Developmental changes in genetic and environmental influences on Chinese child and adolescent anxiety and depression

BACKGROUND

Twin and family studies using Western samples have established that child and adolescent anxiety and depression are under substantial genetic, modest shared environmental, and substantial non-shared environmental influences. Generalizability of these findings to non-Western societies remains largely unknown, particularly regarding the changes of genetic and environmental influences with age. The current study examined changes in genetic and environmental influences on self-reported anxiety and depression from late childhood to mid-adolescence among a Chinese twin sample. Sex differences were also examined.

METHOD

Self-reported anxiety and depression were collected from 712 10- to 12-year-old Chinese twins (mean = 10.88 years, 49% males) and again 3 years later. Quantitative genetic modeling was used to examine developmental changes in genetic and environmental influences on anxiety and depression, and sex differences.

RESULTS

Heritability of anxiety and depression in late childhood (23 and 20%) decreased to negligible in mid-adolescence, while shared environmental influences increased (20 and 27% to 57 and 60%). Shared environmental factors explained most of the continuity of anxiety and depression (75 and 77%). Non-shared environmental factors were largely time-specific. No sex differences were observed.

CONCLUSIONS

Shared environmental influences might be more pronounced during the transition period of adolescence in non-Western societies such as China. Future research should examine similarities and differences in the genetic and environmental etiologies of child and adolescent internalizing and other psychopathology in development between Western and non-Western societies.

The prognostic value of pretreatment 2-(18F)-fluoro-2-deoxy-D-glucose positron emission tomography scan in women with cervical cancer

There is substantial risk that prognosis determined with routine clinical staging for cervical cancer may be inaccurate. This is primarily due to understaging due to the lack of detection of nodal disease. This is particularly true for para-aortic nodal metastases. Treatment based on such staging may also be inadequate for the same reason. Positron emission tomography (PET) has been demonstrated to be useful in the staging of cervical cancer and superior to either computed tomography or magnetic resonance imaging in the detection of nodal disease. Our objective was to determine the prognostic value of pretreatment 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) PET scan in women with cervical cancer. We reviewed the records of 56 women with cervical cancer who underwent FDG PET scan prior to treatment. The primary outcome was the effect of abnormal FDG uptake consistent with metastatic nodal disease on 20-month disease-free survival. The pretreatment PET scan demonstrated abnormal FDG uptake in the pelvic nodes alone in 14 (25%) women, in pelvic and para-aortic nodes in 10 (17.9%), and in neither pelvic nor para-aortic nodes in 32 (57.1%). Women with positive pelvic nodes by PET as well as women with positive para-aortic nodes had significantly poorer 20-month disease-free survival compared to women with negative nodes (P= 0.0003 and P= 0.0017, respectively). We conclude that pretreatment FDG PET scan revealing abnormal FDG uptake consistent with nodal disease is a robust predictor of disease recurrence and may alter the therapeutic management of some patients.

Definitive and palliative radiotherapy for cervix cancer in the elderly

The elderly population is increasing in number. Aggressive therapeutic intervention in this patient group may not always be possible because of age, the presence of co-morbidity, and poor functional status. Hence, individualized management of cervix cancer (CC) in the elderly is often practiced. Because of the preceding consideration, the cases of 79 women 65 years of age and older with CC treated with radiation over the last 20 years were reviewed. The cases were classified into two groups--those who were aggressively irradiated (group 1: 43 patients) and those managed less intensively for palliation (group 2: 36 patients). Local tumor control, complications, and survival were assessed. There were fewer extremely aged (> or = 75 years of age) women (p = 0.006) with advanced stage disease (p = 0.012) in group 1 than in group 2. Also, group 1 women experienced fewer treatment failures (p < 0.0003) and more of them were alive and well at last follow-up (p < 0.005) than those from group 2. The median survival periods for groups 1 and 2 were 60 months and 11 months, respectively (p < 0.0001); the corresponding 5-year crude survival rates were 54% and 19%, respectively (p = 0.002). Two women required remedial surgery for bowel obstruction/perforation after irradiation, and one patient sustained chronic radiation cystitis.

Whole-body [18F]fluoro-2-deoxyglucose positron emission tomography scan staging prior to planned radical hysterectomy and pelvic lymphadenectomy

The aim of the study was to determine the effectiveness of whole-body [18F]fluoro-2-deoxyglucose positron emission tomography (FDG PET) imaging in properly selecting candidates for radical hysterectomy who are at low risk for subsequent chemoradiation. Retrospective study of 14 women undergoing planned radical hysterectomy and pelvic lymphadenectomy with clinically localized cervical cancer and either negative or inconclusive metastatic nodal disease by PET scan was performed. Pelvic lymph nodes were clearly negative by FDG PET scan in 12 of the 14 women. Two women had focal FDG uptake suspicious, although not definitive, for nodal metastasis, and pelvic nodes were positive at surgery in both. Computed tomography (CT) scan failed to detect nodal disease in either woman. Neither PET nor CT was effective at detecting parametrial disease, and both also failed to detect the primary tumor in some cases. Women with FDG PET scans that are clearly negative for nodal disease are good candidates for radical hysterectomy and are at low risk for subsequent chemoradiation.

Cancer of the cervix with endometrial extension treated by radiotherapy: a retrospective case-control study

BACKGROUND

Studies determining prognosis of cancer of the cervix with endometrial extension (CCEE) in a case-control fashion are scant.

METHODS

A case-control retrospective study of 20 women with CCEE and 16 patients with cervical cancer not extending to the endometrium (CCNEE) treated by radiation was undertaken. The patient groups were matched for age, disease stage, the presence of bulky/barrel-shaped tumor in the cervix, intercurrent illness, total radiation dose, and hemoglobin level. The overall mean follow-up was 54 months (range 8 to 218 months).

RESULTS

The numerical rates of local and systemic failure as well as 5-year survival were worse for patients with CCEE versus CCNEE. However, the observed differences were not statistically significant.

CONCLUSION

Involvement of the endometrium by cancer of the cervix seems to confer a worse outcome among cervical cancer patients treated by radiation alone.

Are adolescents attempting to buy cigarettes on the internet?

OBJECTIVE

To assess the prevalence of, and demographic and smoking behaviour correlates of, attempting to purchase cigarettes via the internet among adolescent current smokers.

METHODS

A representative sample of 17 181 10th and 12th grade California students completed a written questionnaire on tobacco related attitudes and behaviour during the 1999-2000 school year. Logistic regression analyses were used to determine the variables associated with attempting to purchase cigarettes on the internet.

RESULTS

Among youth under 18 years of age who were current smokers (n = 1689), 2.2% (95% confidence interval 1.5% to 2.9%) reported attempting to purchase cigarettes on the internet. Attempted internet purchases were more likely among younger respondents, males, frequent smokers, and respondents reporting lower perceived availability of tobacco products from retail and social sources.

CONCLUSIONS

Few adolescent smokers in California surveyed during the 1999-2000 school year had attempted to obtain cigarettes from the internet. As internet access increases, future studies should examine whether internet cigarette vendors sell to minors and whether adolescents are purchasing cigarettes on the internet.

Adolescent smoking in Wuhan, China: baseline data from the Wuhan Smoking Prevention Trial

BACKGROUND

This study reports the prevalence of adolescent smoking in the urban and rural areas of Wuhan, China, the capital of Hubei Province, on the Yangtze River in central China.

METHODS

Smoking behavior was examined by age, gender, and urbanicity as part of the Wuhan Smoking Prevention Trial. Subjects included 6994 seventh- to ninth-grade students attending 22 randomly selected schools in urban and rural districts. Outcome measures included lifetime smoking, past-30-day smoking, established smoking (>100 cigarettes in lifetime), and susceptibility to smoking (absence of a firm commitment not to smoke).

RESULTS

Lifetime smoking prevalence was 47% among boys and 18% among girls. Past-30-day smoking prevalence was 16% among boys and 4% among girls. Established smoking prevalence was 2% among boys and 0% among girls. The prevalence of susceptibility to smoking was 31% among boys and 10% among girls. Smoking increased significantly with age (p<.0005). Susceptibility was more prevalent in rural areas than in urban areas (p<.05), but there were no urban-rural differences in lifetime, past 30-day smoking, or established smoking. Trend analyses revealed that smoking increased with age more rapidly among boys than among girls (p<.05). Smoking was more prevalent among rural boys than among urban boys, but it was more prevalent among urban girls than among rural girls (p<.05).

CONCLUSIONS

Adolescent smoking is a significant public health problem in China. Boys are at particularly high risk, as are girls living in urban areas. Effective smoking prevention programs for adolescents, as well as restrictions on tobacco industry marketing and youth access to tobacco, are needed to prevent tobacco-related morbidity and mortality in China.

Ethnic variation in peer influences on adolescent smoking

Previous research has indicated that the influence of peers on adolescent smoking may differ across ethnic groups. Although many studies have focused on African Americans, Hispanics, and Whites, few studies have included Asian Americans, Pacific Islanders, and multi-ethnic adolescents as distinct groups. Using data from a statewide sample of 5870 eighth-grade adolescents in California, this study examined ethnic differences in the association between peer influence variables and smoking behavior and susceptibility. Informational peer influence (best friends' smoking behavior) and normative peer influence (prevalence estimates of peer smoking) were investigated. We hypothesized that informational peer influences would be stronger among Whites (whose families originate primarily from the individualistic cultures of the USA and Western Europe) than among Asian Americans, Pacific Islanders, Hispanics, and African Americans (whose families originate primarily from collectivist cultures). Conversely, we hypothesized that normative peer influences would be stronger among ethnic minority adolescents from collectivist cultural backgrounds than among Whites. Consistent with previous studies, friends' smoking and prevalence estimates of peer smoking were risk factors for past 30-day smoking and susceptibility to smoking across ethnic groups. The influence of friends' smoking behavior was stronger among Whites than among several other groups: Pacific Islanders, African Americans, and Hispanic/Latinos. The influence of prevalence estimates of peer smoking was stronger among Whites than among multiethnic adolescents. Results indicate that cultural factors may play a role in peer influences on smoking initiation. Smoking prevention interventions for adolescents should address the differences in peer influences across ethnic groups.

Hazard of smoking initiation by age among adolescents in Wuhan, China

BACKGROUND

Knowledge about age of smoking initiation among adolescents in China is helpful for exploring cultural differences in adolescent smoking behavior and informative for global tobacco control. However, little has been documented on this issue.

METHOD

Adolescents (6,473) attending grades 7, 8, and 9 completed the baseline survey of a longitudinal, randomized smoking prevention trial. Data were collected in classrooms with a paper-and-pencil questionnaire. A survival model was used in the statistical analysis.

RESULTS

The hazard of smoking initiation for boys showed a pattern previously observed in the United States: very low (<2%) before 7 years of age, increasing rapidly after age 10, and peaking at 14-15 years of age. The hazard for girls was below or around 1% until 12 years of age before it increased. The hazard levels were similar for adolescents both in urban and in rural areas, but higher for those in grade 7 than in grades 8 and 9.

CONCLUSIONS

Chinese boys in Wuhan, China, experienced a hazard pattern of smoking initiation by age similar to those observed in the United States, while Chinese girls there experienced a rather low risk of smoking initiation. The hazard pattern suggests that the best time for smoking prevention is between 10 and 15 years of age. Adolescents in lower grades are at higher risk of early smoking initiation, suggesting a potential cohort effect in adolescent smoking initiation in Wuhan, China.

Peer influences and susceptibility to smoking among California adolescents

Using data from a diverse statewide sample of 10th-grade adolescents in California, in 1996-97, this study investigated the associations between peer influence variables and susceptibility to smoking. Peer influence variables included attitudes about the social consequences of smoking and subjective norms, as described by the Theory of Reasoned Action. Among never-smokers (N=2681) and ever-smokers (N=4248), attitudes about social consequences of smoking and subjective norms each were associated with an increased risk of susceptibility to smoking. The model explained a larger proportion of the variance in susceptibility among ever-smokers than among never-smokers. Results indicate that peer influences, including perceptions of the social consequences of smoking and perceived social norms, may make adolescents susceptible to smoking.

English language use as a risk factor for smoking initiation among Hispanic and Asian American adolescents: evidence for mediation by tobacco-related beliefs and social norms

Acculturation increases the risk of smoking among Hispanic and Asian American adolescents, but the underlying mechanisms are not understood. This study examined associations between English language use and smoking among 4,167 Hispanic and 2,836 Asian American adolescents in California. Potential mediators were assessed, including access to cigarettes, perceived consequences, friends' smoking, cigarette offers, refusal self-efficacy, and prevalence estimates of peer smoking. English language use was associated with increased risk of lifetime smoking in both groups. This association became nonsignificant after access, perceived consequences, friends' smoking, and offers were controlled for. The acculturation process (as indicated by English language use) may be associated with smoking-related psychosocial variables, which may lead to an increased risk of experimentation with smoking.

Ovarian remnant excision necessitating resection of the anterior hypogastric system

Ovarian remnant syndrome is an unfortunate complication after bilateral oophorectomy. A case of an ovarian remnant involving the hypogastric vasculature is presented. Successful surgical management required resection of the involved hypogastric artery.

Measuring exposure to pro- and anti-tobacco marketing among adolescents: intercorrelations among measures and associations with smoking status

Exposure to tobacco-related marketing has been implicated as one of the risk factors for tobacco use among adolescents. However, tobacco-related marketing exposure has been measured in different ways in different studies, including perceived pervasiveness, receptivity, recognition, recall, and affect. It is not known whether these measures represent one or more underlying constructs and how these underlying constructs are associated with adolescent smoking status. This study analyzed data from 5,870 eighth-grade students in California, collected in 1996-1997 as part of the Independent Evaluation of the California Tobacco Control, Prevention, and Education Program. An exploratory factor analysis of multiple measures of tobacco-related marketing exposure revealed four distinct factors: perceived pervasiveness of protobacco marketing, perceived pervasiveness of antitobacco marketing, recognition of specific anti-tobacco advertisements, and receptivity to protobacco marketing. Receptivity to pro-tobacco marketing showed the strongest association with smoking status; higher levels of receptivity were associated with higher levels of smoking. Two measures of exposure to anti-tobacco marketing (perceived pervasiveness of anti-tobacco marketing and recognition of specific anti-tobacco ads) were highest among established smokers and lowest among susceptible nonsmokers. The same pattern was evident for perceived pervasiveness of pro-tobacco marketing. Results suggest that exposure to tobacco-related marketing is a multidimensional construct, and each dimension may have a unique contribution to the process of smoking initiation. Because adolescents are exposed to numerous pro- and anti-tobacco messages, it is important to develop anti-tobacco media campaigns that can successfully counter pro-tobacco marketing efforts. Potential strategies include targeting the susceptible nonsmokers who are at high risk for smoking and developing messages to decrease receptivity.

The relationship between home smoking bans and exposure to state tobacco control efforts and smoking behaviors

PURPOSE

To examine the relationship between home smoking bans and adult smokers' exposure to the statewide California Tobacco Control Program (TCP) and their cigarette smoking behavior.

DESIGN

Cross-sectional survey that was part of the statewide Independent Evaluation of the California Tobacco Control, Prevention and Education Program.

SETTING

Random telephone interviews within 18 California counties.

SUBJECTS

A representative sample of 1315 adult smokers, aged 25 years and older.

MEASURES

The telephone survey included questions about smoking behavior, quitting smoking, exposure to tobacco control program components, home smoking rules, and attitudes related to tobacco use and environmental tobacco smoke (ETS).

RESULTS

Smokers with a home smoking ban were twice as likely (OR = 2.29; 95% CI 1.22, 4.29) to have heard of TCP community programs and three times more likely (OR = 3.18; 95% CI 1.34, 7.57) to have seen and talked about the ETS media spot than smokers with no home smoking policy. Multivariate regression models indicated that having a home smoking ban was related to smoking fewer cigarettes per day and greater interest in quitting smoking compared with smokers with no smoking rules in the home (p < .05).

CONCLUSIONS

These findings suggest that smokers reporting exposure to the California TCP were more likely to have restrictive home smoking policies and that more restrictive home smoking policies were associated with reduced smoking behavior.

Exposure to, and perceived usefulness of, school-based tobacco prevention programs: associations with susceptibility to smoking among adolescents

PURPOSE

To examine the relationships of exposure to school-based tobacco prevention programs and perceived usefulness of such programs to smoking susceptibility.

METHODS

An ethnically representative sample of 6929 Grade 10 students participated in a cross-sectional survey of tobacco-related activities and behaviors. Perceived usefulness of prevention programs was investigated according to two dimensions: perceived helpfulness of information received at school with regard to making decisions about tobacco use and perceived availability of social resources that might help students cope with tobacco-related issues.

RESULTS

The extent of exposure to school prevention programs and both dimensions of perceived usefulness of these programs were inversely associated with susceptibility to smoking. In addition, perceived information helpfulness mediated the effect of program exposure on susceptibility status, whereas perceived availability of social resources moderated that effect. The study also presented evidence suggesting ethnic/cultural variability in the status of susceptibility to smoking at this age.

CONCLUSIONS

The study indicates a need to examine the perceptions of students receiving school prevention programs. Perceived usefulness of school prevention programs may be used to identify youth at high risk for smoking susceptibility. Future studies, however, should investigate other dimensions of perceived usefulness as well as intrapersonal, interpersonal, and environmental correlates of this construct.

English language use as a risk factor for smoking initiation among Hispanic and Asian American adolescents: evidence for mediation by tobacco-related beliefs and social norms

Acculturation increases the risk of smoking among Hispanic and Asian American adolescents, but the underlying mechanisms are not understood. This study examined associations between English language use and smoking among 4,167 Hispanic and 2,836 Asian American adolescents in California. Potential mediators were assessed, including access to cigarettes, perceived consequences, friends' smoking, cigarette offers, refusal self-efficacy, and prevalence estimates of peer smoking. English language use was associated with increased risk of lifetime smoking in both groups. This association became nonsignificant after access, perceived consequences, friends' smoking, and offers were controlled for. The acculturation process (as indicated by English language use) may be associated with smoking-related psychosocial variables, which may lead to an increased risk of experimentation with smoking.

Ethnic differences in adolescent smoking prevalence in California: are multi-ethnic youth at higher risk?

OBJECTIVE

Although ethnic differences in adolescent smoking have been well documented, smoking among multi-ethnic adolescents has received little research attention. This study examined smoking prevalence and tobacco related psychosocial risk factors among multi-ethnic adolescents in California, as compared with white, African American, Asian American, and Hispanic adolescents.

DESIGN

This study used a cross sectional design. Data were obtained from the independent evaluation of the California Tobacco Control, Prevention, and Education Program.

SETTING

Students completed a paper-and-pencil survey in their classrooms.

SUBJECTS

Data were collected from a stratified random sample of 5072 eighth grade students (age 13-14 years) in California during the 1996-97 school year. The data were weighted by school enrollment in analyses to make the estimates representative of the population of California students attending public schools.

MAIN OUTCOME MEASURES

Outcome variables included self reported smoking prevalence, susceptibility to smoking, access to tobacco, and related attitudes, beliefs, and behaviours. Ethnicity was assessed with a self reported, "check all that apply" question.

RESULTS

Results indicated that multi-ethnic adolescents were at higher risk than single-ethnic adolescents on several variables, including 30 day cigarette smoking prevalence, lifetime smokeless tobacco use, buying cigarettes, receiving cigarette offers, and expected friends' reaction if the respondent smoked. For several other variables (lifetime cigarette smoking prevalence, susceptibility to smoking, and number of friends who smoked), Hispanic adolescents were at higher risk than all other ethnic groups including multi-ethnic adolescents. Although susceptibility to smoking was highest among Hispanics, multi-ethnic adolescents scored significantly higher on susceptibility than the three other single-ethnic groups.

CONCLUSIONS

Multi-ethnic adolescents may be at increased risk for smoking and may have easier access to cigarettes. Culturally targeted smoking prevention interventions for adolescents should address the unique social challenges faced by multi-ethnic adolescents that may increase their risk for smoking.

Acculturation and attitudes about contraceptive use among Latina women

Previous studies have shown that acculturation among Latinos is associated with increases in health-risk behaviors. This study examined associations between acculturation and contraceptive use among 291 low- to moderately acculturated Latina women. Respondents completed a survey assessing acculturation, contraceptive use, and related attitudes. Moderately acculturated women expressed lower intentions to use contraceptives, were less certain that they would be able to use contraceptives consistently for the next 6 months, and reported lower social support for contraceptive use, than did unacculturated women. Unacculturated women expressed more traditional cultural attitudes favoring large families than did moderately acculturated women. Social norms and low self-efficacy may place moderately acculturated Latinas at high risk for unintended pregnancy and STDs.

Perceived consequences of teenage childbearing among adolescent girls in an urban sample

PURPOSE

The purpose of this study was to examine the perceived positive consequences of teenage childbearing among female adolescents, and to determine whether perceived consequences of teenage childbearing are associated with other attitudes and sexual risk behaviors.

METHODS

The sample consisted of 584 female students attending three urban high schools in Los Angeles, California. The respondents' mean age was 15.8 years, and 72% were Hispanic/Latina. Respondents completed a paper-and-pencil survey assessing their attitudes and risk behaviors relevant to teenage pregnancy. Multiple regression and logistic regression analyses were used to examine the associations between perceived consequences of teenage childbearing and demographic variables, educational variables, parental characteristics, psychosocial variables, attitudes, and sexual behavior.

RESULTS

Higher scores on a scale of perceived positive consequences of teenage childbearing were associated with increased risk of sexual intercourse and unprotected sexual intercourse. Higher scores on this scale were found among girls who were Latinas, were non-U.S. natives, had low levels of expected educational attainment, had low parental monitoring, had good communication with parents, and wished to have many children.

CONCLUSION

Potential strategies for preventing adolescent pregnancy include educating girls about the difficulties of teenage childbearing, countering their positive illusions about the expected benefits, and teaching them more adaptive ways to meet their emotional needs.

Is acculturation a risk factor for early smoking initiation among Chinese American minors? A comparative perspective

OBJECTIVE

To determine the extent to which Chinese American and white minors differ in age of smoking initiation, and to determine the effect of acculturation on smoking initiation.

DESIGN

Cross-sectional telephone surveys.

SETTING

Stratified random samples of the state of California, United States.

SUBJECTS

347 Chinese American and 10 129 white adolescents aged 12 through 17 years, from the California Tobacco Survey (1990-93) and the California Youth Tobacco Survey (1994-96).

OUTCOME MEASURES

Hazards (risk) of smoking initiation by age, smoking initiation rate, cumulative smoking rate, mean age of smoking initiation, and acculturation status.

STATISTICAL METHODS

Life table methods, proportional hazards models, and chi(2) tests.

RESULTS

The risk of smoking initiation by age among Chinese American minors was about a third of that among white minors. The risk for Chinese Americans continued to rise even in later adolescence, in contrast to that for whites, which slowed after 15 years of age. Acculturation was associated significantly with smoking onset among Chinese Americans. Acculturation, smoking among social network members, attitudes toward smoking, and perceived benefits of smoking were associated with the difference in hazards of smoking onset between Chinese American minors and their white counterparts.

CONCLUSIONS

Chinese American adolescents had a lower level and a different pattern of smoking onset than white adolescents. Levels of acculturation and other known risk factors were associated with the hazards of smoking initiation among Chinese American minors and with the difference in smoking initiation between the Chinese and white adolescents. Tobacco prevention policies, strategies, and programmes for ethnically diverse populations should take acculturation factors into account.

Attitudes toward anti-tobacco policy among California youth: associations with smoking status, psychosocial variables and advocacy actions

To prevent smoking and exposure to environmental tobacco smoke, California has implemented anti-tobacco policies, including laws restricting youth access to tobacco, and smoking bans in workplaces, schools, restaurants and bars. Although studies have examined adults' attitudes toward anti-tobacco policies, little is known about adolescents' awareness of and support for these policies. This study examined attitudes toward anti-tobacco policies in a sample of 6887 10th grade California adolescents. Awareness of anti-tobacco policies was highest among current smokers and lowest among susceptible never-smokers. Support for anti-tobacco policies was highest among non-susceptible never-smokers and lowest among current smokers. Policy awareness and support were significantly associated with psychosocial tobacco-related variables (e.g. perceived consequences of smoking, friends' smoking, perceived access to cigarettes, prevalence estimates of smoking among peers, cigarette offers and cigarette refusal self-efficacy). Policy awareness and support were associated with the probability of performing advocacy actions against tobacco use. Although these results cannot prove a causal association, they suggest that adolescents' attitudes toward anti-tobacco policies may play a role in their decisions about smoking. Tobacco control and education programs should include information about existing anti-tobacco policies, and should educate youth about the importance and benefits of anti-tobacco policies.

A persistent sinus tract from the vagina to the sacrum after treatment of mesh erosion by partial removal of a GORE-TEX soft tissue patch

Mesh erosion is an unfortunate complication of abdominal sacral colpopexy. A sinus tract from the vagina to the sacrum developed in a patient after partial removal of a GORE-TEX Soft Tissue Patch because of mesh erosion. Successful management eventually required complete removal of all GORE-TEX material and resection of the sinus tract.

Variation in the impact of social network characteristics on physical functioning in elderly persons: MacArthur Studies of Successful Aging

OBJECTIVES

Social support and social networks have been shown to exert significant effects on health and functioning among elderly persons. Although theorists have speculated that the strength of these effects may differ as a function of sociodemographic characteristics and prior health status, few studies have directly tested the moderating effects of these variables.

METHODS

Longitudinal data from the MacArthur Study of Successful Aging were used to examine the effects of structural and functional social support on changes in physical functioning over a 7-year period, measured by the Nagi scale, in a sample of initially high-functioning men and women aged 70 to 79 years. Multiple regression analyses were used to test the main effects of social support and social network variables, as well as their interactions with gender, income, and baseline physical performance.

RESULTS

After controlling for potential confounding effects, respondents with more social ties showed less functional decline. The beneficial effects of social ties were stronger for respondents who were male or had lower levels of baseline physical performance.

DISCUSSION

The effects of social support and social networks may vary according to the individual's gender and baseline physical capabilities. Studies of functional decline among elderly persons should not ignore this population variation in the effects of social networks.

The relation between cortisol excretion and fractures in healthy older people: results from the MacArthur studies-Mac

BACKGROUND

In persons with depression, higher urinary cortisol is associated with lower bone mineral density.

OBJECTIVE

To examine the relation between urinary free cortisol (UFC) and fractures.

SETTING

Community-based samples from Durham, NC, East Boston, MA, and New Haven, CT.

PARTICIPANTS

684 men and women, aged 70 to 79 at baseline, who were part of the MacArthur Study of Successful Aging.

DESIGN

Cohort study. Participants with previous history of fractures at baseline were excluded.

MEASURES

The primary exposure variable was overnight (8:00 p.m. to 8:00 a.m.) UFC (microg/g creatinine) at baseline (1988). Outcomes were self-reported hip, arm, spine, wrist, or other fracture during the follow-up period (1988-1995). Covariates were baseline age, gender, race, body mass index, current physical activity, lower extremity strength, depression subscale of the Hopkins Symptom Checklist, and current use of cigarettes and alcohol.

ANALYSIS

Logistic regression was used to predict the occurrence of incident fractures (1988-1995) as a function of quartiles of baseline UFC. Models were adjusted for age, gender, and race and were also multiply adjusted for the remaining covariates listed above. Gender-stratified models and models that excluded corticosteroid users were also run.

RESULTS

In multiply adjusted models, higher baseline levels of UFC were significantly associated with incident fractures. Odds of fracture (95% Confidence Intervals) for increasing quartiles of baseline UFC, multiply adjusted, were: 2.28 (.91, 5.77); 3.40 (1.33, 8.69); 5.38 (1.68, 17.21). Results were not materially influenced by exclusion of persons using corticosteroids.

CONCLUSIONS

Higher baseline UFC is an independent predictor of future fracture.

Self-efficacy beliefs and perceived declines in functional ability: MacArthur studies of successful aging

Longitudinal data from a cohort of older men and women, aged 70-79, were used to test the hypothesis that stronger self-efficacy beliefs would protect against onset of perceived functional disabilities over a 2.5-year follow-up, independent of underlying physical ability. Standard self-report scales were used to assess perceived functional disabilities, ranging from mild performance difficulties (measured by a 5-item scale based on items by Nagi) to more severe disabilities (measured by the 7-item Katz Activities of Daily Living Scale [ADL]). Performance-based measurements of strength, balance, and gait provide more objective assessments of physical abilities. Self-efficacy beliefs were measured in terms of beliefs relating to managing interpersonal relationships and beliefs relating to managing more instrumental daily activities. Gender-specific multiple regression models revealed that weaker instrumental self-efficacy beliefs predicted declines in reported functional status as measured by the Nagi performance scale among both men and women, independent of standard sociodemographic, health status, and health behaviors. Among men, instrumental efficacy beliefs were also negatively related to reports of onset of Katz ADL. Self-efficacy beliefs were unrelated to measured changes in actual physical performance abilities for both men and women. These findings suggest that self-efficacy beliefs have significant impacts on perceptions of functional disability, independent of actual underlying physical abilities. Through such influences on perceptions of disability, self-efficacy beliefs may importantly affect lifestyles and quality of life at older ages.

Vaginal hysterectomy for the woman with a moderately enlarged uterus weighing 200 to 700 grams

OBJECTIVES

The purpose of this study was to compare the surgical outcomes of women with moderately enlarged uteri undergoing vaginal hysterectomy with those of women with uteri of normal size undergoing vaginal hysterectomy. A secondary objective was to investigate the roles of uterine morcellation and laparoscopically assisted vaginal hysterectomy in the treatment of these women.

STUDY DESIGN

Thirty consecutive women during a 2-year period with uterine enlargement to a weight of between 200 and 700 g underwent vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy limited to lysis of adhesions or adnexectomy. These patients with uterine enlargement (group 1) were compared with 160 women with uteri weighing <200 g who also underwent vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy during the same interval (group 2). The 2 groups were compared for total complications, operative time, hospital stay, perioperative hemoglobin concentration change, and use of vaginal uterine morcellation and laparoscopically assisted vaginal hysterectomy.

RESULTS

Operative time for vaginal hysterectomy was significantly longer for women in group 1 than for women in group 2 (66.6 +/- 26.2 minutes vs 53.0 +/- 25.5 minutes, P =.008). There was a linear relationship between uterine weight and operative time: Operative time = 47.156 + 0.056 x Uterine weight (r = 0.20, F = 7.66, degrees of freedom 1, 188, P = .006). Vaginal morcellation of the uterus was needed in 80.0% of the women in group 1 and in 10.0% of the women in group 2 (P < .001). Two women in group 1 (6.7%) and 9 women (5.6%) in group 2 had laparoscopically assisted procedures for lysis of adhesions, adnexectomy, or both, unrelated to uterine size (P =.69). There were no significant differences between the 2 groups with respect to perioperative hemoglobin concentration change or hospital stay. Finally, the rates of major surgical complications were similar in the 2 groups (3.3% in group 1 vs 4.3% in group 2, P > .99, 95% confidence interval -8.1% to 5.9%).

CONCLUSIONS

Although vaginal hysterectomy requires a modest increase in operative time, it is as safe and effective for the woman with a moderately enlarged uterus as for the woman with a uterus of normal size. Vaginal uterine morcellation is the key to a successful operation and obviates the need for either abdominal or laparoscopically assisted hysterectomy solely to deal with moderate uterine enlargement.

Hazards of smoking initiation among Asian American and non-Asian adolescents in California: a survival model analysis

BACKGROUND

Information about the risk of smoking initiation among whites, African Americans, and Latino Americans has provided an important information base for smoking prevention programs among adolescents from these ethnic backgrounds. Unfortunately, there is a lack of such information for Asian Americans, a fast-growing ethnic minority group with much internal diversity.

METHOD

This study used cross-sectional data from 20,482 subjects 12-17 years of age, randomly sampled in California, to describe and compare the risk of smoking initiation for adolescents by age among Asian American and other non-Asian ethnic groups, using survival analysis. Computer-aided telephone interview techniques were used in data collection.

RESULT

The risk of early smoking initiation among Asian American adolescents is about a third of that of Caucasians. However, the risk among Asian Americans continues to increase throughout adolescence, while the same risk among Caucasians and African Americans plateaus around 14-15 years of age. Significant differences in the levels and patterns of smoking initiation among Asian American subgroups were observed, with Chinese Americans showing the lowest risk of smoking initiation and Filipino Americans the highest, Japanese and Korean Americans being in-between.

CONCLUSION

Asian American adolescents may be especially at risk of smoking initiation later in adolescence, even though they are at lower risk early in adolescence. Smoking prevention programs for Asian Americans should continue throughout adolescence and early adulthood.

Service utilization among homeless and runaway youth in Los Angeles, California: rates and reasons

PURPOSE

To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area of Los Angeles, California; identify demographic and other correlates of utilization; and contextualize the findings with qualitative data.

METHOD

During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless.

RESULTS

Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%), substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles versus all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including rules perceived to be restrictive, and concerns youth had about confidentiality and mandated reporting. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets.

CONCLUSIONS

Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that we understand the perceived barriers to service utilization.

Smoking patterns of Asian-American youth in California and their relationship with acculturation

PURPOSE

To examine patterns of smoking behavior among subgroups of Asian-American youth in California and their relationship with acculturation status.

METHODS

Data were from the 1990-1996 California Tobacco Survey and the California Youth Tobacco Survey, which assessed smoking-related attitudes and behaviors among California youth in grades 7-12. Among the 20,482 respondents, 1,810 were Asian-Americans. Variables assessed included lifetime smoking prevalence, 30-day smoking prevalence, and age of smoking onset. Acculturation status was assessed with measures of English usage, language spoken at home, and age at immigration to the United States.

RESULTS

Of the 1,810 Asian-Americans (52% male), 19% were Chinese, 33% Filipino, 8% Japanese, 13% Korean, and 26% other Asian-Americans. Lifetime smoking prevalence was 16.1% for Asians and 26.1% for non-Asians. The 30-day smoking rate was 6.9% for Asians and 14.2% for non-Asians. Subgroup-specific analyses revealed differences in lifetime smoking prevalence (18.9% for Filipinos, 17.3% for Japanese, 16.3 % for Koreans, 11.0% for Chinese, and 13.7% for other Asian-Americans) and 30-day smoking rate (8.6% for Filipinos, 8.3% for Koreans, 7.4% for Japanese, 2.8% for Chinese, and 7.2% for other Asian-Americans). Gender differences in lifetime smoking prevalence varied by Asian subgroup; smoking prevalence was higher among males than among females for Chinese and Koreans, but smoking prevalence was higher among females than among males for Japanese and other Asians. The average age of smoking onset was 12.9 years for Asians and 12.8 years for non-Asians. Age of smoking onset differed among Asian-American subgroups but did not differ by gender. In addition, smoking behaviors of the Asian respondents were significantly associated with their acculturation status.

CONCLUSIONS

Asian-American youth have relatively lower smoking rates and later age of smoking onset than non-Asian youth in California. In addition, subgroups of Asian-American youth vary widely in their smoking behavior. High levels of acculturation among Asian-American youth are associated with higher smoking prevalence rates and earlier age of smoking onset.

The role of social networks and media receptivity in predicting age of smoking initiation: a proportional hazards model of risk and protective factors

The increasing prevalence of adolescent smoking demonstrates the need to identify factors associated with early smoking initiation. Previous studies have shown that smoking by social network members and receptivity to pro-tobacco marketing are associated with smoking among adolescents. It is not clear, however, whether these variables also are associated with the age of smoking initiation. Using data from 10,030 California adolescents, this study identified significant correlates of age of smoking initiation using bivariate methods and a multivariate proportional hazards model. Age of smoking initiation was earlier among those adolescents whose friends, siblings, or parents were smokers, and among those adolescents who had a favorite tobacco advertisement, had received tobacco promotional items, or would be willing to use tobacco promotional items. Results suggest that the smoking behavior of social network members and pro-tobacco media influences are important determinants of age of smoking initiation. Because early smoking initiation is associated with higher levels of addiction in adulthood, tobacco control programs should attempt to counter these influences.

Service utilization among homeless and runaway youth in Los Angeles, California: rates and reasons

PURPOSE

To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area (Los Angeles, California); identify demographic and other correlates of utilization; and contextualize the findings with qualitative data.

METHOD

During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless.

RESULTS

Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%) and substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles vs. all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including restrictive rules, confidentiality and reporting problems, and negative interactions with staff members. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets.

CONCLUSIONS

Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that barriers to use of these services are eliminated.

Vaginal hysterectomy in women with history of previous cesarean delivery

OBJECTIVE

This study aimed to compare surgical outcomes with vaginal hysterectomy between women who have had >/=1 cesarean delivery and those who have not had a cesarean delivery. A secondary objective was to analyze the effect of previous vaginal birth on the complication rate of vaginal hysterectomy.

STUDY DESIGN

A retrospective analysis was performed on 221 women undergoing vaginal hysterectomy. Women were separated into those who had a history of previous cesarean deliveries (N = 35) and those who did not (N = 186). The groups were analyzed for the indications for surgery, perioperative hemoglobin loss, operative time, length of hospitalization, and complications. Trends in the complication rate for women in the previous cesarean group were also studied from the perspectives of numbers of previous cesarean deliveries and of vaginal delivery history. The 95% confidence intervals for the difference between proportions as well as P values for probability tests were calculated. P <.05 was considered significant.

RESULTS

Previous cesarean delivery experience did not affect hemoglobin change, hospital stay, or operative time among women undergoing vaginal hysterectomy. A total of 11.3% of women in the previous cesarean group had complications, versus 4.3% for the noncesarean group (P =.10, 95% confidence interval -3.8% to 18.0%). Complications did not increase with increasing number of previous cesarean deliveries (U = 1020.5, P =.28). Also, a trend toward fewer complications among patients with a history of cesarean delivery who had also had a vaginal delivery was demonstrated (U = 836, P =.05). Overall, women who were undergoing vaginal hysterectomy who had a history of >/=1 previous vaginal delivery had a complication rate of 3.2%, versus 17.6% for women who had not had a previous vaginal birth (P =.004, 95% confidence interval -27.5% to -1.3%).

CONCLUSIONS

In this study women who had a history of previous cesarean delivery were not at higher risk for greater hemoglobin loss, longer hospital stay, more prolonged operative time, or significantly more perioperative complications when undergoing vaginal hysterectomy than were those women who had no history of previous cesarean delivery. Likewise, increasing the number of previous cesarean deliveries did not have an adverse impact on the complication rate. Previous vaginal delivery lowered the risk of complications from vaginal hysterectomy.

Functional decline in the elderly: evidence for direct and stress-buffering protective effects of social interactions and physical activity

Advances in medical technology and improvements in health behavior have greatly increased the proportion of Americans who survive into old age. Consequently, identifying environmental and behavioral factors that enhance or protect the health and functional capacity of older adults is an important goal. This study investigated the extent to which social interactions and physical activity can protect older adults from the declines in functional ability that typically occur with age and the extent to which they buffer the negative effects of widowhood on physical functioning. Data were from the Longitudinal Study of Aging, a six-year follow-up of over 7,000 respondents in the 1984 National Health Interview Survey. Using individual growth curve models which examine the effects of predictor variables on change over time, this study investigated how physical activity, social interactions, and widowhood are related to the rate of change in functional health over a six-year period. Results suggested that physical activity and social interactions each exerted independent effects on functional decline. In addition, physical activity and social interactions buffered the effects of widowhood on functional decline, especially in men who died before the end of the study. Results suggest a need for health promotion programs to encourage both physical and social activities in the elderly.

Street youth, their peer group affiliation and differences according to residential status, subsistence patterns, and use of services

This study characterizes subcultural differences within an inner-city street youth population. Variations in residential status, subsistence patterns, and service utilization according to peer group affiliation were explored. A brief structured interview was administered to 752 youth, ages 12 to 23 years, who had been living on the streets for two or more consecutive months, or who were fully integrated into the "street economy." Subjects were recruited for the study using a stratified probability sampling design, with 30% recruited from community-based service sites and 70% from street locations and at natural "hang-outs." Five street youth groups were identified: "punks/skinheads," "druggies," "hustlers," "gang members," and "loners." The results demonstrated unique patterns with respect to places stayed/slept, means of financial support and economic subsistence, and use of available services according to peer group affiliation. The implications of these findings and recommendations for future research and service provision are discussed.

Desired family size and son preference among Hispanic women of low socioeconomic status

Among 432 Hispanic women aged 18-50 interviewed at a Los Angeles obstetrics and gynecology clinic, respondents reported wanting an average of 2.8 sons but only 0.1 daughters. Being older than 30, having no more than an eighth grade education, being separated, divorced or widowed, being Spanish-speaking or having been born outside the United States, and having a large family of origin were all positively associated with a desire for a greater number of sons. A multivariate analysis indicated that women who preferred to speak Spanish were 10.9 times as likely as those who preferred English to desire a greater number of sons, and those with more children were 2.5 times as likely as those with fewer children to have a strong desire for sons. Family planning programs for Hispanics may be more effective if they acknowledge this important motive for childbearing.

Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.

Homeless youth and their exposure to and involvement in violence while living on the streets

PURPOSE

The purpose of this research were to explore homeless youths' histories of exposure to violence, perpetration of violence, and fear of violent victimization, and to examine the extent to which these constructs are associated with demographic variables.

METHODS

A sample of 432 youth (between 13 and 23 years old) who were homeless or at imminent risk for homelessness were sampled from both service and street sites. The percentage of youth who reported exposure to each type of violence was calculated. Multiple regression analyses were used to examine differences in the risk of exposure to violence across gender, ethnicity, age, and length of time homeless.

RESULTS

Respondents reported a high rate of exposure to violence. Female respondents reported levels of exposure to violence that were as high as those reported by males. Females were more likely to report having been sexually assaulted and fearing victimization, and tended to be less likely to report perpetrating violence. With a few exceptions, ethnic identity was not a significant predictor of exposure to violence or fear of victimization. Age tended to be inversely associated with risk of exposure to violence. Length of time homeless was not associated with fear of victimization.

CONCLUSIONS

Homeless youth are at high risk for exposure to a variety of forms violence as both witnesses and victims. The overall rates of exposure to violence and patterns of association with demographic variables are significantly higher than those reported in national samples of adolescents.

Identification of adolescents at risk for smoking initiation: validation of a measure of susceptibility

Primary prevention of smoking in adolescents requires effective screening instruments for identifying those adolescents who are most likely to experiment with cigarettes. This study investigated the predictive value of a measure of susceptibility to smoking (the lack of a firm commitment not to smoke) for predicting smoking initiation 1 and 2 years later among 687 seventh-grade nonsmokers. Results showed that susceptible adolescents were approximately two to three times more likely to experiment with cigarettes during the ensuing 2 years than were nonsusceptible adolescents. At the lower levels of smoking, these relationships persisted even after controlling for psychosocial variables. Measures of susceptibility to smoking could be an effective tool for identifying adolescents at increased risk of experimenting with cigarettes or assessing their readiness for smoking-prevention programs.

Hysterectomy after endometrial ablation

OBJECTIVES

Our purpose was to determine the number of women undergoing hysterectomy after endometrial ablation and the indications for the subsequent surgery.

STUDY DESIGN

Forty-two premenopausal women, who had severe menorrhagia associated with a clinically normal examination result, underwent rollerball endometrial ablation between November 1990 and December 1991. Thirty-seven women whom we gave ongoing care were evaluated by chart review. Four women who received care elsewhere were interviewed by telephone. One woman was lost to follow-up. Patients were followed up a minimum of 4 years. Age, parity, operating time, endometrial preparation, preablation sterilization, and preablation dysmenorrhea were assessed in regard to subsequent hysterectomy. Patient satisfaction was assessed at 24 months. Life-table analysis was performed to determine cumulative probability of hysterectomy.

RESULTS

Fourteen of the 41 women (34%) underwent hysterectomy within 5 years after rollerball endometrial ablation. Continued abnormal menstrual bleeding and menstrual pain were significantly associated with subsequent hysterectomy. Eleven of the 14 cases of hysterectomy were associated with gross abnormality such as myomas, adenomyosis, endometriosis, and chronic hematosalpinx. A linear relationship between hysterectomy and time was noted.

CONCLUSION

On the basis of our findings one third of women undergoing rollerball endometrial ablation for menorrhagia can expect to have a hysterectomy within 5 years. If the linear relationship noted during the first 5 years is extrapolated, theoretically, all women may need hysterectomy by 13 years. Most patients undergo hysterectomy because of significant pelvic abnormality. Further studies with longterm follow-up are needed to define the role of endometrial ablation for menorrhagia.

Drug use, needle sharing, and HIV risk among injection drug-using street youth

Infection drug use is the second most common HIV risk behavior in the United States, but little is known about injection drug use and needle-sharing behavior among street youth, a group at high risk for HIV infection. This study investigates the drug use histories, injection drug use behaviors, and needle-sharing practices of 106 injection drug using youth in Los Angeles, California. Respondents report high rates of injection drug use and needle sharing, indicating that these youth are at particularly high risk for HIV infection. Results suggest a need for outreach services tailored to the unique needs of injection drug-using adolescents.

Stages of change of smoking cessation: relationships with other health behaviors

Health behaviors are often intercorrelated, suggesting that these behaviors may be manifestations of underlying attitudes toward health. Changes in these attitudes may cause simultaneous changes in several health behaviors. As individuals progress among the stages of change of one health behavior, such as smoking cessation, they may make changes in other health behaviors as well. This study evaluated the hypothesis that subjects in the later stages of change of smoking cessation would practice more healthful behaviors than subjects in the early stages of change. Subjects were 929 respondents in the California Behavioral Risk Factor Surveillance Study who were current smokers or had quit smoking within the past year. Subjects in the more advanced stages of smoking cessation showed more healthful levels of alcohol use and exercise than subjects in the earlier stages. These results suggest that people may make improvements in several health behaviors concurrently. If so, lifestyle-based health promotion programs may be able to take advantage of shifts in attitudes toward health behavior to modify several health behaviors simultaneously.

Recognition and liking of tobacco and alcohol advertisements among adolescents: relationships with susceptibility to substance use

BACKGROUND

Exposure to tobacco and alcohol advertising has been associated with adolescent substance use. However, it is not clear whether favorable reactions to advertising are an antecedent to or a consequence of substance use. This study investigated relationships between adolescents' levels of susceptibility to substance use and their recognition and liking of tobacco and alcohol advertising.

METHOD

Eighth-grade students viewed pictures of tobacco and alcohol advertisements with brand names and identifying information obscured, attempted to identify the brand name and type of product being advertised, and rated their liking of the advertisements. Subjects were divided into three substance use status groups: nonsusceptible nonusers (have never used and do not intend to do so), susceptible nonusers (have not used but have not made a firm commitment not to experiment in the future), and users (have tried the substance).

RESULTS

Susceptible nonusers liked the tobacco advertisements at a level that was significantly greater than that of the nonsusceptible nonsmokers and comparable to that of the users. Liking of the alcohol advertisements generally increased with alcohol use status.

CONCLUSIONS

These results suggest that tobacco advertisements ostensibly targeted to adult smokers may have the effect of recruiting new adolescent smokers.

Social relationships and physical activity in health club members

The results of this study support the hypothesis that social variables are related to exercise behavior and satisfaction. Exercise frequency was related to having friends at the health club and socializing outside the club with people met at the club. Frequency of skipping workouts was negatively associated with having friends at the club. The results shown in Table 2 suggest that of the three social variables, socializing outside the club with people met at the club was the best predictor of exercise frequency, having friends at the club was the best predictor of frequency of skipping, and exercising with a friend was the best predictor of exercise satisfaction. The three social variables explained 11% of the variance in exercise frequency, 8% of the variance in skipping frequency, and 4% of the variance in satisfaction. These findings suggest that friendships that involve exercising together and the social contacts that result from exercising in public places such as health clubs may motivate exercise behavior. A large segment of the population may derive social, as well as physical, benefits from exercise, and these social benefits may encourage them to adhere to their exercise programs. The significant interaction of marital status and socialization with people met at the club in the prediction of exercise frequency suggests that social interaction may be a more important motivator of exercise behavior for single people than for people who are married or have significant others. Exercise programs involving social interaction may be especially effective for single, divorced, or widowed people.