Kristie Long Foley

Over 2,000 North Carolina high school students completed surveys measuring community risk and protective factors and individual health risk behaviors including dating violence perpetration and victimization. Females reported more date fighting perpetration than males (8.8% to 4.0%), as well as greater levels of date fighting victimization (7.2% and 5.0%). In multivariate models, factors associated with date fighting perpetration among females and males included riding with a drinking driver. Neighborhood organization was protective for both groups. Cigarette use, drinking and driving, and being a minority were also associated with perpetration among females, while tobacco use was associated with date fighting perpetration by males. Factors associated with victimization among both genders included riding with a drinking driver. Females were more likely to be victimized if they used marijuana, whereas males were less likely to be a victim of date fighting if they perceived their community to be “organized.” Findings reflect comparable individual risk factors for date fighting across genders, with few exceptions, and warrant further investigation of the role of community assets in protecting young people from dating violence.

This paper evaluates psychometric properties of a recently developed measure focusing on the health-related quality of life (HRQL) of long-term cancer survivors, the Quality of Life in Adult Survivors scale (QLACS), in a sample of breast cancer survivors. This represents an important area of study, given the large number of breast cancer patients surviving many years post diagnosis.

Clinical studies indicate that breast cancer patients treated with breast conserving surgery (BCS) without radiotherapy (RT) have a greater risk of recurrence and mortality compared to those receiving BCS plus RT. However, this relationship has been underdeveloped among low-income women in the community who may face barriers in accessing adjuvant treatment and post-treatment surveillance. It is possible that the prognostic significance of omission of RT in clinical trials underestimates the significance of risk in the community. Using cancer registry, Medicaid claims, and the Social Security Master Death File, we evaluated receipt of RT in women with early stage breast cancer treated with BCS and mean 6-year overall and cancer-specific survival. Logistic regression was used to assess correlates of RT. The Kaplan–Meier method was used to determine survival by RT status and a multivariate Cox proportional hazards regression was used to evaluate the role of RT status on overall and cause-specific survival. A total of 65% of women received RT, and 82% of the sample survived the study period. Death rates of 16% and 51% were observed among those who did and did not receive RT, respectively (P < 0.001). One-third of women who died from cancer (8 of 24) received radiation. Use of RT was associated with a statistically significant decrease in all-cause (hazard ratio = 0.42, 95% CI 0.21–0.85) and cancer-specific mortality (hazard ratio = 0.22, 95% CI −0.09 to 0.57). Adjuvant radiation following BCS was underused in this sample of poor breast cancer patients. Lack of adjuvant RT may be a proxy for inadequate access to care and poor cancer surveillance after treatment.

Aims  To identify state, local and organizational characteristics associated with local law enforcement agencies’ implementation of two dramatically different approaches to enforcement of underage drinking laws: compliance checks and Cops in Shops programs. Compliance checks use underage decoys to attempt to purchase alcohol from retail merchants, while Cops in Shops programs deploy undercover law enforcement officers in alcohol outlets to detect and cite persons under the age of 21 who attempt to purchase alcohol.Design  Cross‐sectional telephone interview conducted as part of the Tobacco Enforcement Study (TES), which examined enforcement of laws related to youth access to tobacco.Setting  Data were collected in 1999 among law enforcement agencies in all 50 states of the United States.Participants  Representatives of city police departments, departments of public safety, sheriffs or county police were included (n = 920 local agencies).Measurements  Alcohol compliance checks and Cops in Shops programs were the primary outcomes. Covariates included state level policies (e.g. beer tax), agency resources (e.g. number of sworn officers) and community demographics (e.g. college dormitory population).Findings  Local enforcement agencies were more likely to perform alcohol compliance checks than to have a Cops in Shops program (73.9% compared to 41.1% in cities > 25 000 and 55.7% compared to 23.9% in cities ≤ 25 000). Conducting compliance checks for tobacco age‐of‐sale laws was positively associated with alcohol compliance checks and Cops in Shops (OR 3.30, P < 0.001; OR 1.84, P = 0.001, respectively). Having a Drug Abuse Resistance Education (DARE) officer was negatively related to conducting compliance checks (OR 0.67, P = 0.03). Special community policing units were associated with departments having Cops in Shops programs (OR 1.80, P = 0.006).Conclusions  This study used a nationally representative sample of communities to better understand state and local factors that shape local law enforcement agencies’ use of two distinct approaches to underage drinking enforcement. The strong link observed between tobacco and alcohol compliance checks may indicate a culture within some law enforcement agencies supporting strict enforcement of age‐of‐sale laws.

A comprehensive training program to develop tobacco-specific standardized patient instructors (SPIs) was implemented and evaluated at Wake Forest University. Descriptive statistics were used to assess SPIs' experience with the training program and medical students' perceptions of the SPI-student interaction. Two standardized scales, used to assess student performance on counseling (Tobacco Intervention Risk Factor Interview Scale [TIRFIS]) and cultural competency (Tobacco Beliefs Management Scale-Tobacco Cultural Concerns Scale [TBMS-TCCS]), were tested for internal and interrater reliability and sensitivity to varied student performance. Costs of the program were measured. SPIs highly rated the content, organization, and presenters of the training program. Medical students positively evaluated their experience with the SPIs. The TIRFIS and TBMS-TCCS subscales demonstrated good internal reliability, and inconsistencies in ratings by different SPIs were minimal. In addition, a range of scores on both measures attest to the sensitivity of the instruments to assess variations in student performance. Significant start-up costs are associated with developing this training program, although costs decline when SPIs are retained long term. The SPI training program was effective in developing a cohort of knowledgeable and reliable SPIs to train medical students in ways to improve their tobacco intervention counseling skills. Retaining SPIs long term should be a primary goal of implementing a cost-effective, successful training program.

Background: To elucidate meanings ascribed to the cancer experience by long‐term survivors.Methods: Semi‐structured interviews were conducted with 58 cancer survivors (>15 years post‐diagnosis). Respondents described how cancer affected their quality of life (QOL) generally and in 17 domains. Systematic content analyses were conducted to extract themes relating to meanings assigned to the cancer experience. Themes were analyzed by cancer type, gender, and age and confirmed using quantitative assessments of self‐rated health and QOL.Results: Four themes were identified: Personal Growth, That's Life. Relinquishing Control, and Resentment. Women more frequently acknowledged Personal Growth, and men more often indicated minimal impact on their lives (That's Life). Older survivors were disproportionately classified as That's Life and younger survivors as Personal Growth. No differences were observed by cancer type or ethnicity. Those who saw cancer as personal growth had the highest QOL, while those who resented cancer had the lowest QOL.Conclusions: Most long‐term survivors retrospectively report that cancer either positively influenced their lives or had little long‐term impact. Those who express Resentment report that pain, physical deformities, and social isolation significantly reduced their QOL. This qualitative study highlights how cancer survivors incorporate the cancer experience within their overall lives. Copyright © 2005 John Wiley & Sons, Ltd.

To compare adults' approval of adolescents' alcohol use among white, black, and Latino youth and to evaluate the effects of approval on most recent alcohol consumption, past 30-day use and binge drinking. A cross-sectional telephone survey of N = 6245 adolescents from 242 communities was conducted as part of the National Evaluation of the Enforcing Underage Drinking Laws Program. The survey assessed perceived availability of alcohol, underage alcohol use, and problems related to underage drinking. Ordinary least squares regression modeling was used to test the relationships between adults' approval and most recent consumption. Logistic regression modeling was used to measure the association among approval, past 30-day use and binge drinking. Perceived consequences, parent and adult relative provision of alcohol, and drinking with a parent were protective of underage drinking. Providing alcohol at a party, however, was associated with a two-fold increase in past 30-day use and binge drinking. There were minimal differences on adults' approval across the three racial/ethnic groups. Adults' approval of alcohol use is highly correlated with youth drinking behavior and has differential effects on adolescents' alcohol use depending on the social context in which the alcohol is provided.

Providing researchers with access to millions of scientific documents from journals, books, series, protocols and reference works.

Objectives. This study compared the effects of a traditional ideology of care and role conflict on the intrinsic rewards (self-gain) and consequences (self-loss) of caregiving among African Americans and Whites. Methods. Using a cross-sectional telephone survey of caregivers in North Carolina (n = 481), the authors performed a structural equation groups analysis to assess the equality of an a priori caregiving model for African Americans (n = 257) and Whites (n = 224). Results. Despite a stronger preference for family care among African Americans, traditional caregiving ideology was associated with more self-gain among Whites only; there was no relationship between preference for family care and self-loss for either group. Furthermore, role conflict was unrelated to self-gain but was related to more self-loss for both groups. Three additional relationships differed between African Americans and Whites: age and self-gain, gender and self-gain, and care recipient depression and role conflict. However, 12 proposed relationships were statistically significant and equivalent for African Americans and Whites. Discussion. The findings suggest that contextual elements that influence preference for family care and role conflict are almost identical for African Americans and Whites. Caregiver demographics are associated with caregiving ideology, whereas care recipient frailty is related to role conflict. However, there are differences between African American and White caregivers, which primarily stem from the role of age, gender, and preference for family care with self-gain.