environmental tobacco smoke (ETS) compared with their counterpart in 2000. Whereas gender, grade, race/ethnicity, and exposure to antitobacco messages were insignificant predictors for openness to future smoking, exposure to ETS either in homes or in cars was a strong predictor for openness to future smoking (the higher the exposure to ETS, the more open to future smoking) in both unadjusted and adjusted multivariate models. Exposure to protobacco messages had a greater effect on openness to future smoking than exposure to antitobacco messages. The rate of transition from openness to future smoking to tobacco use initiation is higher among white adolescents than among minority adolescents. Conclusions: More efforts should be made to reduce adolescents' exposure to ETS and protobacco messages. (Contains 3 tables.)

Objective: To examine the prevalence and trend of inhalant use among Indiana public school students. Methods: The Alcohol, Tobacco, and Other Drug Use among Indiana Children and Adolescents surveys conducted annually between 1991 and 2004 were reanalyzed using 2-way moving average, Poisson regression, and ANOVA tests. Results: The prevalence had increased during 1991-1997, decreased during 1997-2002, and increased again since 2003. Poisson model estimated an average annual decrease rate of 5.6%. The intensity of inhalant use had also decreased. More males and Hispanics use inhalants. Conclusion: Inhalant use needs to be addressed in drug prevention programs.

There has been no research linking implementation of a public smoking ban and reduced incidence of acute myocardial infarction (AMI) among nonsmoking patients. An ex post facto matched control group study was conducted to determine whether there was a change in hospital admissions for AMI among nonsmoking patients after a public smoking ban was implemented in Monroe County compared with Delaware County, Indiana without such a ban. Poisson analysis was conducted for 44 months of hospital admissions. A significant drop occurred in the number of admissions among nonsmoking patients in Monroe County after the ban whereas a non-significant decrease in the number of admissions occurred in Delaware County. The changes in the number of smoking-patient admissions before and after the ban were not significant. (Contains 2 tables.)

With in-vehicle use of cell phones rapidly increasing, the safety of young drivers, who represent 14% of licensed drivers but 26% of drivers involved in fatal crashes, may be disproportionately threatened. The authors used a questionnaire to examine the association between in-vehicle cell-phone use and accidents or near-accidents among 1,291 conveniently recruited college students in 4 states. Of the 1,185 respondents who were drivers, 87% had a cell phone, and 86% of the cell-phone owners reported talking while driving at least occasionally. Of the 762 reported accidents or near-accidents, 21% (n = 159) involved at least 1 of the drivers talking while driving. Chi-square tests and logistic regression analyses showed that the frequency, not the duration, of drivers talking while driving was related to experiencing accidents or near-accidents. Differences between drivers who used cell phones and nonusers in unsafe driving behaviors and attitudes were also examined, and target groups for intervention efforts against talking on a cell phone while driving are suggested.Key Words: cell-phone use, college students, safe driving, talking while driving

Objectives: To develop valid and reliable alternate forms to measure college students' attitudes toward health. Methods: Final scale, composed of 2 different but equivalent 15-item forms, was administered to 2 sets of college students. The mixed format of 30 items was administered to one sample of college students whereas a pre-post format was administered to another set of students. Results: Item analysis showed adequate internal consistency of each subscale for both forms. Equivalent form reliability coefficients were .91 and .88. Factor analyses confirmed the 3 underlying constructs of the scale. Conclusions: Statistical analyses demonstrated the comparability of the alternate forms.

Since the terrorist attacks of September 11, 2001 (9-11), terrorism poses a continuous threat to those living in the United States. A substantial number of people may have experienced behavioral and life changes since the attacks, with possible implications for public health. This study investigated behavioral and life changes American people have experienced since the attacks. Using random-digit dialing that included unpublished numbers and new listings, a nationally representative cross-sectional sample of 807 U.S. adults ages 18 or older was interviewed. Logistic regression analyses indicated that gender, age, race/ethnicity, and employment status were significant predictors for experiencing different outcome variables. The qualitative data obtained from an open-ended question regarding life changes were analyzed and synthesized. The 9-11 events have considerably affected Americans' lifestyles and behavior, which may have various implications for public health policy makers and educators. (Contains 2 tables.)

Examined attitudes and knowledge among U.S., Thai, Costa Rican, and Puerto Rican female college students regarding breast self-examination (BSE). Students completed surveys before and after watching an instructional video on BSE. BSE practice was low in all four countries. Students considered BSE a necessary part of individual healthy behaviors. There was no relationship between BSE and preventive health practices. (SM)

Evaluated the use of videotape for HIV/AIDS education in Russian schools, pretesting and posttesting students on their attitudes, knowledge, and practices related to HIV/AIDS and their HIV/AIDS education at school. Results confirmed a lack of HIV/AIDS education and insufficient information sources (parents, friends, and public health). Video education significantly improved students' knowledge and attitude scores. (SM)