Detecting and Documenting Intimate Partner Violence

The objective of this research was to assess rates of clinician screening for intimate partner violence (IPV) and to evaluate documentation of cases. The authors reviewed 527 charts of women aged 18 to 65 seen in the emergency department of an academic medical center. Of the 527 charts reviewed, 150 charts (29%) indicated patients were screened; 23 patients (15%) were positive for IPV. Prevalence of lifetime exposure to IPV was 4.4%, and prevalence of current IPV was 2.8%. Few aspects of patient safety (whether the patient felt safe going home, whether a gun was in the home) were charted. Screening and documentation rates in emergency departments are far from optimal.

Physical activity across the curriculum: year one process evaluation results

BACKGROUND

Physical Activity Across the Curriculum (PAAC) is a 3-year elementary school-based intervention to determine if increased amounts of moderate intensity physical activity performed in the classroom will diminish gains in body mass index (BMI). It is a cluster-randomized, controlled trial, involving 4905 children (2505 intervention, 2400 control).

METHODS

We collected both qualitative and quantitative process evaluation data from 24 schools (14 intervention and 10 control), which included tracking teacher training issues, challenges and barriers to effective implementation of PAAC lessons, initial and continual use of program specified activities, and potential competing factors, which might contaminate or lessen program effects.

RESULTS

Overall teacher attendance at training sessions showed exceptional reach. Teachers incorporated active lessons on most days, resulting in significantly greater student physical activity levels compared to controls (p < 0.0001). Enjoyment ratings for classroom-based lessons were also higher for intervention students. Competing factors, which might influence program results, were not carried out at intervention or control schools or were judged to be minimal.

CONCLUSION

In the first year of the PAAC intervention, process evaluation results were instrumental in identifying successes and challenges faced by teachers when trying to modify existing academic lessons to incorporate physical activity.

Brain cancer in a residential area bordering on an oil refinery

Both in response to community concerns about brain cancer related to an oil refinery and in order to more fully understand the etiology of primary site brain cancer (glioma), a highly focused cancer cluster investigation was conducted. The components included: (1) a literature review of occupational exposures in the petroleum refining and petrochemical industries, (2) comparisons between observed and expected cases, (3) comparisons between mean age at diagnosis and median survival time and (4) interviews concerning exposures of cases. Evidence from the literature review revealed little, if any, effect of petroleum refinery or petrochemical exposure on the risk for brain cancer. There was no statistically significant increase in the number of brain cancer cases in the community (observed = 12, expected = 9.46, standardized mortality ratio = 1.27). There was no statistically significant decrease in mean age at diagnosis or median survival time among those most exposed. Reports of exposure from the case interviews were highest for eating processed meats (98.5%), dental X-rays (96.6%), dog ownership (91.2%) and swimming (80.3%). There were no major occupational exposures identified. It seems unlikely that petrochemicals are involved in any significant way in the etiology of most brain cancers (gliomas). A follow-up case-control study should focus primarily on those risk factors mentioned frequently by the cases.

African American smokers interested and eligible for a smoking cessation clinical trial: predictors of not returning for randomization

PURPOSE

Recruitment is often the rate-limiting step in conducting clinical trials among ethnic minorities. Little is known about participants who consent and enroll into a trial, but do not return for randomization. Why participants fail to return for randomization is largely unknown.

METHODS

We compared 287 enrolled African American smokers who did not return for randomization, to the 500 who returned and were randomized to participate in a clinical trial for smoking cessation in African Americans. Analyses were conducted to identify variables associated with not returning for randomization.

RESULTS

Univariate comparisons found the nonrandomized group to be significantly different from those randomized. Logistic regression showed younger age, less readiness to quit, having been proactively recruited, lacking a regular source of health care, believing that they will be smoking in 6 months, less church attendance, and a lower literacy level to be jointly related with not returning for randomization.

CONCLUSIONS

African American participants who did not return for randomization into a clinical trial were different from those who did. Better understanding of these factors may allow researchers to target recruitment efforts resulting in enhanced accrual in clinical trials and increased efficiency.

Smoking in urban African Americans: behaviors, gender differences, and motivation to quit

OBJECTIVE

This study describes smoking behaviors and gender differences, and correlates these factors with motivation to quit smoking among African-American smokers at a community-based health center.

DESIGN

A 62-item survey assessed depression, hassles, readiness to change, and demographics.

METHODS

Participants (N = 81) were interviewed in an adult clinic waiting room.

RESULTS

On average, participants smoked 13 cigarettes per day. Many reported attempts to reduce smoking-related health risks: 46% switched brands, 57% reduced their smoking, and 19% smoked only on some days. Fifty-nine percent indicated depressive symptoms. For women vs men, noteworthy differences were: reduction in number of cigarettes smoked (66.7% vs 40.0%; P = .023), switching brands (58.8% vs 23.3%; P = .003), number of attempts to quit in the past year (2.7 vs 1.2; P = .034), and high concern about weight gain (52.9% vs 26.7%; P = .047). Cigarettes smoked per day was negatively correlated with motivation to quit (P = .022). Variables positively correlated with motivation to quit included: harm reduction strategies (P = .002), intention to quit in 30 days (P<.0001), and intention to quit in 6 months (P<.0001).

CONCLUSIONS

Women showed more potential indications of readiness to quit, including more attempts to quit, reductions in number of cigarette smoked, and brand switching. Knowledge of cessation barriers, gender differences, and correlates to motivation may prove useful for investigators conducting research in this population.

Tobacco use and quit attempts among methadone maintenance clients

OBJECTIVES

This study examined tobacco use prevalence, types of tobacco used, interest in quitting, and prior quit attempts among persons in methadone maintenance treatment.

METHODS

Counselors collected surveys from 84% (550 of 655) of all clients in a 4-county metropolitan area.

RESULTS

Most clients (77%) smoked cigarettes. Of the 59 former tobacco users, only 6 reported using a cessation pharmacotherapy to quit. Three quarters of the current smokers had attempted to quit at least once, with an average of 5 attempts. Most smokers (80%) were "somewhat" or "very" interested in quitting.

CONCLUSIONS

The quit ratio among methadone maintenance treatment clients was 12%, compared with 50% nationwide. To reduce morbidity and mortality, cessation interventions must be developed and disseminated.