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Biomedical subjects

B Stanton

Publications and source records attributed to B Stanton.

At least 37 records · Page 2Linked to original sources
PubMed1998

Distress symptoms among urban African American children and adolescents: a psychometric evaluation of the Checklist of Children's Distress Symptoms.

OBJECTIVES: To explore the factor structure of the Checklist of Children's Distress Symptoms (CCDS); to examine whether there is a higher-order single construct underlying the CCDS measure; and, to assess the association between children's distress symptoms, as reflected by the CCDS factors, and children's self-reported exposure to community violence (both victimization and witness events). DESIGNS: Community-based cross-sectional survey. SETTINGS: Ten public housing developments in an eastern metropolis. PARTICIPANTS: A total of 349 low-income urban African American children and adolescents (198 males; 151 females), 9 through 15 years of age. MEASURES: Children's distress symptoms, exposure to community violence, and selected demographic information including parental education, parental employment status, perceived health status, and school performance. ANALYSIS: Exploratory factor analysis was performed to determine the factorial structure of the CCDS measure. Second-order confirmatory factor analysis was performed to determine if there is a higher-order single underlying construct among CCDS factors. Pearson correlation coefficients were computed to assess the relationship between exposure to violence and CCDS factors. MAJOR FINDINGS: The exploratory factor analysis yielded a 6-factor solution for the CCDS measure with satisfactory internal consistency. The confirmatory factor model with a single second-order construct yielded a good fit to the data. In general, youth who experienced violent victimization or witnessed violent events reported higher levels of distress symptoms than those who did not. Distress symptoms labeled as "intrusive thoughts," "distraction," and "lack of belongingness" were most frequently associated with exposure to violence. Distress symptoms did not differ on the basis of sex or age. CONCLUSIONS: The CCDS has utility as a measure of distress symptoms among urban African American children and adolescents. Whereas analysis provided support for a single higher-order construct, using the proposed 6-factor structure should enhance our understanding of the psychological impact of exposure to violence on youth and contribute to more effective intervention efforts.

Adolescent↗
PubMed1998

Drug trafficking and drug use among urban African-American adolescents: a causal analysis.

OBJECTIVE: To test the hypothesis that involvement in drug trafficking leads to illicit drug use among urban African-American adolescents. METHODS: Self-reports of substance use, illicit drug use, and drug trafficking were obtained at baseline and every 6 months for 24 months from 383 African-American early adolescents. Transitions between involvement in drug trafficking and illicit drug use over time were examined. Path analysis was conducted to examine the causal relation between drug trafficking and drug use. RESULTS: Among the 35 youth who were initially involved only in drug trafficking, 22 (67%) subsequently used illicit drugs. Of the 53 youth who were initially involved only in illicit drug use, only 19 (42%) continued using drugs at later waves (p < 0.05). Path analysis revealed that baseline drug trafficking had a strong effect on subsequent drug trafficking and drug use, whereas baseline drug use did not have an effect on subsequent drug use or drug trafficking. CONCLUSIONS: Initiation of drug trafficking by adolescents appears to lead to sustained involvement in drug-related activities, including continued drug trafficking and drug use. By contrast, initiation of drug use does not necessarily lead to continued involvement in drug-related behaviors.

Adolescent↗
PubMed1997

Evolution of risk behaviors over 2 years among a cohort of urban African American adolescents.

OBJECTIVE: To examine the evolution of risk behaviors over 2 years among a community-based cohort of low-income African American preadolescents and young adolescents enrolled in a randomized trial of an acquired immunodeficiency syndrome risk reduction intervention. DESIGN: Longitudinal, community-based cohort. SETTING: Nine recreation centers serving 3 public housing developments. SUBJECTS: Three hundred eighty-three African American youths aged 9 through 15 years at baseline. INTERVENTIONS: Frequency distributions, chi 2 analyses, and regression analyses regarding 10 risk behaviors were conducted. To assess whether a specific risk behavior or its protective (nonrisk) behavioral analogue, composing a risk-nonrisk behavioral complex (eg, was sexually active and was sexually abstinent or used drugs and refrained from drugs), was stable over time, kappa values were determined for the 10 risk-nonrisk behavioral complexes. MAIN OUTCOME MEASURES: Instrument assessing risk/ behaviors administered at baseline and every 6 months aurally and visually via talking computer. RESULTS: The prevalence of sexual intercourse, cigarette smoking, alcohol consumption, and drug use increased notably over time. Drug use increased from a 6-month cumulative prevalence of 7% at baseline to 27% at the 24-month follow-up (P < .001). Cumulatively over the 2-year study interval, 81% of youths had engaged in fighting, 58% had engaged in sexual intercourse, and from 33% to 40% had engaged in truancy, knife or bat carrying or both, alcohol consumption, drug use, and cigarette smoking. All of the risk-nonrisk behavioral complexes except weapon carrying were stable during the semiannual assessment intervals. Fighting (kappa = 0.22, P < .01), sexual intercourse (kappa = 0.33, P < .001), alcohol consumption (kappa = 0.21, P < .001), and unprotected sexual intercourse (kappa = 0.34, P < .05) were stable for 2 years. Six risk-nonrisk behavioral complexes were stable for the 2-year interval among youths aged 13 through 15 years at baseline, while only 2 risk-nonrisk behavioral complexes were stable among younger youths. The intervention seemed to affect the stability of 4 risk behaviors: truancy, drug use, unprotected sexual intercourse, and, possibly, fighting. For unprotected sexual intercourse, this intervention effect seemed to be due to stabilization of nonparticipation in risky behavior. Intervention youths were less likely to adopt a risk behavior (ie, engage in it for > or = 2 risk assessment periods) than control youths, but they were not less likely to experiment with a risk behavior. CONCLUSIONS: There is evidence that although the prevalence of risk behaviors does change with age, most risk-nonrisk behavioral complexes seem to be relatively stable over time and stability may increase with time. Risk reduction interventions seem to decrease risk adoption, stabilize nonrisk behaviors, and possibly destabilize risk behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1997

A quarter century of violence in the United States. An epidemiologic assessment.

During the past quarter century violence consistently has been a major problem in the United States. During this period, the profile of violence has changed. Adolescent and young adults are assuming a substantially greater role in serious and fatal violent events. The increased use of firearms, particularly by male youth and young adults, has rendered their acts of violence more lethal.

Adolescent↗
PubMed1997

Effectiveness of the 40 adolescent AIDS-risk reduction interventions: a quantitative review.

OBJECTIVE: (1) To review evaluations of Acquired Immunodeficiency Syndrome (AIDS) prevention interventions targeting adolescents to determine whether these efforts have been effective in reducing risk behaviors. (2) To examine the relation between intervention design issues and outcomes measures. METHOD: A systematic review of five electronic databases and hand-searches of 11 journals, were undertaken for articles published from January 1983 through November 1995 that reported evaluations of adolescent AIDS risk-reduction interventions conducted in the United States. Outcomes examined include: improved attitudes about AIDS risk and protective behaviors, increased intention to abstain from sexual intercourse or to use condoms, and reduced sexual risk behaviors. RESULTS: Forty studies that met preestablished inclusion criteria were found. For each outcome assessed, a majority of studies found a positive intervention impact (88% of studies assessing changes in knowledge; 58% changes in attitude, 60% changes in intention to use condoms, 73% in condom use, and 64% in decreasing number of sexual partners). Interventions that demonstrated an increase in intention to use a condom were significantly more likely to be theory-based than those that did not show any significant changes in intention (100% vs. 0%, p = .048). Interventions that increased condom use and decreased the number of sexual partners were longer in duration than those that did not improve these outcomes. CONCLUSIONS: AIDS risk reduction interventions can be effective in improving knowledge, attitudes, and behavioral intentions and in reducing risk practices. The positive relationship between improved outcomes and several elements of intervention design underscores the need for increased focus on intervention design in future studies.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Good news for everyone?

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Acquired Immunodeficiency Syndrome↗
PubMed1996

Design issues addressed in published evaluations of adolescent HIV-risk reduction interventions: a review.

OBJECTIVE: This study was conducted to determine: (1) issues in intervention design that have been addressed in behavioral interventions targeting human immunodeficiency virus (HIV)-risk behaviors among adolescents; (2) specific choices made in intervention design; (3) historic changes in the likelihood that issues in intervention design will be addressed; and (4) if an association exists between quality of evaluation design and the number of intervention design issues addressed. DESIGN: Literature search employing five electronic databases and 11 journals for articles published from January 1983 through December 1993 reporting evaluations of adolescent HIV-risk reduction interventions. MAIN OUTCOMES MEASURES: The frequency with which 12 issues in intervention design were addressed: basing the intervention on a theory of behavioral change; specifying a target population; involving the targeted community in the formulation of the intervention; addressing developmental issues; providing facts; strengthening interpersonal skills; describing the media (format) for delivering the intervention; specifying potentially relevant characteristics of the interventionists; describing the duration of the intervention; providing boosters; pilot testing the intervention; and including other potentially augmentative elements. RESULTS: Twenty-eight published intervention articles were included in these analyses. The median number of intervention design issues addressed in any study was six (range three to nine), although this number increased significantly over time (p < .01). There was substantial variability in the frequency with which each individual design issue was addressed, with some design issues (e.g., inclusion of specific facts and the description of the channel employed) being addressed in all studies. Other design issues were addressed in less than one-quarter of studies [e.g., basing the intervention on a theory of behavioral change (18%) and addressing developmental issues (21%)]. The targeted community was involved in one-third of studies. More recent studies and studies employing a randomized evaluation design with both preintervention and postintervention assessments addressed more intervention design issues than did earlier studies and studies employing other evaluation designs (p = .01 and p = .03, respectively). CONCLUSION: The majority of published adolescent HIV-risk reduction studies have not addressed important issues in intervention design. However, more recent studies and studies employing a strong evaluation design have addressed a greater number of these issues. Frameworks to guide intervention efforts (e.g., to serve as "practice guidelines") are needed to allow for both accurate replication and meaningful comparison of differing intervention approaches.

Adolescent↗
PubMed1996

The rate and pattern of alcohol consumption among Chinese adolescents.

OBJECTIVE: To assess the prevalence and pattern of alcohol consumption and its relation to participation in other social activities and problem behaviors among adolescents residing in the People's Republic of China. METHODS: Data were collected from a sample of 1,040 students in 6th, 8th, and 10th grades from five public schools in Beijing, China by using a self-administered questionnaire. Chi-square statistics and two-way ANOVA were used to assess the gender and grade difference in lifetime alcohol use of various alcoholic beverages. The age-adjusted and grade-adjusted odds ratio was used to assess the association between alcohol use and selected social activities and problem behaviors. RESULTS: Approximately 70% of the study sample reported prior alcohol consumption. The rate of drinking among males was significantly higher than among females (78% vs. 61%, p < .00001), and the rates among both genders increased with advancing grade (54%, 72%, and 84%, respectively, p < .001). Beer was the most commonly consumed alcoholic beverage. The results also suggested a progression from beer to wine and/or liquor. Drinking behavior was positively associated with participation in unstructured social activities and other problem behaviors. CONCLUSIONS: Alcohol use was prevalent among adolescents residing in China. The findings underscore the need for and importance of intervention efforts targeting alcohol consumption among early adolescents in China.

Adolescent↗
PubMed1996

Challenges and rewards of involving community in research: an overview of the "Focus on Kids" HIV Risk Reduction Program.

Acquired immunodeficiency syndrome (AIDS) continues to be a significant concern for adolescents, especially in minority populations. There is a scarcity of knowledge of the cultural context of sexual behavior in this age group and the influences that lead to early initiation of sex and unsafe sex. Few efforts targeting young adolescents have been community based, although there has been an increased awareness of the need for such research and intervention programs. Four key processes have been defined in gaining community participation in health education programs: (a) defining the community and reaching the community; (b) recognizing tensions among service, research, and community participation; (c) involving community residents; and (d) considering cultural differences in a community. These processes are used to describe the "Focus on Kids" project, a human immunodeficiency virus (HIV) risk reduction intervention that resulted in significant increases in condom use demonstrated by a randomized controlled trial.

Adolescent↗
PubMed1996

Cigarette smoking among Chinese adolescents and its association with demographic characteristics, social activities, and problem behaviors.

The rate and pattern of cigarette smoking were assessed using data collected in 1991 from 1,040 6th, 8th, and 10th grade youth in Beijing, People's Republic of China. One-fifth of the youth reported having ever smoked cigarettes. The rate of smoking appears to increase with advancing age and is associated with poorer academic performance and participation in unstructured activities and other problem behaviors. In contrast to data from European and United States youth, smoking is significantly more prevalent among males (29%) than among females (11%, p < .0001). The data underscore the need for smoking-prevention programs targeting Chinese early adolescents.

Achievement↗
PubMed1996

Similarity of risk and protective behaviors among African-American pre- and early adolescent members of naturally occurring friendship groups.

To determine whether self-reported risk and protective behaviors, expectations, and attitudes are more similar among African-American early adolescents within a community-based friendship group than across groups, a cross-sectional study was conducted among 382 African-American youth 9 through 15 years of age forming 76 community-based groups of 3 through 10 same-gender friends. Each member of the friendship group reported his/her own past involvement in nine risk behaviors (sexual intercourse, substance abuse, drug-trafficking, and other delinquent activities) and two protective behaviors (high academic performance and regular church attendance) and their expectations and feelings regarding several of these behaviors. Intraclass correlation coefficients were calculated overall and by gender and age. Members were generally more similar within friendship groups than across groups with regard to several risk behaviors and expectations including sexual intercourse and drug-trafficking. Particularly striking was the similarity among members of "junior" friendship groups (e.g., median age of youth < 11 years) of both risk and protective behaviors and expectations. The finding of enhanced similarity of risk behaviors and expectations among members within groups suggests that intervention delivery through community-based friendship groups may be a useful approach for risk prevention efforts targeting pre-adolescent African-American youth living in low-income settings.

Achievement↗
PubMed1995

Comparative sperm chromatin structure assay measurements on epiillumination and orthogonal axes flow cytometers.

The sperm chromatin structure assay (SCSA) measures the susceptibility of sperm nuclear DNA to acid-induced denaturation in situ, and was developed on two Ortho flow cytometers, an FC200 [Becton Dickinson Immunocytometry Systems (BDIS), Westwood, MA] and a Cytofluorograf 30 (BDIS), both having orthogonal axes of fluorochrome excitation, emission, and sample flow. Sperm cells are first treated with a pH 1.4 buffer to denature DNA in situ and then stained with the metachromatic dye acridine orange (AO). The metachromatic fluorescence measured reflects relative amounts of denatured (red fluorescence) and native (green fluorescence) DNA present per cell. The extent of DNA denaturation is quantified by the calculated parameter alpha t [alpha t = red/(red+green) fluorescence]. Alpha t variables important for correlations with fertility and toxicant-induced chromatin damage include mean (X alpha t), standard deviation (SD alpha t), and cells outside the main population (COMP alpha t). Mean green fluorescence intensity is an important measure for DNA content and/or degree of sperm chromatin condensation. This study showed that the SCSA can be successfully run on two epiillumination-type instruments, an Ortho ICP22A (BDIS, San Jose, CA) and Skatron Argus (Tranby, Norway), and two additional orthogonal axes instruments, a Becton Dickinson FACScan (BDIS) and a Coulter Elite (Coulter Corporation, Hialeah, FL). Epiillumination instruments produced a different fluorescence distribution than orthogonal instruments, but the resulting alpha t values showed strong conformity and interpretation of results was the same. SCSA values obtained on the Coulter Elite were most similar to the Cytofluorograf 30; the FACScan green fluorescence distribution was narrower and allowed resolution of cell doublets.(ABSTRACT TRUNCATED AT 250 WORDS)

Acridine Orange↗
PubMed1995

Violent crime in the United States. An epidemiologic profile.

OBJECTIVES: To determine if (1) there was an increase in the rates of acts of violence in the United States from 1973 to 1992 and (2) there were disproportionate changes in rates of violent crime among specific demographic groups. METHODS: Crime data from the Uniform Crime Reporting Program and the National Crime Victimization Survey beginning in January 1973 and ending in December 1992 were examined. Homicide data from 1970 to 1991 were examined with the National Center for Health Statistics mortality data from the Centers for Disease Control and Prevention. Analyses were performed for overall crime rates as well as for specific demographic groups. RESULTS: Rates of victimization from all types of violent crime have increased among adolescents and young adults (from ages 10 through 25 years), regardless of gender or race. Absolute rates were highest among African Americans and males. Both the highest rates and the greatest increases in homicide from 1971 to 1990 were among adolescents and young adults, while rates for those aged 25 years and older decreased. A substantial increase in firearm-related homicides among adolescents and young adults occurred as well, with rates decreasing for those aged 25 years and older. Overall rates of homicide have remained relatively constant during the past two decades. Data addressing overall trends in the rates of non-fatal violence during the past 20 years are inconclusive. CONCLUSIONS: Adolescents are now experiencing the highest and most rapidly increasing rates of lethal and non-lethal violence. The increase in violence among youths 10 to 14 years of age is especially important and alarming. The concentration of violence among children and adolescents has important intervention implications. Because adolescence is a time of great developmental changes, approaches to understanding and preventing violence among our nation's youths should incorporate a developmental perspective that also focuses on the relationship and interactions between individuals and their environments, at the family, community, and societal levels.

Adolescent↗
PubMed1995

Perceived risks and benefits of alcohol, cigarette, and drug use among urban low-income African-American early adolescents.

Perceptions about drugs and the social environment may be important influences on cigarette, alcohol and drug use, yet little is known regarding the perspective of early adolescent boys and girls, especially among minority urban youths. Among 351 African-American low-income urban youth, 9 through 15 years of age, completing a community-based computerized questionnaire, 25% acknowledged alcohol, cigarette, and/or illicit drug use in the past 6 months; 19% expected to use one of those substances in the next 6 months. Family exposure to drugs increased the likelihood that youths expected to use drugs by factors of 4.5 (boys) and 2.5 (girls). Other factors (feelings about drugs, community drug use, long-term expectations) distinguished users from nonusers or had different associations with use in boys and girls. Gender-specific perceptions about drugs may have the potential to be modified in drug and substance use prevention programs.

Adolescent↗
PubMed1995

Development of a culturally, theoretically and developmentally based survey instrument for assessing risk behaviors among African-American early adolescents living in urban low-income neighborhoods.

The creation of developmentally and culturally appropriate data-gathering instruments is necessary as health researchers and interventionists expand their investigations to community-based minority adolescent populations. The creation of such instruments is a complex process, requiring the integration of multiple data-gathering and analytic approaches. Recent efforts have delineated several issues to be considered in survey design for minority populations: community collaboration; problem conceptualization; application of the presumed model of behavioral change; and dialect and format of delivery. This paper describes the process of creating a culturally and developmentally appropriate, theoretically grounded instrument for use in monitoring the impact of an AIDS educational intervention on the behavior and health outcomes of urban African-American pre-adolescents and early adolescents. Three phases of research were involved: preliminary (and ongoing) ethnographic research including extensive participant observation, as well as, focus group and individual interviews with 65 youths; construction and testing of the preliminary instrument involving two waves of pilot testing (N1 = 57; N2 = 45); and, finalization of the instrument including reliability testing and assessment of tool constructs and selection of the mode of delivery (involving 2 additional waves of pilot testing (N3 = 91; N4 = 351). The essential role played by the community in all phases of instrument development is underscored.

Adolescent↗
PubMed1995

Diverting managed care Medicaid patients from pediatric emergency department use.

OBJECTIVE: To evaluate the health outcomes of managed care Medicaid children with non-emergent conditions who were not authorized to be seen in the Pediatric Emergency Department (PED) by their primary care provider. DESIGN: Consecutive case surveillance from 6/29/92 to 2/2/93. SETTING: University based PED (17,500 visits/year) in inner city Baltimore. PARTICIPANTS: Cases were MAC children denied authorization to be seen for non-emergent conditions in the PED. Age and complaint matched MAC children were selected from the university based Pediatric Ambulatory Center (PAC) and from non-emergent PED visits (PED-seen) in order to compare utilization rates after denial. INTERVENTION: The Maryland Access to Care (MAC) Medicaid program (started in 12/91) emphasizes primary care and appropriate health care utilization by incorporating the following elements of managed care: assignment to primary care provider, gatekeeping, mandatory enrollment and fee for service. METHODS: Consecutive case surveillance from 6/29/92 to 2/2/93 was used to evaluate the health outcomes of MAC children denied authorization for non-emergent care in a university based PED. One week following denial, a pediatric nurse practitioner contacted the patient's caretaker and the MAC provider to ascertain health outcome. Medicaid claims data was used to compare the six month health care utilization of the denied group to age and complaint matched children seen in the PED (PED-seen) or in a primary care clinic (PAC). RESULTS: 216 MAC patients were not authorized for a PED visit by their MAC providers. 123 (57%) saw their MAC provider within one week of the denied PED visit. 40 (18%) were not seen because their presenting complaint had resolved completely. No adverse health outcomes occurred because of delay in health care delivery. The subsequent ER utilization rate of the denied group was the same as the PED-seen comparison group, and significantly higher than that of the PAC group (P = .002). The denied group was hospitalized at a significantly higher rate relative to these comparison groups (P = .003). CONCLUSIONS: Diverting Medicaid children classified as non-emergent in an ER to their MAC providers can be a safe practice short-term. However, denial of a PED visit has no impact on subsequent ER utilization by Medicaid participants and may be associated with higher hospitalization rate. Gatekeeping in this setting does not necessarily change the health care seeking behavior of these patients.

Baltimore↗
PubMed1994

Do provider practices conform to the new pediatric immunization standards?

OBJECTIVE: Standards for pediatric immunization practices were issued by the Centers for Disease Control and Prevention, Atlanta, Ga, in May 1992. This article provides baseline data on immunization practices related to eight of the standards. DESIGN: Survey of pediatric providers before publication of the standards. SETTING: Baltimore, Md. PARTICIPANTS: Forty of the 41 health centers, clinics, and private practices serving children in designated high-risk census tracts participated in the survey. One hundred seventy-three of the 251 eligible physicians and nurse practitioners at the sites responded. MAIN OUTCOME MEASURES: Conformity with the eight standards was measured as a percentage of either sites or physicians and nurse practitioners across the sites. RESULTS: Conformity with the standards varied, ranging from nearly universal conformity with the need to educate parents and guardians about immunizations (standard 5) to less than 3% for simultaneous administration of all vaccine doses when a child is first eligible (standard 8). For most of the standards, considerable variability was found between and within public and private sites. CONCLUSIONS: Providers often followed practices that did not conform to the new standards (prior to issuance). Some of the standards are ambiguous and require clarification before they can be fully applied. The impact of the standards on immunization rates and pediatric primary health care has yet to be tested empirically.

Baltimore↗