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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]

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]

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]

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]

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]

Objective. To examine the association of perceived discrimination and health-related quality of life using cross-sectional survey. Methods. We measured perceived discrimination using a nine-item discrimination scale and measured health-related quality of life with the mental component summary (MCS) and physical component summary (PCS) scores of the Short Form-12 questionnaire. The sample was drawn from adult members of an East Coast American Indian Tribe. Results. After adjusting for age, sex, marital status, education, and smoking status, perceived discrimination scores greater than the sample median were associated with higher odds of poor mental functioning (odds ratio = 2.25, 95% CI = 1.03 - 4.91) but not with poor physical functioning (odds ratio = 1.18, 95% CI = 0.53 - 2.63). Conclusions. Our findings support results from previous studies linking perceived discrimination to worse mental health outcomes. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined residents' perspectives on the adequacy of women's health (WH) training in internal medicine (IM). This study sought residents' opinions regarding comfort level managing 13 core WH topics, their perceived adequacy of training in these areas, and the frequency with which they managed each topic. The association between reported comfort level and perceived adequacy of training and management frequency was also assessed. Methods: A 67-item questionnaire was administered from April to June 2009 to 100 (64%) of the 156 residents from the traditional, primary care, and IM-pediatrics residency programs at a single institution. Descriptive and correlation statistics were used to examine the relationships between self-reported comfort level, perceived adequacy of training opportunities, and frequency managing WH issues. Data was stratified by sex, IM program, and post-graduate year (PGY). Results: The majority of residents reported low comfort levels managing 7 of 13 topics. Over half of residents perceived limited training opportunities for 11 of 13 topics. With the exception of cardiovascular disease in women, greater than 75% of residents reported managing the 13 topics five or more times in the prior 6 months. Correlation analysis suggested a linear relationship between low comfort levels and limited training opportunities, and between low comfort levels and low frequency managing WH topics ( r=0.97 and r=0.89, respectively). Stratified analyses by sex, IM program, and PGY showed no significant differences. Conclusions: Key gaps remain in WH training. Our results emphasize the importance of reinforcing WH training with hands-on management opportunities. Understanding institution-specific strengths and weaknesses may help guide the development of targeted initiatives. [ABSTRACT FROM AUTHOR]

BACKGROUND National estimates of middle school bullying approximate 40%, making it the leading form of school violence. Meta-analysis of conventional anti-bullying efforts have shown mixed results, averaging small reductions in bullying behavior. Social-Emotional Learning and Positive Youth Development provide a theory-driven alternative for approaching bullying and victimization by strengthening social competencies that reduce related youth risk behaviors. METHODS A sample of 7th grade students ( N = 323) participated in Take the Lead (TTL); a 16-session curriculum designed to build social competencies of all participants. Data were coded and collected using a pretest/posttest time-lag control group cohort study design. Participants self-reported bully and victim behaviors using the Peer Relations Questionnaire. Extracted data were assessed for changes in bullying and victim behaviors, from pretest to posttest, between groups and sexes. RESULTS Participants in TTL reported significant reductions in bullying (p < .001), and victimization (p < .001), from pretest to posttest, and compared to controls (p < .001). Findings remained consistent between sexes (p < .001). Control groups experienced increases in bully and victim behaviors during the same time period, which were significantly reduced following participation in TTL (p < .001). CONCLUSION Identifying intervention alternatives to address bullying behaviors must remain a research priority. This study supports the application of theory-driven SEL and PYD constructs within a curriculum designed to improve social competencies of all students. [ABSTRACT FROM AUTHOR]

Objectives: Despite findings suggesting that young adults are more concerned about experiencing an unplanned pregnancy or contracting a sexually transmitted infection (STI) than becoming human immunodeficiency virus (HIV) infected, no empirical work has investigated whether the specific focus of an intervention may be more or less efficacious at changing sexual behavior. Participants: Participants were 198 college students randomized to 1 of 4 conditions: pregnancy intervention, STI intervention, HIV intervention, or a control condition during 2008–2009. Methods: The authors compared the efficacy of 3 theory-based, sexual risk–reduction interventions that were exactly the same except for an exclusive focus on preventing pregnancy, STI, or HIV. Condom use and risky sexual behavior were assessed at baseline and 4-week and 8-week follow-up. Results: Participants exposed to the pregnancy or STI interventions reported greater condom use and less risky sexual behavior than those exposed to the HIV intervention. Conclusions: The focus of sexual risk–reduction interventions may lead to differential behavior change among young adults. [ABSTRACT FROM PUBLISHER]

Racial/ethnic minorities are disproportionately affected by barriers to health care access and utilization. The primary objective was to test for an independent association between household food insecurity and health care access/utilization. In this cross-sectional survey, 211 Latinos (predominantly, Puerto-Ricans) with type 2 diabetes (T2D) were interviewed at their homes. Factor analyses identified four barriers for health care access/utilization: enabling factor, doctor access, medication access and forgetfulness. Multivariate logistic regression models examined the association between each of the barrier factors and food insecurity controlling for sociodemographic, cultural, psychosocial, and diabetes self-care variables. Higher food insecurity score was a risk factor for experiencing enabling factor (OR = 1.46; 95% CI = 1.17-1.82), medication access (OR = 1.26; 95 CI% = 1.06-1.50), and forgetfulness (OR = 1.22; 95 CI% = 1.04-1.43) barriers. Higher diabetes management self-efficacy was protective against all four barriers. Other variables associated with one or more barriers were health insurance, perceived health, depression, blood glucose, age and education. Findings suggest that addressing barriers such as food insecurity, low self-efficacy, lack of health insurance, and depression could potentially result in better health care access and utilization among low income Puerto-Ricans with T2D. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To determine whether collaborative behavioral management (CBM) reduces substance use, crime and re-arrest among drug-involved parolees. Design Step'n Out was a randomized behavioral trial of CBM versus standard parole (SP) during 2004-08. CBM adapted evidence-based role induction, behavioral contracting and contingent reinforcement to provide parole officer/treatment counselor dyads with positive tools in addition to sanctions to manage parolees' behavior over 12 weeks. Setting Six parole offices in five states in the USA. Participants Parolee volunteers with a mandate for addiction treatment and a minimum of 3 months of parole ( n = 476). Follow-up was 94% at 3 months and 86% at 9 months. Measurements Drug use and crime in a given month from calendar interviews 3 and 9 months after parole initiation, and re-arrests from criminal justice administrative data. Findings The CBM group had fewer months in which they used their primary drug [adjusted risk ratio (ARR) 0.20, 95% confidence interval (CI): 0.05, 0.78, P = 0.02] and alcohol (ARR 0.38, 95% CI: 0.22, 0.66, P = 0.006) over follow-up. CBM had its greatest effects among parolees who reported marijuana or another 'non-hard' drug as their primary drug; parolees who preferred stimulants or opiates did not benefit. No differences were seen in total crime, re-arrests or parole revocations. Conclusions Collaborative behavioral management may reduce substance use among primary marijuana or other 'non-hard' drug-using parolees without increasing revocations. Because the majority of drug violation arrests in the United States are for marijuana, these findings have important implications for the management of a substantial proportion of the US community correctional population. [ABSTRACT FROM AUTHOR]