A Dental Program Evaluation and Follow-up

Abstract

College-aged individuals are at risk for bicycle-related head injuries, but the risk of such injuries can be reduced by their use of bicycle helmets. The objective of this research was to measure the rate of bicycle helmet use by university bicyclists at a large public university in the southwestern United States at three different times. Bicyclists riding onto campus were observed as they rode through a main campus entrance in 1985, 1990, and 1994, and the percentage of bicyclists who were wearing a helmet was recorded. The bicyclists were unaware that their helmet use was being monitored. In 1985, 10% of bicyclists were wearing helmets; in 1990, only 4.4% wore helmets. In 1994, the proportion of helmet-wearing bicyclists had increased to 24%. Although the sample sizes were small, the 1994 increase was statistically significant. The reasons for the increase are unclear, and further study is needed to identify factors related to university bicyclists' use of bicycle helmets.     

WHAT DO BICYCLE HELMET LAWS DO? EVIDENCE FROM CANADA

Twenty‐one states and the District of Columbia require youths to wear helmets when riding a bicycle, and there has been a push to extend such laws to adults. We provide new evidence on helmet laws by studying Canada using difference‐in‐differences models and restricted area‐identified public health survey data with information on cycling and helmet use for nearly 800,000 individuals from 1994 to 2014. We first confirm prior patterns from the United States that laws requiring youths to wear helmets significantly increased youth helmet use. We then provide the literature's first comprehensive evidence that “all‐age” bicycle helmet laws significantly increased both adult and youth helmet use by 50%–190% relative to pre‐reform levels, with larger effects for younger adults and less‐educated adults. All‐age helmet laws had modest effects at reducing cycling and increasing in‐home exercise during winter months among adults but did not meaningfully affect weight. Overall, our findings confirm that all‐age helmet laws can be effective at increasing population helmet use without significant unintended adverse health consequences. (JEL I18, I12, K32)     

Moving targets: bicycle-related injuries and helmet use among university students.

We conducted a cross-sectional study to evaluate bicycling habits and helmet use in a sample of university students in a southwestern state university. Thirty-one of 100 students in our sample owned bicycle helmets; of these, 17 (54.8%) wore helmets during most (more than three fourths) of their bicycle trips. Almost half of the students reported that more than 25% of their bicycling was done in heavy traffic but they rarely used bicycle trails. Sixty-five students in the sample had sustained at least one minor injury during the previous 5 years, and 18 had been hospitalized as a result of bicycle-related injuries. We found no substantial differences between male and female subjects in bicycle-related hospitalizations, although male subjects were more likely to sustain minor injuries than were females. Helmet ownership was most strongly associated with previous injury experience, especially hospitalization resulting from bicycling injuries (OR = 3.6; 95% CI = 1.3, 10.1). We also observed an association between helmet ownership and possession of insurance coverage for bicycling injuries (OR = 3.0; 95% CI = 1.2, 7.6). Ethnicity was a factor in helmet ownership--helmets were owned by 26 of 69 (37.7%) of non-Hispanic whites, in contrast to 1 of 24 (4.2%) of all other ethnic groups combined. Our survey data suggest that perceived risk is an important factor in bicyclists' use of safety helmets.     

A multidimensional approach to the generation of helmets' design criteria: a preliminar study

The design and development process of helmets incorporates systematically design criteria related to safety to accomplish European and local standards for the commercialization. However, there are few studies focused on user's comfort and adaptation. Present study tackles a multidimensional approach to gain better understanding of the interaction between helmet and user to generate design criteria for the internal helmet surface. Morphological characteristics of the target population, pressure distribution over head and subjective perception of fitting and discomfort are the factors considered to establish the criteria that assure a proper fit. Ten men corresponding to helmet size M and usual drivers of motorbike wore two helmet models in three sizes (S, M and L). The head shape of participants was acquired using the head scanner of I-Ware laboratory and an instrumented pad was used to measure pressure in five head regions. After wearing the helmet, users filled in a perception questionnaire about fitting, comfort and usability considering the five regions. Users' fitting perception provided the relation between pressure levels and the comfort felt in the five regions. This study constitutes a first approach to a new methodology to generate criteria to improve the design of helmets under a multidimensional approach.     

Broken Promises: Abstinence Pledging and Sexual and Reproductive Health

Approximately 12% of girls and young women in the United States pledge abstinence. Yet most break their pledges, engaging in first intercourse before marriage. The extant literature reports few differences between pledge breakers and nonpledgers in sexually transmitted infections and nonmarital pregnancies. The present research maintains that previous studies may have obscured important differences in exposure risk and hypothesizes that female pledge breakers who have higher exposure risk are more likely to experience human papillomavirus (HPV) and nonmarital pregnancies. To test this hypothesis, this study uses the National Longitudinal Study of Adolescent to Adult Health, logistic regression, and event history modeling. The results show that, after accounting for differences in exposure risk, pledge breakers have higher risk of HPV and nonmarital pregnancy. As a set, the results are consistent with the argument that pledgers use condoms and contraceptives less consistently and highlight unintended consequences of abstinence promotion.     

Impact of legislation requiring moped and motorbike riders to wear helmets

In 1992, a package of measures was adopted by the city of Barcelona to obligate riders of motorcycles with a power capacity inferior to 125 cc to use helmets, until then only compulsory for larger motorcycles. Interrupted time series analyses with the use of a control group is used to investigate the effect of these measures on the number of serious injuries and number of deaths. The results indicate a significant decrease in the number of serious cases in the treated group—smaller motorcycles and mopeds—a decrease which does not occur in the control group —larger motorcycles. The impact of the adopted measures is abrupt and permanent but the change in riders helmet wearing habits has not been influenced so much by the media campaign as by the coming into force of the legislation with the potential application of sanctions.     

The effects of an intervention campaign to enhance seat belt use on campus.

The national health objectives for the year 2000 called for an increase in the use of safety restraints to 85% of motor vehicle occupants. An assessment on one campus indicated that only 79% of those observed were wearing seat belts. Nursing faculty and students undertook a multimodal intervention campaign to increase seat belt use in the campus community. Observed use of seat belts increased to 81% after the week-long intervention consisting of reminder banners, media coverage, permanent reminder signs, roll-over demonstrations, a presentation on the need for seat belt use, and distribution of seat belt use pledge cards. Although the increase was small, it was statistically significant and could represent considerable savings in healthcare costs if even 2% of the population could be saved from serious injury by using seat belts. In addition, the change in seat belt use represented a decline of nearly 10% in the number of nonusers.     

A process evaluation of an intervention to promote home smoking bans among low income households

Exposure to secondhand smoke occurs primarily in the home due to passage of smoke-free legislation. Creation of a total household smoking ban can reduce associated health conditions such as asthma, lung cancer, heart disease and stroke. This paper describes the results of a randomized control trial of a minimal intervention to create smoke-free homes. 2-1-1 callers were invited to participate in the trial and were randomized to an intervention (mailings and a coaching call) or a control group (no intervention). We assessed reach, dose, fidelity, and receptivity to the intervention through program records and a 3-month follow-up survey with intervention participants. For the intervention materials, materials were mailed to 244 participants (99.2%) and 227 participants (92.3%) received the coaching call intervention. 92.3% received all intervention components. Participants who had full household bans at 3 months were more likely to conduct behaviors leading to a smoke-free home (i.e., making a list of reasons, having a family talk, posting a pledge) than were those with no/partial ban. The intervention materials also were rated higher in relevance and usefulness by non-smokers than smokers. Results demonstrate that this minimal intervention had high fidelity to the delivery of components and relatively high receptivity.     

Changes in body weight and fat mass of men and women in the first year of college: A study of the "freshman 15"

Students entering their first year of college are faced with many stresses and changes, including changes in eating and exercise behavior. A common but often undocumented myth among college students is that there is a high risk of gaining 15 pounds of weight during freshman year. The objective of this study was to measure changes in body weight and percentage of body fat among first-year college students. Using a digital scale with bio-electrical impedance, the authors measured height, weight, and percentage of body fat for a sample of students who volunteered to be weighed during a health assessment in the university dining halls. The authors sent e-mails inviting those same students to complete a second measurement in February of the academic year. Sixty-seven of the 217 students who volunteered for the health assessment agreed to undergo a second set of measurements in the spring. The mean change in body weight was 2.86 pounds (1.3 kg, SD = 4.0 kg), and the mean change in percentage of body fat was 0.7% (SD = 4.0%). For those students who gained weight only, the mean increase in body weight (as measured by body mass index, weight divided by height in kg/m2) was 6.82 pounds (3.1 +/- 2.4 kg) and percentage of body fat was 0.9 +/- 3.8%. The authors found that the first year of college is a period in which weight and fat gain may occur. The exact causes behind these changes are unclear and warrant further research to plan or improve intervention and prevention.     

The association of multiple risk factors with fruit and vegetable intake among a nationwide sample of college students

Few college students meet fruit and vegetable intake recommended requirements, and most receive no information from their institutions about this issue. The avoidable disease burden among students is large, the necessary information infrastructure exists, and Healthy People 2010 objectives indicate efforts should be taken to increase intake. OBJECTIVE: The authors examined the association of high-risk behaviors and fruit and vegetable intake to inform design of multiple risk factor interventions. PARTICIPANTS AND METHODS: The authors obtained data from a sample of 40,209 18- to 25-year-old college students who completed the American College Health Association-National College Health Assessment during the spring 2002 and 2003 semesters. RESULTS: Predictors of high fruit and vegetable intake for men and women included better: seatbelt and helmet use, physical activity, perceived health, sleep, self-care behaviors, and grades. Other notable predictors of high intake were reduced likelihood of cigarette smoking, alcohol use, drinking and driving, and feeling hopeless in both sexes; reduced likelihood of drinking and driving among men; and a greater likelihood of anorexia among women. CONCLUSIONS: The authors discuss implications of these findings.     

Intervention fidelity in psychosocial oncology

Intervention fidelity refers to strategies that practitioners and researchers use to monitor, enhance, or evaluate the accuracy and consistency of the delivery of an intervention to ensure that it is implemented according to how it was planned. The purpose of the authors in this article was to evaluate intervention fidelity in the psychosocial oncology intervention effectiveness research. Twenty-eight studies located in a previous systematic review on psychosocial oncology intervention effectiveness comprised the sample for this research. A treatment fidelity checklist was applied to each study independently by each author (MP & PB). Percent agreement between raters ranged from 68% to 100% (M = 89%). Overall, the mean proportion of adherence was 0.57 (SD 0.12), which may be considered to be moderate fidelity. Critical examination and applicability of the checklist in examining and assessing intervention fidelity were highlighted and discussed. Overall, intervention fidelity was adequately addressed in the psychosocial oncology intervention effectiveness research, and integrity was confirmed in the majority of studies reviewed. Suggestions for future psychosocial oncology effectiveness research were made.     

My student body: a high-risk drinking prevention web site for college students

The authors investigated the efficacy of an interactive Web site, MyStudentBody.com: Alcohol (MSB:Alcohol) that offers a brief, tailored intervention to help heavy drinking college students reduce their alcohol use. They conducted a randomized, controlled clinical trial to compare the intervention with an alcohol education Web site at baseline, postintervention, and 3-month follow-up. Students were assessed on various drinking measures and their readiness to change their drinking habits. The intervention was especially effective for women and persistent binge drinkers. Compared with women who used the control Web site, women who used the intervention significantly reduced their peak and total consumption during special occasions and also reported significantly fewer negative consequences related to drinking. In addition, persistent heavy binge drinkers in the experimental group experienced a more rapid decrease in average consumption and peak consumption compared with those in the control group. The authors judged MSB:Alcohol a useful intervention for reaching important subgroups of college binge drinkers.     

Image concerns in pledges to give blood: Evidence from a field experiment

We use a field experiment to study how social image concerns affect a commonly used strategy to attract new donors: pledges to engage in a charitable activity. While waiting for their appointment, visitors to a local government office are offered sign-ups for blood donations in a crowded waiting room. We randomly vary the visibility of the pledge to donate and the organization for which blood donations are solicited (charitable vs. commercial). Our setting provides natural variation in who observes the pledge. We do not find that visibility increases pledges to donate. Exploring heterogeneity in treatment effects, we find that visibility increases pledges when participants are observed by friends or family. Almost all subjects renege on their pledge.     

The Association of Multiple Risk Factors With Fruit and Vegetable Intake Among a Nationwide Sample of College Students

Few college students meet fruit and vegetable intake recommended requirements, and most receive no information from their institutions about this issue. The avoidable disease burden among students is large, the necessary information infrastructure exists, and Healthy People 2010 objectives indicate efforts should be taken to increase intake. Objective: The authors examined the association of high-risk behaviors and fruit and vegetable intake to inform design of multiple risk factor interventions. Participants and Methods: The authors obtained data from a sample of 40,209 18- to 25-year-old college students who completed the American College Health Association-National College Health Assessment during the spring 2002 and 2003 semesters. Results: Predictors of high fruit and vegetable intake for men and women included better: seatbelt and helmet use, physical activity, perceived health, sleep, self-care behaviors, and grades. Other notable predictors of high intake were reduced likelihood of cigarette smoking, alcohol use, drinking and driving, and feeling hopeless in both sexes; reduced likelihood of drinking and driving among men; and a greater likelihood of anorexia among women. Conclusions: The authors discuss implications of these findings.     

The impact of in-vehicle cell-phone use on accidents or near-accidents among college students

With in-vehicle use of cell phones rapidly increasing, the safety of young drivers, who represent 14% of licensed drivers but 26% of drivers involved in fatal crashes, may be disproportionately threatened. The authors used a questionnaire to examine the association between in-vehicle cell-phone use and accidents or near-accidents among 1,291 conveniently recruited college students in 4 states. Of the 1,185 respondents who were drivers, 87% had a cell phone, and 86% of the cell-phone owners reported talking while driving at least occasionally. Of the 762 reported accidents or near-accidents, 21% (n = 159) involved at least 1 of the drivers talking while driving. Chi-square tests and logistic regression analyses showed that the frequency, not the duration, of drivers talking while driving was related to experiencing accidents or near-accidents. Differences between drivers who used cell phones and nonusers in unsafe driving behaviors and attitudes were also examined, and target groups for intervention efforts against talking on a cell phone while driving are suggested.     

Outcomes of a technology-based social norms intervention to deter alcohol use in freshman residence halls

OBJECTIVE: The authors tested a prototype intervention designed to deter alcohol use in residence halls. PARTICIPANTS: Approximately 384 freshmen participated in the study over a 2-year period. METHODS: The authors devised a feedback method that assessed residents' blood alcohol concentration (BAC) at night and allowed the readings to be retrieved the next day via the Web. Residents in an intervention hall received their BAC readings as well as normative feedback. In a comparison hall, residents could retrieve only the BAC readings. RESULTS: The authors found statistically significant hall differences, but they were small in size and not meaningful. CONCLUSIONS: Qualitative findings suggest the intervention had an overall positive impact, but the actions of a subgroup of rebellious drinkers might have obscured the effect. Social norms interventions could provoke some episodes of excessive drinking in students who find these messages objectionable. More research is needed to evaluate delayed BAC feedback.     

Screening and brief intervention for alcohol problems in a university student health clinic

The purposes of this study were (1) to determine whether a university student health center (SHC) is a feasible location to introduce a campus-based screening and brief intervention (SBI) program for alcohol and (2) to determine whether the patients seen in the SHC differ in terms of the prevalence and severity of alcohol-related problems compared with students reported by emergency department programs. The authors used motivational interview techniques to counsel subjects from a convenience sample of patients waiting for medical treatment in the SHC who had screened positive with the Alcohol Use Disorders Identification Test (AUDIT). The authors interviewed patients again after 3 months. Seventy-five percent of eligible students participated. Sixty percent screened positive and received an intervention. The authors contacted 66 students (51.2%) again after 3 months. Seventy-five percent of students interviewed again after 3 months reported that SBI was helpful, 92% found the information clear, and 90% thought that the SHC was a good place to learn this information.     

Coital debut: the role of religiosity and sex attitudes in the Add Health Survey

Recent reviews suggest that religiosity is associated with the delay of adolescent coital debut (Rostosky, Wilcox, Wright, Randall, in press; Wilcox, Rostosky, Randall, Wright, 2001). Few studies, however, have examined this association using longitudinal data to test theoretically driven models. We analyzed data from 3,691 adolescents (ages 15-21), testing the hypothesis that adolescent religiosity and sex attitudes (at Wave 1) predict later coital debut (at Wave 2) and that these predictive relationships vary by gender. Findings indicated that beyond demographic factors and number of romantic partners, religiosity reduced the likelihood of coital debut for both males and females. After accounting for the effects of religiosity, anticipation of negative emotions after coital debut (sex attitude factor 1) further reduced its likelihood for females and males. Finally, adolescent girls - but not boys - who anticipated positive emotions following sexual intercourse (sex attitude factor 2) were more likely to debut. While virginity pledge status was associated with coital debut for boys and girls, more conservative beliefs about sex appeared to mediate its effect. Finally, a significant interaction between race and religiosity indicated that African American adolescent males who had either signed a virginity pledge or were more religious were significantly more likely to debut than both White non-Hispanic males and African American males who were less religious and/or who had not signed a pledge. The implications of these results for adolescent pregnancy prevention programming are discussed.     

Rocking the Vote: Using Personalized Messages to Motivate Voting among Young Adults

We examined a nationwide effort to encourage young adults to vote in the 1996 U.S. presidential election. During the year before the election, individuals were given the chance to sign and self-address one of two kinds of postcards pledging to vote; these cards were mailed back to the individuals within 2 weeks prior to the election. It is important to note that some individuals completed pledge cards that prompted them to provide their own reason for voting by completing the sentence, "I will vote because ______," whereas other individuals completed pledge cards that did not contain this sentence prompt. We conducted a large-scale survey of individuals who filled out pledge cards and determined that receiving a pledge card with the sentence prompt had a positive influence on voting. Moreover, this effect was found above and beyond demographic and psychological predictors of voting. Implications of these findings are discussed.     

Gambling as an emerging health problem on campus

OBJECTIVE: The authors documented the prevalence of gambling and correlates to health among undergraduates. METHODS: The authors analyzed data from a health-habit questionnaire (gambling questions included) given to students enrolled in a university-required course. RESULTS: Gambling and problems with gambling were more frequent among men than women regardless of venue. Athletes more frequently bet on sports and played games of chance, had gambling debt, and sought help for gambling than did nonathletes. More than 50% of fraternity members gambled and had a higher prevalence of gambling debt than did other men. Several gambling practices were correlated with failure to use seatbelts, driving or riding with someone under the influence, and using drugs (including cigarettes). Twice as many students who had gambling problems reported considering or attempting suicide than did those who did not report gambling problems, and gambling was correlated with depression. CONCLUSION: These results indicate that gambling is correlated with high-risk health behaviors and indicates the need for intervention for college students with gambling problems.