Youth Assets, Neighborhood Factors, Parental Income, and Tobacco Use: A Longitudinal Study of Health Disparities

This study aimed to assess how the relationship between youth assets and future no-tobacco use among youth might differ according to race/ethnicity, neighborhood factors and socio-economic status. Five waves of annual data were collected from 1111 youth/parent pairs living in Oklahoma, USA who were randomly selected to participate in the Youth Asset Study (YAS). A marginal logistic regression model using all five waves of no-tobacco use, demographics, and their interaction was used to compare the change in tobacco use over time. Among 1111 youth, (Mean age = 14.3; 53% female; 39% White, 28% Hispanic, 24% Black, and 9% other), the percentage of youth tobacco use increased significantly from baseline to wave 5 (4 years after baseline) for all racial/ethnic groups and all parental income groups. Assets were prospectively associated with no tobacco use in the past 30 days for Black, White and Hispanic youth and for youth in all income categories (adjusted odds ratio range = 1.9-2.7). There was one statistically significant association between the neighborhood environment and future no tobacco use. To conclude, the protective effects of youth assets in terms of prevention of tobacco use among youth do not differ by youth race/ethnicity or parental income in the presence of neighborhood environmental factors.

Demographic Factors Predict Disparities in Number of Assets Youth Possess

OBJECTIVES

This study's purpose was to determine if youth race/ethnicity, youth age and sex, parent income and education, household wealth, family poverty, and family structure were prospectively associated with youth assets in a community-based sample of racially/ethnically and economically-diverse youth and their parents.

METHODS

Five waves of data were collected annually (2003 to 2008) from youth (N = 1111; Mean age = 14.4 years, SD = 1.6) and their parents using in-person, computer-assisted interviewing methods. Marginal logistic regression models and generalized estimating equations were conducted to assess prospective associations between the demographic factors and the number of assets the youth possessed (more than or less than the median number of 12 assets).

RESULTS

Results indicated that 1-parent families (Odds Ratio = 0.62, 95% CIs = 0.50-0.76) lower parental education, (OR = 0.67, CI = 0.48-0.95 and OR = 0.77, CI = 0.61-0.97), and youth age (OR = 0.70, CI = 0.55-0.88 and OR = 0.59, CI = 0.45-0.77) were the only demographic factors that independently, prospectively, and significantly predicted which youth would possess less than the median number of assets.

CONCLUSIONS

Youth assets may be 1 mechanism that explains the negative effects of some demographic factors, particularly 1-parent families and low-parent education, on youth risk behaviors and health.

The Association between Multiple Youth Assets and Sexual Behavior

Purpose.

To investigate the possible positive cumulative effects that youth assets may have on youth sexual behaviors.

Design.

Cross-sectional data were collected from a randomly selected population by in-home, in-person interviews. Mantel-Haenszel chi-square test and logistic regression were conducted to determine the potential cumulative effects that youth assets may have on youth sexual behaviors and to test for significant asset by sexual risk behavior trends.

Setting.

Racially diverse inner-city neighborhoods in two midwestern cities.

Subjects.

Teenagers (n = 1350; mean age = 15.2 years) and parents of the teenagers (n = 1350). The response rate was 51%.

Measures.

Demographic factors, nine youth assets, and five sexual behavior outcomes.

Results.

Significant (p < .05) trends and odds ratios (ORs) were found for three of the five youth sexual behavior outcomes. Youths with more assets were more likely to have never participated in sexual intercourse (OR = 1.32). Of sexually active youths, those with more assets were more likely to have delayed first intercourse until at least 17 years of age (OR = 1.47) and to have used birth control at last sexual intercourse (OR = 1.18). Nonsignificant (p > .05) results were found for current sexual activity and number of sexual partners.

Conclusions.

The results generally support the notion that the more assets adolescents possess, the more likely they are to engage in positive behavior. Practitioners planning asset-based teenage pregnancy prevention programs might consider promoting several specific youth assets.

Team Science Approach to Developing Consensus on Research Good Practices for Practice-Based Research Networks: A Case Study

Using peer learning strategies, seven experienced PBRNs working in collaborative teams articulated procedures for PBRN Research Good Practices (PRGPs). The PRGPs is a PBRN-specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings. This paper describes the team science processes which culminated in the PRGPs. Skilled facilitators used team science strategies and methods from the Technology of Participation (ToP®), and the Consensus Workshop Method to support teams to codify diverse research expertise in practice-based research. The participatory nature of "sense-making" moved through identifiable stages. Lessons learned include (1) team input into the scope of the final outcome proved vital to project relevance; (2) PBRNs with diverse domains of research expertise contributed broad knowledge on each topic; and (3) ToP® structured facilitation techniques were critical for establishing trust and clarifying the "sense-making" process.

Practice-based Research Network Research Good Practices (PRGPs): Summary of Recommendations

INTRODUCTION

Practice-based research networks (PBRNs) conduct research in community settings, which poses quality control challenges to the integrity of research, such as study implementation and data collection. A foundation for improving research processes within PBRNs is needed to ensure research integrity.

METHODS

Network directors and coordinators from seven U.S.-based PBRNs worked with a professional team facilitator during semiannual in-person meetings and monthly conference calls to produce content for a compendium of recommended research practices specific to the context of PBRNs. Participants were assigned to contribute content congruent with their expertise. Feedback on the draft document was obtained from attendees at the preconference workshop at the annual PBRN meeting in 2013. A revised document was circulated to additional PBRN peers prior to finalization.

RESULTS

The PBRN Research Good Practices (PRGPs) document is organized into four chapters: (1) Building PBRN Infrastructure; (2) Study Development and Implementation; (3) Data Management, and (4) Dissemination Policies. Each chapter contains an introduction, detailed procedures for each section, and example resources with information links.

CONCLUSION

The PRGPs is a PBRN-specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings.

The predictive influence of family and neighborhood assets on fighting and weapon carrying from mid- to late adolescence

Using a developmental, social-ecological approach to understand the etiology of health-risk behavior and inform primary prevention efforts, we assess the predictive effects of family and neighborhood social processes on youth physical fighting and weapon carrying. Specifically, we focus on relationships among youth and their parents, family communication, parental monitoring, as well as sense of community and neighborhood informal social control, support, concerns, and disorder. This study advances knowledge through its investigation of family and neighborhood structural factors and social processes together, employment of longitudinal models that estimate effects over adolescent development, and use of self-report and observational measures. Data from 1,093 youth/parent pairs were analyzed from the Youth Assets Study using a Generalized Estimating Equation approach; family and neighborhood assets and risks were analyzed as time varying and lagged. Similar family assets affected physical fighting and weapon carrying, whereas different neighborhood social processes influenced the two forms of youth violence. Study findings have implications for the primary prevention of youth violence, including the use of family-based approaches that build relationships and parental monitoring skills and community-level change approaches that promote informal social control and reduce neighborhood concerns about safety.

Prospective association between negative life events and initiation of sexual intercourse: the influence of family structure and family income

OBJECTIVES

We examined the prospective association between negative life events and time to initiation of sexual intercourse and the influence of family structure and family income on this association.

METHODS

We followed up a randomly selected sample (n=649) of ethnically diverse parents and their children aged 12 to 17 years over a 5-year period. We conducted Cox proportional hazards regression analysis to examine the relation between negative life events and time to initiation of sexual intercourse. Family structure and family income were assessed as confounders.

RESULTS

Negative life events were significant predictors of time to initiation of sexual intercourse in adolescents. After controlling for demographic variables, youths reporting 1 negative life event had a hazard of initiation of sexual intercourse 1.40 times greater and youths reporting 2 or more negative life events had a hazard of initiation of sexual intercourse 1.61 times greater compared with youths reporting no negative life events. Family structure and family income were not significant confounders of the relation between initiation of sexual intercourse and negative life events.

CONCLUSIONS

Interventions to prevent initiation of sexual intercourse should focus on youths with recent negative life events, regardless of family income and structure.

Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study

Background

Four practice-based research networks (PBRNs) participated in a study to determine whether networks could increase dissemination, implementation, and diffusion of evidence-based treatment guidelines for chronic kidney disease by leveraging early adopter practices.

Methods

Motivated practices from four PBRNs received baseline and periodic performance feedback, academic detailing, and weekly practice facilitation for 6 months during wave I of the study. Each wave I practice then recruited two additional practices (wave II), which received performance feedback and academic detailing and participated in monthly local learning collaboratives led by the wave I clinicians. They received only monthly practice facilitation. The primary outcomes were adherence to primary care-relevant process-of-care recommendations from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Guidelines. Performance was determined retrospectively by medical records abstraction. Practice priority, change capacity, and care process content were measured before and after the interventions.

Results

Following the intervention, wave I practices increased the use of ACEIs/ARBs, discontinuation of NSAIDs, testing for anemia, and testing and/or treatment for vitamin D deficiency. Most were able to recruit two additional practices for wave II, and wave II practices also increased their use of ACEIs/ARBs and testing and/or treatment of vitamin D deficiency.

Conclusions

With some assistance, early adopter practices can facilitate the diffusion of evidence-based approaches to other practices. PBRNs are well-positioned to replicate this process for other evidence-based innovations.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-014-0169-x) contains supplementary material, which is available to authorized users.

Prospective Associations Among Assets and Successful Transition to Early Adulthood

Objectives. We investigated prospective associations among assets (e.g., family communication), which research has shown to protect youths from risk behavior, and successful transition to early adulthood (STEA). Methods. We included participants (n = 651) aged 18 years and older at study wave 5 (2007-2008) of the Youth Asset Study, in the Oklahoma City, Oklahoma, metro area, in the analyses. We categorized 14 assets into individual-, family-, or community-level groups. We included asset groups assessed at wave 1 (2003-2004) in linear regression analyses to predict STEA 4 years later at wave 5. Results. Individual- and community-level assets significantly (P < .05) predicted STEA 4 years later and the associations were generally linear, indicating that the more assets participants possessed the better the STEA outcome. There was a gender interaction for family-level assets suggesting that family-level assets were significant predictors of STEA for males but not for females. Conclusions. Public health programming should focus on community- and family-level youth assets as well as individual-level youth assets to promote positive health outcomes in early adulthood.

Prospective associations between negative life events and youth tobacco use

OBJECTIVE

To examine the prospective associations between commonly-occurring negative life events (NLEs) and adolescent tobacco use.

METHODS

NLEs were examined prospectively over 4 years from 1111 adolescents (mean age = 15.17 years). Family structure and parent education were assessed as confounders. Fourteen NLEs were examined and categorized into none, one, 2, or 3 or more events.

RESULTS

Prospective analyses indicated that NLEs were significantly associated with tobacco use in the following wave. NLEs assessed at each wave were significantly associated with tobacco use the next year. Family structure and parent education did not influence the relationship between tobacco use and NLEs.

CONCLUSIONS

Interventions to prevent tobacco use should focus on youth with a recent history of NLEs, regardless of family education and family structure.

The influence of assets and environmental factors on gender differences in adolescent drug use

For adolescents, illicit drug use remains a significant public health problem. This study explored prospectively the differential effects of 17 youth assets and 5 environmental factors on drug use in adolescent males and females (Youth Asset Study - a 5-wave longitudinal study of 1117 youth/parent pairs). Baseline analyses included 1093 youth (53% female). Mean age was 14.3 years (SD = 1.6) and the youth were 40% Non-Hispanic White, 28% Hispanic, 24% Non-Hispanic Black, and 9% Non-Hispanic other. Analyses revealed that 16 assets for males and 15 for females as well as the total asset score were prospectively associated with no drug use. No environmental factors were prospectively associated with any drug use for males, and for a subset of females, only Neighborhood Support was significant. This study confirms and extends previous work regarding youth drug use by recognizing the importance of the protective effect of assets for both males and females.

Promoting patient-centered preventive care using a wellness portal: preliminary findings

Optimal delivery of preventive services requires appropriate information processing and patient involvement. However, information is limited in preventive service delivery that integrates health information technology (HIT). This study aimed to develop and pilot test an Internet-based wellness portal to facilitate patient-centered care. Guiding portal development, an advisory panel systematically identified portal elements/features and engaged in the Delphi technique to achieve consensus on portal structure. To pilot test the portal, 30 patients were randomly recruited from 2 practices to complete a questionnaire. Frequency statistics were compiled for structured questions, and content analyses were conducted to examine qualitative responses on portal utility. Participant age ranged from 23 to 83 years (mean, 41 years). About 78% were female, 22% were ethnic minorities, and 80% had some college education. The portal provides a personalized wellness plan for preventive services based on patient demographics, medical history, risk factors, medications, laboratory tests, and functions like symptoms tracking, access to education materials, and secure patient-practice communication. Patients rated the portal in ease of use, importance, and utility/value. Over 90% found the portal easy to use in terms of navigation, finding information, comprehension, and instructions. Patients regarded the portal as an important tool in achieving wellness, improving patient-practice interactions, and a valuable resource. Contents analyses showed that patients found the portal helpful, particularly its reminder and tracking functions. Patients with basic computer literacy may use a simple, consumer-oriented Web site to manage their preventive care. The portal exemplifies how HIT may encourage active patient participation in their care and potentially improve health outcomes.

A longitudinal study of youth assets, neighborhood conditions, and youth sexual behaviors

PURPOSE

To prospectively determine whether individual, family, and community assets help youth to delay initiation of sexual intercourse (ISI); and for youth who do initiate intercourse, to use birth control and avoid pregnancy. The potential influence of neighborhood conditions was also investigated.

METHODS

The Youth Asset Study was a 4-year longitudinal study involving 1,089 youth (mean age = 14.2 years, standard deviation = 1.6; 53% female; 40% white, 28% Hispanic, 23% African American, 9% other race) and their parents. Participants were living in randomly selected census tracts. We accomplished recruitment via door-to-door canvassing. We interviewed one youth and one parent from each household annually. We assessed 17 youth assets (e.g., responsible choices, family communication) believed to influence behavior at multiple levels via in-person interviews methodology. Trained raters who conducted annual windshield tours assessed neighborhood conditions.

RESULTS

Cox proportional hazard or marginal logistic regression modeling indicated that 11 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for ISI; seven assets (e.g., educational aspirations for the future, responsible choices) were significantly associated with increased use of birth control at last sex; and 10 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for pregnancy. Total asset score was significantly associated with all three outcomes. Positive neighborhood conditions were significantly associated with increased birth control use, but not with ISI or pregnancy.

CONCLUSIONS

Programming to strengthen youth assets may be a promising strategy for reducing youth sexual risk behaviors.

Interpreting the psychometric properties of the components of primary care instrument in an elderly population

Objective:

To determine the psychometric properties of the Components of Primary Care Instrument (CPCI) in a patient population aged 65 or older.

Materials and Methods:

795 participants in the OKLAHOMA Studies, a longitudinal population-based study of predominantly Caucasian, elderly patients, completed the CPCI. Reliability analysis and confirmatory factor analysis were done to provide psychometric properties for this elderly sample. Models were constructed and tested to determine the best fit for the data including the addition of a method factor for negatively worded items.

Results:

Cronbach's alphas were comparable to values reported in prior studies. The confirmatory factor analysis with factor inter-correlations and a method factor each improved the fit of the factor model to the data. The combined model's fit approached the level conventionally recognized as adequate.

Conclusion:

CPCI appears to be a reliable tool for describing patient perceptions of the quality of primary care for patients over age 65.

School-related assets and youth risk behaviors: alcohol consumption and sexual activity

BACKGROUND

Two risk behaviors, alcohol consumption and early initiation of sexual intercourse (ISI), can have devastating consequences for youth. The purpose of this study was to determine the association of school connectedness and school-related behaviors (eg, academic performance, skipping school, getting into trouble at school) with these 2 risk behaviors.

METHODS

The Youth Asset Survey (YAS) was administered to 1117 youth/parent pairs in their homes using Computer-Assisted Personal/Self-Interviewing (CAPI/CASI). The YAS measures 17 youth assets and risk behaviors including alcohol consumption and sexual activity.

RESULTS

The mean age of the sample was 14.3 years; 53% were female; and 70% were from 2-parent homes. Five school-related behaviors were positively associated with no ISI. Four school-related behaviors were positively associated with reporting no alcohol consumption in the past 30 days, including the School Connectedness asset (only among 12- to 13-year-olds), not skipping school (only among non-Hispanic Caucasians), staying out of trouble, and paying attention.

CONCLUSIONS

School is very much a part of the lives of youth and therefore the relationship they have with their school experience is important and may influence their involvement in risk behaviors. Feeling connected to school is a positive asset that can protect youth from such risky behaviors as sexual initiation and alcohol consumption.

Parental youth assets and sexual activity: differences by race/ethnicity

OBJECTIVES

To examine how the relationship between parental-related youth assets and youth sexual activity differed by race/ethnicity.

METHODS

A random sample of 976 youth and their parents living in a Midwestern city participated in the study. Multivariate logistic regression analyses were conducted for 3 major ethnic groups controlling for the other demographics.

RESULTS

Parental monitoring had the strongest association with sexual abstinence for all 3 ethnic/racial groups. Family communication and relationship with mother were also important for white and black youth respectively.

CONCLUSIONS

Parental youth assets, especially parental monitoring, can be important in the decision to delay sexual intercourse.

Quality improvement as a tool for translating evidence based interventions into practice: what the youth violence prevention community can learn from healthcare

Health care has been working for the past 2 decades to improve the translation of evidence based practice (EBPs) into care. The strategies used to facilitate this, and lessons learned, can provide useful models for similar work taking place in youth violence prevention. This article discusses the history of evidence translation in health care, reviews key strategies used to support translation of evidence based practice into care, and suggests lessons learned that may be useful to similar efforts in youth violence prevention and intervention services.

Engaging patients and clinicians through a wellness portal to improve the health of Oklahomans

Patient-centeredness is one of the key dimensions of the patient-centered medical home model, yet it is still not uniformly understood. A goal-directed care approach that incorporates active preparation and comprehensive patient visits has been suggested to empower patients and improve health outcomes by various resources, including patient-side health IT (e.g. portals). In the context of a recent randomized controlled trial funded by the Agency of Healthcare Research and Quality, we developed a patient Wellness Portal that was linked to a previously designed and implemented clinician-portal. A six-month pilot implementation study was followed by a 12-month randomized controlled trial to determine the impact of the Portal on patient and practice-level outcomes. Results indicate that the Wellness Portal was easy to use, well received by patients, helped users educate themselves about their conditions, gauge their health status, and create a longitudinal wellness plan for discussion during an annual wellness visit. A preliminary analysis also showed that a greater proportion of patients received preventive services in the Portal intervention group than in the control group.

Reliability and Validity of the Youth Asset Survey: An Update

Purpose.

Improve and expand an existing youth asset scale.

Design.

Consisted of seven steps: (1) review of poorer-performing items and constructs, (2) literature review for relevant new asset constructs/items, (3) review of revised instrument by panel of experts, (4) qualitative review through focus group research, (5) pilot-test of instrument, (6) evaluation of the performance of the instrument in a longitudinal study, and (7) conduct of test-retest analysis.

Subjects/Setting.

Youth (N = 1111) recruited through canvassing of randomly selected census tracts and blocks.

Measures.

Youth Asset Survey (YAS).

Analysis.

Factor analysis was conducted on 50% of the baseline data and repeated on the second half of the baseline data. Correlations were computed for the test-retest analysis.

Results.

Following modifications to the YAS based upon qualitative research, the survey was administered to youth (mean age, 14.3years; 53% female; 39% white, 28% Hispanic, 23% African-American, 9% other). Cronbach α = .55–.92. A majority (27 of 34) of α ≥ .65. All items loaded on one construct at α ≥ .40. The final results yielded 17 constructs assessed via 61 items. Spearman correlations and intraclass correlations ranged from .60 to .82 and .58 to .87, respectively.

Conclusion.

The results generally suggest that the expanded YAS is a reliable and valid measure of assets.

Development of an obesity counseling model based on a study of determinants of intentional sustained weight loss

BACKGROUND

Overweight and obesity are at epidemic proportions. This study examines the attitudes and actions of Oklahoma clinicians in obesity treatment, and the characteristics and perceptions of a subset of their patients who lost weight and were able to maintain weight loss.

METHODS

Our study was a small mixed method study involving both surveys and interviews. Descriptive statistics were calculated, content analysis of interviews performed, and a model outline for obesity counseling was developed.

RESULTS

Only 38% of the 66 clinicians surveyed try to motivate their patients to lose weight. Patients interviewed recommended that clinicians treat obesity as a medical problem. We incorporated themes from the patient interviews into the S-MASS model for obesity screening and counseling.This was positively reviewed by clinicians and patients.

CONCLUSION

The S-MASS model can function as a guide to help the clinician/patient team develop successful strategies for weight loss and maintenance of weight loss.

The association of attendance at religious services and involvement in church/religious activities and youth assets, by gender, with youth's engagement in sexual intercourse

Purpose

Previous research has shown that religion plays a role in the lives of many youths. This paper aims to extend previous research and examine attendance at religious services and involvement in religious/church activities as separate items to determine if one aspect was more strongly associated with never having had sexual intercourse among youth in the USA. It also aims to consider the effect of other youth assets, and analyze all by gender.

Design/methodology/approach

Cross‐sectional data were examined to assess youth assets and risk behaviors. Multivariate regression was used to determine whether the assets or religion questions were significant in the presence of the other assets/religion questions. The eight assets examined, in addition to church attendance and involvement in religious groups were adult role models, peer role models, family communication, involvement in sports and groups, community involvement, aspirations for the future, responsible choices, and good health – diet and exercise.

Findings

Involvement in church/religious activities, but not attendance at religious services, was associated with never having had sexual intercourse among males and females. Analysis also determined that several of the other youth assets were protective of sexual intercourse among males and among females.

Research limitations/implications

Findings from this study may be limited by the validity of the self‐reported measures. The data were cross‐sectional, making it impossible to draw inferences about the causal directions of the relationships found in this study. Future research should focus on developing interventions to strengthen youth assets.

Practical implications

Developing gender and culturally specific interventions to promote youth assets may reduce the number of young people engaging in sex.

Originality/value

The paper extends previous research and examines attendance at religious services and involvement in religious/church activities as separate items to determine if one aspect was more strongly associated with never having had sexual intercourse.

Methodological considerations in a community-based longitudinal study

OBJECTIVES

To describe methodological issues and strategies relevant to conducting a community-based longitudinal study.

METHODS

Study participants (N=1117 youth/parent pairs) residing in neighborhoods that were randomly selected using a multistage sampling procedure and 2000 census data. Data were collected annually using in-home, in-person, computer-assisted interviewing methods. Numerous retention methods were used to track and retain participants.

RESULTS

The initial response rate was 61%. The retention rate is 97%, and the valid interview completion rate is 93% after nearly 4 waves of data collection.

CONCLUSIONS

In order for community-based longitudinal studies to overcome barriers to enrollment and retention, particular attention must be given to appropriate planning and available resources.

Integrating screening and interventions for unhealthy behaviors into primary care practices

BACKGROUND

Four unhealthy behaviors (tobacco use, unhealthy diet, physical inactivity, and risky alcohol use) contribute to almost 37% of deaths in the U.S. However, routine screening and interventions targeting these behaviors are not consistently provided in primary care practices.

METHODS

This was an implementation study conducted between October 2005 and May 2007 involving nine practices in three geographic clusters. Each cluster of practices received a multicomponent intervention sequentially addressing the four behaviors in three 6-month cycles (unhealthy diet and physical inactivity were combined). The intervention included baseline and monthly audits with feedback; five training modules (addressing each behavior plus stages of change [motivational interviewing]); practice facilitation; and bimonthly quality-circle meetings. Nurses, medical assistants, or both were taught to do screening and very brief interventions such as referrals and handouts. The clinicians were taught to do brief interventions. Outcomes included practice-level rates of adoption, implementation, and maintenance.

RESULTS

Adoption: Of 30 clinicians invited, nine agreed to participate (30%).

IMPLEMENTATION

Average screening and brief-intervention rates increased 25 and 10.8 percentage points, respectively, for all behaviors. However, the addition of more than two behaviors was generally unsuccessful. Maintenance: Screening increases were maintained across three of the behaviors for up to 12 months. For both unhealthy diet and risky alcohol use, screening rates continued to increase throughout the study period, even during the periods when the practices focused on the other behaviors. The rate of combined interventions returned to baseline for all behaviors 6 and 12 months after the intervention period.

CONCLUSIONS

It appears that the translational strategy resulted in increased screening and interventions. There were limits to the number of interventions that could be added within the time limits of the project. Inflexible electronic medical records, staff turnover, and clinicians' unwillingness to allow greater nurse or medical-assistant involvement in care were common challenges.

Youth Assets and Sexual Activity Among Hispanic Youth

Hispanic females, ages 15-19, experienced the highest birth rates and smallest decline in birth rates over the past decade compared to youth of other racial/ethnic groups. This study’s purpose was to investigate relationships among a series of protective factors, or youth assets, and sexual activity in the Hispanic/Latino youth population. Data were collected from Hispanic youth and their parents (N=232 youth/parent pairs) in randomly selected households using in-person, in-home interview methods. Independent variables were nine youth assets; “never had sexual intercourse” was the dependent variable. Data were analyzed using logistic regression analysis. Three assets were found to be significantly associated with whether or not Hispanic/Latino youth ever had sexual intercourse. Odds of never having had sexual intercourse were at least three times higher for youth with the Peer Role Models, Use of Time (religion), or Responsible Choices assets, compared to youth without these assets. Further Hispanic youth asset/risk behavior research is merited.

Protective assets for non-use of alcohol, tobacco and other drugs among urban American Indian youth in Oklahoma

OBJECTIVE

This study explored associations between nine youth assets and tobacco, alcohol and other drug non-use among participating American Indian adolescents.

METHODS

Data from 134 American Indians, ages 13-19 years, participating in an inner-city youth asset study, were analyzed. Individual logistic regression analyses were conducted, controlling for demographic variables, with nine youth assets as the independent variables and alcohol, tobacco and other drug non-use as the dependent variables.

RESULTS

Among American Indian youth, nearly 79% reported not using alcohol in the past 30 days. The prevalence of tobacco non-use was somewhat lower than that of alcohol, with 71% reporting not using tobacco in the past 30 days. For other drug non-use, 87% reported not using other drugs in the past 30 days. The non-parental adult role models asset was significantly associated with non-use of alcohol (OR = 4.4, 95% CI 1.5-13.3), tobacco (OR = 7.5, 95% CI 2.2-25.6), and other drugs (OR = 5.0, 95% CI 1.5-16.8). The use of time (religion) asset was also significantly associated with alcohol non-use (OR = 2.8, 95% CI 1.1-7.2). The family communication asset was associated only with other drug non-use (OR = 3.1, 95% CI 1.02-9.4). For tobacco non-use, an interaction was observed between family structure and the good health practices (exercise/nutrition) asset. Among youth in single-parent households, the odds of tobacco non-use were 4.4 times greater among those who possessed the good health practices (exercise/nutrition) asset.

CONCLUSIONS

Despite the relatively small sample size of American Indian youth, these results suggest an important role for specific youth assets in the prevention of substance abuse among American Indian youth.

Associations between youth assets and sexual activity: does adult supervision play a role?

BACKGROUND

Youth participation in sexual risk behaviours continues to be a critically important public health topic. Additionally, as youth are frequently being left alone during the day without adult supervision, there are increased opportunities for sexual risk-taking behaviour. This study examined how the relationships of nine youth assets and sexual activity may vary according to the stratification of youth into two groups: self-care and supervised.

METHODS

Data were collected through at-home, in-person interviews from a random sample of inner-city youth (mean age = 15.4 years; 51.5% female; 48.8% White; 22.4% Black; 18.5% Hispanic; 10% Native American) and their parents (n = 1079 parent/youth pairs). Nine youth assets were analysed using multiple logistic regression. Examples of assets youth may possess are: positive role models, family communication, school connectedness, constructive use of time and aspirations for the future. The item used to assess sexual intercourse was 'Have you ever had sexual intercourse ("done it", "had sex", "made love", "gone all the way")?'. Asset/risk behaviour associations that were unique to one of the two strata were the focus of the study.

RESULTS

Thirty-seven per cent of youth spent two or more hours per day home alone. Youth who were supervised had a greater number of unique significant associations between assets and sexual activity than youth who were in the self-care group.

CONCLUSIONS

Youth in supervised settings may be less likely to participate in sexual activity because of the presence of assets. Certain assets may also be important in deterring sexual activity for youth who are in self-care.

Youth assets and sexual abstinence in Native American youth

Compared with youth of other races/ethnicities, Native American youth (ages 15-19 years) are more likely to have participated in sexual intercourse, thus placing them at greater risk for sexually transmitted diseases (STDs) and unintended pregnancies. This study's purpose was to investigate relationships among protective factors (assets) and sexual intercourse in a Native American youth population. Data were collected from Native American youth and their parents (N=126 youth/parent pairs) living in randomly-selected households using in-person, in-home interview methods. Nine youth assets were the independent variables and never had sexual intercourse was the dependent variable. Data were analyzed using logistic regression. One significant (p<.05) asset main effect and one asset by youth age interaction were found. Youth with the Non-Parental Adult Role Models asset were 3.8 times more likely to have never had sex compared with youth without the asset. Further study of the influence of protective factors among Native American youth is warranted.

A matched case-control study: investigating the relationship between youth assets and sexual intercourse among 13- to 14-year-olds

BACKGROUND

The number of teenagers engaging in sexual intercourse has consistently changed over the past several years. This can become a major challenge when trying to determine why teens continue to have sex. The purpose of this paper was to investigate the relationship between youth assets and sexual intercourse among 13- to 14-year-olds.

METHODS

Cross-sectional data were collected using in-person at-home interviews from a random sample of inner-city neighbourhood 13- to 14-year-old teenagers (n = 64 matched pairs; 36% 13-year-olds, 53% female, 45% white, 28% African-American, 16% Hispanic and 11% Native American). Nine individual youth assets were analysed using conditional logistic regression (matching for several demographic variables) to assess the association between assets and abstinence in younger teens.

RESULTS

Conditional logistic regression analyses showed that two assets, positive Peer Role Models [odds ratios (OR) = 4.67, 95% confidence intervals (CI) = 1.93, 11.27] and Use of Time (Religion) (OR = 2.20, 95% CI = 1.04, 4.65), were significantly related (P < 0.05) to younger teens never having engaged in sexual activity.

CONCLUSION

These findings suggest, when considering abstinence behaviour, involvement in religious activities and having positive peer role models appear to be protective factors related to delaying sexual intercourse among teens aged 13-14 years.

Youth-parent communication and youth sexual behavior: implications for physicians

BACKGROUND AND OBJECTIVES

This study explores youth and parent agreement about conversations on specific topics related to sexual risk behavior and youth-parent relationship. The study's objective was to determine if the amount of agreement was associated with youth sexual behavior.

METHODS

Data were collected using a computer-assisted data entry system from one parent and one youth in 1,350 randomly selected households in inner-city areas of two Midwestern cities.

RESULTS

Youth-parent positive agreement scores about these conversations were significant after controlling for youth age, race, gender, family structure, and parental income and education. Scores were associated with youth abstinence and with the use of contraception if the youth had become sexually active.

CONCLUSIONS

In this study, youth-parent agreement regarding their communication was associated with positive youth behaviors, including abstinence and the use of contraception if sexually active.

Potential Protective Effect of the Community Involvement Asset on Adolescent Risk Behaviors

The potential of Community Involvement as a protective factor (youth asset) for eight adolescent risk behaviors was examined in this study. Cross-sectional data were collected from a randomly-selected population using in-home, in-person interviews in racially diverse inner-city neighborhoods of two Midwestern cities. Research participants were teenagers (n=1,278) and parents of the teenagers (n=1,278). Data included demographic variables; eight adolescent risk behaviors, including sexual activity, violence and the use of tobacco, alcohol and drugs. This study found youth with the Community Involvement asset were significantly (p

Clinical decision-making in blood pressure management of patients with diabetes mellitus: an Oklahoma Physicians Resource/Research Network (OKPRN) Study

BACKGROUND

Outcomes can be improved when the blood pressure (BP) is kept below 130/80 in patients with diabetes mellitus. However, physicians and patients achieve this target less than 50% of the time. The purpose of this study was to determine the reasons for this apparent quality deficit from the perspective of a small random sample of family physicians.

METHODS

Nine family physicians completed interviews about encounters with diabetic patients with BP >or=130/80 for whom no change in management was recorded. Four investigators analyzed the transcribed interviews to identify and categorize reasons for failure to intervene.

RESULTS

Ninety-eight (62%) of 159 patients had BP >or=130/80 at the index visit. No change in management was recorded in 73 (74%). Physicians gave 175 reasons for nonintervention in 3 broad categories, physician-related, patient-related, and information/measurement-related reasons, and 10 subcategories. In most cases they gave more than one reason (mean 2.4) per case. The most frequent subcategories were limited treatment options (47/73; 64%), inadequate information on which to intervene (43/73; 59%), and patient nonadherence (27/73; 37%). Competing demands were mentioned in 10 cases (13.7%). Physicians differed with regard to the kinds of reasons given.

CONCLUSIONS

Physicians have a variety of clinical reasons for not responding to elevated BP in diabetic patients. Some might be addressed with better technology (eg, more reliable BP measurements) or health care system reforms (eg, less expensive medications). Others (eg, patient nonadherence) are more challenging. Methods for measuring quality must be robust enough to account for legitimate clinical reasons for not achieving BP targets. Physician-based interventions will need to take into account different physician personalities and practice styles.

Youth assets, aggression, and delinquency within the context of family structure

OBJECTIVE

To identify youth assets associated with reduced aggressive and delinquent behavior of youth residing in 1-parent households but not of youth residing in 2-parent households.

METHODS

Data were collected from inner-city youth and their parents (N = 1,277 youth-parent pairs) using in-home, in-person interviews. Logistic regression analyses, stratifying by 1- and 2-parent household status, were conducted.

RESULTS

Several assets were significantly associated with reduced risk behavior only for youth residing in 1-parent households.

CONCLUSIONS

There appear to be specific assets (eg, Family Communication, Responsible Choices) that are more important for youth living in 1- versus 2- parent households.

Management of prescription refills in primary care: an Oklahoma Physicians Resource/Research Network (OKPRN) study

BACKGROUND

Management of prescription refills is a significant challenge for primary care practices, but little information exists on the best way to do it.

METHODS

Using the "best practices research" method within a primary care practice-based research network, we delineated steps involved in the process and the most important requirements for each step. We identified potential exemplary practices for each step and conducted practice audits and patient surveys to document actual performance. Methods with the highest performance ratings for the predetermined requirements for the steps were combined into a "best" unified approach.

RESULTS

Half of the surveyed practices were satisfied with at least one step in their current refill management process, but only 9% (3 practices) were satisfied with all 5 steps. Practice audits identified acceptable methods for each step. The best combined method involves teaching patients to call the pharmacy first for prescription refills, accepting only fax requests from the pharmacy, allowing a nurse or medical assistant to make most refill decisions, documenting them in the chart immediately, responding back to the pharmacy by fax, and relying on the pharmacy to notify the patient when the refill is ready. Patient satisfaction with this method was reasonably good. The cost per refill was approximately $0.25 excluding overhead associated with office equipment and utilities.

CONCLUSIONS

A satisfactory method for managing prescription refills in primary care practices was identified using the best practices research method.

Practice facilitators: a review of the literature

BACKGROUND

Practice facilitators (PFs) are health care professionals who assist primary care clinicians in research and quality improvement projects. Although they have been used in Europe and Australia for more than 20 years, the concept is relatively new in the United States. The recent evolution of primary care practice-based research networks (PBRNs) has led to greater awareness and expansion of this concept.

OBJECTIVES

This study's objective was to review the literature on PFs and describe their origin, training, funding, roles, methods they use, and their impact on patient care outcomes in primary care.

METHODS

We searched four electronic databases from 1966 through the present, reviewing all articles pertaining to PFs in an effort to understand the history, training, financing, roles, methods, and impact of PFs.

RESULTS

Since the early 1980s, PFs have worked with individual practices on relationship building, education, and quality improvement (QI), particularly in the area of prevention. A number of publications provide information on the roles of PFs in primary care and methods they use to enhance practices. Many prospective, uncontrolled studies and a few randomized, controlled trials have documented the effectiveness of PFs but usually in combination with other interventions. A number of primary care PBRNs in the United States have begun to use PFs as a way to bridge the gap between research and practice. Limited information has been published about the training and funding of PFs.

CONCLUSIONS

The PF concept seems to be a useful practice enhancement approach in primary care.

Relationships among youth assets and neighborhood and community resources

Recent research suggests that a youth development framework emphasizing youth assets may be a promising intervention strategy for preventing adolescent risk behaviors. Understanding how neighborhood and community resources relate to youth assets may aid in identifying environmental strategies to complement individually oriented asset-building interventions. In this study, 1,350 randomly selected inner-city youth and their parents (paired interviews) were interviewed in person. After controlling for demographic characteristics of youth and parents using multivariate logistic regression, parental perception of neighborhood safety was associated with the nonparental adult role model asset, peer role model asset, and for African American youth, the community involvement asset. City services and neighborhood services were associated with use of time (groups/sports) and use of time (religion), respectively. Psychological sense of community was associated with community involvement for Native American youth. Findings suggest that neighborhood and community-level influences should be considered when designing youth development interventions to reduce risk behaviors.

Youth assets and sexual risk behavior: the importance of assets for youth residing in one-parent households

CONTEXT

Youth assets are associated with a reduction in sexual risk behavior; however, little is known about this association among youth at high risk of engaging in unsafe behavior, such as those in one-parent households.

METHODS

In-home interviews were used to collect data from 1,253 inner-city teenagers and their parents. Multivariate logistic regressions were conducted separately for youth from one- and two-parent households to assess relationships between youth assets and four behaviors related to sexual risk: never having had sexual intercourse, not being currently sexually active, having delayed intercourse until age 17, and having used birth control at last intercourse.

RESULTS

Among youth living in one-parent households, those with the aspirations for the future, good health practices (exercise/nutrition), peer role models and family communication assets had significantly elevated odds of reporting one of the behaviors examined (odds ratios, 1.8-7.3). The peer role models asset also interacted with parental education to significantly predict an absence of current sexual activity for youth in one-parent households (21.2). Among youth living in two-parent households, community involvement was linked to increased odds of never having had sex (1.9), but no other significant relationships were found. Youths' total number of assets significantly predicted three of the four behaviors among youth in one-parent households (1.2-1.8), but predicted only sexual inexperience among those in two-parent households (1.4).

CONCLUSION

Future research should more fully investigate the role of family structure in relationships between youth assets and risk behaviors. Certain youth assets may be particularly effective in reducing sexual risk behavior among youth in one-parent households.

The potential protective effect of youth assets on adolescent alcohol and drug use

OBJECTIVES

We examined the association between adolescent alcohol and drug use and 9 youth assets in a low-income, inner-city population.

METHODS

An in-person survey of 1350 adolescents and parents assessed youth assets and risk behaviors. We analyzed data with chi(2) tests and logistic regression analyses.

RESULTS

When we controlled for appropriate variables, there were significant positive relationships between several youth assets and nonuse of alcohol and drugs. Furthermore, youths who possessed all of the statistically significant youth assets were 4.44 times more likely to report nonuse of alcohol and 5.41 times more likely to report nonuse of drugs compared with youths who possessed fewer youth assets.

CONCLUSIONS

Our study supports the view that specific youth assets may protect youths from alcohol and drug use.

The potential protective effects of youth assets from adolescent sexual risk behaviors

PURPOSE

To examine the relationship among individual youth assets and adolescent sexual risk behaviors.

METHODS

Cross-sectional, in-home interview data from randomly selected inner-city neighborhood teenagers (N = 1253) and their parents (N = 1253) were analyzed. Demographic information (e.g., age, parental income, family structure) was statistically controlled for while investigating the relationships among youth asset and sexual activity outcomes using logistic regression analyses. Potential interactions between the demographic variables and the assets were also examined. The five sexual risk behaviors included "never had sexual intercourse," current sexual activity, number of lifetime sexual partners, current use of birth control, and age at first intercourse.

RESULTS

Youth mean age was 15.4 (+/- 1.7) years; 52% were female; 49% were Non-Hispanic Caucasian, 23% Non-Hispanic African-American, 19% Hispanic and 10% Non-Hispanic Native American. Sixty-three percent reported never having had sexual intercourse. Multiple logistic regression analyses indicated that, after controlling for the demographic variables and the other significant assets, Non-Parental Adult Role Models, Peer Role Models, Use of Time (Religion), and Future Aspirations were independently significantly related (p <.05) to whether or not youth had ever participated in sexual intercourse. Individual multiple logistic regression analyses indicated that, after controlling for the demographic variables, Peer Role Model and Family Communication assets were each significantly associated with birth control use by sexually active youth (p <.05).

CONCLUSIONS

Specific youth assets may have a protective effect from certain sexual risk behaviors.

A youth development approach to profiling sexual abstinence

OBJECTIVE

To use youth and parent demographic factors, youth assets (strengths), and community constructs to develop age-group-specific profiles for youth who abstain from sexual activity.

METHODS

Data were collected using in-person interviews of youth (N = 1253) residing in randomly selected, inner-city neighborhood households. Data were analyzed to create classification trees.

RESULTS

Results indicated that assets typically were the most important factors related to abstinence and that the profiles differed for each age group.

CONCLUSIONS

When sexual abstinence is considered, the influence of youth and parent demographics, youth assets, and community factors appears to vary across adolescent developmental age periods.

Reliability and validity of the youth asset survey (YAS)

PURPOSE

To describe the construction of a survey that was developed to measure youth assets. The paper details the ten youth developmental assets measures within the survey, including the psychometric properties of those measures derived from factor analysis and reliability testing.

METHODS

Three studies were conducted, including a study of 1,350 randomly selected youth (mean age = 15.4 years; 52% female; 47% white, 22% black, 19% Hispanic, 10% Native American), using in-person interviews, to develop an asset instrument tool. Factor analysis was performed on a correlation matrix, using principal axis factoring, and varimax rotation. The criteria were set to extract eight factors.

RESULTS

The eight factors extracted represented six developmental assets as originally defined, including Family Communication, Peer Role Models, Future Aspirations, Responsible Choices, Community Involvement, and Non-Parental Role Models. One asset (Constructive Use of Time) was split into two specific assets: groups/sports and religious time. Two assets did not form factors (Good Health Practices [exercise/nutrition] and Cultural Respect) and were defined as one-item assets. All factor loading scores were.40 or higher and all Cronbach alphas were.60 or higher.

CONCLUSIONS

Factor analyses suggest that the constructs are reliable measures of youth developmental assets. The psychometrically sound asset measures presented here will provide scientists with valid and reliable instruments to assess and compare the prevalence of youth assets across populations and to investigate potential relationships between youth assets and other outcomes, such as youth risk behaviors.

Adolescent tobacco use: the protective effects of developmental assets

PURPOSE

To examine the effects of 10 youth developmental assets on adolescent tobacco use.

DESIGN

Survey of a randomly selected sample using in-home interviewing methodology.

SETTING

Inner-city areas of two midsized Midwestern cities.

SUBJECTS

The researchers studied 1,350 teen-parent pairs.

MEASURES

Demographic information, adolescent self-reported tobacco use, eight developmental asset Likert scales, and two one-item developmental asset measures.

RESULTS

The response rate was 51%. Logistic regression results indicate that youth who possess nine of 10 developmental assets examined are significantly less likely to report tobacco use than youth with low levels of assets. Adjusting for youth age, race, gender, parental income and education, and family structure, significant odds ratios include the following: nonparental adult role model, 2.09 (95% confidence interval [CI] = 1.45, 3.02); peer role models, 2.48 (95% CI = 1.87, 3.29); family communication, 1.73 (95% CI = 1.29, 2.31); use of time (organized groups), 1.77 (95% CI = 1.28, 2.44); use of time (religion), 2.49 (95% CI = 1.86, 3.33); good health practices (exercise/nutrition), 1.61 (95% CI = 1.21, 2.14); community involvement, 1.66 (95% CI = 1.07, 2.58); future aspirations, 2.06 (95% CI = 1.42, 2.99); and responsible choices, 2.21 (95% CI = 1.55, 3.15).

CONCLUSIONS

The findings of this study support the view that certain developmental assets may serve to protect youth from risk-taking behaviors, particularly tobacco use. Limitations include cross-sectional data and three scales with alphas below .7.

The effectiveness of magnet therapy for treatment of wrist pain attributed to carpal tunnel syndrome

We conducted a double-blind placebo-controlled randomized clinical trial in which 30 patients with pain attributed to carpal tunnel syndrome had either a 1000 gauss magnet or a placebo metal disk applied to the carpal tunnel area using a Velcro wrap for a period of 45 minutes. Pain was measured on a visual analogue scale using 0 and 10 as anchors. Presenting symptoms including numbness, tingling, burning, and pain did not differ significantly between the 2 groups. There was significant pain reduction across the 45-minute period for both groups. However, t test comparisons found no significant differences between the groups for beginning pain, pain at 15 minutes, pain at 30 minutes, or pain at 45 minutes. The use of a magnet for reducing pain attributed to carpal tunnel syndrome was no more effective than use of the placebo device.

An adolescent age group approach to examining youth risk behaviors

PURPOSE

To investigate relationships among youth risk behaviors and demographic factors using an adolescent age group approach.

DESIGN

Cross-sectional data from a randomly selected population. Risk behaviors were compared within specific demographic factors and by adolescent age groups.

SETTING

Racially diverse, inner-city neighborhoods in two midwestern cities.

SUBJECTS

Teenagers (n = 1350) and parents (n = 1350) of the teenagers.

MEASURES

Truancy; arrested/picked up by police; weapon carrying; fighting; sexual intercourse; tobacco, alcohol, and other drug use; demographic factors; and family structure.

RESULTS

Youth mean age was 15.4 (+/- 1.7) years and 52% were female; racial/ethnic characteristics were 47% White, 22% Black, 19% Hispanic, and 10% Native American. Parents' mean age was 42.2 (+/- 8.4) years and 81% were female. chi 2 analyses indicated numerous significant (p < .05) youth risk behavior differences within the demographic factors and that many of the differences varied by adolescent age group. For example, risk behavior differences within racial/ethnic groups were most profound in the middle and older age groups, whereas risk behavior differences within parent income, education levels, and family structure were most apparent in the younger age groups. Of the demographic factors, family structure was most frequently associated with the risk behaviors.

CONCLUSIONS

The results generally suggest that the relationships among risk behaviors and demographic factors vary within the adolescent age groups included in this study. The results will be useful for developing age-appropriate prevention programs for youth who fit the profile for these risk behaviors. The study protocol also includes specific sampling methods that may be useful for future studies that intend to collect data from difficult-to-reach populations.