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BackgroundCigarette smoking is the strongest risk factor for COPD. Smoking burden is frequently measured in pack-years, but the relative contribution of cigarettes smoked per day versus duration towards the development of structural lung disease, airflow obstruction and functional outcomes is not known.MethodsWe analysed cross-sectional data from a large multicentre cohort (COPDGene) of current and former smokers. Primary outcome was airflow obstruction (FEV1/FVC); secondary outcomes included five additional measures of disease: FEV1, CT emphysema, CT gas trapping, functional capacity (6 min walk distance, 6MWD) and respiratory morbidity (St George’s Respiratory Questionnaire, SGRQ). Generalised linear models were estimated to compare the relative contribution of each smoking variable with the outcomes, after adjustment for age, race, sex, body mass index, CT scanner, centre, age of smoking onset and current smoking status. We also estimated adjusted means of each outcome by categories of pack-years and combined groups of categorised smoking duration and cigarettes/day, and estimated linear trends of adjusted means for each outcome by categorised cigarettes/day, smoking duration and pack-years.Results10 187 subjects were included. For FEV1/FVC, standardised beta coefficient for smoking duration was greater than for cigarettes/day and pack-years (P<0.001). After categorisation, there was a linear increase in adjusted means FEV1/FVC with increase in pack-years (regression coefficient β=−0.023±SE0.003; P=0.003) and duration over all ranges of smoking cigarettes/day (β=−0.041±0.004; P<0.001) but a relatively flat slope for cigarettes/day across all ranges of smoking duration (β=−0.009±0.0.009; P=0.34). Strength of association of duration was similarly greater than pack-years for emphysema, gas trapping, FEV1, 6MWD and SGRQ.ConclusionSmoking duration alone provides stronger risk estimates of COPD than the composite index of pack-years.Trial registration numberPost-results; NCT00608764.

The current study aims to describe the Mediterranean diet (MD) adherence across the US regions, and explore the predictive factors of MD adherence among US adults. Cross-sectional secondary data analysis. MD adherence score (0-9) was calculated using the Block 98 FFQ. Hot spot analysis was conducted to describe the geospatial distribution of MD adherence across the US regions. Logistic regression explored predictors of MD adherence. Nationwide community-dwelling residency in the USA. Adults aged ≥45 years (n 20 897) who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007. The mean of MD adherence score was 4·36 (sd 1·70), and 46·5 % of the sample had high MD adherence (score 5-9). Higher MD adherence clusters were primarily located in the western and northeastern coastal areas of the USA, whereas lower MD adherence clusters were majorly observed in south and east-north-central regions. Being older, black, not a current smoker, having a college degree or above, an annual household income ≥ $US 75K, exercising ≥4 times/week and watching TV/video <4 h/d were each associated with higher odds of high MD adherence. There were significant geospatial and population disparities in MD adherence across the US regions. Future studies are needed to explore the causes of MD adherence disparities and develop effective interventions for MD promotion in the USA.

BackgroundEmerging studies have investigated the contribution of food environment to obesity in the USA. However, the findings were inconsistent. Methodological explanations for the inconsistent findings included: (1) using individual store/restaurant exposure as food environment indicator, and (2) not accounting for non-stationarity assumption. This study aimed to describe the spatial distribution of obesity and examine the association between community food environment and obesity, and the variation of magnitude and direction of this association across the USA.MethodsData from 20 897 adults who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment between January 2003 and October 2007 were eligible in analysis. Hot Spot analysis was used to assess the spatial distribution of obesity. The association between community food environment and obesity and the variation of this association across the USA were examined using global ordinary least squares regression and local geographically weighted regression.ResultsHigher body mass index (BMI) clusters were more likely to locate in socioeconomically disadvantaged, rural, minority neighbourhoods with a smaller population size, while lower BMI clusters were more likely to appear in more affluent, urban neighbourhoods with a higher percentage of non-Hispanic white residences. There was an overall significant, inverse association between community food environment and obesity (β=−0.0210; p<0.0001). Moreover, the magnitude and direction of this association varied significantly across the US regions.ConclusionsThe findings underscored the need for geographically tailored public health interventions and policies to address unique local food environment issues to achieve maximum effects on obesity prevention.

This article reflects on a conceptual model for mapping the work that fits under the broad heading of students as partners in learning and teaching in higher education (Healey, Flint, & Harrington, 2014). We examine the nature and purpose of the model with reference to specific examples, and reflect on the potential and actual uses of the model in the development of practice and policy, focussing particularly on students as co-inquirers in SoTL. The article also provides a framework for the other articles in a special section of \"Teaching & Learning Inquiry\" on students as co-inquirers. [This article contains a student response by Lianne van Dam.]

Objectives. We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. Methods. In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. Results. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. Conclusions. Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.

The editors and contributors to this collection explore what it means to adopt an \"academic literacies\" approach in policy and pedagogy. Transformative practice is illustrated through case studies and critical commentaries from teacher-researchers working in a range of higher education contexts--from undergraduate to postgraduate levels, across disciplines, and spanning geopolitical regions including Australia, Brazil, Canada, Cataluña, Finland, France, Ireland, Portugal, South Africa, the United Kingdom, and the United States.

Crosby et al present a study determining the association between African American adolescent females' condom use and their acquisition of biologically confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis. Sexually active African American adolescent females (aged 14-18) were recruited from multiple venues in low-income neighborhoods of Birmingham AL from Dec 1996 through Apr 1999. The findings suggested that using condoms consistently could result in substantial, but not complete, protection against STD acquisition.

Theories of health behavior posit that change is accomplished by modifying factors deemed as mediators. A set of mediators from several theoretical models used in sexual risk reduction programs was assessed among a sample of 522 African American female adolescents. The goal was to determine whether self-esteem was associated with sexually transmitted disease (STD), pregnancy, and the set of theoretical mediators controlling for covariates. Bivaríate analyses showed no relationship between self-esteem and STD or pregnancy; multivaríate regression analysis revealed a significant relation between self-esteem and the set of mediators. Girls higher in self-esteem were more likely to hold positive condom attitudes, felt more efficacious in negotiating condom use, had more frequent communication with sex partners and parents, perceived fewer barriers to using condoms, and were less fearful of negotiating condom use. Self-esteem should be considered when designing and evaluating sexual risk reduction programs for this population.

During adolescence, girls form self-concepts that facilitate the transition to adulthood. This process may entail engaging in risky sexual behaviors resulting in STD infection and pregnancy. This study assessed the relation between self-concept and unwanted, unprotected sex refusal among 335 African American adolescent girls. The second aim was to determine whether attributes of partner communication about sex would act as a mediating mechanism on this hypothesized relationship. These assessments were made within the context of several theoretical models (social cognitive theory and theory of gender and power). Self-concept was composed of self-esteem, ethnic identity, and body image, whereas attributes of partner communication about sex was conceptualized as frequency of communication, fear of condom use negotiation, and self-efficacy of condom use negotiation. Structural equation modeling was used to analyze data. The results showed that self-concept was associated with partner communication attributes about sex, which in turn, was associated with frequency of unprotected sex refusal. The hypothesized mediating role of partner communication was also supported. STD-HIV preventive interventions for this population may be more effective if they target self-concept as opposed to only self-esteem, incorporate an Afrocentric approach, and focus on enhancing several attributes of partner communication about sex.