Positive and Negative Outcome Expectations of Smoking: Implications for Prevention

Background. To inform the development of messages for tobacco prevention programs, we examined seven positive and five negative outcome expectations of smoking as risk factors for smoking uptake.Methods. A cross-sectional, self-administered survey of 471 students in grades 6–12 who were never or experimental smokers was performed. Logistic regression was used to examine the relationship between outcome expectations and susceptibility to becoming a smoker in the future, a measure of intent and resistance to peer smoking.Results. A total of 36.1% of the sample was susceptible to smoking. All positive outcome expectations showed a strong and significant association with susceptibility. Students were most likely to be susceptible if they believed they would enjoy smoking (OR = 29.4). Three of the five negative outcome expectations were significantly associated with susceptibility, but the strength of these associations was much lower than that observed for the positive expectations (OR = 0.5 to 0.6). A strong belief in the negative outcomes of smoking did not alter the association between susceptibility and positive outcome expectations.Conclusions. These findings suggest that teaching adolescents and teens about the negative consequences of smoking is unlikely to change their intent to smoke. Preventive efforts should identify ways to address the positive expectations adolescents have about smoking, possibly by offering alternative means for achieving these outcomes.     

One of society's most vulnerable groups? A systematically conducted literature review exploring the vulnerability of deafblind people

The vulnerability of deafblind people is considered axiomatic; they are seen not only as a vulnerable group but also as one of the most vulnerable. This paper aims to synthesise existing knowledge to determine what is known about such vulnerability. A comprehensive literature search was undertaken between April 2013 and May 2014. The review method was informed by systematic review principles. An approach based on a ‘hierarchy of evidence’ would have reduced the amount of literature reviewed significantly, to the point where synthesis would not be possible. Included material was appraised and an interpretative rather than aggregative approach to synthesis adopted. Drawing on principles of critical interpretive synthesis, rather than being a determiner of whether material should be included or excluded, a critique of the literature is offered within the synthesis. Twenty‐eight references were identified for inclusion, originating from the UK, USA, Australia, Continental Europe and the Nordic Countries. No empirical studies specifically examining the experience of vulnerability of deafblind people were found. However, deafblind people describe feelings of vulnerability in studies exploring their experiences more generally, and in personal accounts of living with the impairment. Literature produced by practitioners and specialist organisations also explores the topic. Deafblind people are identified as a population ‘at risk’ of various adverse outcomes, particularly when compared to the non‐deafblind majority, and deafblind people describe being and feeling vulnerable in various situations. The literature largely relates to negative outcomes and includes significantly less exploration of positive risk taking, coping capacity and resilience. Deafblind people do not appear to describe themselves as being vulnerable as a permanent state, suggesting a need for greater exploration of the experience among all sections of this heterogeneous population, with consideration of the concepts of resilience and coping capacity.     

A randomized controlled trial of home visits by neighborhood mentor mothers to improve children's nutrition in South Africa

Malnourished children and babies with birth weights under 2500 g are at high risk for negative outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve nutritional outcomes for young children in South Africa. One “mentor mother” was recruited from each of 37 neighborhoods in Cape Town, South Africa. Mentor mothers were trained to conduct home visits to weigh children under six years old and to support mothers to problem-solve life challenges, especially around nutrition. Households with underweight children were assigned randomly on a 2:1 ratio to the Philani program (n?=?500) or to a standard care condition (n?=?179); selection effects occurred and children in the intervention households weighed less at recruitment. Children were evaluated over a one-year period (n?=?679 at recruitment and n?=?638 with at least one follow-up; 94%). Longitudinal random effects models indicated that, over 12 months, the children in the intervention condition gained significantly more weight than children in the control condition. Mentor mothers who are positive peer deviants may be a viable strategy that is efficacious and can build community, and the use of mentor mothers for other problems in South Africa is discussed.     

The Roles of Prevention Messages,Risk Perception,and Benefit Perception in Predicting Binge Drinking among College Students

To account for the effect of prevention-message exposure on binge drinking among college students, I hypothesized a conceptual model outlining potential mechanisms including perceived probability of negative consequences (PPNC), perceived severity of negative consequences (PSNC), perceived probability of positive consequences (PPPC), and perceived beneficiality of positive consequences (PBPC) from binge drinking, based on the two-step process model. I conducted an online survey at a public university in the US (N = 278). Findings suggested only PBPC was significantly related to binge drinking and the relationship was positive; prevention-message exposure was not directly associated with binge drinking, but was positively associated with PPNC, PSNC, PPPC, and PBPC; none of the mediational paths was significant; higher risk perception (interaction between PPNC and PSNC) was significantly related to less binge drinking, while benefit perception (interaction between PPPC and PBPC) was not predictive of binge drinking. Implications of findings were discussed.     

Preventing mother-to-child transmission in Guayaquil,Ecuador: HIV knowledge and risk perception

Abstract

An important step in preventing mother-to-child transmission is testing pregnant women for HIV. Health literacy measures, such as HIV knowledge and risk perception, may determine which women are tested in prenatal clinics where routine opt-out testing is not available. A survey was conducted in Guayaquil, Ecuador in 2006 (n=485), where approximately 0.7% of HIV tests in prenatal clinics were positive. Pregnant women over the age of 18 were invited to complete the survey in the waiting rooms at four city hospitals. There were 67.2% of women reported being tested previously for HIV. The most notable finding was that women who perceived a risk were 1.74 times more likely to request testing (p=0.021), but a woman's risk perception was not related to established risk factors. In addition, a physician's recommendation would result in the testing of nearly all women (94.3%). This data suggest that interventions in prenatal care clinics should incorporate educational strategies to increase accurate perception of personal risk. These efforts must occur in conjunction with increasing the access to HIV tests to achieve the goal of universal prenatal testing.     

A Comparison of Birth Outcomes Among US-Born and non–US-Born Hispanic Women in North Carolina

Objective: To compare birth outcomes between non–US-born and US-born Hispanic women in North Carolina (NC). Methods: A retrospective comparison of birth outcomes from linked NC birth/death certificate data (1993–1997) for 22,234 Hispanic births by mother's place of birth was conducted. Results: Mexico-born Hispanic women (58%) had significantly fewer medical risks, tobacco or alcohol use during pregnancy; however, they also had significantly less education and prenatal care than US-born Hispanic women (21%). Infant mortality rate, low birth weight, and prematurity were low and did not differ significantly. Lethal anomalies were the primary cause of infant mortality in non–US-born Hispanics versus Sudden Infant Death Syndrome (SIDS) in US-born Hispanics. Conclusions: Despite increased risk factors among US-born women, we found no difference in Hispanic birth outcomes in NC by mother's place of birth. These data contradict national data and may be related to findings of both positive and negative aspects of acculturation in NC.     

Alcohol Expectancies and the Personal and Parental Drinking Patterns of Women

ABSTRACT

Background and objectives: Successful employment outcomes for pregnant women result from a complex interplay between the woman, her employer, her prenatal care provider, laws and other influences.

Methods: A mail survey about management of employment during pregnancy was sent to directors of US residency programs that train prenatal care providers. Each physician was randomly assigned one of 4 vignette patients whose job involved prolonged standing, rotating shifts and lifting 40 lbs. Half the vignette patients had risk factors for preterm birth and half would have financial difficulty if placed on an unpaid antenatal leave.

Results: The 301 respondents estimated that they provide a written job restriction for 20% of their employed pregnant patients, although in 6 clinics the job restriction rate was 100%. For vignettes with preterm birth risk factors, 62.5% of physicians would always recommend a job restriction, 35.6% would do so sometimes, and 2.2% would rarely do so. When the vignette did not have risk factors for preterm birth, 21.5% of the physicians would always recommend a job restriction, 51.3% would do so sometimes, 25.9% would do so rarely and 1.3% would never do so. Economic factors were not associated with prescribing job restrictions. One in 5 of the residency programs provides no teaching on occupational health issues in pregnancy, and 65.1% provide 2 hours or less.

Conclusions: Variability in employment recommendations suggests that some women may not obtain the job modifications that they need, whereas others may be restricted unnecessarily. The limited curriculum time devoted to this topic may make it difficult to train physicians about complex employment issues during pregnancy.     

Preventing Teen Pregnancy Through Persuasive Communications: Realities, Myths, and The Hard-Fact Truths

Effective campaigns are desperately needed to combat the serious social problem of teen pregnancy. However, public health campaigns are most often noted for failures, rather than successes. One reason for a campaign failing to have the intended effect is lack of theoretical guidance at the formative evaluation stage. The study reported here is a theoretically-based formative evaluation with inner city teens. Six focus groups were conducted to determine knowledge, attitudes, beliefs, and recommendations for effective campaigns to deter teen pregnancy. The results indicate that campaign messages need to combat positive attitudes toward pregnancy, negative attitudes toward birth control, the perception of personal invulnerability, and emphasize the negative consequences of sexual intercourse. This study's findings also suggest that campaigns with these messages need to start at an early age in order to effectively prevent teen pregnancy.     

‘I can choose’: the reflected prominence of personal control in representations of health risk in Canada

Multidisciplinary research has contributed to a better understanding of the personal and societal correlates of risk perception. However, representations of ‘health risk’ remain to be characterised more fully. Drawing on a Canadian study conducted in 2004, an analysis was conducted to develop better characterisations of individual representations of health risk. The study involved a national telephone survey (N = 1503) and face-to-face semi-structured interviews with individuals across Canada (N = 73) in which participants’ representations of health, risk and health risk were elicited using a word association technique. In the telephone survey, it was found that representations of health risk were most frequently negative, with many participants referring to disease and illness. The concept of health risk was also associated with lifestyle, individual control and personal agency, suggesting that individual health behaviour and personal responsibility for health were prominent features of public discourse on health risk in Canada. However, subtle variations in representations of health risk were observed in analyses of semi-structured interviews, pointing to important differences according to age and gender in this specific discourse. There was agreement among participants that health risks were associated with individual vulnerability and menace to life or health, and that such vulnerability increased with age. However, women were less likely to focus on the idea of actively making choices to control health risks and less frequently made references to the positive aspects of health risks.     

The effect of special health care needs and health status on school functioning

BackgroundPast studies have shown that specific child conditions are associated with poor school outcomes. A national health survey with noncategorical measures of health and indicators of school functioning offers the opportunity to examine this association.ObjectivesTo compare links between two health measures (children with special health care needs and general health status) and multiple school outcomes.MethodsThe analysis was based on 59,440 children aged 6–17 years from the 2007 National Survey of Children's Health. Child health was assessed using the Children with Special Health Care Needs (CSHCN) screener and a question on general health status. CSHCN were classified by the complexity of their health care needs. Indicators of school functioning included special education use, many problem reports, repeated a grade, lack of school engagement, and many missed school days.ResultsOverall 22% of children were identified as CSHCN: 13% with more complex needs (C-CSHCN) and 9% with medication use only (CSHCN-RX). Approximately 17% of children were in less than optimal health. After controlling for a child's sociodemographic characteristics C-CSHCN had an increased risk of all of the negative school outcomes compared to children without SHCN, while CSHCN-RX had an increased risk of only one school outcome (many missed school days). Children in less than optimal health were at an increased risk of all negative school outcomes compared to children in optimal health.ConclusionsThe CSHCN screener and health status question identify related, but distinct, groups of children with worse outcomes on the indicators of school functioning.