Cigarette smoking is a behavior which is most often developed during adolescence. The association between smoking onset and nicotine addiction has not been clearly established among ethic minorities. To better understand this relationship, this study used a qualitative approach to investigate relevant beliefs and norms associated with cigarette smoking initiation and development of nicotine addiction among 52 high school students who identified themselves as current smokers. In general, it was found that both boys and girls believed nicotine addiction starts during an individual's initial cigarette smoking event. The majority of both groups reported that their second smoking event was initiated during the same or next day after their first event. In addition, this research confirmed that friends and siblings who use tobacco are strong reinforcers in youth smoking initiation.

Recent drug-use monitoring among Houston adolescents has detected a concoction of cigarettes or marijuana sticks laced with embalming fluid and PCP ("fry"). To shed light on this mixture, the current pilot study used a qualitative approach to investigate relevant beliefs and norms associated with fry initiation and perceived addiction among 38 youth who were attending outpatient and inpatient drug-user treatment programs in the spring of 2003. Respondents perceived that addiction to fry could occur as early as initial consumption, and the majority of participants indicated that their second fry event occurred either the same day as their initial use or the next day. In addition, fry use was perceived to have extremely dangerous consequences. Youth stated that users have impaired motor skills, hallucinations, long-term mental health problems, incoherent behavior, paranoia, and aggressive behaviors. Implications for these results are discussed.

OBJECTIVE:Baseline data from the Heart Attack REACT Study provided the opportunity to explore population subgroup differences in exposure to health information in an ethnically diverse sample from 5 regions across the United States.METHODS:During the 4-month baseline period of the REACT study, some 1,200 residents from the 20 study communities were surveyed using random digit dial telephone methods. Respondents were asked to recall health messages seen and/or heard recently, and the sources of these messages. Comparisons were made between sociodemographic subgroups defined by age, sex, race/ethnicity, education, income, work status, and geographic location.RESULTS:Except for education level differences, the amount of exposure to health information did not vary significantly by sociodemographics; however, significant variation among subgroups in the types of messages cited and the sources of these messages was observed. Minority and low-income groups were found to have less exposure to chronic disease prevention information, eg, on nutrition, exercise, and heart disease. Additionally, the sources of health information most popular among sociodemographic subgroups appeared to be a determining factor in the types of messages received.CONCLUSIONS:The results of these analyses support previous findings, adding to the sparse body of information on the best channels for reaching under-served populations.

BACKGROUND Patient delay in seeking health care for heart attack symptoms is a continuuing problem in the United States. METHODS Investigators conducted focus groups (N = 34; 207 participants) in major U.S. regions (NE, NW, SE, SW, MW) as formative evaluation to develop a multi-center randomized community trial (the REACT Project). Target groups included adults with previous heart attacks, those at higher risk for heart attack, and bystanders to heart attacks. There were also subgroups reflecting gender and ethnicity (African-American, Hispanic-American, White). FINDINGS Patients, bystanders, and those at higher risk expected heart attack symptoms to present as often portrayed in the movies, that is, as sharp, crushing chest pain rather than the more common onset of initially ambiguous but gradually increasing discomfort. Patients and those at higher risk also unrealistically judge their personal risk as low, understand little about the benefits of rapid action, are generally unaware of the benefits of using EMS/9-1-1 over alternative transport, and appear to need the "permission" of health care providers or family to act. Moreover, participants reported rarely discussing heart attack symptoms and appropriate responses in advance with health care providers, spouses, or family members. Women often described heart attack as a "male problem," an important aspect of their underestimation of personal risk. African-American participants were more likely to describe negative feelings about EMS/9-1-1, particularly whether they would be transported to their hospital of choice. CONCLUSIONS Interventions to reduce patient delay need to address expectations about heart attack symptoms, educate about benefits and appropriate actions, and provide legitimacy for taking specific health care-seeking actions. In addition, strategy development must emphasize the role of health care providers in legitimizing the need and importance of taking rapid action in the first place.

Introduction: A national abstention-based pregnancy prevention program was tested among high school inner city youth. Since 1980, the Alpha Phi Alpha Fraternity Inc has implemented the Project Alpha, a national fraternity program, to teach males about sexual responsibility. This paper reports on the evaluation of a new subcomponent of Project Alpha.Methods: The study population consisted of 200 males attending high school in Houston, Texas. The study used a quasiexperimental pretest-posttest untreated reference group design. Measured constructs included knowledge, self-efficacy, perceived risk, beliefs, social norms and sexual intentions.Intervention: Based on the pantheoretical model,ten 50-minute sessions featuring role model stories were distributed and discussed to intervention students. These stories were facilitated by college and graduate students and featured stories of community members and professional athletes who support teenage abstention from sex.Results: The inclusive approach of using community role models to promote behavioural change was found to make a positive impact. Significant effects were observed on student knowledge, self-efficacy, perceived social norms and beliefs.

Personal risk perceptions of acute myocardial infarction (AMI) affect people's preventive health behaviors as well as their beliefs during a heart attack episode. The authors investigated factors that are associated with personal risk perceptions of having an AMI. A random-digit-dial survey was conducted among 1294 respondents, aged 18 years or older, in 20 communities across the nation as part of the Rapid Early Action for Coronary Treatment (REACT) trial. Results of two mixed-model linear regression analyses suggested that worse perceived general health, more risk factors, and greater knowledge were associated with greater perception of AMI risk. The results also showed that women who answered, incorrectly, that heart disease is not the most common cause of death for women in the United States reported significantly lower risk perceptions than women who answered this question correctly. The findings in this study suggest that interventions need to target specific misconceptions regarding AMI risk.

BACKGROUND There are few data on possible age and sex differences in presentation of symptoms for patients with acute coronary disease. OBJECTIVE To investigate demographic differences in presentation of symptoms at the time of hospital presentation for acute myocardial infarction (AMI) and unstable angina. METHODS The medical records of patients who presented with chest pain and who also had diagnoses of AMI (n = 889) or unstable angina (n = 893) on discharge from 43 hospitals were reviewed as part of data collection activities of the Rapid Early Action for Coronary Treatment trial based in 10 pair-matched communities throughout the USA. RESULTS Dyspnea (49%), arm pain (46%), sweating (35%), and nausea (33%) were commonly reported by men and women of all ages in addition to the presenting complaint of chest pain. After we had controlled for various characteristics through regression modeling, older persons with AMI were significantly less likely than were younger persons to complain of arm pain and sweating, and men were significantly less likely to report vomiting than were women. Among persons with unstable angina, arm pain and sweating were reported significantly less often by elderly patients. Nausea and back, neck, and jaw pain were more common complaints of women. CONCLUSIONS Results of this study suggest that there are differences between symptoms at presentation of men and women, and those in various age groups, hospitalized with acute coronary disease. Clinicians should be aware of these differences when diagnosing and managing patients suspected to have coronary heart disease.

Coronary heart disease (CHD) remains the leading cause of mortality in the U.S. Innovations in reperfusion therapies can potentially reduce CHD morbidity and mortality associated with acute myocardial infarction (AMI) when treatment is initiated within the first few hours of symptom onset. However, delay in seeking treatment for AMI is unacceptably lengthy, resulting in most patients being ineligible for reperfusion therapies. The Rapid Early Action for Coronary Treatment (REACT) Trial is a four-year, 20-community, randomized trial to design and test the effectiveness of a multi-component intervention to reduce patient delay for hospital care-seeking for AMI symptoms. This manuscript describes the development and content of the theoretically-based REACT intervention and summarizes: (1) the research literature used to inform the intervention; (2) the behavioral theories used to guide the development, implementation, and evaluation of the intervention; (3) the formative research undertaken to understand better decision-making processes as well as barriers and facilitators to seeking medical care as perceived by AMI patients, their families, and medical professionals; (4) the intervention design issues that were addressed; (5) the synthesis of data sources in developing the core message content; (6) the conceptualization for determining the intervention target audiences and associated intervention components and strategies, their integration with guiding theoretical approaches and implementation theories for the study, and a description of major intervention materials developed to implement the intervention; and (7) the focus of the outcome, impact, and process measurement based on the intervention components and theories on which they were developed.

To inform intervention development in a multisite randomized community trial, the Rapid Early Action for Coronary Treatment (REACT) project formative research was undertaken for the purpose of investigating the knowledge, beliefs, perceptions, and usual practice of health care professionals. A total of 24 key informant interviews of cardiologists and emergency physicians and 15 focus groups (91 participants) were conducted in five major geographic regions: Northeast, Northwest, Southeast, Southwest, and Midwest. Transcript analyses revealed that clinicians are somewhat unaware of the empirical evidence related to the problem of patient delay, are concerned about the practice constraints they face, and would benefit from concrete suggestions about how to improve patient education and encourage fast action. Findings provide guidance for selection of educational strategies and messages for health providers as well as patients and the public.