A Voice of Their Own: Women Moving Into Their Fifties

This purpose of this qualitative study was to illuminate the developmental journey experienced by women moving into their fifties. A purposive sample of 23 women was asked to document any changes they perceived in themselves as they moved from their forties into their fifties. Themes identified included stepping out of the mold, letting go, walking in balance, moving in new directions, redefining relationships, and experiencing a freedom “to be.” Understanding the patterns of meaning experienced by healthy women at midlife can provide clinicians with a blueprint for enabling women to become all they can be during late midlife and thereafter.     

Adolescents' Perceptions of Print Cigarette Advertising: A Case for Counteradvertising

Coverage of medical and health care issues has become a staple of the American press. To explain today's saturation of such coverage, I present a political continuum from reporting on the health of President Franklin Roosevelt to that of Republican presidential candidate Robert Dole. I suggest that the public can better be served by disclosures of medical records of political candidates as well as of elected officials.     

Density and Proximity of Tobacco Outlets to Homes and Schools: Relations with Youth Cigarette Smoking

This study investigated the associations of youth cigarette smoking with tobacco outlet densities and proximity of tobacco outlets to youth homes and schools across different buffers in 45 midsized California communities. The sample comprised 832 youths who were surveyed about their smoking behaviors. Inclusion criteria included both home and school addresses within city boundaries. Observations in the 45 cities were conducted to document addresses of tobacco outlets. City- and buffer-level demographics were obtained and negative binomial regression analyses with cluster robust standard errors were conducted. All models were adjusted for youth gender, age, and race. Greater densities of tobacco outlets within both a 0.75 and 1-mile buffer of youth homes were associated with higher smoking frequency. Neither tobacco outlet densities around schools nor distance to the nearest tobacco outlet from home or school were associated with youths past-30-day smoking frequency. Lower population density and percent of African Americans in areas around homes and lower percent of unemployed in areas around schools were associated with greater smoking frequency. Results of this study suggest that restricting outlet density within at least 1-mile surrounding residential areas will help to reduce youth smoking.     

In Their Own Words: Assessment of Satisfaction with Residential Location among Migrants in Nairobi Slums

Using qualitative data collected from a sample of rural-urban migrants over the age of 15 in two Nairobi slums interviewed in 2008, this paper discusses the migrants’ extent of satisfaction with their residential location and decision to migrate. The study sheds light on why people continue to migrate to, and stay in, the rapidly growing slum settlements despite the high levels of poverty and poor health conditions in these areas. Tenure status is related to satisfaction for all ages. Environmental factors were frequently mentioned as a source of dissatisfaction. Life cycle and ‘age-cohort effects’ may also affect satisfaction for different age groups in terms of who is satisfied as well as the issues that are considered for satisfaction. High levels of dissatisfaction with slum life may be responsible for high out-migration in slum areas, although it does not mean that those who remain do so because they are satisfied. At the same time, challenges associated with slum life do not automatically signify dissatisfaction. Perceived success, as well as conditions in the area of origin can be used to explain and understand satisfaction/dissatisfaction with slum life. Satisfaction with migration and residential location may be related not only to the destination place, but also to events in the area of origin.     

The Association between Point-of-Sale Advertising Bans and Youth Experimental Smoking: Findings from the Global Youth Tobacco Survey (GYTS)

Background and Objectives: while existing research has demonstrated a positive association between exposure to point-of-sale (POS) tobacco advertising and youth smoking, there is limited evidence on the relationship between POS advertising restrictions and experimental smoking among youth. This study aims to fill this research gap by analyzing the association between POS advertising bans and youths'' experimental smoking. Methods: Global Youth Tobacco Surveys from 130 countries during 2007–2011 were linked to the WHO “MPOWER” tobacco control policy measures to analyze the association between POS advertising bans (a dichotomous measure of the existence of such bans) and experimental smoking using weighted logistic regressions. All analyses were clustered at the country level and controlled for age, parents'' smoking status, GDP per capita, and country-level tobacco control scores in monitoring tobacco use, protecting people from smoke, offering help to quit, warning about the dangers of tobacco, enforcing promotion/advertising bans, and raising taxes on tobacco. Results: The results suggest that a POS advertising ban is significantly associated with reduced experimental smoking among youth (OR = 0.63, p < 0.01), and that this association is seen for both genders (boys OR = 0.74, p < 0.1; girls OR = 0.52, p < 0.001). Conclusions: POS advertising bans are significantly associated with reduced experimental smoking among youth. Adopting POS advertising bans has the potential to reduce tobacco use among their youth in countries currently without such bans.     

The Association Between Fathers’ Self-assessment of Their Own Parenting and Mothers’ Recognition of Paternal Support: A Municipal-Based Cross-Sectional Study

BackgroundDiscrepancies between parents’ reports of paternal parenting have been gaining attention, but epidemiological evidence is scarce in Asia. This study aimed to clarify agreement/discrepancy between paternal and maternal recognition of paternal parenting and the association between actual paternal parenting time and background factors.MethodsData from couples whose children attended 4-month child health check-ups in Fukushima City were analyzed (N = 509). Based on paternal recognition of paternal parenting (PRPP) and maternal recognition of paternal support (MRPS), couples were classified into four groups. Each group’s paternal household work and parenting time were analyzed. Univariable and multivariable analysis were performed to investigate the association between agreement/discrepancy and background factors of children and parents.ResultsFrequency of positive agreement (PRPP+ and MRPS+) was 83.9%, whereas negative agreement (PRPP− and MRPS−) was 2.6%. As for discrepancy, PRPP+ and MRPS− was 8.4% and PRPP− and MRPS+ was 5.1%. Fathers’ total median parenting time was 2 (weekdays) and 6 (weekends) hours, and showed significant differences among the four groups. Multivariable analysis revealed that compared to positive agreement, maternal mental health condition and pregnancy intention were significantly associated with the discrepancy PRPP+ and MRPS−, paternal mental health condition and marital satisfaction with the discrepancy PRPP− and MRPS+, and maternal mental health condition with negative agreement.ConclusionsWe identified differences in parenting time and mental health characteristics among couples depending on agreement/discrepancy in recognition of paternal parenting. Assessing both parents’ profiles is necessary in clinical practice to promote paternal participation in childcare.Key words: father involvement, coparenting, family relations, parenting time     

Tobacco Use by Chinese American Men: An Exploratory Study of the Factors Associated with Cigarette Use and Smoking Cessation

PURPOSE: There is little information on cigarette use and smoking cessation in Asian Pacific Islanders. This study explored factors associated with tobacco use in the largest Asian American ethnic group - Chinese American men. METHODS: Chinese American men age 17 or older, recruited by convenience sampling, were interviewed by a male trilingual and bicultural interviewer. Open­ended, semi­structured interviews were coded using PRECEDE framework under two categories: cigarette use and smoking cessation. FINDINGS: Smoking, favorably perceived and valued, plays an important role in Chinese society. Lack of appropriate information and some beliefs pose challenges to effective tobacco control. Participants expressed willingness to adhere to no smoking rules and regulation. Attitudes and perceptions in the U.S. towards cigarette smoking, which differ from those in China, reinforce attitudes more favorable to smoking cessation. CONCLUSIONS: Themes elicited challenge mainstream smoking cessation approaches for Chinese American men. Further exploration of these results are needed to develop effective tobacco control in this and possibly other Asian American populations.     

Accuracy of Student Self-Assessment Ability Compared to Their Own Performance in a Problem-Based Learning Medical Program: A Correlation Study

Objective: The purpose of this study was to evaluate the accuracy of self-assessment ability of students enrolled in a Problem-based Learning program. Methods: Seventy students enrolled in their third year of a four-year program were invited to voluntarily participate in the study. Self-assessment questionnaire was used to measure the students' self-assessment ability on two different occasions: 1) prior to standardised oral examination in predicting their performance, and 2) following the examination estimating their performance. The accuracy of the self-assessment was investigated by the relation between self-assessment and performance of the students. Results: Our study showed that self-assessment pre-examination was not accurate compared to performance at the oral examination (r ranging from 0.042 to 0.243).However, accuracy is slightly better when the student self-assesses his performance a posteriori, but the relation stays very low (r ranging from 0.257 to 0.334). Conclusion:According to our results, the students in the third year of a self-directed Problem-based Learning medical four year program demonstrated poor accuracy of the self-assessment when compared to their own performance. This revised version was published online in June 2006 with corrections to the Cover Date.     

“Coming to Town”: The Impact of Urbanicity, Cigarette Advertising, and Network Norms on the Smoking Attitudes of Black Women in Cape Town, South Africa

This study was conducted to examine the effect of urban living on smoking attitudes among black African women in South Africa. We examine how urbanicity affects attitudes toward smoking and how it moderates the relationship between both advertising exposure and network norms on black women's smoking attitudes. Respondents were 975 black women currently living in Cape Town townships, some of which were raised in rural villages or small towns. Respondents completed a cross-sectional survey, which included data on smoking attitudes, norms, and exposure to cigarette advertising. Multiple linear regression analysis was performed with smoking attitudes as the response variable, and urbanicity, cigarette advertising exposure, and network smoking norms as primary explanatory variables. Interactions were tested to determine whether urbanicity modified the effect of advertising exposure and network norms on smoking attitudes. Independent effects of urbanicity, exposure to cigarette advertising, and greater smoking prevalence within women's networks were associated with more favorable smoking attitudes. In addition, urbanicity moderated the relationship between network smoking norms and smoking attitudes, but not cigarette advertising exposure and smoking attitudes. Urbanicity, cigarette advertising, and networks play important roles in women's attitudes toward smoking, and potentially, smoking behavior. Overall, our results suggest that strong and creative anti-smoking efforts are needed to combat the potential for a smoking epidemic among an increasingly urbanized population of black women in South Africa and similar emerging markets. Additional research is warranted.     

This Ad is for You: Targeting and the Effect of Alcohol Advertising on Youth Drinking

Endogenous targeting of alcohol advertisements presents a challenge for empirically identifying a causal effect of advertising on drinking. Drinkers prefer a particular media; firms recognize this and target alcohol advertising at these media. This paper overcomes this challenge by utilizing novel data with detailed individual measures of media viewing and alcohol consumption and three separate empirical techniques, which represent significant improvements over previous methods. First, controls for the average audience characteristics of the media an individual views account for attributes of magazines and television programs alcohol firms may consider when deciding where to target advertising. A second specification directly controls for each television program and magazine a person views. The third method exploits variation in advertising exposure due to a 2003 change in an industry‐wide rule that governs where firms may advertise. Although the unconditional correlation between advertising and drinking by youth (ages 18–24) is strong, models that include simple controls for targeting imply, at most, a modest advertising effect. Although the coefficients are estimated less precisely, estimates with models including more rigorous controls for targeting indicate no significant effect of advertising on youth drinking. Copyright © 2015 John Wiley & Sons, Ltd.     

Talk is cheap: the tobacco companies' violations of their own cigarette advertising code

In two studies, adolescents and adults were shown a series of cigarette advertisements and asked to respond to a variety of questions concerning aspects of the Cigarette Advertising and Promotion Code, specifically, their perceptions of the ages of the models in the ads and of whether the ads depicted smoking as essential to sexual attraction or essential to success. For many of the ads, especially ads for brands most popular among youth, a majority of the participants perceived the models to be less than 25 years old. A majority also perceived many of the ads to depict smoking as essential to sexual attraction or essential to success. Thus, despite their public pledge, the tobacco companies routinely violate a variety of aspects of the Cigarette Advertising and Promotion Code.     

How to Prevent Vaccines Falling Victim to Their Own Success: Intertemporal Dependency of Incidence Levels on Indirect Effects in Economic Reevaluations

ObjectivesIncremental cost-effectiveness analyses may inform the optimal choice of healthcare interventions. Nevertheless, for many vaccines, benefits fluctuate with incidence levels over time. Reevaluating a vaccine after it has successfully decreased incidences may eventually cause a disease resurgence if switching to a vaccine with lower indirect benefits. Decisions may successively alternate between vaccines alongside repeated rises and falls in incidence and when indirect effects from historic use are ignored. Our suggested proposal aims to prevent suboptimal decision making.MethodsWe used a conceptual model of demand to illustrate alternating decisions between vaccines because of time-varying levels of indirect effects. Similar to the concept of subsidies, we propose internalizing the indirect effects achievable with vaccines. In a case study over 60 years, we simulated a hypothetical 10-year reevaluation of 2 oncogenic human papillomavirus vaccines, of which only 1 protects additionally against anogenital warts.ResultsOur case study showed that the vaccine with additional warts protection is initially valued higher than the vaccine without additional warts protection. After 10 years, this differential decreases because of declines in warts incidence, which supports switching to the nonwarts vaccine that causes a warts resurgence eventually. Instead, pricing the indirect effects separately supports continuing with the warts vaccine.ConclusionsIgnoring how the observed incidences depend on the indirect effects achieved with a particular vaccine may lead to repeated changes in vaccines at successive reevaluations, with unintended resurgences, economic inefficiencies, and eroding vaccine confidence. We propose internalizing indirect effects to prevent vaccines falling victim to their own success.     

A (Latent) Class of Their Own: Response Patterns in Trading Off Quantity and Quality of Life in Time Trade-Off Exercises

Background

Conflicting results regarding associations of time trade-off (TTO) valuations with respondent characteristics have been reported, mostly on the basis of regression analyses. Alternative approaches, such as the latent class analysis (LCA), may add to the further understanding of variations in TTO responses.