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This study examined whether the frequency of participation in religious activities and seeking care from spiritual and other traditional medicine (TM) practitioners were associated with blood glucose (HbA1c) control among urban Ghanaians with type 2 diabetes mellitus (T2DM). Findings revealed that increased frequency of participation in religious activities was significantly associated with decreased HbA1c levels, whereas increased use of TM practitioners was significantly associated with increased HbA1c levels. These findings suggest that strategically integrating religious activities into disease management plans for Ghanaians with T2DM who identify as being religious may be a viable intervention mechanism.

The purpose of this qualitative study is to elucidate how food insecurity affects diabetes self-management among adults with type 2 diabetes mellitus (T2DM). Eleven persons with T2DM who screened a...

Background Social support, which is partly emotional support, is associated with adherence to colorectal cancer (CRC) treatment, quality of life, and survival. We hypothesized that the needs, sources, and availability of emotional support would vary by race and income among CRC patients and sought to quantify the emotional support and the perceived adequacy of support reported by patients. Methods We surveyed CRC patients from Detroit and Georgia Surveillance, Epidemiology and End Results registries about the quantity and quality of emotional support received from different sources. We tested differences using the chi-square test, t-tests, and logistic regression. Results There were 1909 patients who met inclusion criteria and 1301 (68%) completed surveys. Among respondents, 68% were white, 25% black, and 7% other. Black patients were more likely to be female and younger and reported lower annual income and education. Patients reported high support from several sources. Among those with a spouse/partner (58%), 95% reported high levels of support; however, older, black, female, or lower income patients were less likely to have spouses/partners ( P < .001). Patients also endorsed high support from family (88.6%), important others (82.9%), and clinicians (71.3%). Black patients were less likely than white patients to report support that was “just right” ( P < .001). Discussion Most patients reported high emotional support from at least 1 source. Black patients were most at risk for low support or unmet support needs. Spouse/partner support was important but only available to 58% of respondents. Patients at risk for unmet emotional support needs may benefit from additional support resources.

Objective: Early identification of individuals who are at risk for suicide is crucial in supporting suicide prevention. Machine learning is emerging as a promising approach to support this objective. Machine learning is broadly defined as a set of mathematical models and computational algorithms designed to automatically learn complex patterns between predictors and outcomes from example data, without being explicitly programmed to do so. The model's performance continuously improves over time by learning from newly available data.Method: This concept paper explores how machine learning approaches applied to healthcare data obtained from electronic health records, including billing and claims data, can advance our ability to accurately predict future suicidal behavior.Results: We provide a general overview of machine learning concepts, summarize exemplar studies, describe continued challenges, and propose innovative research directions.Conclusion: Machine learning has potential for improving estimation of suicide risk, yet important challenges and opportunities remain. Further research can focus on incorporating evolving methods for addressing data imbalances, understanding factors that affect generalizability across samples and healthcare systems, expanding the richness of the data, leveraging newer machine learning approaches, and developing automatic learning systems.

This study described experiences of caregivers of persons with Alzheimer’s disease and other dementias (ADRD) and caregivers of persons with other chronic conditions on self-reported health, type of assistance they provide, perceptions of how caregiving interferes with their lives, and perceived level of support. A secondary analysis was conducted of the 2013 Porter Novelli SummerStyles survey data. Of the 4,033 respondents, 650 adults self-identified as caregivers with 11.6% caring for people with ADRD. Over half of all caregivers reported that caregiving interfered with their lives to some extent. The greater the perceived support caregivers reported, the less they thought that caregiving interfered with their lives (p

Key Points Question Is cumulative social risk (ie, co-occurring sociodemographic barriers) associated with lower receipt of chemotherapy among patients with advanced colorectal cancer, and does social support moderate this association? Findings Data from a cross-sectional survey of 1087 diverse adults with stage III colorectal cancer indicated that participants with 3 or more social risk factors were less likely to receive chemotherapy than participants with 0 risk factors. The association of cumulative social risk with chemotherapy receipt was moderated by access to social support. Meaning These findings suggest that assessing cumulative social risk may identify patients with advanced colorectal cancer who are at higher risk for omitting chemotherapy., This survey study examines whether cumulative social risk is associated with lower receipt of chemotherapy among patients with advanced colorectal cancer (CRC) and whether social support moderates this association., Importance Approximately 38% of patients with advanced colorectal cancer do not receive chemotherapy. Objective To determine whether cumulative social risk (ie, multiple co-occurring sociodemographic risk factors) is associated with lower receipt of chemotherapy among patients with advanced colorectal cancer and whether social support would moderate this association. Design, Setting, and Participants This cross-sectional, population-based, mailed survey study was conducted from 2012 to 2014. Participants were recruited between 2011 and 2014 from all adults within 1 year after diagnosis of stage III colorectal cancer in the Detroit, Michigan, and State of Georgia Surveillance, Epidemiology, End-Results cancer registries. Patients were eligible if they were aged 18 years or older, had undergone surgery 4 or more months ago, did not have stage IV cancer, and resided in the registry catchment areas. Data analyses were conducted from March 2017 to April 2021. Main Outcomes and Measures The primary outcome was receipt of chemotherapy. Cumulative social risk represented a sum of 8 risk factors with the potential to drain resources from participants’ cancer treatment (marital status, employment, annual income, health insurance, comorbidities, health literacy, adult caregiving, and perceived discrimination). Social support was operationalized as emotional support related to colorectal cancer diagnosis. Results Surveys were mailed to 1909 eligible patients; 1301 completed the survey (response rate, 68%). A total of 1087 participants with complete data for key variables were included in the sample (503 women [46%]; mean [SD] age, 64 [13] years). Participants with 3 or more risk factors were less likely to receive chemotherapy than participants with 0 risk factors (3 factors, odds ratio [OR], 0.48 [95% CI, 0.26-0.87]; 4 factors, OR, 0.41 [95% CI, 0.21-0.78]; 5 factors, OR, 0.42 [95% CI, 0.20-0.87]; ≥6 factors, OR, 0.22 [95% CI, 0.09-0.55]). Participants with 2 or more support sources had higher odds of undergoing chemotherapy than those without social support (2 sources, OR, 3.05 [95% CI, 1.36-6.85]; 3 sources, OR, 3.24 [95% CI, 1.48-7.08]; 4 sources, OR, 3.69 [95% CI, 1.71-7.97]; 5 sources, OR, 4.40 [95% CI, 1.98-9.75]; ≥6 sources, OR 5.95 [95% CI, 2.58-13.74]). Within each social support level, participants were less likely to receive chemotherapy as cumulative social risk increased. Conclusions and Relevance Cumulative social risk was associated with reduced receipt of chemotherapy. These associations were mitigated by social support. Assessing cumulative social risk may identify patients with colorectal cancer who are at higher risk for omitting chemotherapy who can be targeted for support programs to address social disadvantage and increase social support.

Biosensors enable observation and understanding of latent physiological occurrences otherwise unknown or invasively detected. Wearable biosensors monitoring physiological constructs across a wide variety of mental and physical health conditions have become an important trend in innovative research methodologies. Within substance use research, explorations of biosensor technology commonly focus on identifying physiological indicators of intoxication to increase understanding of addiction etiology and to inform treatment recommendations. In this review, we examine the state of research in this area as it pertains to treatment of alcohol use disorders specifically highlighting the gaps in our current knowledge with recommendations for future research. Annually, alcohol use disorders affect approximately 15 million individuals. A primary focus of existing wearable technology-based research among people with alcohol use disorders is identifying alcohol intoxication. A large benefit of wearable biosensors for this purpose is they provide continuous readings in a passive manner compared with the gold standard measure of blood alcohol content (BAC) traditionally measured intermittently by breathalyzer or blood draw. There are two primary means of measuring intoxication with biosensors: gait and sweat. Gait changes have been measured via smart sensors placed on the wrist, in the shoe, and mobile device sensors in smart phones. Sweat measured by transdermal biosensors detects the presence of alcohol in the blood stream correlating to BAC. Transdermal biosensors have been designed in tattoos/skin patches, shirts, and most commonly, devices worn on the ankle or wrist. Transdermal devices were initially developed to help monitor court-ordered sobriety among offenders with alcohol use disorder. These devices now prove most useful in continuously tracking consumption throughout clinical trials for behavioral treatment modalities. More recent research has started exploring the uses for physical activity trackers and physiological arousal sensors to guide behavioral interventions for relapse prevention. While research has begun to demonstrate wearable devices' utility in reducing alcohol consumption among individuals aiming to cutdown on their drinking, monitoring sustained abstinence in studies exploring contingency management for alcohol use disorders, and facilitating engagement in activity-based treatment interventions, their full potential to further aid in understanding of, and treatment for, alcohol use disorders has yet to be explored.

Background Warning labels are a fundamental public health strategy for communicating about tobacco product risks, but effective warning labels for heated tobacco products (HTPs) and e-cigarettes (ECs) are yet to be determined. We examined the effect of two warning label systems for communicating the relative risks of using cigarettes, HTPs, and ECs. Methods 1,280 Korean adults were recruited from an online commercial panel, including susceptible non-users of cigarettes, HTPs, or ECs aged 19 to 29 (n = 444) and current users of these tobacco products aged 19 or older (n = 836). Participants viewed packages for cigarettes, HTPs, and ECs in a 2 × 2 between-subject experiment: “dashboard” icons integrated into warnings vs. no dashboard; different-sized warnings (70% of cigarette packages, 50% of HTP packs, 30% of EC packages) vs. current equal-sized warnings (50% of cigarette/HTP/EC packages). Results Participants exposed to the dashboard warning system were more likely than those who were not to report higher perceived harm of cigarettes than ECs, cigarettes than HTPs, and HTPs than ECs, as well as perceived benefit of switching from cigarettes to HTPs, cigarettes to ECs, and HTPs to ECs. Participants exposed to the different-sized warning system did not report differences in perceived relative harm or benefit compared to those who were not, and no interaction of dashboard warnings with warning sizes was found. Conclusion The use of dashboard icons with texts and colors representing different levels of risk may promote public understanding about the continuum of risk across tobacco products.

Background Insomnia is frequently comorbid with chronic migraine, and small trials suggest that cognitive-behavioral treatment of insomnia (CBTi) may reduce migraine frequency. This study endeavored to provide a quantitative synthesis of existing CBTi trials for adults with chronic migraine using Bayesian statistical methods, given their utility in combining prior knowledge with sequentially gathered data. Methods Completer analyses of 2 randomized trials comparing CBTi to a sham control intervention (Calhoun and Ford, 2007; Smitherman et al, 2016) were used to quantify the effects of a brief course of treatment on headache frequency. Change in headache frequency from baseline to the primary endpoint (6-8 weeks posttreatment) was regressed on group status using a Gaussian linear model with each study specified in the order of completion. To estimate the combined effect, posterior distributions from the Calhoun and Ford study were used as informative priors for conditioning on the Smitherman et al data. Results In a combined analysis of these prior studies, monthly headache frequency of the treatment group decreased by 6.2 days (95%CrI: -9.7 to -2.7) more than the control group, supporting an interpretation that there is a 97.5% chance that the treatment intervention is at least 2.7 days better than the control intervention. The analysis supports the hypothesis that at least for those who complete treatment, there is high probability that individuals who receive CBTi experience greater headache reduction than those who receive a control intervention equated for therapist time and out-of-session skills practice. Conclusion Cognitive-behavioral interventions for comorbid insomnia hold promise for reducing headache frequency among those with chronic migraine. These findings add to a small but growing body of literature that migraineurs with comorbid conditions often respond well to behavioral interventions, and that targeting comorbidities may improve migraine itself.

PROBLEM IDENTIFICATION Lung cancer survivors face many challenges that affect their quality of life and survival. A growing concern is the layered effect of stigma related to cigarette smoking and the perceived life-threatening diagnosis of lung cancer. This experience may affect lung cancer survivors' physical, psychological, and social well-being, negatively influencing their quality of life. LITERATURE SEARCH CINAHL®, PubMed®, PsycINFO®, and Web of Science were searched from January 2000 through August 2017, using combinations of four keywords. DATA EVALUATION Extracted data included research aims, design, method, analytical approach, sample size, gender, ethnicity/race, setting, stigma measure, smoking status, and major results. SYNTHESIS Of 163 studies initially identified, 30 (19 quantitative, 8 qualitative, 2 theoretical reviews, and 1 mixed method) were included. Quantitative studies were analyzed by statistical significance and relevant findings. Thematic analysis was used to evaluate qualitative studies. IMPLICATIONS FOR RESEARCH Future research should focus on the development and testing of tailored and multilevel interventions to support the management of stigma and lessen the negative impact it has on quality of life, with special considerations for vulnerable subpopulations.

Objective This mixed methods study sought to understand who makes decisions about whether preschool-aged Mexican American children engage in eating, outdoor play, sleep, and screen time behaviors. Methods Forty Mexican American mothers of children ages 3–4 participated in two interviews, during which both closed- and open-ended questions elicited perceptions of who made decisions for the four behaviors, as well as who was present, mealtime rules, and food choice values. Interviews were transcribed, coded for emergent themes, and compared across participants. Results Participants generally perceived themselves to be primary decision makers for all four behaviors; however, food decisions often seemed to be made collaboratively with the child. Fathers were most likely to participate in evening television decisions. Other family members were rarely mentioned. Selecting foods that children liked was a strong food choice value, while cost was rarely mentioned. Participants appeared to have low perceived control over their child's behaviors relative to their perceived roles in decision making. Conclusions Mothers may be the primary audience for obesity prevention messages for preschool-aged, Mexican American children; however, health promotion programs may need to increase mothers' awareness of their control over children's behaviors. Understanding how children's behaviors are regulated is an important aspect of obesity prevention for low-income, Mexican American children.

Depression is a leading cause of disability and is associated with suicide risk. However, a quarter of patients with major depression remain undiagnosed. Prior work has demonstrated that a smartphone user's depression level can be detected by analyzing data gathered from their smartphone's sensors or from their social media posts over a few weeks after enrollment in a user study. These studies typically utilize a prospective study design, which is burdensome as it requires participants smartphone data to be gathered for prolonged periods before their depression level can be assessed. In contrast, we present a feasibility study of our Mood Assessment Capable Framework (Moodable) that facilitates almost instantaneous mood assessment by analyzing instantaneous voice samples provided by the user as well as historical sensor data harvested (scraped) from their smartphone and recent social media posts. Our retrospective, low-burden approach means that Moodable no longer requires study participants to engage with their phone for weeks before a depression score can be inferred. Moodable has the potential to minimize user data collection burden, increase user compliance, avoid study awareness bias and offer a near instantaneous depression screening. To lay a solid foundation for Moodable, we first surveyed 202 volunteer participants about their willingness to share voice samples and various smartphone and social media data types for mental health assessment. Based on these findings, we then developed the Moodable app. Thereafter, we utilized Moodable to collect short voice samples, and a rich array of retrospectively harvested data from users' smartphones (location, browser history, call logs) and social media accounts (instagram, twitter and facebook), with appropriate permissions, of 335 volunteer participants who also responded to 9 depression related questions of the Patient Health Questionaire (PHQ-9). Moodable then used machine learning to build classification models and classify the user's depression and suicidal ideation, for users which scores where unknown to the models. Results of Moodable's screening capability are promising. In particular, for the depression classification task we achieved F1 scores (the harmonic mean of the precision and recall) of 0.766, sensitivity of 0.750, and specificity of 0.792. For the suicidal ideation task we achieved F1 scores of 0.848, sensitivity of 0.864, and specificity of 0.725. This work could significantly increase depression-screening at the population level and opens numerous avenues for further research into this newly proposed paradigm of instantaneously screening depression and suicide risk levels from voice samples and retrospective smartphone and social media data.

Objective We examined the perspectives of child and family-serving professionals (CFSP) and state policymakers on protective factors to develop policy and program recommendations including current and needed approaches for addressing ACEs. Methods In 2018, we conducted semi-structured, in-depth interviews with 23 CFSP and 24 state policymakers in South Carolina. Data were analyzed applying the Multiple Streams Theory using thematic analyses. Results CFSPs and policymakers had varying opinions on state government involvement and primary prevention for ACEs. Three protective factors emerged from their perspectives: 1) loving, trusting, and nurturing relationships; 2) safe home environments; and 3) opportunities to thrive. For each of these protective factors, participants suggested policy options that support existing community efforts, attempt to alleviate poverty, and improve child and family serving systems. Conclusion This study suggests that CFSPs and policymakers recognize the importance of protective factors in a child’s life to buffer the effect of ACEs. More awareness is needed about the feasibility and significance of primary prevention of ACEs. The study’s findings can be used to strengthen advocacy priorities for a wide range of public health outcomes associated with ACEs and help further bridge the gap between research and policy.

In contrast to well-established relationships between headache and affective disorders, the role of alcohol use in primary headache disorders is less clear. This paper provides a narrative overview of research on alcohol use disorders (AUDs) in primary headache and presents a meta-analysis of the role of alcohol as a trigger (precipitant) of headache. The majority of studies on AUDs in headache have failed to find evidence that migraine or tension-type headache (TTH) is associated with increased risk for AUDs or problematic alcohol use. The meta-analysis indicated that 22% (95% CI: 17–29%) of individuals with primary headache endorsed alcohol as a trigger. No differences were found between individuals with migraine (with or without aura) or TTH. Odds of endorsing red wine as a trigger were over 3 times greater than odds of endorsing beer. An absence of increased risk for AUDs among those with primary headache may be attributable to alcohol’s role in precipitating headache attacks for some susceptible individuals. Roughly one fifth of headache sufferers believe alcohol precipitates at least some of their attacks. Considerable study heterogeneity limits fine-grained comparisons across studies and suggests needs for more standardized methods for studying alcohol-headache relationships and rigorous experimental designs.

Objective To quantitatively synthesize extant literature on perceived triggers of primary headache disorders. Methods A meta-analytic review of headache trigger survey studies was conducted. Endorsement rates, assessment method, and headache and sample characteristics were extracted from included articles. Separate random-effects models were used to assess trigger endorsement rates and post-hoc meta-regressions examined potential moderator variables. Results 85 articles from 1958 to 2015 were included, involving 27,122 participants and querying 420 unique triggers (collapsed into 15 categories). Four-fifths (0.81; 95% CI .75 to .86) of individuals with migraine or tension-type headache endorsed at least one trigger. Rates increased with the number of categories queried (OR: 1.18, 1.08–1.30) and year of publication (OR: 1.04, 1.00–1.08). The triggers most commonly endorsed were stress (.58, .53–.63) and sleep (.41, .36–.47). Conclusions Extreme heterogeneity characterizes the headache trigger literature. Most individuals with a primary headache disorder perceive their attacks to be triggered by one or more precipitants, the most common of which are stress and sleep. However, trigger endorsement is influenced by method of assessment. Enhancing methodological consistency and prioritizing experimental studies would improve our understanding of headache triggers.

Objective Test the impact of tailoring CRC screening messages for African Americans (AAs) using novel theoretical variables and to examine moderating effect of communication preferences. Methods Participants were randomized to receive two minimally tailored or two enhanced tailored print newsletters addressing CRC. The enhanced intervention was tailored on Self-Determination Theory and other novel psychological constructs. Minimal tailoring only used information available in the patient's EHR. The primary outcome was CRC screening based on EHR. Participants were AA members aged 50–74 of an integrated health care delivery system not up to date on CRC screening. Results We enrolled 881 participants. CRC screening participation rates at 1-year follow up were 20.5% and 21.5% in the minimally and enhanced tailored groups, respectively. Communication preferences moderated the impact of the intervention. Specifically, among those with an autonomous communication preference, screening rates in the minimally and enhanced tailored groups were 17.1% and 25.9%, respectively, while no intervention effect was evident among those with a directive preference. Conclusion Future research is needed to explore the impact of communication preference tailoring for other health behaviors and among other populations. Practice implications Tailored communications should consider communication style preference to help guide the content and tone of messages.

Objective To explore how a sample of Mexican American mothers with preschool-aged children recruited from a Midwestern Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic obtained information about 4 behaviors associated with childhood obesity risk: eating, physical activity, screen time, and sleep. Design One-on-one structured interviews in which participants were asked how they communicated with family, learned to take care of their first infant, and obtained information about the 4 targeted behaviors for their preschool-aged child. Setting An urban WIC clinic in the Midwest. Participants Forty Mexican-descent mothers enrolled in WIC with children aged 3–4 years. Phenomenon of Interest Exposure to information about the 4 targeted behaviors among Mexican-descent mothers participating in WIC. Analysis Quantitative and qualitative data were used to characterize and compare across participants. Results Participants primarily obtained information from their child's maternal grandmother during their first child's infancy and from health professionals for their preschool-aged child. Participants typically obtained information through interpersonal communication, television, and magazines. Participants were most interested in healthy eating information and least interested in screen time information. Some participants did not seek information. Conclusions and Implications Participants engaged in different patterns of information seeking across their child's development and the 4 behaviors, which suggests that future research should be behaviorally specific. Findings from this study suggest several hypotheses to test in future research.

Background This research sought to further validate the rat nitroglycerin (NTG) migraine model by comparing the effects of single versus recurrent NTG episodes on behavioral endpoints that mirror ICHD-3 diagnostic criteria for migraine, and to determine if the altered behavioral endpoints are reduced after administration of sumatriptan. Methods Separate cohorts of rats were administered NTG (10 mg/kg/2 ml) or saline (Experiment 1: single injection; Experiment 2: repeated injections; Experiment 3: repeated injections with sumatriptan [0.0, 0.3 and 1.0 mg/kg/ml] rescue. Behavioral endpoints were assessed 2 h after final NTG administration and included time in light/dark chambers for photophobia and activity, pain facial ratings, and cool (5 °C) and warm (46 °C) tail dip. Results The first two experiments demonstrated that repeated (n = 5) but not single NTG injections produced photophobia, decreased activity, and yielded less weight gain than saline injections. Experiment 3 showed that sumatriptan attenuated hypoactivity, reduced facial expressions of pain, and reversed weight alterations in a dose-dependent manner. Conclusions These findings identify numerous clinical homologies of a recurrent NTG rat migraine model that may be useful for screening novel pharmacotherapies.

Obesity rates remain high among children in the United States (US), but children of low-income, minority families are at particularly high risk. Latinos are the largest and most rapidly growing US population group. Effective strategies will require attention to a wide array of culturally mediated variables that influence child feeding practices through the social contexts in which behaviors take place. This paper presents the design and implementation of a qualitative study examining low-income, Latina mothers’ perceptions of child weight status and feeding practices, and their associations with the development of overweight in children. Guided by the social ecologic model and social contextual model on the role of the family in mediating health behavior, the Latina Mother Child Feeding Practices (LMCFP) study provided a systematic exploration of the influence of social class, culture, and environmental factors associated with mothers’ perceptions of child overweight on feeding practices and behaviors. The design for this qualitative study consisted of three sequential phases: focus groups, in-depth interviews and cognitive interviews with Latina mothers conducted by Spanish-speaking researchers. Results showed the important role of socio-cultural factors in influencing Latina mothers’ child feeding practices. In the short-term, this research yielded information to develop a child-feeding questionnaire appropriate for low-income, Latina mothers. Findings have important implications in developing nutrition education strategies for child health promotion that account for the social and cultural context of minority, low-income caregivers.

PurposeThis study explores the potential utility of a culturally tailored diabetes management intervention approach by testing associations between acculturation and diabetes-related beliefs among Mexican-American adults with type 2 diabetes.MethodsData from 288 Mexican-American adults with type 2 diabetes were obtained via a bilingual, telephone-administered survey. Participants were drawn from a stratified, random sample designed to obtain maximum variability in acculturation. The survey assessed diabetes-related beliefs, intervention preferences, and the following three acculturation constructs from the Hazuda acculturation and assimilation scales: Spanish use, value for preserving Mexican culture, and interaction with Mexican Americans.ResultsOnly one outcome—preference for a program for Mexican Americans—was associated with all three acculturation variables. Spanish use was positively associated with belief in susto as a cause of diabetes, preference for expert-driven health guidance, and involvement of others in taking care of diabetes. Value for preserving Mexican culture was related to a more holistic view of health, as evidenced by an increased likelihood of consulting a curandero, use of prayer, and interest in a diabetes program with religious content. Value for cultural preservation was also related to higher suspicion of free diabetes programs. Interaction with Mexican Americans was associated with a belief that insulin causes blindness.ConclusionFindings from this study suggest distinct relationships between acculturation constructs and diabetes-related beliefs and preferences, thus arguing against the use of a single acculturation construct to determine diabetes intervention design. Cultural tailoring may enhance the cultural appropriateness and ultimate effectiveness of diabetes interventions for Mexican American adults.

Interviewer effects can have a substantial impact on survey data and may be particularly operant in public health surveys, where respondents are likely to be queried about racial attitudes, sensitive behaviors and other topics prone to socially desirable responding. This paper defines interviewer effects, argues for the importance of measuring and controlling for interviewer effects in health surveys, provides advice about how to interpret research on interviewer effects and summarizes research to date on race, ethnicity and gender effects. Interviewer effects appear to be most likely to occur when survey items query attitudes about sociodemographic characteristics or respondents' engagement in sensitive behaviors such as substance use. However, there is surprisingly little evidence to indicate whether sociodemographic interviewer-respondent matching improves survey response rates or data validity, and the use of a matched design introduces possible measurement bias across studies. Additional research is needed to elucidate many issues, including the influence of interviewers' sociodemographic characteristics on health-related topics, the role of within-group interviewer variability on survey data and the simultaneous impact of multiple interviewer characteristics. The findings of such research would provide much-needed guidance to public health professionals on whether or not to match interviewers and respondents on key sociodemographic characteristics.

Tailored health communications to date have been based on a rather narrow set of theoretical constructs. This study was designed to test whether tailoring a print-based fruit and vegetable (F & V) intervention on relatively novel constructs from self-determination theory (SDT) and motivational interviewing (MI) increases intervention impact, perceived relevance, and program satisfaction. The study also aimed to explore possible user characteristics that may moderate intervention response. African American adults were recruited from two integrated health care delivery systems, one based in the Detroit Metro area and the other in the Atlanta Metro area, and then randomized to receive three tailored newsletters over 3 months. One set of newsletters was tailored only on demographic and social cognitive variables (control condition), whereas the other (experimental condition) was tailored on SDT and MI principles and strategies. The primary focus of the newsletters and the primary outcome for the study was fruit and vegetable intake assessed with two brief self-report measures. Preference for autonomy support was assessed at baseline with a single item: “In general, when it comes to my health I would rather an expert just tell me what I should do”. Most between-group differences were examined using change scores. A total of 512 (31%) eligible participants, of 1,650 invited, were enrolled, of which 423 provided complete 3-month follow-up data. Considering the entire sample, there were no significant between-group differences in daily F & V intake at 3 month follow-up. Both groups showed similar increases of around one serving per day of F & V on the short form and half a serving per day on the long form. There were, however, significant interactions of intervention group with preference for autonomy-supportive communication as well as with age. Specifically, individuals in the experimental intervention who, at baseline, preferred an autonomy-supportive style of communication increased their F & V intake by 1.07 servings compared to 0.43 servings among controls. Among younger controls, there was a larger change in F & V intake, 0.59 servings, than their experimental group counterparts, 0.29 servings. Conversely, older experimental group participants showed a larger change in F & V, 1.09 servings, than older controls, 0.48. Our study confirms the importance of assessing individual differences as potential moderators of tailored health interventions. For those who prefer an autonomy-supportive style of communication, tailoring on values and other motivational constructs can enhance message impact and perceived relevance.

Despite widespread use of dietary supplements, little is known about correlates and determinants of their use. Using a diverse sample from 7 interventions participating in the Behavior Change Consortium (n ¼ 2539), signal detection methodology (SDM) demonstrated a method for identifying subgroups with varying supplement use. An SDM model was explored with an exploratory half of the entire sample (n ¼ 1268) and used 5 variables to predict dietary supplement use: cigarette smoking, fruit and vegetable intake, dietary fat consumption, BMI, and stage of change for physical activity. A comparison of rates of supplement use between the exploratory model groups and comparably identified groups in the reserved, confirmatory sample (n ¼ 1271) indicates that these analyses may be generalizable. Significant indicators of any supplement use included smoking status, percentage of energy from fat, and fruit and vegetable consumption. Although higher supplement use was associated with healthy behaviors overall, many of the identified groups exhibited mixed combinations of healthy and unhealthy behaviors. The results of this study suggest that patterns of dietary supplement use are complex and support the use of SDM to identify possible population characteristics for targeted and tailored health communication interventions. J. Nutr. 138: 205S‐211S, 2008.

Counseling by health care professionals represents a potentially important intervention for the prevention and treatment of pediatric obesity. One promising approach to weight-control counseling in pediatric practice is motivational interviewing. This article explores conceptual issues related to the application of motivational interviewing for the prevention and treatment of pediatric obesity. Given the paucity of studies on motivational interviewing and pediatric obesity, we examine what is known about the application of motivational interviewing to modify diet, physical activity, and other behaviors in children and adolescents. We begin with a brief overview of motivational interviewing, describe some nuances of applying this approach to pediatric overweight, and conclude with research and clinical recommendations.

This review describes empirical evidence for a bidirectional relationship between tension-type headache (TTH) and sleep. In its most severe form, chronic TTH (CTTH) affects 2-3 % of the population and can be very disabling. Sleep dysregulation triggers episodic TTH, and sleep disorders may complicate and exacerbate headache. The majority of CTTH sufferers also have insomnia, and longitudinal data suggest that insomnia is a risk factor for new-onset TTH. Similarly, observational studies suggest that sleep disturbance is a risk factor for new-onset TTH and for progression from episodic to chronic TTH (i.e., headache "chronification"). CTTH is the most common headache secondary to sleep apnea and other sleep-related breathing disorders. Psychiatric disorders are comorbid with both TTH and insomnia and may further complicate diagnosis and treatment. Developments in diagnostic classification of sleep-related headache are presented.

Background Anxiety sensitivity (AS), the fear of arousal-related bodily sensations due to beliefs about presumed harmful consequences, predicts fear and avoidance among musculoskeletal pain patients but remains largely unexplored in headache. The aims of this cross-sectional study were to evaluate AS among young adult migraine and tension-type headache sufferers and to assess relations with headache impact and perceived susceptibility to headache triggers. Methods A total of 2350 young adults (72.6% with primary headache; 64.9% female; 22.5% minority) completed measures of AS and headache symptomatology. Generalized linear models assessed relations between AS and ICHD-II diagnosis, headache-related disability, and perceived trigger susceptibility. Canonical correlation analyses quantified relations with headache symptomatology. Results AS reliably differentiated headache sufferers from those without headache, being highest among chronic migraineurs and episodic migraineurs with aura. AS accounted for 8.4% of variance in headache symptomatology and was most strongly associated with prototypical migraine symptoms. AS predicted headache-related disability and trigger variables, even after controlling for headache frequency and severity. AS accounted for more unique variance in disability than depression and anxiety symptoms combined. Conclusions AS predicts pain itself, adjustment to pain, and evaluation of factors influencing pain among primary headache sufferers, even after controlling for headache burden. Further study of AS among headache patients is warranted.

Background. Hyperoxic reperfusion from global ischemia worsens functional outcome because of oxygen radical-mediated injury. This study tested the hypothesis that hyperoxic reperfusion would exacerbate postischemic renal dysfunction. Methods. Twenty-nine healthy, uninephrectomized, male mongrel rabbits (Oryctolagus cuniculus) in 3 groups were subjected to 30 minutes of complete normothermic renal ischemia followed by reperfusion under hyperoxic or normoxic conditions. The groups were: hyperoxically reperfused (n = 8), normoxically reperfused (n = 8), hyperoxic sham (no ischemia, n = 5), and allopurinol-pretreated (50 mg/kg, intravenously), hyperoxically reperfused animals (n = 8). Plasma concentrations of creatinine, urea nitrogen and electrolytes were measured at 0, 24, 48, and 72 hours after ischemia and served as functional outcome markers. Histopathologic analysis of kidneys for injury was performed by an expert who was blinded to the procedures. Results. Plasma creatinine in hyperoxically reperfused rabbits was significantly elevated above normoxic ( P =.02) and sham ( P =.003) animals by 48 hours and remained elevated to 72 hours. Plasma urea nitrogen in hyperoxically reperfused rabbits was significantly elevated above the normoxic group ( P =.01), the sham group ( P =.02), and the allopurinol group ( P =.04) by 72 hours. These coincided with a significantly elevated histopathologic injury score in hyperoxically reperfused rabbits compared with sham ( P =.019), normoxic ( P =.035), and allopurinol-pretreated hyperoxically reperfused animals ( P =.037). Conclusions. Hyperoxic reperfusion exacerbates renal dysfunction after 30 minutes of complete normothermic ischemia. This dysfunction may be mediated by oxygen radical-related injury. (Surgery 2000;128:815-21.)

Higher rates of attrition in health research have been reported for African Americans (AAs). However, little is known about which AAs are more prone to drop out and why. One potential predictor that has not been explored is Ethnic Identity (EI). This study examined the association between EI and loss-to-follow-up among AAs enrolled in a health promotion intervention to increase fruit and vegetable intake.Five hundred and sixty AA adults from two integrated health care delivery systems in Atlanta and Detroit were enrolled into a randomized intervention trial. At baseline, all participants were classified into six EI core groups: Afrocentric, Black American, Bicultural, Multicultural, Assimilated, and High Cultural Mistrust. We examined loss-to-follow-up rates by these EI type.Overall, 92 participants (16%) were lost to follow up. Loss-to-follow-up rates were higher among those classified as Afrocentric (24%) than those without an Afrocentric identity (13%). After adjustment for covariates, Afrocentric participants were 1.9 times (CI: 1.1-3.6) more likely to be lost to follow up than participants without this identity type.Assessing EI of AAs in research studies may help identify groups at risk for dropout and/or non-response.

When research designed to close the disparities gap is conducted in real-world health care settings, unique sensitivities may arise, particularly when race is the focus of interventions. Researchers encountered this issue in the course of a randomized trial investigating the influence of ethnic identity (EI) among African American (AA) study participants. The study was conducted by the research programs at three health maintenance organizations (HMOs) and the University of Michigan Center for Health Communications Research, as described in this issue of the journal (Resnicow et al., 2009). This commentary describes the research partnership's concerns for the racially sensitive nature of the study and the precautions undertaken to mitigate them. The research study's experiences may be informative and insightful for health plans and research centers invested in health disparities research.

9579 Background: Physician-based medical decision making (DM) has declined in favor of more patient-centered approaches. Most studies indicate that patients want to be involved; however, the level of desired involvement varies between patients wanting to make their own decisions and those preferring to leave decisions to physicians. Little is known of the factors associated with DM preferences. Given data demonstrating the influence of religion among cancer patients, we explored religiosity and decision making preferences in colorectal cancer (CRC) patients. Methods: We surveyed a population-based cohort of Stage III CRC patients from the Detroit and Georgia SEER registries. Patients were queried about desired level of involvement in DM, trust in physicians, religiosity, receipt of adjuvant chemotherapy, and demographics. Religiosity was assessed using the Holland System of Belief Inventory. Physician trust was assessed using the Wake Forest Physician Trust scale. Responses were collected along a Likert scale and results were dichotomized. Surveys were analyzed using univariate and bivariate methods. Results: Thus far, 430 CRC patients have responded (56% response rate). The median participant age is 61 years, 45% are female, and 19% are black. 54% indicated a preference for shared DM, 35% prefer “doctors to make [their] decisions”, and 11% prefer to “make [their] own decisions”. The distribution did not differ by age, gender, race, income, or level of education. Higher religiosity was associated with higher trust in the surgeon (p=0.007) but not the oncologist (p=0.3). Patients with higher religiosity scores and higher physician trust were more likely to prefer that their doctors make the decisions (p= 0.023, p

TRAIL and death receptor (TRAIL-R1 and TRAIL-R2) agonistic antibodies have been shown to induce apoptosis in cancer cells and their clinical trials have produced positive results. However, there are no small organic molecular weight compounds that bind to TRAIL-death receptors and induce apoptosis specifically in cancer cells. The purpose of this study was to identify and characterize death receptor agonists (DRAs)/ small molecular weight organic compounds that induce apoptosis in breast cancer cells. The pharmacokinetics of the DRA with a single oral dose was characterized in nude mice. Blood was collected over 72 hour period after drug administration, and analyzed by HPLC-MS/MS for plasma drug concentration. The Cmax, tmax, and AUC of DRA was measured. DRAs inhibited cell viability and colony formation, and induced apoptosis in estrogen-dependent (MCF-7) and independent (MDA-MB-231 and MDA-MB-468) human breast cancer cell lines, but had no effect on human normal mammary epithelial cells and hepatocytes. The ability of DRAs to induce apoptosis was further enhanced in the presence of TRAIL. DRAs formed active TRAIL-DISC (death-inducing signaling complex) similar to that of TRAIL. DRAs inhibited the growth of orthotopically implanted MDA-MB-231 and MDA-MB-468 tumors in nude mice. Histological examination of tumor tissues derived from DRAs-treated nude mice revealed massive caspase-3 activation and apoptosis. Pharmacokinetic data demonstrate that DRA possesses a long terminal half-life, which is acceptable for further clinical development. In conclusion, we have identified, for the first time, DRAs that can be used in the clinic for the treatment of human breast cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 754.