The Detroit Youth Tobacco Survey: Results from Middle School Students

Background: The Detroit Youth Tobacco Survey (DYTS) provided representative data from middle school students, 84.7% of whom were African-American/Black, on self-reported prevalence of tobacco use and awareness, smoking cessation, peer and family influence, environmental tobacco smoke, media exposure and access to tobacco. Results: Over half of the students (53.0%; +/-4.1) used some form of tobacco at least once, with the majority trying cigarettes (47.5%; +/-3.9) and about a quarter (23.1%; +/-3.5) trying cigars. Ten percent (10.2%; +/-2.3) tried bidis or kreteks, and 7.4% (+/-1.4) tried smokeless tobacco. Of middle school students who smoked, nearly one out of four (23.2%; +/-3.1) had their first cigarette before age eleven. Smokers were more likely to have parents who smoked. The majority of middle school students who smoked would like to quit. A third had practiced ways to say “no” to tobacco at school and a quarter had participated in a community event discouraging them from using tobacco. Conclusion: Additional consideration should be given to innovative strategies for middle school students for smoking prevention, reduction of tobacco use and minimizing exposure to environmental tobacco smoke

Using Motivational Interviewing in Public Health Practice to Prevent Fetal Alcohol Syndrome

Background: Surveys of women in prenatal care at busy clinics in Detroit, Michigan have reported 12.5% continue to drink during pregnancy (Flynn et al, 2003) and women in substance abuse treatment programs in Wayne County, MI have an incidence rate for Fetal Alcohol Syndrome (FAS) of 4 in 1,000 births, double the national prevalence rate of FAS. The goal of the current study was to intervene with women at high risk for an alcohol-exposed pregnancy using techniques of Brief Motivational Interviewing (BMI) in a verbal and written format. Methods: One third (33%) of 1,784 women screened at Detroit Department of Health and Wellness Promotion (DHWP) primary health care clinics and HIV/AIDS-STD clinic were found to be at risk of an alcohol exposed pregnancy defined as binge drinking (at least 4 drinks per occasion) or heavy drinking (8 or more drinks per week) in the last three months, while they were having sex with inconsistent or no contraception. This intervention utilized Brief Motivational Interviewing (BMI) and developed written materials based on the principles of BMI to 1) assess readiness for change, 2) strengthen motivation to change, and 3) provide an individualized change plan. For women who received the Individual Level Intervention (n = 77), four sessions of BMI were conducted (two in-person, two via telephone) over a six-month period. A Self-Guided Change version of the intervention (Community Level Intervention) was offered for women (n = 327) who preferred to utilize the materials at home and receive two follow-up telephone calls following baseline interview, also during a six-month period. Results: Both strategies, based on principles of Motivational Interviewing, have been shown to be effective in reducing drinking and increasing contraceptive use. Out of the 404 women participating in the program, 310 (77%) women completed at least one follow-up and were included in the analyses. Overall, 59.9% of the women enrolled in both interventions were no longer at risk for an alcohol-exposed pregnancy at the end of the intervention six months later. Conclusion: Brief Motivational Interviewing, delivered verbally or in a written format, is an effective method of reducing women’s risky behaviors for an alcohol exposed pregnancy. The Individual Level Intervention that included 2 face-to-face sessions resulted in less attrition than the Self-Guided Change version which relied on phone and mail contact only

Healthy Eating and Exercising to Reduce Diabetes: Exploring the Potential of Social Determinants of Health Frameworks Within the Context of Community-Based Participatory Diabetes Prevention

Objectives. We examined a community-based participatory diabetes intervention to identify facilitators of and barriers to sustained community efforts to address social factors that contribute to health. Methods. We conducted a case study description and analysis of the Healthy Eating and Exercising to Reduce Diabetes project in the theoretical context of a conceptual model of social determinants of health. Results. We identified several barriers to and facilitators of analysis of social determinants of a community-identified disease priority (in this case, diabetes). Barriers included prevailing conceptual models, which emphasize health behavioral and biomedical paradigms that exclude social determinants of health. Facilitating factors included (1) opportunities to link individual health concerns to social contexts and (2) availability of support from diverse partners with a range of complementary resources. Conclusions. Partnerships that offer community members tangible resources with which to manage existing health concerns and that integrate an analysis of social determinants of health can facilitate sustained engagement of community members and health professionals in multilevel efforts to address health disparities