How Do Adolescent Smoking Prevention Interventions Work in Different Contextual Settings? A Qualitative Comparative Study Between the UK and Colombia

BACKGROUND

Adolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings.

METHOD

A comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11-15 years). The Theoretical Domains Framework guided a content analysis of the data.

RESULTS

We found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape.

CONCLUSION

These findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping.

Work-family enrichment: A potential buffer of inflammation among black adults?

Background

Inflammation plays a known role in the development of cardiovascular disease (CVD), the leading cause of death in the United States and a condition that disproportionately affects Blacks. Although social stressors are frequently studied, the role of positive experiences in inflammation and its potential for CVD remains understudied. To address this gap, we examined the relationship between work family enrichment and inflammation in a population-based sample of working adults.

Methods

Participants were 447 working adults from Refresher Cohort of the National Study of Midlife Development in the United States (MIDUS) and the oversample of Blacks from the Milwaukee, WI. Serum concentration of pro-inflammatory biomarkers (IL-6/sIL-6r; CPR; Fibrinogen) were obtained via blood draw. Family-to-work enrichment (FtoWE) and work-to-family enrichment (WtoFE) were each assessed with four established survey questions.

Results

Blacks had higher concentrations of IL-6, CRP and Fibrinogen, and lower levels of sIL-6r than whites. A significant inverse relationship was observed between WtoFE and systemic inflammation as well as WtoFE and serum IL-6 concentration.

Conclusions

Individuals who perceived a stronger enhancing effect from work onto family showed lower levels of systemic inflammation and decreased concentrations of the pro-inflammatory cytokine IL-6; highlighting the potential work-family enrichment or other positive experiences may have in buffering the negative cardiovascular effects of inflammation. However, variation between racial groups remain undetermined.

•

Higher concentrations of pro-inflammatory biomarkers were seen among Blacks.

•

Greater WFE conferred less systemic inflammation and lower concentrations of IL-6.

•

Positive experiences from work to family may buffer inflammation, improving CVD risk.

Work as a Social Determinant of Racial Health Inequalities

Interdisciplinary research posits that work is a social determinant of health contributing to racial inequalities in death, disease, and well-being amongst Black individuals in the United States. This study aims to advance research by integrating two theoretical frameworks (Warr's Vitamin Model and Assari's "differential exposure" and "differential gain" mechanisms) to investigate the role of work in eudemonic well-being. We included a nationally representative sample of adults who participated in the Midlife in the United States (MIDUS) Refresher and Milwaukee Refresher projects in 2011-2014, alongside corresponding occupational information (O*NET 17.0). The results of this study indicated that three of nine studied job characteristics systematically differ by race. We found evidence of differential gain by race on psychological well-being. Job characteristics had either benign or negative associations with well-being among Black individuals but consistently positive associations with well-being among non-Black individuals. In contrast to Warr's Vitamin Model, we found little evidence of curvilinear health effects of job characteristics (only 5.5% were statistically significant). Finally, it was found that advanced educational attainment benefited multiple dimensions of well-being among Black individuals but had benign or negative implications for non-Black individuals, after controlling for demographics. Overall, the results highlight racial inequalities in eudemonic well-being because Black individuals face challenges in obtaining jobs that are beneficial to well-being. Collectively, the results reinforce the idea that work is a social determinant of health.

A multi-method exploration into the social networks of young teenagers and their physical activity behavior

Background

There is a need for novel interventions to target inadequate levels of adolescent physical activity behavior. Previous research indicates that better understanding of the processes by which social networks influence physical activity behavior in adolescents may be useful to enhance intervention design.

Methods

This study used a multi-methods approach to aid our understanding about the role of social networks for adolescent physical activity behavior. The quantitative phase of data collection was analyzed using a three-step linear regression model using cross-sectional data from the WiSe study (n = 529 participants, 48.6% female, mean age 14.38 years (SD 0.32)). A demographically reflective sub-sample of schools were invited to take part in the qualitative phase, which involved focus group discussions. Thematic analysis was used to explore findings from the quantitative phase in greater depth, and identify other themes pertaining to the association between social networks and physical activity behavior.

Results

Males’ physical activity behavior was predicted by their friend group (0.46, p = 0.007) whereas females’ physical activity was predicted by their best friend (0.21, p = 0.03). The three main findings that were uncovered by the regression analysis were explored during the qualitative phase: 1) friends have similar physical activity behaviors; 2) friendship social networks may influence differently early adolescent male and female physical activity behavior; 3) popularity and sociability were not associated with physical activity behavior. Two additional themes emerged from the analysis of focus group data: 4) social norms and 5) external factors that may impact the relationship between adolescent physical activity behavior and social networks.

Conclusions

The investigation of the interplay between the findings from each phase of the inquiry indicated that social networks influence in different ways and to different degrees the physical activity of adolescent males and females. In turn, these insights point to the need for a systematic tailoring process for the development and implementation of physical activity behavior interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-10081-0.

MECHANISMS Study: Using Game Theory to Assess the Effects of Social Norms and Social Networks on Adolescent Smoking in Schools-Study Protocol

This proof of concept study harnesses novel transdisciplinary insights to contrast two school-based smoking prevention interventions among adolescents in the UK and Colombia. We compare schools in these locations because smoking rates and norms are different, in order to better understand social norms based mechanisms of action related to smoking. We aim to: (1) improve the measurement of social norms for smoking behaviors in adolescents and reveal how they spread in schools; (2) to better characterize the mechanisms of action of smoking prevention interventions in schools, learning lessons for future intervention research. The A Stop Smoking in Schools Trial (ASSIST) intervention harnesses peer influence, while the Dead Cool intervention uses classroom pedagogy. Both interventions were originally developed in the UK but culturally adapted for a Colombian setting. In a before and after design, we will obtain psychosocial, friendship, and behavioral data (e.g., attitudes and intentions toward smoking and vaping) from ~300 students in three schools for each intervention in the UK and the same number in Colombia (i.e., ~1,200 participants in total). Pre-intervention, participants take part in a Rule Following task, and in Coordination Games that allow us to assess their judgments about the social appropriateness of a range of smoking-related and unrelated behaviors, and elicit individual sensitivity to social norms. After the interventions, these behavioral economic experiments are repeated, so we can assess how social norms related to smoking have changed, how sensitivity to classroom and school year group norms have changed and how individual changes are related to changes among friends. This Game Theoretic approach allows us to estimate proxies for norms and norm sensitivity parameters and to test for the influence of individual student attributes and their social networks within a Markov Chain Monte Carlo modeling framework. We identify hypothesized mechanisms by triangulating results with qualitative data from participants. The MECHANISMS study is innovative in the interplay of Game Theory and longitudinal social network analytical approaches, and in its transdisciplinary research approach. This study will help us to better understand the mechanisms of smoking prevention interventions in high and middle income settings.

Peer social network processes and adolescent health behaviors: A systematic review

Research has highlighted the importance of peers for determining health behaviors in adolescents, yet these behaviors have typically been investigated in isolation. We need to understand common network processes operating across health behaviors collectively, in order to discern how social network processes impact health behaviors. Thus, this systematic review of studies investigated adolescent peer social networks and health behaviors. A search of six databases (CINAHL, Education Resources Information Centre, Embase, International Bibliography of the Social Sciences, Medline and PsycINFO) identified 55 eligible studies. The mean age of the participants was 15.1 years (range 13-18; 51.1% female). Study samples ranged from 143 to 20,745 participants. Studies investigated drinking (31%), smoking (22%), both drinking and smoking (13%) substance use (18%), physical activity (9%) and diet or weight management (7%). Study design was largely longitudinal (n = 41, 73%) and cross-sectional (n = 14, 25%). All studies were set in school and all but one study focused on school-based friendship networks. The Newcastle-Ottawa Scale was used to assess risk of bias: studies were assessed as good (51%), fair (16%) or poor (33%). The synthesis of results revolved around two network behavior patterns: 1) health behavior similarity within a social network, driven by homophilic social selection and/or social influence, and 2) popularity: health behavior engagement in relation to changes in social status; or network popularity predicting health behaviors. Adolescents in denser networks had statistically significant lower levels of harmful behavior (n = 2/2, 100%). Findings suggest that social network processes are important factors in adolescent health behaviors.

The correlation between femoral condyle radii and subject height

In the sagittal plane, the distal femoral condyles can be modeled using anterior and posterior circle segments. The aim of this study was to investigate how the radii of these segments vary with subject height. The MRI scans of 20 male and 20 female knees were analyzed with a computer to extract the radii of each condyle segment. These radii were then correlated with the patient's height. The anteromedial radii ranged from 22.6 to 32.6 mm. The posteromedial radii ranged from 15.4 to 26.3 mm. The anterolateral radii ranged from 19.7 to 30.4 mm. The posterolateral radii ranged from 15.2 to 23.6 mm. The radii had a strong correlation with patient height, with some differences between sexes. Linear regressions of the data yielded equations for estimating condyle radii from height. These radii estimations can be helpful in the clinical assessment of knee movement and treatment outcome.

Magnetic tracking: a novel method of assessing anterior cruciate ligament deficiency

INTRODUCTION

The Lachman test is commonly performed as part of the routine assessment of patients with suspected anterior cruciate ligament (ACL) deficiency. A major drawback is its reliance on the clinician's subjective judgement of movement. The aim of this study was to quantify Lachman movement using a magnetic tracking device thereby providing a more accurate objective measure of movement.

PATIENTS AND METHODS

Ten patients aged 21-51 years were assessed as having unilateral ACL deficiency with conventional clinical tests. These patients were then re-assessed using a Polhemus Fastrak magnetic tracking device.

RESULTS

The mean anterior tibial displacement was 5.6 mm (SD = 2.5) for the normal knees and 10.2 mm (SD = 4.2) for the ACL-deficient knees. This gave an 82% increase in anterior tibial displacement for the ACL deficient knees. This was shown to be highly significant with P = 0.005.

CONCLUSIONS

The magnetic tracking system offers an objective quantification of displacements during the Lachman test. It is convenient, non-invasive and comfortable for the patient and is, therefore, ideally suited for use as an investigative tool.

Instant center of rotation estimation using the Reuleaux technique and a Lateral Extrapolation technique

A mathematical model of a rolling wheel was used to investigate the errors encountered when the Reuleaux technique is employed to estimate planar instant centers of rotation (ICRs). The investigation showed that large errors can result when this pole measurement technique is applied to objects rotating more than 12 degrees. The investigation also showed that these errors can be substantially reduced by applying a new Lateral Extrapolation technique to the pole data. When the Reuleaux technique is applied to marks on a 10cm radius wheel, the resulting offset errors from the ICR are 3.96cm for a 45 degrees roll and 1cm for a 12 degrees roll. Following lateral extrapolation, these offset errors reduce to 0.52cm for the 45 degrees roll and less than 0.04cm for the 12 degrees roll. Thus, the extrapolation technique is over seven times more accurate for a 45 degrees roll, and over 25 times more accurate for a 12 degrees roll. The extrapolation technique has been validated with the model for joints that exhibit both slip and roll, such as the knee. As joint ICR pathway measurement can be used to detect pathology, these accuracy improvements offer potential benefits for clinical applications.

Thromboembolic complications after electrical cardioversion in patients with atrial flutter

PURPOSE

To determine the incidence of thromboembolic complications after cardioversion in patients with atrial flutter.

SUBJECTS AND METHODS

We reviewed 615 electrical cardioversions performed electively in 493 patients with atrial flutter. Embolic complications were evaluated during the 30 days after cardioversion. Follow-up data were obtained by follow-up visits and by contacting the treating physician.

RESULTS

Anticoagulants had been administered in 415 cardioversions (67%). Cardioversion was successful in 570 procedures (93%). Three embolic events (in 3 patients) occurred in the 30 days after 550 successful cardioversions with completed follow-up (0.6% of successful procedures; 95% confidence interval, 0.1% to 1.6%). Two of the 3 patients had not been anticoagulated, whereas the third patient had subtherapeutic oral anticoagulation. No embolic event occurred in procedures performed with adequate anticoagulation. The incidence of embolism in patients regardless of subtherapeutic anticoagulation was 1% (3 of 303 successful cardioversions).

CONCLUSIONS

We observed a low (0.6%) incidence of postcardioversion thromboembolic complications in patients with atrial flutter. Embolic events did not occur in patients with adequate anticoagulation.

Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women

OBJECTIVE

To evaluate the contribution of left atrial (LA) volume in predicting atrial fibrillation (AF).

PATIENTS AND METHODS

In this retrospective cohort study, a random sample of 2200 adults was identified from all Olmsted County, Minnesota, residents who had undergone transthoracic echocardiographic assessment between 1990 and 1998 and were 65 years of age or older at the time of examination, were in sinus rhythm, and had no history of AF or other atrial arrhythmias, stroke, pacemaker, congenital heart disease, or valve surgery. The LA volume was measured off-line by using a biplane area-length method. Clinical characteristics and the outcome event of incident AF were determined by retrospective review of medical records. Echocardiographic data were retrieved from the laboratory database. From this cohort, 1655 patients in whom LA size data were available were followed from baseline echocardiogram until development of AF or death. The clinical and echocardiographic associations of AF, especially with respect to the role of LA volume in predicting AF, were determined.

RESULTS

A total of 666 men and 989 women, mean +/- SD age of 75.2 +/- 7.3 years (range, 65-105 years), were followed for a mean +/- SD of 3.97 +/- 2.75 years (range, < 1.00-10.78 years); 189 (11.4%) developed AF. Cox model 5-year cumulative risks of AF by quartiles of LA volume were 3%, 12%, 15%, and 26%, respectively. With Cox proportional hazards multivariate models, logarithmic LA volume was an independent predictor of AF, incremental to clinical risk factors. After adjusting for age, sex, valvular heart disease, and hypertension, a 30% larger LA volume was associated with a 43% greater risk of AF, incremental to history of congestive heart failure (hazard ratio [HR], 1.887; 95% confidence interval [CI], 1.230-2.895; P = .004), myocardial infarction (HR, 1.751; 95% CI, 1.189-2.577; P = .004), and diabetes (HR, 1.734; 95% CI, 1.066-2.819; P = .03). Left atrial volume remained incremental to combined clinical risk factors and M-mode LA dimension for prediction of AF (P < .001).

CONCLUSION

This study showed that a larger LA volume was associated with a higher risk of AF in older patients. The predictive value of LA volume was incremental to that of clinical risk profile and conventional M-mode LA dimension.

A surface-marker imaging system to measure a moving knee's rotational axis pathway in the sagittal plane

This paper describes a new surface-marker imaging system designed to measure the rotational axis pathway (RAP) of a moving knee in the sagittal plane. Measurement of this parameter can provide important information about a knee's slipping and rolling action that can aid clinical assessment. Seated subjects are video recorded as they actively extend their legs. A series of stills is then captured and analyzed to extract the coordinates of markers placed on the subjects upper and lower legs. These coordinates are then processed to deduce an instant center of rotation (ICR) for each still. These ICRs are then plotted to derive the joint's RAP. The system has been validated with a mechanical model and tested in a clinical study of ten patients with unilateral anterior cruciate ligament (ACL) ruptures. The study found that the system could consistently measure differences between a patients normal and injured knees. Leg extension caused the normal knees ICRs to displace anteriorly with a mean value of 17.4 mm, whereas the injured knees had a mean displacement of 7.5 mm. This loss of roll in the ACL-deficient knees is consistent with their abnormal biomechanical arrangement.

Personal ultrasound imager: abdominal aortic aneurysm screening

BACKGROUND

Miniaturized ultrasonographic machines (2.5-MHz curved-array transducer connected to a compact 2.6-kg console), termed personal ultrasound imagers (PUIs), may enable detection of occult abdominal aortic aneurysms (AAAs).

OBJECTIVES

Our goals were to determine whether a PUI is capable of screening for AAAs and to compare the results with an established screening examination with standard echocardiography (SE).

METHODS

One hundred twenty-five patients (aged >70 years) with hypertension who were referred for transthoracic echocardiography were enrolled. After SE, a focused screening with a PUI examination was performed by a blinded sonographer. An AAA was defined as a focal enlargement of the aorta >30 mm. Results and the length of time to image the aorta were compared for both tests.

RESULTS

We studied 64 men and 61 women (aged 76.8 +/- 5 years; mean blood pressures: systolic 145.7 +/- 18 and diastolic 78.6 +/- 10; body surface area 1.9 +/- 0.2 m(2)). The mean time for SE was 2.9 +/- 1.5 minutes and for the PUI examination was 4.6 +/- 2.3 minutes. By using SE as the gold standard, the sensitivity and specificity of the PUI were 91% and 96%, respectively. The positive predictive value of the PUI was 71%, and the negative predictive value was 99%.

CONCLUSION

A PUI can be used to screen for occult AAAs as an extension of the physical examination. Results are comparable to an established screening strategy that uses more expensive, nonportable echocardiographic equipment.

Shortness of breath secondary to a pet cockatiel

A case of hypersensitivity pneumonitis in a 40-year-old patient secondary to a pet bird is presented. The clinical presentation, diagnosis, and management of hypersensitivity pneumonitis are reviewed.