Statistics for weighing benefits and harms in a proposed genetic substudy of a randomized cancer prevention trial

Summary.  When evaluating potential interventions for cancer prevention, it is necessary to compare benefits and harms. With new study designs, new statistical approaches may be needed to facilitate this comparison. A case in point arose in a proposed genetic substudy of a randomized trial of tamoxifen versus placebo in asymptomatic women who were at high risk for breast cancer. Although the randomized trial showed that tamoxifen substantially reduced the risk of breast cancer, the harms from tamoxifen were serious and some were life threaten-ing. In hopes of finding a subset of women with inherited risk genes who derive greater bene-fits from tamoxifen, we proposed a nested case–control study to test some trial subjects for various genes and new statistical methods to extrapolate benefits and harms to the general population. An important design question is whether or not the study should target common low penetrance genes. Our calculations show that useful results are only likely with rare high penetrance genes.     

Community Economic Development Strategies in Rural Washington: Toward a Synthesis of Natural and Social Capital*

Abstract Routes to economic development attract considerable attention in community and rural sociology. Social scientists draw increasingly on studies of social capital and environmental surroundings as they examine the factors that facilitate and inhibit economic development. However, few empirical analyses exist that analyze the impact of the combination of social infrastructure and natural capital on different forms of economic development such as on industrial recruitment and self‐development. Using data collected from six communities in Washington State, the interaction of a community's social infrastructure and natural capital on industrial recruitment and self‐development efforts is examined. Results suggest that while natural capital positively impacts a community's successful recruitment of outside industries, it is not significant for a community's level of self‐development. However, a community's social infrastructure, measured by the existence of active civic organizations, local businesses that support local community projects, community‐wide fund‐raising capacity, and extra‐local linkages to nearby communities, state, and national agencies, positively affects both industrial recruitment and self‐development. These findings illustrate the need for communities and local activists to carefully weigh their advantages and potential shortcomings when deciding on an economic development strategy.     

The ascendancy of primary care: permanent or temporary?

The conventional wisdom strongly suggests a health care provider food chain for the future: Primary care physicians (PCPs), principally family practitioners, on the top playing the lead role, distantly followed by specialists, with hospitals and other ancillary services even further down the line. Is this a reasonable expectation? Will PCPs dominate the new systems? Or will they be but one of many equally necessary components of these developing integrated health care delivery organizations? Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPs and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers, educators, and administrators. To separate the illusion of primary care dominance of the coming health care system from the likely reality, we should first determine what is driving the apparent present demand for primary care physicians. Next, we will examine the possible and probable reactions to that demand from an economic standpoint and from the points of view of both health care professionals and the public. Finally, we must try to picture how health care provider organizations of the future are likely to look and how they will integrate their health care professionals.     

Older women's fears of violence: the need for interventions that enable active ageing

Women's fear of violence can impact negatively on their active participation in life. An ageing survey conducted with 2,620 Australian respondents aged 50 to 90 years examined aspects of work, learning, social, spiritual and emotional status, health, vision, home, life events, demographics, and asked an open-ended question about what being actively engaged in life meant. Ordinal regression was carried out on two dependent variables: wanting and needing to learn to discourage violence. Analyses found that as women's age increased, those on lower incomes were more likely than others to say they needed to learn how to discourage violence against them. This paper investigates the variables associated with the findings-transport, finances, news media, home safety, and reduced social interactions. Results highlight the importance of understanding women's fear in the context of personal and social issues, and the need to provide learning opportunities to improve safety and social engagement.     

Self-perception of Gambling Problems among Adolescents Identified as At-risk or Problem Gamblers

The relative influence of perceived familial addictive behaviors and personal gambling behaviors on adolescents' self-perceptions of gambling problems was examined. Students from five high schools in Connecticut (N = 3,886) were surveyed. Of those between the ages of 14 and 17 who scored two or more on the South Oaks Gambling Screen--Revised for Adolescents (n = 532; 72% male; 43% Caucasian), 14.3% reported having a current or past problem with gambling. Wagering larger amounts in a single day, gambling on a daily basis, and perceived presence of a family member with a gambling problem were associated with increased odds of self-perception of a gambling problem. Thus, adolescents who may be less likely to be identified for prevention efforts (due to lack of engagement in high stakes gambling or the real/perceived absence of a problematic gambler in the home) appear less likely to perceive a gambling problem. To advance prevention and treatment strategies, the apparent discrepancy between adolescents' self-perceptions and objective reports of problem gambling behaviors warrants further investigation.     

The effect of a novel ADL-based training program on performance of activities of daily living and physical fitness

The purpose of this study was to determine the degree to which a novel training program based on activities of daily living (ADL) would affect performance of ADLs, as well as the fitness of older adults. Fourteen individuals (mean age 82 years) took part in a 10-week control period followed by a 10-week ADL-based training program. Pre- and posttests included the Physical Performance Test (PPT), the Physical Functional Performance-10 (PFP-10), and the Senior Fitness Test (SFT). After the training period, improvements ranging from 7% to 33% (p<.05) were seen on the PPT and PFP-10 and on three items of the SFT. After conversion to standard scores, the magnitude of change in the PPT and the PFP10 was significantly greater (p<.05) than the magnitude of change in the SFT. These data support the idea that this novel ADL-based training program was able to facilitate improved performance of ADLs, as well as select measures of fitness among older adults.     

When women veterans return: The role of postsecondary education in transition in their civilian lives

Objective: The purpose of this study was to assess the current state of postsecondary educational settings’ outreach to military women who become students postservice. Participants: Data for the present cross-sectional study were obtained from the American College Health Association’s (ACHA) 2011–2014 National College Health Assessment II (NCHA). Methods: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with Fisher’s exact test, maximum likelihood multiple logistic regression, as appropriate. Results: Women service member and veteran students received health information from their university/college less often than women students with no military experience on the following topics: alcohol and other drug use, depression and anxiety, sexual assault and relationship violence prevention, and stress reduction. Conclusions: The findings of this research identified clear gaps in service provision for women student veterans on college campuses and provided some possible models for intervention development.     

Building a health communication brand for University of Texas System tobacco control

Objective: Despite declining cigarette smoking rates in the US, there is a continued need for tobacco prevention education campaigns to reach young adults. Recognizing the need for improved tobacco control messaging, the University of Texas (UT) System engaged The University of Texas at Austin Center for Health Communication to develop a brand and message that would strengthen tobacco control efforts at its 14 institutions. Methods: This article describes the iterative process involved in creating a brand for tobacco control, including an environmental scan, identifying potential message themes, and creating and refining logos. Results: This article highlights the process of developing a system-wide tobacco control brand. Specifically, the process included coordinating an interdisciplinary team with content and design experts, and presenting ideas to stakeholders for serial feedback and refinement, among others. Conclusions: Ultimately, this project offers a model for other systems of higher education interested in pursuing similar initiatives.     

Uncertainty,selective exposure,and message efficacy effects during life transitions

Drawing on informational utility, uncertainty management, and self-efficacy models, predictions were developed about how individuals select media messages when faced with the transition from college to postcollege life. Predictions were also made concerning how message exposure influences self-efficacy and behavior. Participants filled out a questionnaire and then browsed a university blog that contained alumni posts about transition success (high-efficacy messages) or failure (low-efficacy messages) in a variety of life domains, including the target domain, romance. Browsing was unobtrusively measured through hyperlink tracking. Results indicate that selective exposure to low-efficacy romance messages was predicted by romance outcome expectancies; romance uncertainty discrepancy had an indirect effect on selective exposure through outcome expectancies and self-efficacy’s impact on outcome expectancies. Thus, outcome expectancies and self-efficacy should be considered when predicting exposure to high- versus low-efficacy messages during a life transition.