Assessing accuracy of a continuous screening test in the presence of verification bias

Summary.  In studies to assess the accuracy of a screening test, often definitive disease assessment is too invasive or expensive to be ascertained on all the study subjects. Although it may be more ethical or cost effective to ascertain the true disease status with a higher rate in study subjects where the screening test or additional information is suggestive of disease, estimates of accuracy can be biased in a study with such a design. This bias is known as verification bias. Verification bias correction methods that accommodate screening tests with binary or ordinal responses have been developed; however, no verification bias correction methods exist for tests with continuous results. We propose and compare imputation and reweighting bias-corrected estimators of true and false positive rates, receiver operating characteristic curves and area under the receiver operating characteristic curve for continuous tests. Distribution theory and simulation studies are used to compare the proposed estimators with respect to bias, relative efficiency and robustness to model misspecification. The bias correction estimators proposed are applied to data from a study of screening tests for neonatal hearing loss.     

The Culture of High-Risk Alcohol Use Among Club and Intramural Athletes

Abstract

Objective: The purpose of this study was to examine the drinking patterns of club and intramural college athletes and compare their alcohol consumption, perceived norms around the excessive use of alcohol, experience of negative consequences, and employment of protective strategies with those of campus varsity athletes. Participants: A total of 442 undergraduate students attending a private, suburban institution in the Northeast participated in the American College Health Association National College Health Assessment-II Web survey in spring 2011. Thirty-five students identified themselves as varsity athletes, 76 identified as club sport athletes, and 196 students identified themselves as intramural athletes. Methods: Survey responses were analyzed using Statistical Package for the Social Sciences. The Pearson's correlation coefficient and test for independence were applied to identify significant relationships between athlete status and identified variables related to alcohol use. Results: Results indicated that there were significant correlations between athlete status and all variables, to varying degrees. Conclusions: These findings have implications for campus health promotion professionals and athletics program coordinators seeking to address high-risk alcohol use among college athletes.     

The Eating Disorders NOS Diagnostic Profile Among College Women

Abstract

The authors examined a proposed profile of eating-related behaviors, associated features, developmental issues, and help-seeking behavior among college women, using an eating disorder response program. The most common symptom scenario was a pattern of regular binge eating, together with daily exercise and occasional purging. The most common associated features were distressing or dysfunctional overconcern about body image and self-esteem, usually with day-to-day stress and intermittent depression. The women who fit this pattern also presented developmental issues of perfectionism, conflictual relationships with parents, and struggles for independence; and they tended to be ambivalent about seeking services. Implications for practice, including the need to develop a framework for eating disorder responses on campus that includes preventive programs and developmental interventions to target emerging and moderate concerns are discussed; limitations and the preliminary nature of the findings are explicated.     

Transforming the Way We Live Together: A Model to Move Communities From Policy to Implementation

Most cities, counties, and neighborhoods are not designed for an aging population. By providing a range of services to all residents, Lifelong Communities allow individuals to age in place. Although the Lifelong Communities Initiative is based on established guiding principles, little information exists regarding the realities of moving from policy to implementation. The Atlanta Regional Commission conducted a case study in Mableton, Georgia, and found successful implementation requires a combination of support from local citizen groups and government. The Atlanta Regional Commission is replicating these best practices in other communities and providing support to those aspiring to launch or expand Lifelong Communities.     

A Qualitative Analysis of College Women's Leaving Processes in Abusive Relationships

Abstract

Objective: This study assessed the process of leaving an abusive dating relationship utilizing a qualitative design. Methods: Participants included 123 college women in abusive dating relationships who participated at the beginning and end of a 10-week academic quarter. Results: Qualitative content analyses were used to analyze the transcribed responses to an open-ended question about women's leaving processes over the interim period. A variety of categories and themes emerged for women in different stages of the leaving process, consistent with the Transtheoretical Model of Change and Investment Model. Data also underscored women's lack of acknowledgment, minimization, and normalization of abuse. Conclusions: These data demonstrate the importance of dating violence intervention and prevention programming on college campuses and offer information that may be useful to college health providers who assist women in abusive dating relationships.     

A Campus-community Coalition to Control Alcohol-related Problems Off Campus: An Environmental Management Case Study

Abstract

The authors report on the effects of a university and community coalition in preventing problems related to college students' off-campus drinking. The Albany, New York, Committee on University and Community Relations used strategies based on an environmental-management approach that focuses on changing the environment in which individuals make decisions about alcohol consumption and related behaviors. Committee initiatives included improving enforcement of local laws and ordinances, creating a safety-awareness campaign for off-campus students, and developing a comprehensive advertising and beverage-service agreement with local tavern owners. The initiatives were associated with a decline in the number of alcohol-related problems in the community, as indicated by decreases in the number of off-campus noise ordinance reports filed by police and the number of calls to a university-maintained hotline for reporting off-campus problems. An environmental management approach, the authors suggest, has promise as an effective means of preventing alcohol-related problems among college students.     

Engaging Intercollegiate Athletes in Preventing and Intervening in Sexual and Intimate Partner Violence

Abstract

Objective: The object of this exploratory evaluation was to evaluate the “Bringing in the Bystander” sexual and intimate partner violence prevention program with a new sample of intercollegiate athletes. Participants and Methods: Fifty-three male and female athletes participated in the program (experimental group), and 86 were in the control group. All completed pretest, posttest, and 2-month follow-up surveys, including assessment of rape myth acceptance, intent to engage in bystander behaviors, bystander confidence, and bystander behaviors. Results: The program worked overall and for both women and men, improved bystander confidence and intent to engage in bystander behaviors, and did not create significant backlash effects (ie, worsening of attitudes as a result of program). Conclusions: The program fits with the intent of the National Collegiate Athletic Association CHAMPS/Life Skills program regarding its focus on the overall development of student-athletes and demonstrates the promising bystander approach compatible with the 2007 American College Health Association toolkit, Shifting the Paradigm: Primary Prevention of Sexual Violence.     

Binge Drinking Among Undergraduate College Students in the United States: Implications for Other Substance Use

Abstract

The authors examined the relationship between binge drinking and other substance use among US college students, using nationally representative data from the 1995 National College Health Risk Behavior Survey implemented by the Centers for Disease Control and Prevention. Compared with nonbinge drinkers, current binge drinkers were significantly more likely to report “ever” using and current use of cigarettes, marijuana, cocaine, and other illegal drugs. The researchers also found that the more often students binge drank, the more likely they were to have ever used cigarettes, marijuana, cocaine, and other drugs, and the more likely they were to report current use of cigarettes and marijuana. Those who design programs to prevent binge drinking and use of other substances should take into account the reality that many students use more than one substance and that the more frequently students report binge drinking, the more likely they are to be using other substances as well.