Clinical Psychology

Videotaped presentations, peer modeling, discussion
groups, role-playing, monitoring smoking, and
checking repeatedly on attitudes and knowledge
about smoking were all used with elementary
schoolchildren. Such an approach seems superior to
those used with adolescents that focus on long-term
negative effects from smoking. The trick seems to be
to focus on immediate negative consequences (e.g.,
from peers) rather than delayed ones (e.g., emphy-
sema). More recent programs have supplemented
these components with modules aimed at analyzing
what leads children and adolescents to start smoking
as well as training in refusal skills for dealing with
pressure to smoke (La Torre et al., 2005).

Alcohol Abuse and Dependence

It is estimated that about 70–74% of adolescents
have tried alcohol before high school graduation;

over 40% of high-school-aged adolescents drink

alcohol within a 1-month period, and 61% of

adult men and 43% of adult women in the United

States consume alcoholic beverages regularly (Pleis

et al., 2010). Highest rates of regular alcohol con-

sumption among adults are among those with a

bachelor’s degree or higher (64%), those with a

family income of $100,000.00 or more (67%), and

White males (66%). Although some studies have

suggested positive health benefits from alcohol for

light or moderate drinkers, consumption of alcohol

has also been associated with a number of negative

outcomes. Heavy alcohol use has been associated

with increased risk for liver or neurological damage,

certain forms of cancer, cardiovascular problems,

fetal alcohol syndrome, physical aggression, suicide,

motor vehicle accidents, and violence (Brannon &

Feist, 2010). This extensive list of alcohol-related

problems has made the treatment and prevention

BOX17-3 Focus on Professional Issues: Ethnicity and Cancer Outcomes

An examination of the incidence and mortality rates

ofcommonformsofcanceramongdifferentethnic

groups reveals a number ofstriking differences

(Meyerowitz, Richardson, Hudson, & Leedham, 1998).

In general, African Americans have the highest inci-

dence rates and mortality rates overall, whereas

Latinos, Chinese Americans, and Native Americans

have the lowest rates. However, incidence and mor-

tality rates also vary according to gender and to

anatomical site of the cancer. Thus, it is difficult to

reach any general conclusions that focus on broad

ethnic labels.

One particular form of cancer in women, breast

cancer, provides an interesting paradox. On the one

hand, African American women have a lower breast

cancer incidence rate than do White American women.

However, African American women have a significantly

higher breast cancer mortality rate than do White

American women. There are many potential explana-

tions, including a higher overall mortality rate for

African American women, the influence of relative

socioeconomic disadvantage for this group, barriers to

treatment, and biological susceptibility to breast cancer

at earlier ages versus later ages.

In order to address whether socioeconomic disad-

vantage and inadequate health care access might

explain this disparity in breast cancer mortality for

African American women, Newman et al. (2006) con-

ducted a meta-analysis of studies that provided breast

cancer mortality data and data on socioeconomic fac-

tors for over 14,000 African American women as well

as over 76,000 White American women. In this way,

mortality rates could be compared between the two

groups while controlling for differences in socioeco-

nomic factors. There were several major findings of

note. First, similar to previous studies, Newman et al.

found that African American women were significantly

more likely to die from breast cancer than were White

American women. Second, this overall effect remained

significant even after controlling for socioeconomic

factors. These results are intriguing in that they sug-

gest that socioeconomic disparities alone are not likely

responsible for the increased mortality risk for African

American women with breast cancer. Although more

research is clearly needed to investigate environmental

and cultural influences on mortality rates, these results

also highlight the need for more research into breast

tumor biology as a risk factor.

500 CHAPTER 17