Thomas, Janet

Tobacco cessation interventions developed for Alaska Native adolescents do not exist. This study employed focus group methodology to explore preferences for tobacco cessation interventions and barriers to participation among 49 Alaska Natives (61% female) with a mean age of 14.6 ( SD = 1.6) who resided in western Alaska. Using content analysis, themes from the 12 focus groups were found to be consistent across village, gender, and age groups. Program location or site (e.g., away from the village, hunting, fishing), a group-based format, and inclusion of medication and personal stories were reported to be important attributes of cessation programs. Motivators to quit tobacco were the perceived adverse health effects of tobacco, improved self-image and appearance, and the potential to be a future role model as a non—tobacco user for family and friends. Parents were perceived as potentially supportive to the adolescent in quitting tobacco. The findings will be used to develop tobacco cessation programs for Alaska Native youth.

OBJECTIVE—To determine whether type 2 diabetes contributes to the presence of depressive and anxiety disorder diagnoses in low-income adults with hypertension, asthma, and/or arthritis. RESEARCH DESIGN AND METHODS—Using a cross-sectional design, this study administered a structured diagnostic interview to low-income primary care patients diagnosed with type 2 diabetes, hypertension, arthritis, and asthma, as well as to those with no chronic illness (n = 326), to determine the 12-month prevalence of depressive and anxiety disorders. A logistic regression (LR) model was used to assess whether a diagnosis of depression and/or anxiety was associated with type 2 diabetes after adjusting for known risk factors. RESULTS—A high prevalence rate of depressive and/or anxiety disorders was found in the total sample (29%) and in all three illness groups: type 2 diabetes (36%), other chronic illnesses (24%), and no chronic illness (31%). Using LR, a main effect was detected for illness group when age and education were controlled (χ2 = 22.66, df 4, P = 0.000). Specifically, the odds of occurrence of a depressive and/or anxiety disorder in those with comorbid type 2 diabetes were twice that in the nondiabetic, chronically ill comparison group (odds ratio 2.26, 95% CI 1.28–4.01, P = 0.005). CONCLUSIONS—These results suggest a positive contribution of type 2 diabetes to increased rates of depressive and/or anxiety disorders in patients with hypertension, asthma, and/or arthritis and support prior research that type 2 diabetes may serve as an indicator of depression and anxiety in low-income adults treated in primary care clinics.

Given the high rates of major depressive disorder in primary care settings, routine use of screening measures to assist in identifying depressed individuals is warranted. The Center for Epidemiologic Studies Depression Scale (CES-D) ( Radloff, 1977 ) is a self-rated measure of distress commonly used to screen for depression in primary care settings. The present study was undertaken to confirm the original four-factor model in a sample of low-income women attending primary care clinics (N = 179). Although the original four-factor structure has been replicated in a variety of population groups, internal validity of the measure has not been previously examined in this population sample. A series of confirmatory factor analytic procedures failed to replicate the original four-factor structure or a second-order model. An exploratory analysis, using principal components and a VARIMAX rotation yielded three factors: Depressed Affect/Somatic Symptoms, Positive Affect, and Interpersonal Difficulties. Results of this study add support to previous research documenting an increased somatic presentation of depression in low-income samples. Implications for the use of the CES-D as a screening tool to identify depression in similar primary care samples are discussed.