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Background Psychoeducational interventions, tested for efficacy in randomized clinical trials, are seldom implemented in clinical practice where cancer survivors and their family caregivers can benefit from them. Objective This study examined the effectiveness of the FOCUS Program on cancer survivors' and their family caregivers' outcomes when implemented at a Cancer Support Community (CSC) affiliate by agency social workers. Study aims were to (1) test effects of the program on survivor and caregiver outcomes as a unit and (2) determine program feasibility in terms of enrollment, retention, intervention fidelity, and satisfaction. Methods A preintervention and postintervention pilot effectiveness study was conducted with 34 cancer survivor-caregiver dyads (ie, pairs). The FOCUS Program, originally delivered by nurses in dyads' homes, was modified to a small-group format and delivered by CSC social workers. The primary outcome was quality of life (QOL). Intermediary outcomes were benefits of illness/caregiving, communication, support, and self-efficacy. Analyses included repeated-measures analysis of variance. Results Dyads had significant improvements in total QOL; physical, emotional, and functional QOL; benefits of illness; and self-efficacy. Effect sizes were similar to prior randomized clinical trial findings. Although dyads were difficult to recruit (enrollment, 60%), both retention (92%) and intervention fidelity (94%) were high. Conclusions It was possible to implement the FOCUS Program at a CSC affiliate by agency staff, obtain positive intervention effects, and maintain intervention fidelity. Implications for practice Researchers and clinicians need to collaborate to implement more evidence-based interventions in practice settings for cancer survivors and their family caregivers.

This cross-sectional study examined the association of self-efficacy with neighborhood walking in older adult (mean age = 76.1, SD = 8.34) fallers (n = 108) and nonfallers (n = 217) while controlling for demographic characteristics and mobility. Hierarchical multiple regression indicated that the full model explained 39% of the variance in neighborhood walking in fallers (P < .001) and 24% in nonfallers (P < .001). Self-efficacy explained 23% of the variance in fallers (P < .001) and 11% in nonfallers (P < .001). Neighborhood walking was significantly associated with self-efficacy for individual barriers in both groups. Self-efficacy for neighborhood barriers trended toward significance in fallers (β = .18, P = .06). Fall history did not moderate the relationship between self-efficacy and neighborhood walking. Walking interventions for older adults should address self-efficacy in overcoming individual walking barriers. Those targeting fallers should consider addressing self-efficacy for overcoming neighborhood barriers.

Objective Although increased frequency of physical activity is associated with fewer depressive symptoms in African-Americans, most studies do not focus on a specific type of activity. Identifying the activity can provide helpful information for designing interventions that focus on depressive symptoms. The objective of this study was to examine the odds of depressive symptoms in relation to walking in African-Americans. Design and Sample A secondary analysis was performed on the National Survey of American Life. The sample was made up of community-dwelling African-American women (n = 1,903) and men (n = 1,075) who did not meet the DSM-IV-TR criteria for depression. Measures Walking was measured by self-reported frequency (i.e., never, rarely, sometimes, often). Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the odds of depressive symptoms in relation to walking. Results Women who reported often walking had lower odds for depressive symptoms than women who reported never walking (OR = 0.56, 95% CI = 0.38–0.82). Walking frequency was not related to depressive symptoms in men. Conclusions Walking frequency is a modifiable risk factor for elevated depressive symptoms in African-American women.

Background: Patient-centered communication is fundamental to individualizing healthcare, but there has been limited evaluation of provider communication with youth. Objectives: The aim was to compare communication outcomes after use of an event history calendar (EHC) and Guidelines for Adolescent Preventive Services (GAPS) to structure interactions during a clinic visit. Patient and provider descriptions of EHC and GAPS communication experiences were also obtained. Methods: This is a secondary analysis of data obtained during a randomized controlled trial. A sequential explanatory mixed-methods approach was used. A split-plot design with one between factor (EHC, GAPS) and one within factor (pretest, posttest) was used for the quantitative portion. Qualitative data were collected from open-ended questions, audiotaped visits, and exit interviews. Providers (n = 9) at three clinics were assigned at random and trained to implement either the EHC or GAPS protocol. Male and female youth (n = 186) were randomly assigned to the EHC or GAPS intervention. Before their clinic visit, youth completed assessments of past communication experiences with healthcare providers (pretest); communication during the current visit was assessed immediately after the visit (posttest). Results: Communication outcomes from pretest to posttest improved for youth in both the EHC and GAPS groups. Post hoc subgroup analysis suggested that men and Arab Americans derived more benefit from the EHC intervention in some aspects of communication. Qualitatively, the EHC group identified improved outcomes in validating patient perspective, being viewed in context, reaching a shared understanding of needs and preferences, and being helped to share power in the healthcare interaction. Discussion: EHC and GAPS provided effective frameworks for structuring communication during a clinic visit. Compared with GAPS, the integrated time-linked assessment captured by the EHC enhanced patient-centered communication in select groups.

Cancer genetic services (counseling/testing) are recommended for women diagnosed with breast cancer younger than 45 years old (young breast cancer survivors—YBCS) and at-risk relatives. We present recruitment of YBCS, identification and recruitment of at-risk relatives, and YBCS willingness to contact their cancer-free, female relatives. A random sample of 3,000 YBCS, stratified by race (Black vs. White/Other), was identified through a population-based cancer registry and recruited in a randomized trial designed to increase use of cancer genetic services. Baseline demographic, clinical, and family characteristics, and variables associated with the Theory of Planned Behavior (TPB) were assessed as predictors of YBCS’ willingness to contact at-risk relatives. The 883 YBCS (33.2% response rate; 40% Black) who returned a survey had 1,875 at-risk relatives and were willing to contact 1,360 (72.5%). From 853 invited at-risk relatives (up to two relatives per YBCS), 442 responded (51.6% response rate). YBCS with larger families, with a previous diagnosis of depression, and motivated to comply with recommendations from family members were likely to contact a greater number of relatives. Black YBCS were more likely to contact younger relatives and those living further than 50 miles compared to White/Other YBCS. It is feasible to recruit diverse families at risk for hereditary cancer from a population-based cancer registry. This recruitment approach can be used as a paradigm for harmonizing processes and increasing internal and external validity of large-scale public health genomic initiatives in the era of precision medicine.

This study determined the effectiveness of the Tobacco Tactics intervention.This was a pragmatic, quasi-experimental study conducted from 2010 to 2013 and analyzed from 2014 to 2015 in five Michigan community hospitals; three received the Tobacco Tactics intervention, and two received usual care. Smokers (N=1,528) were identified during hospitalization, and sent surveys and cotinine tests after 6 months. Changes in pre- to post-intervention quit rates in the intervention sites were compared with usual care control sites.The toolkit for nurses included: (1) 1 continuing education unit contact hour for training; (2) a PowerPoint presentation on behavioral and pharmaceutical interventions; (3) a pocket card entitled "Helping Smokers Quit: A Guide for Clinicians"; (4) behavioral and pharmaceutical protocols; and (5) a computerized template for documentation. The toolkit for patients included: (1) a brochure; (2) a cessation DVD; (3) the Tobacco Tactics manual; (4) a 1-800-QUIT-NOW card; (5) nurse behavioral counseling and pharmaceuticals; (6) physician reminders to offer brief advice to quit coupled with medication sign-off; and (7) follow-up phone calls by trained hospital volunteers.The effectiveness of the intervention was measured by 6-month 30-day point prevalence; self-reported quit rates with NicAlert(®) urinary biochemical verification (48-hour detection period); and the use of electronic medical record data among non-responders.There were significant improvements in pre- to post-intervention self-reported quit rates (5.7% vs 16.5%, p0.001) and cotinine-verified quit rates (4.3% vs 8.0%, p0.05) in the intervention sites compared with no change in the control sites. Propensity-adjusted multivariable analyses showed a significant improvement in self-reported 6-month quit rates from the pre- to post-intervention time periods in the intervention sites compared to the control sites (p=0.044) and a non-statistically significant improvement in the cotinine-verified 6-month quit rate.The Tobacco Tactics intervention, which meets the Joint Commission standards for inpatient smoking, has the potential to significantly decrease smoking among inpatient smokers.This study is registered at www.clinicaltrial.gov NCT01309217.

OBJECTIVE To determine stages of hearing-protection behavioral change and their relationships with cognitions and hearing status. METHOD A cross-sectional study of 769 construction workers who completed a survey and audiometric tests. RESULTS The majority of participants (over 64%) were in the preparation stage. Participants in the action/maintenance stage demonstrated significantly greater benefits, self-efficacy, and interpersonal influence; fewer barriers; and better hearing. This is the first study that shows significantly better health outcome, hearing ability, as the stage progresses. CONCLUSION Study demonstrates preliminary validity of the stages of change with hearing-protection behavior. Future hearing-protection intervention should integrate the stages of change to increase effectiveness.

Background The objective of this study was to determine the factors associated with sun exposure behaviors among Operating Engineers (heavy equipment operators). Methods Operating Engineers (N ¼ 498) were asked to complete a cross-sectional survey. Linear and logistic regression analyses were used to determine health behavioral, perceptional, and demographic factors associated with sun exposure behavior (sun burns, blistering, use of sunscreen, and interest in sun protection services). Results Almost half reported two or more sunburns/summer and the median times blistering was 2 with a range of 0–100. About one-third never used sun block, while just over one-third rarely used sun block. Almost one-quarter were interested in sun protection guidance. Multivariate analyses showed that perceptions of skin type, alcohol problems, fruit intake, BMI, sleep quality, age, sex, and race were significantly associated with at least one of the outcome variables (P < 0.05). Conclusions Operating Engineers are at high risk for skin cancer due to high rates of exposure to ultraviolet light and low rates of sun block use. Subgroups of Operating Engineers are particularly at risk for sun damage. Interventions are needed to decrease sun exposure among Operating Engineers. Am. J. Ind. Med. 55:786–792, 2012. 2012 Wiley Periodicals, Inc.

Background A valid assessment of hearing status is important to detect hearing loss early and prevent further loss in noise-exposed individuals or older adults. Self-report is used widely in research and is often the only possible measure to evaluate hearing ability. Objectives The aims of this study were to establish the level of validity of self-rated hearing by comparing it with the results of audiograms and to examine correlations and changes in self-rated and measured hearing status over time. Methods Survey and audiogram data collected from 403 construction workers at two different time points (Years 1 and 2) were used in the hearing protection intervention study. Self-rated hearing was assessed on a 5-point rating scale using a single question ("How do you rate your hearing?"). Hearing was measured via audiograms conducted at frequencies 0.5 through 8 kHz. Three pure-tone threshold average (PTA) indicators, PTA 0.5-2 kHz, PTA 0.5-3 kHz, and PTA 4-6 kHz, of the worse ear were used and compared with self-ratings at two time points. Results Percentage of agreement between the self-rated and measured hearing was lowest in PTA 4-6 kHz and highest in PTA 0.5-3 kHz for both years. Cohen's kappas showed fair to moderate (.25-.45) agreement. Sensitivity was higher (.82-.89) in the speech frequencies and lower (.51-.55) at higher frequencies. Specificity was better at higher frequencies than at lower frequencies (.83-.89 vs .68-.74). Although there was no appreciable change in self-rated hearing and limited change in measured hearing on all 3 indicators from Years 1 to 2, correlations between self-rated and measured hearing were higher in Year 2. Discussion A single-item question about an individual's hearing ability is moderately useful and valid to assess hearing loss and can be recommended for a population-based study only if audiograms are not available, but self-report hearing screening should not be considered an adequate substitute for the standardized audiometric test. Providing audiograms and feedback on the results apparently enhanced individuals' ability to judge their hearing status.

Objective: Cancer patients and partners often report inadequate communication about illness-related issues, although it is essential for mutual support and informal caregiving. This study examined the patterns of change in dyadic communication between patients with prostate cancer and their partners, and also determined if certain factors affected their communication over time. Method: Using multilevel modeling, this study analyzed longitudinal data obtained from a randomized clinical trial with prostate cancer patients and their partners, to examine their communication over time. Patients and partners (N=134 pairs) from the usual-care control group independently completed baseline demographic assessment and measures of social support, uncertainty, symptom distress, and dyadic communication at baseline, and 4-, 8-, and 12-month follow-ups. Results: The results indicated that (1) patients and partners reported similar levels of open communication at the time of diagnosis. Communication reported by patients and partners decreased over time in a similar trend, regardless of phase of illness; (2) phase of illness affected couples' open communication at diagnosis but not patterns of change over time; and (3) couples' perceived communication increased as they reported more social support, less uncertainty, and fewer hormonal symptoms in patients. Couples' demographic factors and general symptoms, and patients' prostate cancer-specific symptoms did not affect their levels of open communication. Conclusions: Perceived open communication between prostate cancer patients and partners over time is affected by certain baseline and time-varying psychosocial and cancer-related factors. The results provide empirical evidence that may guide the development of strategies to facilitate couples' interaction and mutual support during survivorship. Copyright © 2010 John Wiley & Sons, Ltd.

This study aimed at examining the relationship between quality of life (QOL) in prostate cancer (PCa) patients and partners and how baseline demographics, cancer-related factors, and time-varying psychosocial and symptom covariates affect their QOL over time.Guided by a modified Stress-Coping Model, this study used multilevel modeling to analyze longitudinal data from a randomized clinical trial that tested a family-based intervention to improve QOL in couples managing PCa. Patients and partners from the usual-care control group (N = 134 dyads) independently completed the measurements at baseline, and at 4-, 8-, and 12-month follow-ups.Correlations of QOL between patients and partners over time were small to moderate. Patients' lower education level, partners' older age, higher family income, and localized cancer at baseline were associated with better QOL in couples. Over time, couples' QOL improved as their social support and cancer-related dyadic communication increased and as couples' uncertainty, general symptoms, and patients' prostate cancer-related sexual and hormonal symptoms decreased.Evidence indicates that couples' QOL during cancer survivorship is affected by multiple contextual factors (e.g., baseline demographics and time-varying psychosocial factors and symptoms). Intervention research is needed to explore comprehensive strategies to improve couples' QOL during the continuum of PCa survivorship.

Eating disorder behaviors are prevalent in Latina populations. This study tested Schwartz’s (2006) theoretical view that a broad array of personal identities serves as an internal resource during acculturation and prevents internalization of dysfunctional weight related beliefs. Sixty-six Mexican American women completed measures of personal identities, fat self-definition, eating disorder symptoms and acculturation. Results show that few positive and many negative personal identities predict higher eating disorder scores and effects are mediated through the fat self-definition. Characteristics of personal identities may influence internalization of cultural values related to weight. Interventions focused on overall identity may prevent eating disorders in Latinas.

OBJECTIVE: To estimate prevalence and assess the association of types of trauma with posttraumatic stress disorder (PTSD) in a sociodemographically and racially mixed sample of women from both predominantly Medicaid and privately insured settings who are expecting their first infant. METHODS: Structured telephone diagnostic interview data were analyzed for prevalence of trauma exposure, PTSD, comorbidity, risk behaviors, and treatment-seeking among 1,581 diverse English-speaking nulliparous women. RESULTS: The overall rate of lifetime PTSD was 20.2%, 17% in the predominantly private-payer settings, and 24% in the predominantly public-payer settings. The overall rate of current PTSD was 7.9%, 2.7% in the predominantly private-payer settings and 13.9% in the predominantly public-payer settings. Those with current PTSD were more likely to be African American, pregnant as a teen, living in poverty, with high school education or less, and living in higher-crime areas. Adjusted odds of having current PTSD were highest among those whose worst trauma exposure was abuse (odds ratio 11.9, 95% confidence interval 3.6–39.9), followed by reproductive trauma (odds ratio 6.1, 95% confidence interval 1.5–24.4). Health risk behaviors and exposures were concentrated among those with PTSD. CONCLUSION: These findings affirm that PTSD affects pregnant women. Women with PTSD in pregnancy were more likely to have had exposures to childhood abuse and prior traumatic reproductive event, to have cumulative sociodemographic risk factors, comorbid depression and anxiety, and to have sought mental health treatment in the past. Obstetric risk behaviors occur more in women with PTSD. (Obstet Gynecol 2009;114:839–47) LEVEL OF EVIDENCE: II

To compare a walking exercise to a stretching exercise during pregnancy in high-risk women who were sedentary and had previously experienced preeclampsia.A randomized clinical trial of the effects of the two types of physical exercises was conducted between November 2001 and July 2006 in Washtenaw County, Michigan. Both groups engaged in the assigned exercise five times a week until the end of pregnancy.Women were randomized to either the walking group (n = 41) or the stretching group (n = 38). The walkers exercised an average of 36 (SD, 6) minutes at 18 weeks gestation, 34 (SD, 7) minutes at 28 weeks gestation, and 31 (SD, 12) minutes at the last week of the intervention. On average, they exercised within target heart rate ranges 35% (SD, 32%) at 18 weeks gestation, 22% (SD, 25%) at 28 weeks gestation, and 17% (SD, 25%) at the last week of the intervention. The stretching group engaged in stretching exercises following a 40-minutes videotape. On average, the walking group exercised 4 (SD, 1) times a week at 18 weeks gestation, 4 (SD, 1) time a week at 28 weeks gestation, and 3 (SD, 1) times a week at the last week of the intervention. Equally on average, the stretching group exercised 4 (SD, 2) times a week at 18 weeks gestation, 5 (SD, 1) times a week at 28 weeks gestation, and 3 (SD, 1) times a week at the last week of the intervention. No difference between groups was observed, but both exercised significantly less frequently over the time (p 0.0001). Together, participants reported average 7,040 (SD, 2,612) steps at the beginning and 5,711 (SD, 2,739) steps at the end of the study. The walkers tracked an average 8,501 (SE, 778) steps a day at 20 weeks gestation and 7,418 (SE, 788) steps at 34 weeks gestation (n.s.). The stretchers tracked an average 6,189 (SE, 704) steps at 20 weeks gestation and 4,848 (SE, 452) steps at 34 weeks gestation (p 0.05). The incidence of preeclampsia was 14.6% (95% CI, 5.6 to 29.2) among the walkers and 2.6% (95% CI; 0.07 to 13.8) among the stretchers. The incidence of gestational hypertension was 22 % (95% C.I., 8.7 to 35.2) for the walkers and 40% (95% CI, 23.2 to 55.8) for the stretchers. The mean transferrin level, an antioxidant marker, was significantly higher in the stretching group mean (412 mg/dL, 95%CI, 389 to 435) than the walkers at the time of labor (mean = 368 mg/dL, 95%CI, 346 to 391) (p 0.05). No significant group differences were observed in birth outcomes.Regular stretching exercises may promote endogenous antioxidants among women at risk for preeclampsia.

Background The purpose of this study was to examine the frequency of gardening/yard work in relation to depressive symptoms in African-Americans while controlling for biological and social factors. Methods A secondary analysis was performed on the National Survey of American Life (n=2,903) using logistic regression for complex samples. Gardening/Yard work was measured by self-reported frequency. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Results Biological and social factors, not gardening/yard work, were associated with depressive symptoms. Conclusions Biological and social factors may need to be addressed before the association between gardening/yard work and depressive symptoms can be determined.

Background Hearing loss and tinnitus are prevalent in America, and noise-induced hearing loss is a leading cause of hearing loss. Noise-induced hearing loss has negative impact on quality of life, physical and emotional functioning, social life, and employment. In addition, noise-induced hearing loss results in heavy social and economic burdens on families and communities from all ethnic and socioeconomic groups. Farmers are a group that is particularly high risk for noise-induced hearing loss, and is underserved by programs designed to limit that risk. They are among the most noise-exposed group of workers, and experience the second highest prevalence of noise-induced hearing loss among all occupational categories. In agriculture, 1.5 million workers (43.3%) report exposure to hazardous noise. Although use of hearing protection devices (HPDs) would protect them from noise-induced hearing loss, use among farmers is low. Methods/Design The purpose of this project is to compare the effectiveness of several approaches to influencing hearing protector use. Approaches include: a) an interactive, predictors-based intervention delivered via the Internet; b) a static informational web site; and c) a mailed sampler of hearing protectors. The goals are to further develop an intervention to promote farmers’ use of HPDs, and compare the effectiveness of the interventions delivered in various combinations. Participants will include 701 farmers. Sites will be affiliates of a major farmer organization. Data will be collected at baseline, 6, and 12 months. A random intercept mixed model will be used to explore the fixed effects of the three NIHL prevention interventions over time while adjusting for age and gender. This project will involve a partnership between the University of Michigan and a major farmer organization to accomplish project aims. Discussion Results of this study will be used to inform future research-to-practice studies to increase hearing protector use. Increased use of hearing protectors is expected to reduce rates of noise-induced hearing loss and other negative effects of high noise exposure, and improve quality of life in this high-risk and underserved group. Trial registration Clinicaltrials.gov NCT01454895 Registered 14 October, 2011.

The 2000 United States Census reported significant growth in the number of Hispanic workers. The National Institute for Occupational Safety and Health (NIOSH, 1996) has identified noise-induced hearing loss as a significant occupational threat. Current theoretical models need to be evaluated for their utility with Hispanic workers. The Predictors for Use of Hearing Protection Model (PUHPM) is a framework for increasing workers' use of hearing protection devices (HPDs). Using regression analysis, the explained variance in HPD use by the model predictors was examined in a sample of 208 Hispanic factory workers. Explained variance was lower for Hispanics (R^sup 2^ = .20) than for non-Hispanic Whites (R^sup 2^ = .37). Further research with Hispanic workers is needed to improve the PUHPM fit. Keywords: ethnicity; predictors; hearing protection behavior; model test The 2000 U.S. Census identified a significant growth in the U.S. Hispanic population (U.S. Census Bureau, 2001). While the overall U.S. population increased by 13.2% from the 1990 to the 2000 census, the Hispanic population rose by 57.9%. Additionally, census data showed that the Hispanic population reported a median age (25.9 years) approximately 10 years younger than the overall, suggesting continued proportionally larger population growth. Occupational status and worksite environments can significantly impact individual health and well-being (Lusk & Raymond, 2002). Historically, Hispanics have been disproportionately represented with greater numbers in laborer job classifications versus managerial and professional specialties (Friedman-Jimenez & Ortiz, 1994; Frumkin, Walker, & Friedman-Jimenez, 1999). This phenomenon leads to a proportionally increased risk for exposure to the higher rates of occupational injury and illness for Hispanic workers. Noise is one such exposure of concern. Engineering controls have long been the preferred method to eliminate or reduce worker exposure to noise. Unfortunately, engineering controls have not been able to eliminate hazardous noise exposure for workers. Risk for noise-induced hearing loss (NIHL) has been identified by the National Institute for Occupational Safety and Health (NIOSH, 1996) as the most common occupational disease threat in the United States. Nonetheless, no national surveillance system exists to document hearing loss in workers (NIOSH, 1996; U.S. Department of Health and Human Services, 2000). The protective behavior of hearing protection use remains central to protecting many workers from NIHL. Past studies of hearing protection device (HPD) use have demonstrated that utilization for worker populations in manufacturing (Kerr, Lusk, & Ronis, 2002; Lusk, Kerr, Ronis, & Eakin, 1999; Lusk et al, 2003), construction (Lusk, Ronis, & Kerr, 1995), and farm workers (McCullagh, Lusk, & Ronis, 2002) is below that required to protect workers. The U.S. Bureau of Labor Statistics (2003) indicated that in 2001 the highest percentages of Hispanic workers tend to be found in the areas of agriculture, construction, and manufacturing, suggesting that Hispanics are at significant risk for NIHL. NIOSH has supported the importance of behavioral theories, such as Fender's (1987) Health Promotion Model (HPM) for guiding research toward increasing protective behaviors in workers (NIOSH, 1999). Lusk and colleagues adapted the constructs of the HPM to develop the Predictors of the Use of Hearing Protection Model (PUHPM, Figure 1), specifically for research on the use of hearing protection. PUHPM, which guides this study, evolved from a number of studies with factory and construction workers (Lusk, Hogan, & Ronis, 1997; Lusk & Keleman, 1993; Lusk, Kerr, & Baer, 1995; Lusk, Ronis, & Kerr, 1995; Lusk, Ronis, Kerr, & Atwood, 1994), yet participants were predominantly non-Hispanic White males. Noting the limited cross-cultural testing of the HPM, Kerr et al. …

Commercially available portable metabolic systems have been validated with samples of young, healthy, and well-fit subjects, but use of these systems with a special population, such as healthy but sedentary pregnant women, requires a unique set of considerations. These include a woman's limited testing time necessary for fetal safety, relatively low oxygen consumption, and the unique physiology of pregnancy (woman, the placenta, and the fetus). The purpose of this study was to validate a portable metabolic testing system (VO2000) with healthy sedentary pregnant women. A total of 9 sedentary pregnant women who averaged 30 years of age (SD = 3), 93 kg (SD = 19) weight, 163 cm (SD = 7) height, and at 19 weeks' gestation (SD = 5) volunteered to participate. Submaximum fitness tests using the Cornell protocol were conducted once with two systems (VO2000 and CPX/D, a reference) simultaneously, and then subsequently twice with one system (VO2000). The VO2000 consistently overestimated VO^sub 2^ measurement, compared to the same manufacturer's reference system, by 4.4 +/- 3.6 (SD) ml/kg/min, and when VO2000 was used twice, the mean difference was statistically significant (1.0 +/- 1.8 [SD] ml/kg/min; t^sub (45)^ = 3.9, p Keywords: fitness test; VO2000; inactivity; metabolic testing; reliability; gestation Increasing physical activity among sedentary adults is a major public health goal in the US and many other industrialized countries. A recent Surgeon General's report notes the ever-increasing prevalence of obesity particularly among women (U.S. Department of Health and Human Services [USDHHS], 1999). Pregnancy is a milestone for obesity in later life for women. But many pregnant women receive conflicting advice as to how much exercise is good for them and safe for their fetuses (American College of Obstetricians and Gynecologists, 2002). Conflicting advice is due in part to lack of accurate and precise methods to assess their aerobic fitness. Accurate assessment is the key to effective and safe exercise. Existing aerobic fitness assessment systems are quite costly and require routine calibration and maintenance by trained staff. As such, few clinicians who provide care for pregnant women have access to such systems. A few portable systems that require much less space and technical care are available at substantially less cost. If these portable systems provide reliable and valid measure of aerobic fitness with sedentary pregnant women, as they do with young athletic subjects (Byard & Dengel, 2000; King, McLaughlin, Howley, Bassett, & Ainsworth, 1999; McLaughlin, King, Howley, Bassett, & Ainsworth, 2001; Melanson, Freedson, Hendelman, & Debold, 1996), pregnant women can safely receive tailored exercise regimes during pregnancy based on individual's aerobic fitness level. The purpose of this study was to evaluate the appropriateness of a commercially available portable metabolic testing system with a group of healthy but sedentary pregnant women. One commercially available portable system, the VO2000 (Medical Graphics Corporation, 2000), was tested with pregnant women. BACKGROUND Research demonstrates that people who exercise daily report better mood and fewer physical symptoms (Brown, Goldstein-Shirley, Robinson, & casey, 2001; Sculco, Paup, Fernhall, & Sculco, 2001). The benefits of physical activity for chronic disease and mental well-being have been recognized as the scientific consensus in the U.S. Surgeon General's report on physical activity and health (Dishman, Washburn, & Heath, 2004). What is not well known is how much exercise is sufficient to bring about positive health outcomes without causing adverse effects. …

Objective To measure the satisfaction of impaired health professionals with treatment and monitoring programs in Michigan and Indiana. Method. Mailed surveys assessed overall program satisfaction, usefulness of various aspects of monitoring, and several miscellaneous items. Persons active in the Michigan (n = 620) and Indiana (n = 267) programs in July 2002 were included. Anonymous responses were received from 263 (43%) of Michigan and 120 (45%) of Indiana participants. Results. Means on the 1 to 5 satisfaction subscale were 3.6 (SD = .94) for Michigan and 4.1 (SD = .86) for Indiana. Means on the 1 to 4 monitoring subscale were 2.7 (SD = .62) for Michigan and 2.7 (SD = .57) for Indiana. Forty percent of Michigan respondents and 53% of Indiana respondents lacked insurance coverage for program costs. Thirty-nine percent of Michigan and 35% of Indiana respondents reported substance abuse or mental health difficulties prior to their professional career.

Women treated for breast cancer have shown cognitive deficits with reduced capacity to focus and concentrate or to direct attention. This study examined the relationship between cognitive function prior to any treatment for breast cancer and individual factors including age, education, menopausal status, chronic health problems, and distress. Women newly diagnosed with breast cancer (N=184), ages 27–86 years, were assessed with standardized attention tests, self-reports of effectiveness in cognitive functioning, and measures of distress at about 18 days before surgery. Measured performance on the cognitive tests was not significantly correlated to self-reports of effectiveness in cognitive functioning. Age, education, presence of a chronic health problem, and menopausal status, but not distress, were associated with performance on the cognitive tests. Only age and education, however, were significant (p

Earlier research indicated that attentional fatigue with reduced capacity to direct attention in women treated for breast cancer may be ameliorated by a theoretically based intervention involving regular exposure to the natural environment. This study tested the efficacy of a natural environment intervention aimed at restoring attention in 157 women with newly diagnosed breast cancer. Capacity to direct attention was assessed with a brief battery of objective measures at two time points: approximately 17 days before surgery (time 1) and 19 days after surgery (time 2). A randomly assigned intervention protocol was initiated after the first assessment and before any treatment. The intervention comprised a home-based program involving 120 minutes of exposure to the natural environment per week. The intervention group (n = 83) showed greater recovery of capacity to direct attention from the pretreatment (time 1) to the preadjuvant therapy period (time 2), as compared with the nonintervention group (n = 74). A significant effect of the natural environment intervention was observed even after control was used for the effects of age, education, attention scores at time 1, other health problems, symptom distress, and extent of surgery. The findings suggest therapeutic benefits for capacity to direct attention from early intervention aimed at restoring attention in women with newly diagnosed breast cancer.

Background: Mexican American workers are vulnerable to noise-induced hearing loss, the most common occupational disease in the United States. Objectives: The purpose was to test the applicability of the Health Promotion Model to Mexican American workers' use of hearing protection devices. Method: A correlational descriptive design and path analysis were used to determine the relationships between cognitive-perceptual factors, modifying factors and use of hearing protection devices. A questionnaire was completed by a total of 119 workers in three garment manufacturing plants. Interviews were conducted with the occupational health nurse or safety director in each plant to determine the policy regarding hearing protection also. Results: Factors that directly influenced the use of hearing protection devices were a clinical definition of health, benefits of and barriers to use of hearing protection devices, self-efficacy in the use of hearing protection devices and perceived health status (R 2 =.25, p

BackgroundNovel interventions tailored to blue collar workers are needed to reduce the disparities in smoking rates among occupational groups. ObjectiveThe main objective of this study was to evaluate the efficacy and usage of the Web-enhanced “Tobacco Tactics” intervention targeting operating engineers (heavy equipment operators) compared to the “1-800-QUIT-NOW” telephone line. MethodsOperating engineers (N=145) attending one of 25 safety training sessions from 2010 through 2012 were randomized to either the Tobacco Tactics website with nurse counseling by phone and access to nicotine replacement therapy (NRT) or to the 1-800-QUIT-NOW telephone line, which provided an equal number of phone calls and NRT. The primary outcome was self-reported 7-day abstinence at 30-day and 6-month follow-up. The outcomes were compared using chi-square tests, t tests, generalized mixed models, and logistic regression models. ResultsThe average age was 42 years and most were male (115/145, 79.3%) and white (125/145, 86.2%). Using an intent-to-treat analysis, the Tobacco Tactics website group showed significantly higher quit rates (18/67, 27%) than the 1-800-QUIT NOW group (6/78, 8%) at 30-day follow-up (P=.003), but this difference was no longer significant at 6-month follow-up. There were significantly more positive changes in harm reduction measures (quit attempts, number of cigarettes smoked per day, and nicotine dependence) at both 30-day and 6-month follow-up in the Tobacco Tactics group compared to the 1-800-QUIT-NOW group. Compared to participants in the 1-800-QUIT NOW group, significantly more of those in the Tobacco Tactics website group participated in the interventions, received phone calls and NRT, and found the intervention helpful. ConclusionsThe Web-enhanced Tobacco Tactics website with telephone support showed higher efficacy and reach than the 1-800-QUIT-NOW intervention. Longer counseling sessions may be needed to improve 6-month cessation rates. Trial RegistrationClinicaltrials.gov NCT01124110; http://clinicaltrials.gov/ct2/show/NCT01124110 (Archived by WebCite at http://www.webcitation.org/6TfKN5iNL).

Background The objective of this study was to evaluate the effectiveness of the inpatient, nurse-administered Tobacco Tactics program for patients admitted for psychiatric conditions in two Veterans Affairs (VA) hospitals compared to a control hospital. Methods This is a subgroup analysis of data from the inpatient tobacco tactics effectiveness trial, which was a longitudinal, pre- post-nonrandomized comparison design with 6-month follow-up in the three large Veterans Integrated Service Networks (VISN) 11 hospitals. Results Six-month self-reported quit rates for patients admitted for psychiatric conditions increased from 3.5% pre-intervention to 10.2% post-intervention compared to a decrease in self-reported quit rates in the control hospital (12% pre-intervention to 1.6% post-intervention). There was significant improvement in self-reported quit rates for the pre- versus post-intervention time periods in the Detroit and Ann Arbor intervention sites compared to the Indianapolis control site (P = 0.01) and cotinine results were in the same direction. Conclusion The implementation of the Tobacco Tactics intervention has the potential to significantly decrease smoking and smoking-related morbidity and mortality among smokers admitted to VA hospitals for psychiatric disorders.

The purpose of this study was to offer the Sun Solutions intervention to operating engineers ( N = 232) to decrease sun exposure and skin cancer. The majority (82%) of the engineers worked outside between 10 a.m. and 3 p.m., 4 to 5 hours a day; 81.4% reported more than one sunburn during the past year and 70% sometimes or never used sunscreen compared to 30% who wore sunscreen approximately 50% or more of the time. Most reported that the intervention was helpful (97%), most were satisfied (96%) with the intervention, and 84% expressed a future intention to use sunscreen. Regarding sun protective behaviors, the intervention significantly improved perceived self-efficacy ( p < .05) and increased perceived barriers ( p < .05). Regarding sunburn and skin cancer, the intervention increased perceived benefits ( p < .05), susceptibility ( p < .05), and severity ( p < .05) for sunburning, but not skin cancer ( p > .10). The Sun Solutions intervention showed the potential to increase sunscreen use and decrease the risk of sunburn and skin cancer among operating engineers.

The authors assessed the dental checkup frequency of adults living in the Detroit tricounty area and identified demographic, access and subjective factors associated with visits to a dentist made not because of a dental problem.Data are from a 1994 probability-based sample of adults who were interviewed and received an in-home oral examination. The authors used the variables of age, sex, education level, income level, dental insurance status, usual place for care, objective measures of oral health, and subjective assessments of health, pain and dental anxiety to predict the frequency of dental checkups.The authors found that differences in dental checkup behavior were related to demographics, access to dental care, subjective ratings of oral and general health and other self-assessments, and clinical parameters of oral health. In multiple logistic regression analysis considering all variables simultaneously, sex, income, having a usual place for care and level of dental care anxiety were found to be associated with having dental checkups. The authors determined the statistical significance level at P.05.A total of 69.7 percent of the study population reported having had a dental checkup at least once a year in the past five years. The authors found that four factors associated with infrequent dental checkups: being male, having lower income levels, not having a usual place for care and being anxious about receiving dental care.Dental health professionals should consider the correlates of dental checkup frequency identified in this study and the usefulness of proposed strategies to increase and sustain regular preventive visitation patterns in their own patient populations.

Introduction. Consistent use of hearing protection devices (HPDs) decreases noise-induced hearing loss, however, many workers do not use them consistently. Past research has supported the need to use a conceptual framework to understand behaviors and guide intervention programs; however, few reports have specified a process to translate a conceptual model into an intervention. Purpose. The strongest predictors from the Health Promotion Model were used to design a training program to increase HPD use among construction workers. Subjects/Setting. Carpenters (n = 118), operating engineers (n = 109), and plumber/pipefitters (n = 129) in the Midwest were recruited to participate in the study. Design. Written questionnaires including scales measuring the components of the Health Promotion Model were completed in classroom settings at worker trade group meetings. Measures. All items from scales predicting HPD use were reviewed to determine the basis for the content of a program to promote the use of HPDs. Three selection criteria were developed: (1) correlation with use of hearing protection (at least .20), (2) amenability to change, and (3) room for improvement (mean score not at ceiling). Results. Linear regression and Pearson's correlation were used to assess the components of the model as predictors of HPD use. Five predictors had statistically significant regression coefficients: perceived noise exposure, self-efficacy, value of use, barriers to use, and modeling of use of hearing protection. Using items meeting the selection criteria, a 20-minute videotape with written handouts was developed as the core of an intervention. A clearly defined practice session was also incorporated in the training intervention. Conclusion. Determining salient factors for worker populations and specific protective equipment prior to designing an intervention is essential. These predictors provided the basis for a training program that addressed the specific needs of construction workers. Results of tests of the effectiveness of the program will be available in the near future.

BACKGROUND: Most programs addressing psychosocial concerns of cancer survivors are in-person programs that are expensive to deliver, have limited availability, and seldom deal with caregivers' concerns. OBJECTIVE: This study examined the feasibility of translating an efficacious nurse-delivered program (FOCUS Program) for patients and their caregivers to a tailored, dyadic Web-based format. Specific aims were to (1) test the preliminary effects of the Web-based intervention on patient and caregiver outcomes, (2) examine participants' program satisfaction, and (3) determine the feasibility of using a Web-based delivery format. METHODS: A phase 2 feasibility study was conducted with cancer patients (lung, breast, colorectal, prostate) and their family caregivers (N = 38 dyads). The Web-based intervention provided information and support tailored to the unique characteristics of each patient, caregiver, and their dyadic relationship. Primary outcomes were emotional distress and quality of life. Secondary outcomes were benefits of illness/caregiving, communication, support, and self-efficacy. Analyses included descriptive statistics and repeated-measures analysis of variance. RESULTS: Dyads had a significant decrease in emotional distress, increase in quality of life, and perceived more benefits of illness/caregiving. Caregivers also had significant improvement in self-efficacy. There were no changes in communication. Participants were satisfied with program usability, but recommended additional content. CONCLUSIONS: It was possible to translate a clinician-delivered program to a Web-based format that was easy to use and had positive effects on dyadic outcomes. IMPLICATIONS FOR PRACTICE: The Web-based program is a promising way to provide psychosocial care to more patients and caregivers using fewer personnel. It needs further testing in a larger randomized clinical trial.

Objectives: The goals of this investigation were (1) to evaluate the Oral Health Status Index in relation to demographic characteristics, socioeconomic status, and preventive behaviors of an adult population; and (2) to understand how individual index components performed as indicators of oral health status com- pared to the composite index. Methods: The Oral Health Status Index (OHSI) was used on a probability sample of adults, aged 18-93 years, living in the Detroit tricounty area. Data were collected on 509 subjects via in-home dental examina- tions. Bivariate and multivariate analyses were used to compare the OHSl and its components, including decayed, missing, and replaced teeth, free ends, and moderate and severe periodontal disease measures. Results: The mean OHSI score for subjects was 77.3 (SE= 1.83) with a range of -8.0 to 700.0. In regression analyses, OHSl scores were positively correlated with subjects' education level, self-rated oral health scores, and frequency of dental checkups and negatively correlated with age, nonwhite race, and smoking. Of the index components, missing teeth performed well as an indicator of oral health status. Missing teeth were positively correlated with age, nonwhite race, and smoking and negatively correlated with education level, self-rated oral health, and use of Medicaid. About 53 percent of variance in OHSl scores was explained by the multivariate models, compared to 46 percent for missing teeth. Conclusions: Choosing an indicator of oral health status likely will depend upon the characteristics of the population to be studied. As a composite measure of oral health status, the OHSlperformed acceptably; however, missing teeth, an index component, also worked well. Continued evaluation of the OHSl is warranted. (J Public Health Dent 1 997;57(4):233-42)

In this study, the Health Promotion Model (HPM) was used as the basis for a structural equation model of male and female blue collar workers' self-reported use of hearing protection devices (HPDs). Overall use did not differ by gender; in addition, self-efficacy and barriers to use of HPDs were the two best predictors of this behavior for both men and women. Despite the similarities in HPD use and the most important predictors of that use between men and women, the predictive models differed by gender in several ways. Significant predictors of use among men also included age and value of use of HPDs. For women, ethnic status and plant site were additional significant predictors of use. Because the influences of plant site and gender on self-reported use of HPDs could not be separated in this study, further research should address worksite culture and assess differences by gender. Knowledge of these differences will aid development of more effective interventions and may increase the use of hearing protection.

Canonical correlation analyses of a previous dental survey suggested that dental checkups, flossing, and tooth brushing could all be predicted from a single equation. Most theories and research about the influence of beliefs on behavior, however, suggest different behaviors will be best predicted by different behavior-specific measures. The current survey investigated influences on brushing, flossing, and dental checkups in a probability sample of adults in the Detroit tri-county area. Both behavior-specific variables, such as perceived benefits and costs of flossing, and general variables, such as gender, were included as predictors. Canonical correlation analysis indicated three equations were needed to predict the three oral health behaviors. Flossing frequency, for example, was best predicted by confidence in flossing ability and beliefs about the benefits of and barriers to flossing. The results suggest that even these closely related behaviors are best predicted using separate equations that include mostly behavior-specific predictors.

Introduction: Research is needed that prospectively characterizes the intergenerational pattern of effects of childhood maltreatment and lifetime posttraumatic stress disorder (PTSD) on women's mental health in pregnancy and on postpartum mental health and bonding outcomes. This prospective study included 566 nulliparous women in 3 cohorts: PTSD-positive, trauma-exposed resilient, and not exposed to trauma. Methods: Trauma history, PTSD diagnosis, and depression diagnosis were ascertained using standardized telephone interviews with women who were pregnant at less than 28 gestational weeks. A 6-week-postpartum interview reassessed interim trauma, labor experience, PTSD, depression, and bonding outcomes. Results: Regression modeling indicates that posttraumatic stress in pregnancy, alone, or comorbid with depression is associated with postpartum depression (R2= .204; P < .001). Postpartum depression alone or comorbid with posttraumatic stress was associated with impaired bonding (R2= .195; P < .001). In both models, higher quality of life ratings in pregnancy were associated with better outcomes, while reported dissociation in labor was a risk for worse outcomes. The effect of a history of childhood maltreatment on both postpartum mental health and bonding outcomes was mediated by preexisting mental health status. Discussion: Pregnancy represents an opportune time to interrupt the pattern of intergenerational transmission of abuse and psychiatric vulnerability. Further dyadic research is warranted beyond 6 weeks postpartum. Trauma-informed interventions for women who enter care with abuse-related PTSD or depression should be developed and tested.

Background The Michigan Prevention Research Center, the University of Michigan Schools of Nursing, Public Health, and Medicine, and the Michigan Department of Community Health propose a multidisciplinary academic-clinical practice three-year project to increase breast cancer screening among young breast cancer survivors and their cancer-free female relatives at greatest risk for breast cancer. Methods/design The study has three specific aims: 1) Identify and survey 3,000 young breast cancer survivors (diagnosed at 20–45 years old) regarding their breast cancer screening utilization. 2) Identify and survey survivors’ high-risk relatives regarding their breast cancer screening utilization. 3) Test two versions (Targeted vs. Enhanced Tailored) of an intervention to increase breast cancer screening among survivors and relatives. Following approval by human subjects review boards, 3,000 young breast cancer survivors will be identified through the Michigan Cancer Registry and mailed an invitation letter and a baseline survey. The baseline survey will obtain information on the survivors’: a) current breast cancer screening status and use of genetic counseling; b) perceived barriers and facilitators to screening; c) family health history. Based on the family history information provided by survivors, we will identify up to two high-risk relatives per survivor. Young breast cancer survivors will be mailed consent forms and baseline surveys to distribute to their selected high-risk relatives. Relatives’ baseline survey will obtain information on their: a) current breast cancer screening status and use of genetic counseling; and b) perceived barriers and facilitators to screening. Young breast cancer survivors and high-risk relatives will be randomized as a family unit to receive two versions of an intervention aiming to increase breast cancer screening and use of cancer genetic services. A follow-up survey will be mailed 9 months after the intervention to survivors and high-risk relatives to evaluate the efficacy of each intervention version on: a) use of breast cancer screening and genetic counseling; b) perceived barriers and facilitators to screening; c) self-efficacy in utilizing cancer genetic and screening services; d) family support related to screening; e) knowledge of breast cancer genetics; and f) satisfaction with the intervention. Discussion The study will enhance efforts of the state of Michigan surrounding cancer prevention, control, and public health genomics. Trial registration NCT01612338

To examine the frequency of leisure-time physical activity (LTPA) in relation to depressive symptoms in a nationally representative sample of African American (AA) women and AA men with guidance by Stokols' Social Ecological Framework.A secondary analysis of AA women (n=1811) and AA men (n=1038) was performed on the National Survey of American Life, where a four stage national area probability sampling was conducted. Interviews were conducted 2001-2003. Clinically depressed AA were excluded from the current study. LTPA was measured by self-report frequency (never, rarely, sometimes, often) of participation in sports/exercise. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the relationship between LTPA and depressive symptoms, adjusting for biopsychobehavioral and sociophysical environmental factors.Compared with AA women and AA men who reported never participating in LTPA, the multivariate OR for depressive symptoms in AA women and AA men who reported participating in LTPA often was 0.42 (95% CI=0.24-0.72) and 0.41 (95% CI=0.25-0.69) respectively.Increased frequency of LTPA was associated with fewer depressive symptoms in a nationally representative sample of non-clinically depressed AAs.

Noise-induced hearing loss (NIHL) is a major occupational health problem that can be prevented through the use of hearing protection devices (HPDs).The purpose of this study is to identify significant factors related to firefighters' use of HPDs.A total of 404 firefighters from 35 fire departments in multiple states in the United States participated in an Internet-based survey from March 2010 to May 2011.Pearson correlations and multiple regression analysis suggested that several modifying and cognitive-perceptual factors were significantly related to HPD use, including noise exposure, interpersonal influences, organizational support, perceived barriers to HPD use, and perceived susceptibility to hearing loss. The multiple regression model explained 56% (R(2) = .56, adjusted R(2) = .54) of the variance in firefighters' use of HPDs (F(13, 372) = 35.65, p .001).Future research should focus on incorporating these significant predictors into effective behavioral interventions designed to promote the use of HPDs in this population.

Operating Engineers (heavy equipment operators in construction) may be at particular risk for heart disease and cancer related to their exposure to environmental dust and smoking, the sedentary nature of their job, and long hours of exposure to the sun. The aim of this study was to characterize the health behaviors of Operating Engineers. This cross-sectional survey from a convenience sample of Operating Engineers ( N = 498) used validated instruments to measure smoking, drinking, diet, exercise, sleep, and sun exposure. Univariate and bivariate analyses to detect differences by age were conducted. The sample scored significantly worse on all five health behaviors compared to population norms. Those who were older were less likely to smoke and chew tobacco and more likely to eat fruits and vegetables. Many were interested in services to improve their health behaviors. Health behavior interventions are needed and wanted by Operating Engineers.

Assessing veterans' desire to see a chaplain can be difficult. Due to alleged personal weakness associated with seeing a chaplain while on active duty, veterans may still be reluctant to admit a need. Additionally chaplains may be challenged with multiple time demands. We devised and correlated with known instruments a single item containing four graded responses. One correlation was strong, suggesting the question's potential for serving as a useful tool for allocation of chaplains' time.

A survey was conducted to identify (a) factors that influence preventive dental behaviors and (b) target groups for interventions. Data were collected in face-to-face interviews with a probability sample of 662 dentate adults living in the Detroit tricounty area. The interviews included questions about demographic and socioeconomic variables and about three preventive behaviors: brushing, flossing, and preventive dental visits. All behaviors were positively associated with socioeconomic status. Females were more likely than males to perform each of the behaviors at the recommended frequency. The behaviors were only weakly associated with age. Whites were more likely than nonwhites to make regular dental visits, but frequency of brushing and flossing did not vary substantially across racial groups. The impact of race on frequency of dental visits was reduced when socioeconomic status was statistically controlled. Findings suggest that socioeconomic status, race, and sex remain important considerations when planning dental health education or other interventions.

The specific aims of this study were to develop a questionnaire and conduct a survey of college students 18-22 years of age, in order to determine (1) their perception of being vulnerable and susceptible to health problems and (2) their interest in receiving help and information about health maintenance. Material from four 2-h focus groups provided the content for the initial questionnaire. Pilot testing of the early drafts consisted of several phases in which students completed the tool in both group situations and in face-to-face interviews. The final questionnaire was completed by 364 students on two campuses in the Midwest. Two scales were identified using factor analysis and analysis for internal consistency. The Vulnerability/Susceptibility Scale demonstrated a good reliability (Kuder-Richardson-20 = 0.8136) and five factors were identified through factor analysis. The Information Scale demonstrated a high reliability (Kuder-Richardson-20 = 0.8958) and two factors were identified through factor analysis. Based on analysis of variance (ANOVA) data, a model was developed using the variables of the Vulnerability/Susceptibility Scale, the Information Scale, gender and health rating. The model was then tested using multiple regression analysis. This study identified health related areas about which the students feel vulnerable/susceptible and are interested in receiving health help/information. This study suggests which population of college students might be most receptive to health information and future behavioral strategies.

The objective of this study was to determine the predictors of sleep quality among head and neck cancer patients 1 year after diagnosis.This was a prospective, multisite cohort study of head and neck cancer patients (N = 457).Patients were surveyed at baseline and 1 year after diagnosis. Chart audits were also conducted. The dependent variable was a self-assessed sleep score 1 year after diagnosis. The independent variables were a 1 year pain score, xerostomia, treatment received (radiation, chemotherapy, and/or surgery), presence of a feeding tube and/or tracheotomy, tumor site and stage, comorbidities, depression, smoking, problem drinking, age, and sex.Both baseline (67.1) and 1-year postdiagnosis (69.3) sleep scores were slightly lower than population means (72). Multivariate analyses showed that pain, xerostomia, depression, presence of a tracheotomy tube, comorbidities, and younger age were statistically significant predictors of poor sleep 1 year after diagnosis of head and neck cancer (P.05). Smoking, problem drinking, and female sex were marginally significant (P.09). Type of treatment (surgery, radiation and/or chemotherapy), primary tumor site, and cancer stage were not significantly associated with 1-year sleep scores.Many factors adversely affecting sleep in head and neck cancer patients are potentially modifiable and appear to contribute to decreased quality of life. Strategies to reduce pain, xerostomia, depression, smoking, and problem drinking may be warranted, not only for their own inherent value, but also for improvement of sleep and the enhancement of quality of life.

Cognitive assessment in individuals with cancer requires both measured performance on neuropsychological tests and self-report of effectiveness in functioning. Few instruments are available to assess the perceived impact of cognitive alterations on daily functioning in individuals treated for cancer. In this study, we investigated the psychometric properties of a theoretically based instrument, and the Attentional Function Index (AFI), designed to measure perceived effectiveness in common activities requiring attention and working memory, particularly the ability to formulate plans, carry out tasks, and function effectively in daily life.Women (N=172), ages 27-86 years, completed the questionnaire before primary treatment for early stage breast cancer. Construct validity was established using exploratory principal component factor analysis with varimax rotation.A 13-item instrument emerged with 3 subscales, namely effective action, attentional lapses, and interpersonal effectiveness, which explained 74.69% of total variance. The internal consistency coefficients (Cronbach's α) were 0.92 for the total instrument, and ranged from 0.80 to 0.92 for the 3 subscales. Further examination of validity indicated that the scores on the AFI (1) showed expected correlations with established measures of ability to concentrate, cognitive failures, states of confusion, and mental fatigue, and (2) could distinguish differences in perceived cognitive functioning between younger and older age groups. AFI scores were not significantly associated with years of education or presence of comorbid conditions.The brief AFI has demonstrated usefulness for assessment of perceived cognitive functioning in populations with life-threatening and chronic illness, such as breast cancer.

Background: Similar to patients with other chronic disorders, patients with serious mental illness (SMI) are often poorly adherent with prescribed medications. Objective: We conducted a randomized controlled trial examining the effectiveness of a pharmacy-based intervention (Meds-Help) in increasing antipsychotic medication adherence among Department of Veterans Affairs (VA) patients with SMI. We also examined the impact of Meds-Help on psychiatric symptoms, quality of life, and satisfaction with care. Methods: We enrolled 118 patients from 4 VA facilities with schizophrenia, schizoaffective, or bipolar disorder who were on long-term antipsychotics but had antipsychotic medication possession ratios (MPRs)

Title. Correlates of recent and regular mammography screening among AsianAmerican women. Aim. This paper is a report of a study of the health beliefs, knowledge and selected demographic variables that influence mammography utilization among AsianAmerican women. Background. Breast cancer is the most frequently occurring cancer in AsianAmerican women and its incidence is increasing at a greater rate than for other racial and ethnic groups in the United States of America (USA). Compared to White women, breast cancer also is more likely to be diagnosed at a later stage with larger tumours in Asian-Americans. Method. A self-administered questionnaire was used with Asian-American women residing in the USA. Data were collected in 2005 and 315 women participated in the study. Results. Fifty-five per cent of participants reported having their last mammogram within the past 13 months, and 33% reported having annual mammograms in each of the past 5 years. Based on multivariate logistic regression analyses, clinical breast examination, barriers and knowledge of recommendations of the frequency of mammography screening were associated with both recent and regular mammography practice after controlling for all other demographic, psychosocial and behavioural variables in the model. Conclusion. Intervention strategies tailored to knowledge, language and cultural factors associated with mammography use should target at-risk subgroups, particularly those who are recent immigrants and those with limited English language ability. Culturally appropriate strategies should be developed to promote lifelong mammography screening for this rapidly growing and diverse population.

Purpose Our prior work has shown that the health behaviors of head and neck cancer patients are interrelated and are associated with quality of life; however, other than smoking, the relationship between health behaviors and survival is unclear. Patients and Methods A prospective cohort study was conducted to determine the relationship between five pretreatment health behaviors (smoking, alcohol, diet, physical activity, and sleep) and all-cause survival among 504 head and neck cancer patients. Results Smoking status was the strongest predictor of survival, with both current smokers (hazard ratio [HR] = 2.4; 95% CI, 1.3 to 4.4) and former smokers (HR = 2.0; 95% CI, 1.2 to 3.5) showing significant associations with poor survival. Problem drinking was associated with survival in the univariate analysis (HR = 1.4; 95% CI, 1.0 to 2.0) but lost significance when controlling for other factors. Low fruit intake was negatively associated with survival in the univariate analysis only (HR = 1.6; 95% CI, 1.1 to 2.1), whereas vegetable intake was not significant in either univariate or multivariate analyses. Although physical activity was associated with survival in the univariate analysis (HR = 0.95; 95% CI, 0.93 to 0.97), it was not significant in the multivariate model. Sleep was not significantly associated with survival in either univariate or multivariate analysis. Control variables that were also independently associated with survival in the multivariate analysis were age, education, tumor site, cancer stage, and surgical treatment. Conclusion Variation in selected pretreatment health behaviors (eg, smoking, fruit intake, and physical activity) in this population is associated with variation in survival.

Background Various factors in hospitals can adversely affect patients’ outcomes, including faulty communication between nurses and physicians. Whether specific communication elements (timeliness, accuracy, openness, understanding) can influence adverse outcomes is unknown. Objectives To determine the relationships between patients’ outcomes and (1) nurses’ perceptions of elements of communication between nurses and physicians and (2) characteristics of the practice environment. Methods A cross-sectional survey design was used. Information on ventilator-associated pneumonia, bloodstream infection associated with a central catheter, and pressure ulcers was collected from 25 intensive care units in southeastern Michigan. Simultaneously, 462 nurses in those units (response rate, 53.3%) were anonymously surveyed. The Conditions for Work Effectiveness Questionnaire-II and the Practice Environment Scale of the Nursing Work Index were used to measure characteristics of the practice environment. The Intensive Care Unit Nurse-Physician Questionnaire was used to measure communication between nurses and physicians. Statistical tests included correlation and multiple regression. Analyses were conducted at the unit level. Results Unit response rates varied from 6% to 100%. Together, variability in understanding communication and capacity utilization were predictive of 27% of the variance in ventilator-associated pneumonia. Timeliness of communication was inversely related to pressure ulcers (r= −0.38; P=.06), and workplace empowerment and scores on the Acute Physiology and Chronic Health Evaluation III were positive predictors of ventilator-associated pneumonia (R2=0.36; P=.005). Conclusions Not all elements of communication were related to the selected adverse outcomes. The connection between characteristics of the practice environment at the unit level and adverse outcomes remains elusive.

This article reports results of a randomized controlled trial designed to test an intervention to increase parent-adolescent sexual risk communication among Mexican parents. Data were analyzed from parents (n = 791) randomly assigned to an HIV risk reduction or health promotion intervention. Measures were administered at pretest, posttest, and 6- and 12-month follow-ups. Generalized estimation equation (GEE) analysis indicates parents in the HIV risk reduction intervention reported significantly more general communication (p < .005), more sexual risk communication (p < .001) and more comfort with communication (p < .001) than parents in the control intervention. Behavioral, normative, and control beliefs significantly mediated the effect of the intervention on all communication outcomes. This study demonstrates the efficacy of an intervention to increase the quality and quantity of parent-adolescent communication related to general and sex-specific communication.

Smoking negatively affects serum carotenoid levels, and it is a negative prognostic factor for head and neck cancer. In this study, micronutrient levels were examined in 60 smoking and non-smoking head and neck cancer patients. The goal was to determine if oxidation of the carotenoid lycopene would occur to a greater extent in smokers. Subjects were drawn from a prospective cohort study and matched on seven demographic factors. Serum levels of alpha-carotene, zeaxanthin, and 2,6-cyclolycopene-1,5-diol A, an oxidation product of lycopene, were all lower in smokers versus non-smokers (18%, 22%, and 8%, respectively) while beta-carotene, beta-cryptoxanthin, and lutein were about the same in the two groups. Levels of lycopene, gamma-tocopherol, and alpha-tocopherol were higher in smokers, and notably serum alpha-tocopherol was 48% higher in smokers. The majority of vitamin E intake was from supplements. The higher levels of alpha-tocopherol in smokers were interesting in that higher alpha-tocopherol levels have been associated with higher mortality in head and neck cancer. Although this was a pilot investigation, there was no evidence that 2,6-cyclolycopene-1,5-diol A formation was appreciably affected by smoking status, but alpha-tocopherol levels were higher in smokers.

To characterize and compare quality of life (QOL) in patients with head and neck cancer shortly before initial treatment and 1 year later and to study the predictors of changes in QOL over 1 year.Prospective cohort study.Three otolaryngology clinics.Three hundred sixteen patients having newly diagnosed squamous cell head and neck cancer.Health-related QOL was assessed using the 36-item Short-Form Health Survey and a head and neck cancer-specific QOL scale.Over 1 year, QOL decreased for physical functioning measures and eating but improved for mental health QOL. Depression and smoking were major predictors of poor QOL at baseline. Major predictors of change in QOL from baseline to 1 year were treatment factors, especially feeding tube placement (9 scales), chemotherapy (3 scales), and radiation therapy (3 scales). Baseline smoking and depressive symptoms also remained significant predictors of several QOL scales at 1 year.Health-related physical QOL tended to decline over 1 year and mental health QOL improved. The major predictors of change in QOL were treatment factors, smoking, and depressive symptoms. Physicians should alert patients to the relative effects on QOL one may experience with different treatments.

Background. This prospective, cohort study is the first to describe 5 health behaviors of head and neck cancer patients the first year after diagnosis. Methods. Patients (N ¼ 283) were recruited in otolaryngol- ogy clinic waiting rooms and asked to complete written surveys. A medical record audit was also conducted. Descriptive statis- tics and multivariate analyses were conducted to determine which variables were associated with the 5 health behaviors. Results. Half of the patients smoked and 25% were problem drinkers. Over half of the smokers and drinkers quit 1 year post- diagnosis. Smoking and problem drinking were highly associ- ated and both were associated with lower body mass index (BMI) (p < .01). Moreover, physical activity and sleep were associated with each other (p < .01). Low SLEEP (Medical Out- comes Study Sleep Scale) scores were common and highly associated with depression (p < .01). Conclusion. The health behaviors of head and neck cancer patients are interrelated, and assessing and treating these behaviors together may be beneficial. V C 2007 Wiley Periodi

Advances in computer technology and accessibility enable researchers to provide individually tailored interventions for behavioral change. Using multimedia technology, this study developed and tested a computer-based hearing test and a tailored intervention. The purpose of this study was to evaluate, using a randomized experimental design, the efficacy of the intervention to increase workers’ use of hearing protection. The tailored intervention developed by the research team showed more significant short-term effect measured immediately after the intervention than the control intervention. For the long-term effect measured 1 year after the intervention, both tailored and control groups showed significant increase in their reported use (7% vs. 6%) from preintervention to postintervention, but no significant difference between the two groups. The change accomplished in this study was small progress toward the desired level of 100% use of hearing protection to prevent noise-induced hearing loss. This finding showed that changing workers’ hearing protection behavior is difficult.