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The purpose of this study was to examine the relationship between Health Action Process Approach (HAPA) postintentional constructs (maintenance self-efficacy, recovery self-efficacy, action planning, coping planning) and medication adherence among phase II cardiac rehabilitation (CR) patients. Purposive sampling was used to recruit 91 phase II CR patients age 50 years and over. All respondents completed paper and pencil questionnaire examining HAPA postintentional constructs (action planning, coping planning, maintenance self-efficacy, recovery self-efficacy), medication adherence, and demographic characteristics. Validity and reliability were confirmed for all scales included in the questionnaire. Descriptive statistics were used to describe respondents’ characteristics. Bivariate statistics (correlation, Mann-Whitney U-test, Kruskal Wallis test) were used to examine associations between medication adherence and each HAPA postintention construct as well as medication adherence and respondent demographic characteristics. Better medication adherence was associated with greater maintenance self-efficacy (r = −.290, p = .006) and better action planning skills (r = −.233,p = .027) and coping planning skills (r = −.277,p = .008) as indicated by higher scores on the maintenance self-efficacy, action planning, and coping planning scales. There was no significant linear relationship between medication adherence and recovery self-efficacy (r = −.103,p = .335) or medication adherence and any of the respondents’ demographic characteristics (p > .05). Only maintenance self-efficacy remained significant in a multivariate model predicting medication adherence. Greater maintenance self-efficacy was associated with increased medication adherence; health professionals working in CR settings might consider opportunities to enhance maintenance self-efficacy for medication adherence. Additional research is needed to identify strategies for promoting maintenance self-efficacy for medication adherence. [ABSTRACT FROM AUTHOR]

Medical specialty camps can play an important role in the positive development of psychosocial outcomes for children and youth with sickle cell disease (SCD). This study examined how sense of mastery and attitude towards illness outcomes changed over 6 months for 100 campers aged 8–16 years with SCD. The outcomes were measured twice before and twice after camp. Latent growth curve modeling was used to analyze data. Results showed no changes in the outcomes for this study population. Implications for future research designs, populations, and outcomes are discussed, as are implications for communications about camp, and policy and practice. [ABSTRACT FROM AUTHOR]

Purpose: Assessment of distress and well-being of patients with cancer is not always documented or addressed in a clinical visit, reflecting a need for improved psychosocial screening. Methods: A multidisciplinary team completed process mapping for emotional distress assessment in two clinics. Barriers were identified through cause-and-effect analysis, and an intervention was chosen. Patient-reported outcomes were collected over 6 months using the validated National Comprehensive Cancer Network Emotional Distress Thermometer (EDT) paper tool. The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) measures were compared before and after intervention. Results: During 6 months, a total of 864 tools were collected from 1,344 patients in two ambulatory clinics (64%). Electronic medical record documentation of distress increased from 19.2% to 34% during the 6 months before and after intervention. QOPI measures showed an increase in emotional well-being documentation. Of 29 new and 835 return patients, 62% indicated mild distress (EDT, 0 to 3), 18% moderate (EDT, 4 to 6), and 11 % severe (EDT, 7 to 10). The average distress score of new patients was significantly higher than that of return patients (5.39 [n = 26] v 2.52 [n = 754]; P < .001). The top problems for patients with moderate and severe distress were worry, fatigue, pain, and nervousness; depression and sadness were particularly noted in patients reporting severe distress. Eleven percent of patients were referred to the social worker on site. Conclusion: A pilot intervention collecting Patient-reported outcomes in two ambulatory clinics led to increase in psychosocial distress screening followed by sustained improvement, indicated by both process and QOPI measures. [ABSTRACT FROM AUTHOR]

Data that inform preexposure prophylaxis (PrEP) implementation for women involved in criminal justice (WICJ) systems are scarce. In a survey of PrEP attitudes, acceptability, and barriers across the criminal justice system, incarcerated women (n = 48) were more likely than WICJ on probation (n = 125) to be eligible for PrEP (29% vs. 15%; p = .04) and willing to take PrEP if offered (94% vs. 78%; p = .01). In multivariate models, PrEP eligibility directly correlated with being incarcerated (adjusted odds ratio [aOR] 4.81, 95% confidence interval [CI] 1.76-13.1) and inversely correlated with Hispanic/Latina ethnicity (aOR 0.31; 95% CI 0.10-0.96). Recent partner violence exposure was associated with PrEP eligibility (aOR 3.29; 95% CI 1.54-7.02) and discordant risk perception (aOR 2.36; 95% CI 1.18-4.70). Findings demonstrate high potential for PrEP for all WICJ, though implementation efforts will need to address partner violence. [ABSTRACT FROM AUTHOR]

Asthma is a leading cause of chronic illness among school-aged children and adolescents. Current trends have led to school faculty and staff becoming increasingly responsible for managing student asthma, often without optimal training or resources. The purpose of this project was to establish whether facilitated access to personalized student asthma action plans (AAPs), education, proper use, and school nurse support improved reported self-efficacy regarding student asthma exacerbation prevention and management in elementary and preschool faculty and staff. Thirty-five participants from an urban, underserved Connecticut school were surveyed to determine perceived self-efficacy regarding student asthma exacerbation prevention and management. AAPs were then placed with students' asthma inhalers, and all participants were instructed on their use. Three months later, participants were resurveyed. A statistically significant difference after both the initial education and 3-month survey was identified. Providing elementary and preschool faculty and staff with facilitated access to student action plans and education on their use can improve perceived self-efficacy regarding student asthma exacerbation prevention and management. [ABSTRACT FROM AUTHOR]

The current study investigates the relationship between intimate partner violence (IPV), childhood trauma, trait anxiety, depression, and anxious attachment in college students. Ninety-three male and 161 female undergraduate students at Fairfield University, ranging in age from 17 to 23, with a mean age of 18.8 years, participated. Participants completed five self-report inventories: The Conflict in Adolescent Dating Relationships Inventory (CADRI), the Childhood Trauma Questionnaire (CTQ), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), and the Adult Attachment Scale (AAS). IPV perpetration in college dating relationships was related to childhood emotional and physical abuse, emotional and physical neglect, and trait anxiety. IPV victimization in college dating relationships was related to childhood emotional and physical abuse, childhood emotional and physical neglect, and an anxious attachment style. IPV perpetration and victimization were also significantly correlated with one another. Subscale analyses suggest that childhood emotional abuse was related to being both the perpetrator and victim of verbal or emotional abuse in dating relationships. Childhood physical abuse, physical neglect, and emotional abuse were related to both perpetration and victimization of physical IPV. Threatening behavior perpetration in dating relationships was related to childhood emotional abuse, emotional neglect, physical abuse, and physical neglect; however, being the victim of threatening behavior was only related to childhood emotional abuse, physical neglect, and emotional neglect, not childhood physical abuse. These results support the relationship between childhood trauma and dating violence in college students. They also support a role for anxiety in IPV, although trait anxiety was related to perpetration and an anxious attachment style was correlated with IPV victimization. In addition, they suggest that different experiences of childhood trauma may relate to different aspects of IPV in college dating relationships. [ABSTRACT FROM AUTHOR]

Graduate school environments are recognized for contributing to elevated stress levels among student populations. Purpose: The objective was to test whether a behavioral intervention, delivered through an online course on behavior change, is effective in preventing declining mental health. Methods: Data were collected via a quasi-experimental longitudinal study to observe the effect of self-directed behavioral interventions on mental health. Participants included students enrolled in a course on Health Behavior Change at the Yale School of Public Health (n = 45) and a control group (n = 33) of students in the same graduate program. Analyses were conducted to evaluate differences at post-intervention and at a 12-week follow-up assessment in indicators of mental and general health. Results: Enrolled students reported significantly improved mental health outcomes as compared to the control students. At follow-up, multiple differences persisted, with participants who had completed the course reporting sustained improvements in general and mental health. Discussion: Self-directed behavior change interventions are effective in promoting mental and physical health among graduate student populations. Translation to Health Education Practice: This curriculum-based intervention can support student wellbeing in a variety of academic programs. [ABSTRACT FROM AUTHOR]

Limited research evaluates substance use prevention and intervention strategies for cultural sensitivity, appropriateness of content, patient/provider interactions, and implementation for racial and ethnic minority populations. This study uses the Consolidated Framework for Implementation Research (CFIR) to examine a community-based evaluation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for implementation among the Black community in a small, urban setting. Data were gathered through four separate focus groups, one for service providers (n = 7), one for community youth leaders (n = 8), and two for community members (n = 10). Findings suggest that a range of multi-level service needs and underlying mechanisms of implementation should be considered when administering SBIRT within community health settings serving Black populations. This community-involved evaluation of SBIRT responds to the call for the examination of implementation in specific settings, and suggests a need for further examinations of strategies that support engagement through SBIRT and other innovations. [ABSTRACT FROM AUTHOR]

Objective To provide preliminary descriptive data on caregiver and child weight status, parenting styles, feeding styles, and feeding practices of a small American Indian sample. Methods Participants included a subsample of American Indian caregivers ( n = 23) identified from a larger study that was conducted in five states. Using previously validated instruments, means, standard deviations, and ranges for general parenting styles, feeding styles, and feeding practices were explored. Results In general, most caregivers reported healthy feeding practices. Most caregivers scored higher on responsive compared to restrictive or permissive in general parenting. Of the sample, 12 caregivers (52.2 %) were classified in the indulgent feeding style category, 5 caregivers (21.7 %) were classified as authoritative, 5 (21.7 %) uninvolved, and 1 (4.3 %) authoritarian. Conclusions More investigations are needed to explore questions raised by this study about using common tools that measure childhood obesity with American Indian families. [ABSTRACT FROM AUTHOR]

Objectives: To assess longitudinal changes in occupational effort-reward imbalance (ERI) and demand-control (DC) scores across pregnancy and examine associations with blood pressure (BP) during pregnancy. Methods: A pilot repeated-measures survey was administered four times to a sample of working women across pregnancy using the ERI and DC instruments. Demographic data and blood pressure measurements were collected at each interval. Growth mixture modeling was used to examine trajectories of change in occupational characteristics. Associations with BP were examined using repeated-measures linear regression models. Results: ERI model components (effort, reward, and overcommitment) all declined across pregnancy while job control remained stable. Increasing ERI trajectory was associated with higher systolic BP (b = 8.8; p < 0.001) as was high overcommitment; declining ERI also showed a lesser association with higher BP. Associations between DC trajectories and BP were much smaller, and non-significant once controlled for overcommitment. Conclusions: Self-assessed efforts, rewards, and overcommitment at work decline across pregnancy in our participants, while job control remains stable. Replication in a more diverse pregnant working population is warranted to confirm these results. These preliminary data suggest that further investigation into the factors that may be linked with improved work psychosocial climate during pregnancy may be useful in order to improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

A father's perception of his role or, how his partner views his role, at mealtimes influences his feeding practices is currently unknown. Therefore, the aim of this study was to evaluate the influence of father-reported maternal and paternal perceptions of the role of the father on child feeding practices, as well as child body weight. Biological fathers of varied racial, ethnic, education, and income backgrounds (n = 150) of preschool age children from a Northeastern state in the United States were interviewed one-on-one using the Role of the Father Questionnaire to assess a father's perception of his role and of his partner's perception of his role in mealtimes and The Child Feeding Questionnaire to assess paternal feeding practices. Height and weight for each father and child were measured. Linear regression was used to examine the relationship between the role of the father, paternal feeding practices and child BMI z-score. Overall, the findings revealed that only the father's perception of his role at mealtimes was associated with higher perceived responsibility for child feeding (β = .033, p = 0.020), and lower use of controlling feeding practices, including pressure to eat (β = −.048, p = 0.029) and restriction (β = −.030, p = 0.05) and was not moderated by the father's appraisal of his partner's perception of his role at mealtimes. Thus, a father's beliefs regarding his role at mealtimes, and not his views of the mother's perception, may be related to his own feeding practices. [ABSTRACT FROM AUTHOR]

We conducted an exploratory research study looking at fathering interactions as they relate to the wraparound care given by the Partnership for Kids or PARK Project, a school-based system of care in Bridgeport, Connecticut. The questions posed by our research focused on how fathers' positive interaction measured by their levels of engagement and accessibility can moderate the effect of the school-based system of care intervention on the mental health outcomes of children with serious emotional disturbances. We found that, although not statistically significant, children's access to their father did have a moderating effect on CBCL scores for internalizing behaviors and total problems. There was very small change in CBCL scores for externalizing behaviors. Further, the moderating effect of father accessibility and father engagement had a lasting effect as a moderator through 12 months into the intervention, especially with regard to internalizing behavior scores. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to determine the perceptions of end-of-life care practices and experience with infants who have died in the NICU among neonatologists, advanced practitioners, nurses, and parents, and also to determine perceived areas for improvement and the perceived value of a palliative care team. Study Design This descriptive, exploratory cross-sectional study using surveys consisting of 7-point Likert scales and free response comments was sent to all neonatologists (n = 14), advanced practitioners (n = 40), and nurses (n = 184) at Connecticut Children's Medical Center's neonatal intensive care units (NICUs) in April 2013 and to all parents whose infants died in these NICUs from July 1, 2011, to December 31, 2012 (n = 28). Results The response rates were 64.3% for physicians; 50.0% for practitioners; 40.8% for nurses; and 30.4% for parents. Most providers reported they feel comfortable delivering end-of-life care. Bereavement support, debriefing/closure conferences, and education did not occur routinely. Families stressed the importance of memory making and bereavement/follow-up. Consistent themes of free responses includemodalities for improving end-of-life care, inconsistency of care delivery among providers, and the importance of memory making and follow-up. Conclusion End-of-life experiences in the NICU were perceived as variable and end-oflife practices were, at times, perceived as inconsistent among providers. There are areas for improvement, and participants reported that a formalized palliative care teamcould help. Families desire memory making, follow-up, and bereavement support. [ABSTRACT FROM AUTHOR]

To determine if receiving a prescheduled appointment is associated with an increased likelihood of complying with follow-up eye care among individuals identified as at risk for glaucoma during community-based glaucoma screening in an urban underserved population. This study sampled 362 individuals aged ≥30 years without known glaucoma from low-income, predominantly black/Hispanic neighborhoods in New Haven, Connecticut presenting to one of twelve community-based glaucoma screening events from May 2010 to October 2012. A quasi-experimental design systematically assigned 63 individuals identified as at risk for glaucoma into either intervention or control group with a 1:2 ratio. Individuals in the control group ( n = 41) received counseling on glaucoma and a recommendation for obtaining a follow-up appointment at the eye department of a local community health center, which offers affordable health services with income-adjusted fee discounts to uninsured, low-income patients. Those in the intervention group ( n = 22) received the same counseling and a prescheduled appointment at the community health center. The overall rate of follow-up compliance within 3 months of screening was 30 % (41 % in the intervention group; 24 % in the control group). Multivariate logistic regression analysis adjusting for sex, age, ethnicity, health insurance status, car access, living situation, and smoking status found that follow-up compliance was significantly associated with intervention (adjusted odds ratio 4.8; 95 % confidence interval 1.1-20.9). Providing prescheduled appointments can improve follow-up compliance after community-based glaucoma screening. This finding may be potentially applicable to community-based health screening for other preventable diseases. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) victimization and perpetration and power imbalances in parenting partners may result in poor outcomes for parents and children. Previous work in this area has focused on the maternal experiences, neglecting to examine paternal effects. The present study aimed to elucidate the role of IPV, power, and equity in parenting and child outcomes in an urban sample of adolescent parents. 159 male and 182 female parents in a relationship were recruited through university-affiliated hospitals. Power, equity, and IPV were measured at 6 months post-partum and were used as predictors for parenting and child outcomes 12 months post-partum using general estimating equations. Gender interactions and mediation effects of depression were also assessed. Higher perceived relationship equity was related to better infant temperament (B = 0.052, SE = 0.023, p = 0.02) whereas higher partner power was related to poorer social development (B = −0.201, SE = 0.088, p = 0.02) and fine motor development (B = −0.195, SE = 0.078, p = 0.01). IPV victimization was associated with poor infant temperament (B = −2.925, SE = 1.083, p = 0.007) and lower parenting competence (B = −3.508, SE = 1.142, p = 0.002). Depression mediated the relationship between IPV and parenting and IPV and infant temperament. No gender effects were found. IPV, inequities, and power imbalances were disadvantageous for parenting and child outcomes. Our results suggest that these dynamics may negatively affect both males and females. Interventions to reduce violence in both partners and promote equity in relationships could benefit couples and their children. [ABSTRACT FROM AUTHOR]

Little research has been conducted on the prevalence of physical health problems in Cambodian refugees and the relationship between their mental and physical health. We identified the relationship between mental and physical health problems and barriers to healthcare access in Cambodian refugee adults. We used a cross-sectional survey design with a snowball sample of 136 Cambodian refugee adult residents of Connecticut and Western Massachusetts. 61 % reported being diagnosed with three or more physical conditions and 73 % with depression, posttraumatic stress disorder (PTSD) or both. Language and transportation problems were the primary barriers to accessing care. Participants with probable comorbid PTSD and depression had 1.850 times more physical health problems than those without either condition ( p > .001; CI 1.334-2.566). Age moderated this relationship. Participants who had been diagnosed with both depression and PTSD reported a consistent number of health conditions across the age span while those who had no mental health conditions or only one of the two reported fewer health conditions when they were younger and more when they were older. These two groups were significantly different from the group reporting both. There is a significant relationship between chronic comorbid mental and physical health diseases affecting Cambodian refugees resettled in the US Having comorbid depression and PTSD puts Cambodian refugees at risk for physical health problems no matter their age. It is vital that those treating Cambodian genocide survivors identify and treat their prevalent comorbid health conditions. Language and transportation barriers must be addressed to improve access to mental and physical health care in this population. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the relationship between back pain severe enough to restrict activity (restricting back pain) and subsequent mobility disability in community-living older persons. Design Prospective cohort study. Setting Greater New Haven, Connecticut. Participants Community-living men and women aged 70 and older (n = 709). Measurements Restricting back pain and mobility disability (defined as needing help with or unable to walk one-quarter of a mile, climb a flight of stairs, or lift and carry 10 pounds) were assessed during monthly telephone interviews for up to 159 months. The association between restricting back pain and subsequent mobility disability was evaluated using a recurrent-events Cox model. Secondary analyses evaluated the association between restricting back pain and mobility disability for two or more consecutive months (persistent mobility disability). Additional analyses were repeated in participants without baseline mobility disability. Results The event rate for mobility disability was 7.26 per 100-person months (95% confidence interval ( CI) = 6.89-7.64). Mobility disability episodes lasted for a median of 2 months (interquartile range ( IQR) 1-4). In a recurrent-event Cox regression analysis, after adjusting for 11 covariates, restricting back pain was strongly associated with mobility disability (hazard ratio ( HR) = 3.23, 95% CI = 2.87-3.64). The association was maintained when the outcome was defined as persistent mobility disability (adjusted HR = 3.63, 95% CI = 3.15-4.20) and when participants with baseline mobility disability were omitted (adjusted HR = 3.71, 95% CI = 3.22-4.28). Conclusion Restricting back pain was strongly associated with mobility disability. Interventions that prevent or ameliorate restricting back pain may be effective for reducing the burden of mobility disability in older persons. [ABSTRACT FROM AUTHOR]

We developed and tested a theoretically-based pamphlet entitled 'Influenza in Pregnancy,' specifically designed to increase pregnant women's knowledge, reduce barriers to maternal vaccination, and subsequently improve vaccine uptake. A randomized control trial was conducted on pregnant women (n = 135) at three locations in Connecticut during the 2011-2012 season to evaluate the impact of the patient-centered pamphlet. The women were randomized to one of three groups: the pamphlet; pamphlet/benefit statement (vaccinating the pregnant woman also benefits the young infant); or control. A Chi square analysis compared the intervention with control using the primary outcome of vaccination. A secondary outcome of the perceptions of health beliefs of maternal vaccination were measured through General Linear Model/ANOVA model for repeated measures. Overall 66.9 % (89/133) were vaccinated. Both the pamphlet group 72.9 % (35/48) (χ² = 6.81, df = 1 p = .009), and the pamphlet/benefit statement group 86.1 % (31/36) (χ² = 13.74, df = 1, p < .001), had significantly higher vaccine uptake than the control group 46.9 % (23/49). The potential barrier, perception of vaccine safety (F = 4.973, df = 2, p < .01), and benefit of vaccination to mother and infant (F = 6.690, df = 2, p < .01) significantly improved for the intervention groups compared to control group. The pamphlet significantly increased the pregnant women's perceptions of the safety and benefit of the vaccine, and the overall uptake. [ABSTRACT FROM AUTHOR]