Perceived parental monitoring and health risk behaviors among urban low-income African-American children and adolescents.

PURPOSE: To examine gender and age differences among urban, low-income, African-American children and adolescents in perceived monitoring by their parents, and the association of perceived parental monitoring with family characteristics, health risk behaviors, and risk perceptions. METHODS: Three cross-sectional surveys were conducted in 1992 (n = 455), 1994 (n = 355), and 1996 (n = 349). Respondents aged 9-17 years were recruited from low-income urban areas including public housing communities and associated recreation centers. Both multivariate analysis of variance and correlation analysis were performed. RESULTS: Low levels of perceived parental monitoring were associated with participation in several health risk behaviors, including sexual behavior, substance/drug use, drug trafficking, school truancy, and violent behaviors. Females perceived themselves to be more monitored than did males. In general, the perceived parental monitoring tended to decrease with advancing age of the youth. CONCLUSIONS: The strong inverse correlation between perceived parental monitoring and adolescent risk behavior suggests that parental monitoring initiatives may be an effective intervention tool. Longitudinal studies are needed to determine the long-term relationship between perceived parental monitoring and adolescent risk involvements.     

Patterns of initiation of sex and drug-related activities among urban low-income African-American adolescents.

PURPOSE: To examine the pattern of adolescent's involvement in drug-related behaviors and sexual initiation, and its relationship with: (a) age and gender, (b) sensation- seeking, (c) perceptions of peer and family risk involvement, and (d) involvement in high-risk sexual behavior. SUBJECTS: Two hundred and sixty-one urban African-American youth, aged 9 to 15 years at baseline, who were sexually experienced by the end of the 4-year study interval. The longitudinal assessment (4 years) was focused on: (a) alcohol use, illicit drug use, and drug trafficking; (b) high-risk sex; (c) propensity to sensation seeking; and (d) perceived peer and family risk involvement. RESULTS: Involvement increased over the 4-year study interval such that over half of the adolescents reported use of alcohol and/or use of marijuana in the final assessment period. For each of the three drug-related activities examined, the largest proportion of youth who engaged in sexual intercourse never engaged in drug-related activity, and the next largest proportion initiated sexual involvement before drug use. Sensation-seeking scores, which were relatively stable across time, were lower among girls, and also were lower among youth who remained uninvolved in drug-related behaviors. For all three drug-related behaviors, rates of high-risk sex were higher among youth who initiated both sex and drugs, and were lower among youth who reported engaging only in sex. Although youth who did eventually initiate drug use had higher perceived levels of family and peer drug use compared to those who remained uninvolved, these perceptions did not contribute directly to high-risk sexual behavior. CONCLUSIONS: Youth who will become both sexually active and involved with drugs during adolescence are especially vulnerable to involvement in high-risk sexual behavior.     

Perceived cancer risk and risk attributions among African-American residents of a low-income,predominantly African-American neighborhood

Objective. In some national surveys, African-Americans have had lower scores on perceived cancer risk items than whites. Our goals were to confirm low perceptions of cancer risk in an African-American community sample and explore participants' attributions for their perceived cancer risk.

Design. Data were from three cross-sectional surveys. We report levels of perceived absolute and comparative cancer risk in a community sample of African-Americans (N = 88), and African-Americans (Ns = 655, 428) and whites (Ns = 5262, 1679) from two nationally representative Health Information National Trends Surveys (HINTS). We analyzed the content of spontaneously-provided explanations for perceived risk from the community sample.

Results. Perceived absolute and comparative cancer risk were lower in the community and national samples of African-Americans than in the national sample of whites. Participants' spontaneous attributions for low or lower than average risk included not having family history or behavioral risk factors, classes of attributions noted elsewhere in the literature. However, participants also explained that they wanted to avoid wishing cancer on themselves (positive affirmations) and hoped their risk was low (wishful thinking), responses rarely reported for majority-white samples.

Conclusions. Results provide further evidence that cancer risk perceptions are lower among African-Americans than whites. Some participant explanations for low perceived risk (wishful thinking, affirmations) are inconsistent with behavioral scientists' assumptions about perceived risk questions. Results reveal a need to expand cancer risk attribution typologies to increase applicability to diverse populations, and may indicate that perceived cancer risk questions have lower validity in African-American populations.     

Episodic and persistent gun-carrying among urban African-American adolescents.

PURPOSE: To examine whether similar risk factors influenced episodic and persistent gun-carrying among urban African-American adolescents. METHODS: The sample consisted of 705 African-American youths (48.9% male; mean age at baseline = 14.56 years) who were interviewed annually throughout high school as part of a larger study on students who leave school before graduation. Episodic gun-carrying was defined as carrying a gun during one or two waves of the study. Persistent gun-carrying involved carrying a gun during three or four waves. Data were analyzed using multinomial logistic regression to test how risk factors assessed at ninth grade influenced the persistence of gun-carrying. RESULTS: Fifteen percent of students reported carrying a gun episodically, and 5% persistently. "Male gender" (OR = 3.61, 95% CI = 2.16-6.04), "adult weapon-carrying" (OR = 1.58, 95% CI = 1.20-2.09), "marijuana use" (OR = 1.03, 95% CI = 1.01-1.06), "selling drugs" (OR = 3.24, 95% CI = 1.52-6.92), and "fighting" (OR = 1.57, 95% CI = 1.14-2.15) distinguished noncarriers from episodic carriers. Frequency of fighting (OR = 1.60, 95% CI = 1.00-2.57) and selling drugs (OR = 3.29, 95% CI = 1.16-9.35) distinguished episodic gun-carriers from persistent gun-carriers. Variables associated with victimization did not uniquely differentiate among the patterns of gun-carrying. These results were similar for males and females. CONCLUSIONS: Similar risk factors characterize episodic and persistent gun-carrying. Specifically, selling drugs and fighting had a strong dose-response relationship with the persistence of gun-carrying. In this population, episodic gun-carrying should be viewed as very risky and not merely as youthful experimentation or a defensive behavior.     

Increased drug use among old-for-grade and dropout urban adolescents

Introduction: In tracking the epidemic of drug use in our communities, much emphasis has been placed on identifying predictive variables. In this study, we examine the relationship between drug use and school progress among a sample of inner-city adolescents.Methods: A blinded, anonymous questionnaire covering a variety of health risk behaviors was administered to 1,720 adolescent patients who visited our outpatient clinic. Participants were classified as age-appropriate for last school grade completed, older than normal for grade, or as a dropout. A urine specimen was also collected in a blinded, anonymous fashion from each participant, and tested for five common substances of abuse.Results: Nearly 12% of participants tested positive for drugs. Participants who were old for grade were over 40% more likely to be positive for drugs than grade-appropriate respondents, while school dropouts were more than twice as likely to test positive.Conclusions: These results demonstrate that being old-for-grade (OFG) and being a dropout in our population are markers for being at higher risk of substance abuse.     

Perceived risks and benefits of smoking: differences among adolescents with different smoking experiences and intentions

BACKGROUND: Explanations of adolescent smoking often make reference to adolescents' beliefs that they are invulnerable to harm. However, empirical examination of whether adolescents do acknowledge risks. Further, few studies have considered perceived benefits in adolescents' behavioral decisions. This study examined perceived smoking-related physical and social risks and benefits between adolescents who have vs. have not smoked and do vs. do not intend to smoke. METHODS: Three hundred and ninety-five students (mean age = 14.0) completed a survey concerning their smoking experiences, intentions, and perceived risks and benefits of smoking. RESULTS: Adolescent smokers and those who intend to smoke estimated their chance of experiencing a smoking-related negative outcome as less likely than did nonsmokers and non-intenders. Smokers and intenders also reported the chance of addiction as less likely than did others. In contrast, adolescent smokers and intenders perceived the chance of experiencing a smoking-related benefit as more likely than did nonsmokers and non-intenders. CONCLUSIONS: The data suggest that rather than solely focusing on health risks as a way to deter adolescent smoking, the role of perceived social risks and benefits in adolescents' smoking may be an additional critical focus for intervention. In addition, efforts should be made to increase adolescents' awareness of the addictive nature of cigarettes.     

Access to housing subsidies, housing status, drug use and HIV risk among low-income U.S. urban residents

Background

Much research has shown an association between homelessness and unstable housing and HIV risk but most has relied on relatively narrow definitions of housing status that preclude a deeper understanding of this relationship. Fewer studies have examined access to housing subsidies and supportive housing programs among low-income populations with different personal characteristics. This paper explores personal characteristics associated with access to housing subsidies and supportive housing, the relationship between personal characteristics and housing status, and the relationship between housing status and sexual risk behaviors among low-income urban residents.

Methods

Surveys were conducted with 392 low-income residents from Hartford and East Harford, Connecticut through a targeted sampling plan. We measured personal characteristics (income, education, use of crack, heroin, or cocaine in the last 6 months, receipt of welfare benefits, mental illness diagnosis, arrest, criminal conviction, longest prison term served, and self-reported HIV diagnosis); access to housing subsidies or supportive housing programs; current housing status; and sexual risk behaviors. To answer the aims above, we performed univariate analyses using Chi-square or 2-sided ANOVA's. Those with significance levels above (0.10) were included in multivariate analyses. We performed 2 separate multiple regressions to determine the effects of personal characteristics on access to housing subsidies and access to supportive housing respectively. We used multinomial main effects logistic regression to determine the effects of housing status on sexual risk behavior.

Results

Being HIV positive or having a mental illness predicted access to housing subsidies and supportive housing, while having a criminal conviction was not related to access to either housing subsidies or supportive housing. Drug use was associated with poorer housing statuses such as living on the street or in a shelter, or temporarily doubling up with friends, acquaintances or sex partners. Living with friends, acquaintances or sex partners was associated with greater sexual risk than those living on the street or in other stable housing situations.

Conclusions

Results suggest that providing low-income and supportive housing may be an effective structural HIV prevention intervention, but that the availability and accessibility of these programs must be increased.     

Tobacco, alcohol, and other drug use behaviors among adolescents in Erie County, New York.

This article provides estimates of the prevalence of tobacco, alcohol, and other drug use behaviors of ninth-grade students enrolled in public and parochial schools in Erie County, New York. A computer-scannable survey consisting of 50 questions was completed by 7,891 students in the fall of 1992. Survey findings show that tobacco and alcohol are the drugs used most often by ninth-grade students. Results also indicate that cigarette use is strongly associated with other drug use behaviors such as getting drunk, using marijuana, and other illegal drugs. A report detailing findings from the survey has been widely disseminated to school officials and community leaders throughout Erie County. Our experience in conducting this survey suggests that collecting information on the drug use behaviors of adolescents at the local level is both feasible and worthwhile.     

Patterns of drug use among Cuban-American, African-American, and white non-Hispanic boys.

This study examined initiation into drug use during grade school years in a sample of Cuban-American, Black, and White non-Hispanic students in the greater Miami, Fla, area. Findings indicate that first use of alcohol occurs in fifth grade and cigarettes in sixth grade for all subgroups except White non-Hispanics, who peak in the fifth grade. White non-Hispanics had the highest life-time levels of alcohol and cigarette use. Foreign-born Cuban Americans had a lower lifetime prevalence of alcohol and cigarette use than US-born Cuban Americans. Higher acculturation level was related to first use of alcohol. One important implication of this study is that alcohol interventions should begin no later than third grade and smoking interventions no later than fourth grade.     

Tracking of dietary intake patterns is associated with baseline characteristics of urban low-income African-American adolescents

Young peoples' dietary habits may persist over time. However, few studies have examined the dynamic patterns in urban low-income African-American adolescents' intakes. This study examined these dynamic patterns and their predictors and explored the association between the patterns and BMI over time. Dietary data were collected from 181 low-income African-American adolescents using a 152-item FFQ at baseline and 1-y follow-up. High intakes and high BMI were defined as the top quartile and high-fat intake as >35% of energy from fat. Multinomial logistic regression models were fit to study the association between study variables. Correlation coefficients (0.4 < r < 0.6; P < 0.05) between participants' intakes at baseline and at 1-y follow-up suggested tracking, particularly intakes of energy, fat, fiber, calcium, vegetables and fruits, fried food, and snack food. However, the tracking of percentage of energy from fat and sugar-sweetened beverages was weak (0.2 < or = r < 0.3; P < 0.01). Proportion of agreement (>30%) and k-values (>0.2) also indicated tracking. Adjustment for tracking of energy changed little the observed tracking for other micronutrients and food groups. Factor analysis showed moderate tracking in a Western diet pattern (r = 0.47; P < 0.001) but was weaker in 2 healthier diet patterns (r = 0.31-0.36; P < 0.001). Age, gender, physical activity, and BMI predicted dietary changes (P < 0.05). Adolescents who tracked high intakes of energy, fiber, fried food, and snacks were less likely to track high BMI. Decreased energy and snack intakes were negatively related to tracking of high BMI. Overall, urban low-income African-American adolescents tracked their dietary patterns over time. The tracking was affected by baseline characteristics.     

Preventing alcohol, marijuana, and cigarette use among adolescents: peer pressure resistance training versus establishing conservative norms

BACKGROUND. Two strategies for preventing the onset of alcohol abuse, and marijuana and cigarette use were tested in junior high schools in Los Angeles and Orange Counties, California. The first strategy taught skills to refuse substance use offers. The second strategy corrected erroneous normative perceptions about prevalence and acceptability of use among peers and established conservative groups norms regarding use. METHODS. Four experimental conditions were created by randomly assigning schools to receive (a) neither of the experimental curricula (placebo comparison), (b) resistance skill training alone, (c) normative education alone, or (d) both resistance skill training and normative education. Students were pretested prior to the program and post-tested 1 year following delivery of the program. RESULTS. There were main effects of normative education for summary measures of alcohol (P = 0.0011), marijuana (P = 0.0096), and cigarette smoking (P = 0.0311). All individual dichotomous measures of alcohol, marijuana, and tobacco use indicated significant reductions in onset attributable to normative education. There were no significant main effects of resistance skill training. CONCLUSION. These results suggest that establishing conservative norms is an effective strategy for preventing substance use.     

Perceived parenting styles and tobacco, alcohol and cannabis use among French adolescents: gender and family structure differentials

AIMS: To assess associations between parental control or parental emotional support and current tobacco, alcohol or cannabis use among 12-18-year-old students, according to gender and family structure (intact family, reconstituted family, single-parent family). METHODS: A cross-sectional survey was conducted in a national representative sample in France (2003) of 6-12th grade students (N = 16,532), as a part of the ESPAD study (European Study Project on Alcohol and Other Drugs). The self-administered questionnaire included questions on last 30 days' consumption of alcohol, tobacco and cannabis as well as on socio-demographic characteristics, school characteristics, and some simple questions on parental control and parental emotional support. Logistic modelling was carried out and (adjusted Odds Ratio) Ora calculated, adjusted for age, parental educational and characteristics of the school. RESULTS: A negative relationship exists between parental control and substance use, but this relationship is more marked for tobacco (OR a between 1.8 and 5.6 according to level of control, family status and gender) and cannabis (OR between 1.5 and 6.4) than for alcohol (OR a between 1.0 and 2.7). Parental control is more markedly related to substance use in girls than in boys. These tendencies were observed for intact families as well as for single-parent families or reconstituted families. Parental control has a greater impact than emotional support. Among girls, emotional support has a greater impact than among boys. CONCLUSIONS: There is a gradient relationship between parental control and current consumption, especially among girls. Thus, there may be a need for parental control, whatever the family structure.     

Ethnophysiology and contraceptive use among low-income women in urban Brazil

Distrust and dissatisfaction with contraceptive methods among low-income Brazilian women contributes to incorrect contraceptive use, harmful health risks, and an extensive reliance on surgical sterilization. Data from ethnographic fieldwork in a low-income neighborhood in urban Brazil illustrate that women's concerns regarding contraception make sense in the context of their general health and illness beliefs and their understanding of reproductive physiology. Women interpret and experience biomedical concepts and contraceptive methods (such as "hormones" and oral contraceptives, respectively) according to an ethnophysiology of fecundity, menstruation, and conception. These popular representations of reproduction embody social relations and local experience and therefore persist despite the influence of biomedical models. Recognition of this ethnophysiology and greater emphasis on culturally appropriate counseling and education among health care professionals will improve women's experience and effective use of reversible contraception.     

Individual, group and community risk and protective factors for alcohol and drug use among Swedish adolescents

BACKGROUND: A number of factors have been identified that protect adolescents or, alternatively, put them at risk for drug use and other high-risk behaviours. These factors concern different personal and environmental factors, e.g. the community, the school setting, family, peer group and individual characteristics.The aim of the present study was to examine the associations between risk and protective factors and adolescents' use of alcohol and drugs. METHODS: In both May 2003 and 2004, random samples of 4800 adolescents (a total of 9600) in Sweden were contacted and asked to fill out a questionnaire.It concerned use of alcohol and illicit drugs and a large number of adolescent risk and protective factors. A total of 5445 (57%) adolescents agreed to participate. RESULTS: About 44% of the adolescents in grade 9 (15-16 years of age) had been drunk on at least one occasion and nearly 80% of those in grade 11 (17-18 years of age). Almost 15% in grade 9 and 40% in grade 11 had been drinking heavily during the previous month, and 4% in grade 9 and 12% in grade 11 had used cannabis. Strong associations were found between elevated individual, family, school and community risk factors and use of alcohol and drugs. Conversely, protective factors were negatively related to the use of alcohol and drugs. CONCLUSIONS: This study confirms the importance of risk and protective factors within different domains in explaining alcohol and drug use among adolescents. The results support efforts targeting multiple risk and protective factors in alcohol and drug preventive interventions for adolescents.     

Spontaneous cessation of smoking and alcohol use among low-income pregnant women

BACKGROUND: Despite the strong evidence of harmful effects, tobacco and alcohol use during pregnancy continue to be major public health challenges. Some women, however, do stop spontaneously when they learn of their pregnancy. No study has investigated spontaneous cessation of both behaviors in a low-income predominantly unmarried U.S. population. OBJECTIVE: To describe the prevalence of spontaneous cessation of cigarette and alcohol use alone and in combination and associated factors among low-income pregnant women. METHODS: Subjects (N=601) were currently smoking or smoking when they became pregnant and participating in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs in the greater Boston, Massachusetts, area. Baseline interviews assessed the factors being studied and the spontaneous cessation of cigarette and alcohol use with pregnancy. Saliva cotinine verified self-reported smoking status.RESULTS: Spontaneous cessation of smoking and alcohol use was reported by 28% and 80% of the women, respectively; 25% spontaneously quit both, and 15% stopped neither. Multivariable analyses indicated that smoking cessation was less likely in women who had previous births, had a husband or partner who smoked, were born in the United States, were black (non-Hispanic, non-Portuguese), had less than a high school education, were highly addicted, reported lower perceived risk to the fetus, and reported "too many other problems in life to stop." Hispanic ethnicity, younger age, and more social support to quit smoking were related to spontaneous alcohol abstinence. CONCLUSIONS: Targeted multiple strategies, including those aimed at increasing participation of partners, are needed for low-income pregnant smokers.     

The role of trust in use of preventive services among low-income African-American women

BACKGROUND: This study explored factors that predict higher trust in primary care providers, and examined the role of patient trust on the use of preventive services for low-income African-American women. METHODS: We conducted a cross-sectional, population-based telephone survey of 961 African-American women over age 40 in Washington, DC. Two dimensions of trust were examined: overall trust in one's regular primary care provider, and trust that the regular provider had no financial conflict of interest. Self-reported use of mammography, Pap tests, clinical breast exams, colorectal cancer screening, blood pressure, height and weight measurement, diet counseling, and depression screening, as delivered by one's primary care provider, were assessed. An index summarizing overall use of these interventions was the main outcome variable. RESULTS: More than two-thirds of respondents reported high trust in their physician. Older respondents (>65) were more trusting of their physicians overall than were younger respondents (P < 0.01). Primary care characteristics (continuity of care, accessibility of the practice, coordination of specialty care by one's regular provider) were more strongly associated with having high trust than were sociodemographic, health status, and insurance characteristics. Higher trust was significantly associated with greater use of recommended preventive services (OR: 2.3, 95% CI: 1.3, 4.0), controlling for the effects of insurance status, primary care, and patient characteristics. CONCLUSIONS: Trust is associated with use of recommended preventive services in low-income African-American women. Stronger patient-provider relationships, with high levels of trust, may indirectly lead to better health through adherence to recommended preventive services for low income African-American women.     

Increasing the report of alcohol use among low-income pregnant women

PURPOSE: To increase the report of prenatal alcohol use in a community setting. METHODS: A self-administered alcohol screening tool was developed and introduced at 12 randomly selected sites that administer the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). A matched sample of 12 WIC sites continued to use the existing verbal standard of care for assessing alcohol use. RESULTS: Rates of reported prenatal alcohol consumption at the 12 WIC intervention sites were compared with rates at 12 control WIC sites using a repeated-measures analysis of variance (ANOVA) and independent-samples t-tests. Within 8 months of study commencement, rates of reported prenatal alcohol consumption were significantly higher at the intervention sites than at the control sites. DISCUSSION: Use of a brief, self-administered screening tool in the WIC setting significantly increased reports of prenatal alcohol use, a key first step in the reduction of prenatal alcohol use. The WIC setting represents an excellent place to address the significant public health issue of prenatal alcohol exposure.     

Risky sexual behaviors among adolescents with alcohol use disorders.

Little is known about risky sexual activity among adolescents with alcohol use disorders. This study of 371 adolescent drinkers found that those with alcohol disorders were more likely than other drinkers to be sexually active, to have greater numbers of partners, and to initiate sexual activity at slightly younger ages. Independent of alcohol group, females were more likely than males to have unprotected sexual encounters.