Search

Objective: To test the efficacy of using hair stylists as lay health advisors to increase organ donation among African American clients.Design: This study was a randomized, controlled intervention trial where we randomized 52 salons (2,789 clients) to receive a 4 session, stylist-delivered health education program (comparison) or a four session brief motivational intervention that encouraged organ donation (intervention). Intervention stylists received a four-hour training in organ donation education and counseling. Organ donation was measured by self-report questionnaire at 4-month posttest as well as by verified enrollment in the Michigan Organ Donor Registry.Setting: Hair salons in Michigan urban areas.Participants: Blacks (n = 2,449), non-Blacks (n = 261) in Michigan.Main Outcome Measures: Self-reported donation status, registration in Michigan Organ Donor Registry.Results: At posttest, rates of self-reported positive donation status were 19.8% in the intervention group and 16.0% in the comparison group. In multivariate analyses, intervention participants were 1.7 times (95% Cl = 0.98-2.8) more likely than comparison participants to report positive donation status at posttest. Based on verified organ registry data, enrollment rates were 4.8% and 2%, respectively for the intervention and comparison groups. In multivariate analyses, intervention group members were 4.4 (95% CI = 1.3-15.3) more likely to submit an enrollment card than comparison participants.Conclusion: Clients of hair stylists trained to provide brief motivational intervention for organ donation were approximately twice as likely to enroll in the donor registry as comparison clients. Use of lay health advisors appears to be a promising approach to increase donation among African Americans. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We assessed change in fruit and vegetable intake in a population-based sample, comparing an online untailored program (arm 1) with a tailored behavioral intervention (arm 2) and with a tailored behavioral intervention plus motivational interviewing-based counseling via e-mail (arm 3). METHODS: We conducted a randomized controlled intervention trial, enrolling members aged 21 to 65 years from 5 health plans in Seattle, Washington; Denver, Colorado; Minneapolis, Minnesota; Detroit, Michigan; and Atlanta, Georgia. Participants reported fruit and vegetable intake at baseline and at 3, 6, and 12 months. We assessed mean change in fruit and vegetable servings per day at 12 months after baseline, using a validated self-report fruit and vegetable food frequency questionnaire. RESULTS: Of 2540 trial participants, 80% were followed up at 12 months. Overall baseline mean fruit and vegetable intake was 4.4 servings per day. Average servings increased by more than 2 servings across all study arms (P<.001), with the greatest increase (+2.8 servings) among participants of arm 3 (P=.05, compared with control). Overall program satisfaction was high. CONCLUSIONS: This online nutritional intervention was well received, convenient, easy to disseminate, and associated with sustained dietary change. Such programs have promise as population-based dietary interventions. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is a chronic, relapsing illness that is inadequately addressed in primary care practice.Objective: To compare cessation rates among smokers who receive pharmacotherapy alone or combined with either moderate- or high-intensity disease management that includes counseling and provider feedback.Design: Randomized clinical trial from June 2004 to December 2007.Setting: 50 rural primary care practices.Participants: 750 persons who smoke more than 10 cigarettes per day.Intervention: Pharmacotherapy alone (n = 250), pharmacotherapy supplemented with up to 2 counseling calls (moderate-intensity disease management) (n = 249), or pharmacotherapy supplemented with up to 6 counseling calls (high-intensity disease management) (n = 251). Interventions were offered every 6 months for 2 years. All participants were offered free pharmacotherapy. Moderate-intensity and high-intensity disease management recipients had postcounseling progress reports faxed to their physicians.Measurements: Self-reported, point-prevalence smoking abstinence at 24 months (primary outcome) and overall (0 to 24 months) analyses of smoking abstinence, utilization of pharmacotherapy, and discussions about smoking with physicians (secondary outcomes). Research assistants who were blinded to treatment assignment conducted outcome assessments.Results: Pharmacotherapy utilization was similar across treatment groups, with 473 of 741 (63.8%), 302 of 739 (40.9%), 175 of 732 (23.9%), and 179 of 726 (24.7%) participants requesting pharmacotherapy during the first, second, third, and fourth 6-month treatment cycles, respectively. Of participants who saw a physician during any given treatment cycle, 37.5% to 59.5% reported that they had discussed smoking cessation with their physician; this did not differ across the treatment groups. Abstinence rates increased throughout the study, and overall (0 to 24 months) analyses demonstrated higher abstinence among the high-intensity disease management group than the moderate-intensity disease management group (odds ratio [OR], 1.43 [95% CI, 1.00 to 2.03]) and among the combined disease management groups than the pharmacotherapy-alone group (OR, 1.47 [CI, 1.08 to 2.00]). Self-reported abstinence at 24 months was 68 of 244 (27.9%) and 56 of 238 (23.5%) participants in the high- and moderate-intensity disease management groups, respectively (OR, 1.33 [CI, 0.88 to 2.02]), and 56 of 244 (23.0%) participants in the pharmacotherapy-alone group (OR, 1.12 [CI, 0.78 to 1.61] for combined disease management vs. pharmacotherapy alone).Limitation: The effect of pharmacotherapy management cannot be separated from the provision of free pharmacotherapy, and cessation was validated in only 58% of self-reported quitters.Conclusion: Smokers are willing to make repeated pharmacotherapy-assisted quit attempts, leading to progressively greater smoking abstinence. Although point-prevalence abstinence did not differ at 24 months, analyses that incorporated assessments across the full 24 months of treatment suggest that higher-intensity disease management is associated with increased abstinence.Primary Funding Source: National Cancer Institute. [ABSTRACT FROM AUTHOR]

Body & Soul has demonstrated effectiveness as a dietary intervention among African American church members. The process evaluation assessed relationships between program exposure and implementation factors and study outcomes and characterized factors important for adoption, implementation, and maintenance. Data sources included participant surveys and qualitative interviews with program staff, church liaisons, and volunteer advisors who conducted motivational interviewing (MI) calls. Outcomes included changes in dietary intake and psychosocial variables. Process variables included program exposure, participation, and dose and perceptions about MI calls. Results showed that attendance at project events, receiving educational materials, and self-reported quality of the MI calls were associated with significantly (p < .05) greater fruit and vegetable intake, decreased fat consumption, and other secondary outcomes. Interviews indicated implementation and sustainability issues and needs including more training to enhance MI implementation as well as ongoing support and resources. The results have implications for future dissemination efforts of Body & Soul. [ABSTRACT FROM AUTHOR]

BACKGROUND: African Americans have higher tobacco-related morbidity and mortality and are more likely to smoke menthol cigarettes than their white counterparts. This study examined differences between African American menthol and non-menthol smokers in smoking characteristics and cessation. METHODS: The study sample consisted of 600 African American smokers enrolled in a clinical trial that assessed the efficacy of sustained-release bupropion for smoking cessation. Menthol (n = 471) and non-menthol (n = 129) smokers were compared on smoking-related characteristics and abstinence rates at 6 weeks and 6 months. RESULTS: Menthol smokers were younger (41.2 versus 52.9 years), more likely to be female (73.7% versus 56.6%) and more likely to smoke their first cigarette within 30 minutes of waking up (81.7% versus 69.8%) compared to non-menthol smokers (all P < 0.01). Cigarette taste (50% versus 40%, P = 0.054) was rated non-significantly higher by menthol smokers. Seven-day point-prevalence abstinence from smoking at 6 weeks were 28% and 42% (P = 0.006) and at 6 months were 21% and 27% (P = 0.21) for menthol and non-menthol smokers, respectively. At 6 weeks follow-up, stepwise logistic regression revealed that among those younger than 50 years, non-menthol smokers were more likely to quit smoking (odds ratio = 2.0; 95% CI = 1.03-3.95) as were those who received bupropion (odds ratio = 2.12; 95% CI = 1.32-3.39). CONCLUSION: African American menthol smokers had lower smoking cessation rates after 6 weeks of treatment with bupropion-SR, thereby putting menthol smokers at greater risk from the health effects of smoking. Lower overall cessation rates among African Americans menthol smokers may partially explain ethnic differences in smoking-related disease risks. [ABSTRACT FROM AUTHOR]

PURPOSE: Valid methods for assessing physical activity (PA) patterns are essential for accurate evaluation of intervention programs and population surveillance. Numerous self-report PA instruments have been validated in white adults; however, few studies have reported validity in African-Americans. METHODS: Data are from the Healthy Body/Healthy Spirit Trial, a study to increase fruit and vegetable intake and physical activity among adults in 17 black churches. Participants completed a modified version of the CHAMPS activity recall as well as components of the Yale Physical Activity Survey and the Paffenberger Activity Questionnaire. The modified CHAMPS was scored to yield four indices: moderate to vigorous physical activities (MET value > or = 3.0), vigorous activities (MET value > or = 5.0), 'Sports and Recreational Activities,' and all activities. Estimated V(O2) maximum was obtained by submaximal treadmill test in 138 participants, 109 females and 29 males. RESULTS: With the exception of moderate to vigorous activities, the modified CHAMPS indices were significantly correlated with estimated maximum VO(2). Highest correlations were observed for the index of vigorous and sports-related activities, 0.19 and 0.32, respectively. Activity measures were generally uncorrelated with blood pressure, body mass index, or total cholesterol. For the CHAMPS indices, correlations with VO(2max) and other physiologic variables were generally higher for males than females as well as those with income < 30,000 US Dollars and for those participants who did not complete college. CONCLUSION: Responses from the modified CHAMPS were moderately correlated with estimated VO(2max), with higher correlations for vigorous activity and recreational sports indices. The instrument may be useful for assessing physical activity among African-Americans. Stronger correlations for individuals with lower income and educational attainment was an unexpected finding that merits further examination. [ABSTRACT FROM AUTHOR]

This report describes a pilot study of a nursing intervention to increase adherence to combination therapy. The intervention was based on motivational interviewing (MI). Participants completed a baseline assessment using the computer-administered self-interview with audio (ACASI) data collection method and then were randomly assigned to the MI intervention or control condition. Nurse counselors met with participants in the MI intervention group for three adherence sessions. Two months following baseline, participants completed a follow-up assessment. Mean scores on ratings of missed medications were lower for participants in the intervention group than those in the control group. Although there were no significant differences in the number of medications missed during the past 4 days, participants in the MI group reported being more likely to follow the medication regimen as prescribed by their health care provider. The pilot study provided useful information about the acceptability of ACASI and the adequacy of intervention procedures. The results of this pilot study show promise for the use of MI as an intervention to promote adherence to antiretroviral medications. [ABSTRACT FROM AUTHOR]

In this article, the authors present the results of the analysis of the baseline data from Keepin' it R.E.A.L.!, an HIV prevention project developed for mothers and their adolescents. Six hundred twelve mostly male (60.6%) and African American (98.2%) adolescents completed baseline assessments. Eleven percent of the adolescent participants reported initiating sexual intercourse. Adolescent participants expressing higher levels of self-efficacy to resist peer pressure, more favorable outcome expectancies, less communication about sex with their mothers, higher levels of self-concept related to their behavior, lower levels of self-concept related to popularity, and less stress reported fewer types of intimate sexual behaviors. Adolescent participants who reported higher self-efficacy to resist peer pressure to have sex and lower levels of stress were less likely to have initiated sexual intercourse. Selected characteristics of mothers did not contribute to understanding factors associated with intimate sexual behaviors or initiation of sexual intercourse among adolescent participants. [ABSTRACT FROM AUTHOR]

This study examined differences in demography, behavior, attitude, and physician intervention among African American light, moderate, and heavy smokers. Data were derived from an intervention study designed to assess whether a smoking status stamp would increase screening for smoking status and cessation counseling by physicians. Current analysis included 879 African American smokers categorized into three groups: light (<10 cigarettes/day), moderate (10-19 cigarettes/day), or heavy (> or =20 cigarettes/day) smokers based on number of cigarettes per day smoked. Light smokers constituted 40% of study sample, 33% were moderate smokers, and 27% were heavy smokers. Light smokers were more likely to be female (p<0.001) and have a shorter smoking history (p<0.001). Light smokers were not different in age (p=0.334), or the number of previous quit attempts (p=0.551). Although light smokers were more likely than moderate and heavy smokers to be preparing to quit (p<0.001), they were less likely to be asked their smoking status (p=0.031) or told to arrange follow-up for smoking cessation (p=0.034) by their physicians. Many African American smokers are light smokers. Light smokers are more likely to be female and have a shorter smoking history. Despite their readiness to quit, compared to heavier smokers, African American light smokers are asked about smoking less often by their physicians. Programs are needed to enhance physician intervention in this understudied population of smokers. [ABSTRACT FROM AUTHOR]

BackgroundDespite the high prevalence of tobacco use among Alaska Native (AN) people, tobacco cessation interventions developed specifically for this group are lacking. Social media hold promise as a scalable intervention strategy to promote smoking treatment utilization and cessation, given the barriers to treatment delivery (ie, geographic remoteness, limited funding, climate, and travel costs) in the state of Alaska (AK). Building on a longstanding tobacco control research partnership with the AK Tribal Health System, in this study, we are developing and pilot-testing a culturally relevant, Facebook (FB)-delivered intervention that incorporates a digital storytelling approach adapted from the effective Centers for Disease Control Tips from Former Smokers campaign. ObjectiveThis study aims to promote evidence-based smoking treatment (eg, state quitline and Tribal cessation programs) uptake and cessation among AN people. MethodsThis study fulfills the objectives for stage 1 of the National Institute on Drug Abuse behavioral integrative treatment development program. In stage 1a, we will use a mixed method approach to develop the FB intervention. Cultural variance and surface/deep structure frameworks will address the influence of culture in designing health messages. These developmental activities will include qualitative and quantitative assessments, followed by beta testing of proposed intervention content. In stage 1b, we will conduct a randomized pilot trial enrolling 60 AN adults who smoke. We will evaluate the feasibility, uptake, consumer response, and potential efficacy of the FB intervention compared with a control condition (quitline/treatment referral only). Primary outcome measures include feasibility and biochemically verified smoking abstinence at 1-, 3-, and 6-month follow-ups. Secondary outcomes will include self-reported smoking cessation treatment utilization and abstinence from tobacco/nicotine products. We will also explore interdependence (relationship orientation and collaborative efforts in lifestyle change) as a culturally relevant mediator of intervention efficacy. ResultsThe study enrolled 40 participants for phase 1, with data saturation being achieved at 30 AN people who smoke and 10 stakeholders. For phase 2, we enrolled 40 participants. Qualitative assessment of proposed intervention content was completed with 30 AN smokers and 10 stakeholders. We are currently analyzing data from the quantitative assessment with 40 participants in preparation for the beta testing, followed by the randomized pilot trial. ConclusionsThe project is innovative for its use of social media communication tools that are culturally relevant in a behavioral intervention designed to reach AN people statewide to promote smoking treatment utilization and cessation. The study will further advance tobacco cessation research in an underserved disparity group. If the pilot intervention is successful, we will have a blueprint to conduct a large randomized controlled efficacy trial. Our approach could be considered for other remote AN communities to enhance the reach of evidence-based tobacco cessation treatments. International Registered Report Identifier (IRRID)DERR1-10.2196/15155

Objective: We conducted this study to determine if a smoking status stamp would prompt physicians to increase the number of times they ask, advise, assist, and arrange follow-up for African-American patients about smoking-related issues.Design: An intervention study with a posttest assessment (after the physician visit) conducted over four 1-month blocks. The control period was the first 2 weeks of each month, while the following 2 weeks served as the intervention period.Setting: An adult walk-in clinic in a large inner-city hospital.Participants: We consecutively enrolled into the study 2,595 African-American patients (1,229 intervention and 1, 366 control subjects) seen by a housestaff physician.Interventions: A smoking status stamp placed on clinic charts during the intervention period.Main Results: Forty-five housestaff rotated through the clinic in 1-month blocks. In univariate analyses, patients were significantly more likely to be asked by their physicians if they smoke cigarettes during the intervention compared with the control period, 78.4% versus 45.6% (odds ratio [OR] 4.28; 95% confidence interval [CI] 3.58, 5.10). Patients were also more likely to be told by their physician to quit, 39.9% versus 26.9% (OR 1.81; 95% CI 1.36, 2.40), and have follow-up arranged, 12.3% versus 6.2% (OR 2.16; 95% CI 1.30, 3.38).Conclusions: The stamp had a significant effect on increasing rates of asking about cigarette smoking, telling patients to quit, and arranging follow-up for smoking cessation. However, the stamp did not improve the low rate at which physicians offered patients specific advice on how to quit or in setting a quit date. [ABSTRACT FROM AUTHOR]

Researchers assessed the possible moderating effects of school organizational characteristics (school climate, school health, and job satisfaction) on outcomes of a teacher health behavior change program. Thirty-two public schools were matched and randomly assigned either to treatment or control conditions. Organizational, dietary, and physiologic data were collected from third to fifth grade teachers over three years. Treatment schools received a teacher wellness program for two years. Psychometrics of most organizational scales achieved acceptable levels of reliability. Mixed model analyses were conducted to test for moderating effects. Treatment schools with high organizational climate and health scores reported higher fruit and juice and vegetable consumption at Year 2 compared with intervention schools with low scores. Treatment schools with high job satisfaction scores reported higher fruit and juice and lower-fat food consumption at Year 3 compared with intervention schools with low scores. These measures may be used as a tool to assess the environment in which school health promotion programs are presented. Future interventions may need to be tailored to the organizational characteristics of schools. [ABSTRACT FROM AUTHOR]

Presents results of an assessment of the dietary habits of 31 Seventh-Day Adventist vegan vegetarians who consume no animal products. Association between diet and the incidence of coronary heart disease (CHD) and several types of cancer; Decreased risk for CHD and cancer among lacto-ovo vegetarians found in some studies; Mean serum total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels; More.

Since the late 1980s, the eight-component model of the comprehensive school health program (CSHP), has been adopted widely in the United States and internationally. While it is acknowledged that the eight program elements should be delivered in a coordinated, interactive manner, numerous issues regarding how this integration best can be achieved, including who at the school level should have this responsibility and how the eight components relate conceptually and logistically, have not been addressed adequately. In essence, a CSHP transforms several solo performers into an orchestra. This article proposes the school health coordinator as an essential element in the eight-component model of the CSHP -- the maestro, without whom there can be no symphony. The coordinator's principal responsibilities include administration, integration of personnel and programs, evaluation, and direct intervention. Three program elements -- staff wellness, healthy environment, and community/family involvement -- are subsumed within the coordinator's role, effectively reducing the number of program elements from eight to five. Potential benefits in addition to issues regarding feasibility of the SHC, are discussed and studies examining the effectiveness of the SHC model are recommended. [ABSTRACT FROM AUTHOR]

The authors develop and test a culturally sensitive, low-intensity smoking cessation intervention for low-socioeconomic African Americans. African American adult smokers were randomly assigned to receive either a multicomponent smoking cessation intervention comprising a printed guide, a video, and a telephone booster call or health education materials not directly addressing tobacco use. The results of the study were mixed. Although no significant effects were observed for the entire treatment cohort, the results of post hoc analyses suggest that culturally sensitive self-help smoking cessation materials plus a single phone contact can produce short-term cessation rates similar to those reported for majority populations. This conclusion should be tempered by the low completion rate for the booster call and several design limitations of the study. [ABSTRACT FROM AUTHOR]

BackgroundMarijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples but have not yet been applied to marijuana use in pregnancy. ObjectiveThe objective of the study was to evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. MethodsParticipants included patients (n=10) and medical staff (n=12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one-on-one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. ResultsPatient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 5-point Likert scale. Of the 10 participants, 5 reported that they preferred working with the program versus their doctor, and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. ConclusionsThe findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation in a randomized trial is appropriate.

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 = 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 = 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 = 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. [ABSTRACT FROM AUTHOR]

Two short frequency questionnaires, the NCI 19-item Fruit and Vegetable Screener (FVS) and a single question on overall fruit and vegetable consumption (1-item), were evaluated for their ability to assess change in fruit and vegetable (FV) consumption over time and in response to intervention among participants in 5 health promotion trials in the Behavior Change Consortium. Cross-sectional differences and correlations of FV estimates at baseline and at follow-up were compared for the FVS (n = 315) and the 1-item (n = 227), relative to multiple 24-h recall interviews (24HR). The FVS significantly overestimated daily intake by 1.27 servings at baseline among men and by 1.42 and 1.59 servings at baseline and follow-up, respectively, in women, whereas the 1-item measure significantly underestimated intake at both time points in men (0.98 serving at baseline, 0.75 serving at follow-up) and women (0.61 and 0.41 serving). Cross-sectional deattenuated correlations with 24HR at follow-up were 0.48 (FVS) and 0.50 (1-item). To evaluate the capacity of the 2 screeners to assess FV change, we compared mean posttest effects with 24HR by treatment group overall and by gender. Treatment group differences were not significant for either 24HR or 1-item. Among 315 subjects, the FVS treatment group differences were significant both overall and within gender but not when repeated in the sample of 227. Findings suggest multiple 24HR at multiple time points in adequate sample sizes remain the gold standard for FV reports. Biases in FVS estimates may reflect participants' lifestyles and sociodemographic characteristics and require further examination in longitudinal samples representative of diverse populations. [ABSTRACT FROM AUTHOR]

Data collected at 4 Behavioral Change Consortium sites were used to assess social desirability bias in self-reports derived from a dietary fat screener (PFat), a dietary fruit and vegetable screener (FVS), and a 1-item question on fruit and vegetable intake. Comparisons were made with mean intakes derived from up to 3 24-h recall interviews at baseline and follow-up (at 12 mo in 3 sites, 6 mo in the fourth). A social-desirability-related underestimate in fat intake on the PFat relative to the 24HR (percentage energy as fat) was evident in women [baseline b = -0.56 (P = 0.005); follow-up b = -0.62 (P < 0.001)]. There was an overestimate in FVS-derived fruit and vegetable consumption (servings/week) in men enrolled in any intervention at follow-up (b = 0.39, P = 0.05) vs. baseline (b = 0.04, P = 0.75). The 1-item fruit and vegetable question was associated with an overestimate at baseline in men according to SD score (b = 0.14, P = 0.02), especially men with less than college education (b = 0.23, P = 0.01). Women with less than college education expressed a similar bias at follow-up (b = 0.13, P = 0.02). Differences in the magnitude of bias according to gender, type of instrument used, and randomization condition are comparable to what has been seen for other instruments and have important implications for both measuring change in studies of diet and health outcomes and for developing methods to control for such biases. [ABSTRACT FROM AUTHOR]

The American Cancer Society has supported cancer research for more than 50 years and has devoted more than $2.2 billion to cancer research. This article describes an evaluation of the Research Promotion Guide of the American Cancer Society, a reference tool developed by the National Home Office for regional division staff and volunteers whose work involved public relations and fundraising. The purposes of this study were the following: 1) to determine the level and type of use of the guide; and 2) to assess factors that may influence the level and type of use. Fifty- participants were interviewed by telephone. Overall, 78% of them were aware of the guide. Three factors significantly and positively, associated with level of use were: compatibility (the perception that the guide is relevant to one's job); attending a training session; and years employed at the American Cancer Society. This study a pilot project for the Collaborative Evaluation Fellows Project (CEFP), demonstrated that collaboration between nonprofit and academic institutions is feasible and can serve the needs of the students and organizations. The lessons learned can be applied to evaluations in general and to future CEFP projects. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have explored how relationships of perceived environment and physical activity vary across different activity domains and populations. This question was explored in five physical activity intervention trials funded by the National Institutes of Health Behavior Change Consortium.Design: Observational.Settings: San Francisco peninsula, California (N = 94); Eugene, Oregon (N = 122); Atlanta, Georgia (N = 256); Kingston, Rhode Island (N = 109); Memphis, Tennessee (N = 64).Subjects: Ethnically diverse community adults ages 18 to 85 years.Measures: The Neighborhood Environment Walkability Scale and CHAMPS physical activity questionnaire. Response rate among those invited to complete these measures was 90%.Results: Cross-sectional pooled signal detection analysis indicated that people who reported living in neighborhoods with more attractive scenery and ease of walking were more likely to meet national physical activity recommendations (67%) compared with those without these neighborhood attributes (36%; chi2 = 13.04, p = .0003). Within-site multiple regression identified two additional variables--seeing others when walking and encountering loose dogs that make it difficult to walk--as correlates across multiple sites and activity domains (i.e., minutes of weekly moderate or more vigorous activity, walking for errands, walking leisurely) (incremental R2 = 2.0-7.5; p < .05). Analyses of covariance suggested that traffic safety might be particularly important in facilitating or impeding physical activity in response to a formal intervention (for traffic-arm assignment interactions, F = 3.8-7.0, p < or = .05).Conclusions: Relationships between perceived environments and physical activity may differ depending upon population groups and activity domains and merit investigation by using stronger prospective designs. [ABSTRACT FROM AUTHOR]

Purpose: Recruitment is often the rate-limiting step in conducting clinical trials among ethnic minorities. Little is known about participants who consent and enroll into a trial, but do not return for randomization. Why participants fail to return for randomization is largely unknown.Methods: We compared 287 enrolled African American smokers who did not return for randomization, to the 500 who returned and were randomized to participate in a clinical trial for smoking cessation in African Americans. Analyses were conducted to identify variables associated with not returning for randomization.Results: Univariate comparisons found the nonrandomized group to be significantly different from those randomized. Logistic regression showed younger age, less readiness to quit, having been proactively recruited, lacking a regular source of health care, believing that they will be smoking in 6 months, less church attendance, and a lower literacy level to be jointly related with not returning for randomization.Conclusions: African American participants who did not return for randomization into a clinical trial were different from those who did. Better understanding of these factors may allow researchers to target recruitment efforts resulting in enhanced accrual in clinical trials and increased efficiency. [ABSTRACT FROM AUTHOR]

Introduction: Firearm injuries are a leading cause of death for youth/young-adults. We utilized latent class analysis to identify distinct motivational/behavioral patterns of firearm possession in a youth/young-adult emergency department sample to inform prevention strategies., Methods: Cross-sectional data were obtained from surveys conducted among youth/young-adults (age = 16-29; n = 1311) seeking emergency department treatment (7/10/2017-6/25/2018). Latent class analysis was performed for individuals reporting firearm possession (n = 223) using five variables: carriage frequency, social carriage, risky firearm behaviors, ownership/carriage for protection, and recreational ownership/carriage. Descriptive statistics were examined., Results: In this sample, 17.0 % reported having firearms (age-22.7; 48.0 %-male; 49.3 %-Black; 52.5 %-public assistance). Latent class analysis identified four classes: 1-recreational possession (n = 51); 2-possession for protection with low carriage (n = 60); 3-carriage for protection with low risky firearm behaviors (n = 76); and 4-carriage for protection with high risky firearm behaviors (n = 36). Class-1 (recreational possession) had low firearm victimization, violence exposure, and community violence. This class primarily kept long-guns with secure storage patterns. Class-2 (protection with low carriage) were mostly female youth/young-adults with children and reported moderately high rates of violence exposure. Nearly 20 % stored their firearm unlocked. Class-3 and -4 endorsed firearm carriage for protection, with Class-4 also engaging in risky firearm behaviors. Both classes had high violence exposure; however, Class-4 had higher risk profiles including higher marijuana misuse, mental health symptoms, and firearm victimization., Conclusions: Among an emergency department sample, four distinct firearm possession classes emerged with different risk levels. Understanding firearm behaviors and risk/protective factors is critical to tailoring healthcare-focused interventions to address individual needs and reduce injury risk., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interest or personal relationships that could have appeared to influence the work reported in this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The effective management of inflammatory bowel disease (IBD) requires complex self-management behaviors. Both patient activation (the degree to which patients are willing and able to engage in care) and self-efficacy (one's confidence in performing certain behaviors) are thought to play an important role in chronic disease self-management, but patient activation is a broad concept that can be more difficult to precisely target than self-efficacy. We aimed to describe the relationship between patient activation, self-efficacy, and the burden of IBD on patients' daily lives., Methods: Patients with IBD were recruited from a single center to complete a survey including the Patient Activation Measure (PAM-13®), the IBD Self-Efficacy Scale (IBD-SES), and an IBD-specific patient-reported outcome measure. Using multivariable linear regression, we examined the relationship between IBD burden, self-efficacy, and patient activation, adjusting a priori for age, gender, IBD type, IBD medications, active corticosteroid use, anxiety, and depression. We performed a post-hoc mediation analysis to examine self-efficacy as a potential mediator in the relationship between patient activation and the burden of IBD on patient's daily lives., Results: A total of 132 patients with IBD completed the survey (59% Crohn's disease, 41% ulcerative colitis, 52% female). Higher levels of patient activation and higher levels of self-efficacy were each associated with lower IBD burden (patient activation: ß = - 1.9, p < 0.001, self-efficacy: ß = - 2.6, p < 0.001). Post hoc mediation analysis confirmed that the relationship between patient activation and daily IBD burden was mediated by self-efficacy (Average Causal Mediation Effect = - 1.00, p < 0.001, proportion mediated = 0.62, p < 0.001)., Discussion: The relationship between patient activation and IBD burden is highly mediated by self-efficacy, suggesting that self-efficacy could be a more precise target for intervention. Future studies could focus on targeting self-efficacy to build individuals' confidence in IBD self-management and testing of IBD-tailored self-management programs to ultimately improve disease outcomes., Competing Interests: Declarations Conflict of interest All authors report no relevant disclosures., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Some genetic counselors (GCs) may find theories, models, and frameworks (TMFs) useful in clinical skills selection and when reflecting on or evaluating genetic counseling practice. This paper aims to demonstrate how TMFs can be used to postulate how different skills may impact patients'/clients' decisions, behaviors, and outcomes and consider how multiple TMFs can inform the use of various skills or strategies to achieve different goals. Additionally, we provide examples of TMFs that may help GCs in nonclinical aspects of their work, such as implementing and evaluating new interventions or service delivery models. To guide the selection of appropriate TMFs, we provide a set of questions to consider and include examples of skills and approaches that align with different TMFs. While TMFs provide a structured approach and valuable guidance that may help advance genetic counseling practice, they have certain limitations. Additional research is necessary to determine the effectiveness of using TMFs to guide clinical practice and improve patient/client outcomes., (© 2024 National Society of Genetic Counselors.)

Introduction: Compared to White patients, African American (AA) patients have a four-fold higher prevalence of kidney failure and higher hemodialysis non-adherence. Adherence behaviors are influenced by psychosocial factors, including personal meaning of a behavior and self-confidence to enact it. We assessed perspectives of AA hemodialysis patients on unique factors impacting dialysis adherence, and use of motivational interviewing, an evidence-based intervention, to improve these factors, dialysis adherence, and outcomes in AAs., Methods: Self-identified AA hemodialysis patients (N=22) watched a brief video describing motivational interviewing and then completed a semi-structured interview or focus group session. Interview questions explored unique barriers and facilitators of hemodialysis adherence in AAs, and perceived utility of motivational interviewing to address these obstacles. Verbatim transcripts and an iterative inductive/deductive approach were used to develop a hierarchical coding system. Three experienced coders independently coded the same two transcripts. Coding was compared and discrepancies were reconciled by a fourth coder or consensus. Transcripts, quotations, and codes were managed using Microsoft Excel 2016 and SPSS version 28.0., Results: Themes and sub-themes emerged and culminated in a novel conceptual model informed by three theoretical models of behavior change: Theory of Self-Care Management for Vulnerable Populations; Social Cognitive Theory; and Self Determination Theory. This conceptual model will inform the design of a culturally tailored, motivational interviewing-based intervention to improve dialysis adherence in AAs., Conclusions: Integrating AA hemodialysis patient perspectives is critical for enhancing dialysis care delivery and the design of effective interventions such as motivational interviewing to improve dialysis adherence in AA and promote kidney health equity. AA hemodialysis patients view motivational interviewing as a tool to clarify patient priorities, build trust, and promote patient-provider therapeutic alliance. Cultural tailoring of motivational interviewing to address unique barriers of AAs with kidney failure will improve adherence and health outcomes in these vulnerable patients., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology.)

Motivational interviewing (MI), which is recommended for prevention and treatment of pediatric obesity, is a patient-centered counseling style used to modify behaviors. When using MI, pediatric providers generally avoid direct attempts to convince or persuade. Instead, they help patients or parents think about and verbalize their reasons for and against change and how their behavior aligns with their values and goals. MI relies on specific techniques, including reflective listening, to strategically balance the need to "comfort the afflicted" and "afflict the comfortable"; to balance the expression of empathy with the need to build discrepancy for change, thereby encouraging "change talk"., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Adults with type 1 or type 2 diabetes often face financial challenges and other unmet social needs to effective diabetes self-management., Objective: Whether a digital intervention focused on addressing socioeconomic determinants of health improves diabetes clinical outcomes more than usual care., Design: Randomized trial from 2019 to 2023., Participants: A total of 600 adults with diabetes, HbA1c ≥ 7.5%, and self-reported unmet social needs or financial burden from a health system and randomized to the intervention or standard care., Intervention: CareAvenue is an automated, e-health intervention with eight videos that address unmet social needs contributing to poor outcomes., Measures: Primary outcome was HbA1c, measured at baseline, and 6 and 12 months after randomization. Secondary outcomes included systolic blood pressure and reported met social needs, cost-related non-adherence (CRN), and financial burden. We examined main effects and variation in effects across predefined subgroups., Results: Seventy-eight percent of CareAvenue participants completed one or more modules of the website. At 12-month follow-up, there were no significant differences in HbA1c changes between CareAvenue and control group (p = 0.24). There were also no significant between-group differences in systolic blood pressure (p = 0.29), met social needs (p = 0.25), CRN (p = 0.18), and perceived financial burden (p = 0.31). In subgroup analyses, participants with household incomes 100-400% FPL (1.93 (SE = 0.76), p < 0.01), 201-400% FPL (1.30 (SE = 0.62), p < 0.04), and > 400% FPL (1.27 (SE = 0.64), p < 0.05) had significantly less A1c decreases compared to the control group., Conclusions: On average, CareAvenue participants did not achieve better A1c lowering, met needs, CRN, or perceived financial burden compared to control participants. CareAvenue participants with higher incomes achieved significantly less A1c reductions than control. Further research is needed on social needs interventions that consider tailored approaches to population subgroups., Clinical Trials Registry: ClinicalTrials.gov ID NCT03950973, May 2019., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Background: Minority communities are disproportionately impacted by COVID-19. In Michigan in 2024, 59% of Latinx residents, 46% of Black residents, and 57% of White residents have received at least one dose of the vaccine. However, just 7% of Black residents and 6% of Latinx residents report being up-to-date per CDC definition, versus 13% of White residents. Drawing from protection motivation theory, we aimed to identify barriers to COVID-19 vaccination., Methods: Interviews with 24 Black and 10 Latinx Michigan residents self-reported as not up-to-date (n = 15) or up-to-date (n = 19) on COVID-19 vaccines were conducted in 2022-2023. We used a community-based participatory approach in collaboration with 16 leaders from 15 organizations to develop research questions, interview protocols, and methods for data collection and analysis. Thematic coding of interviews was conducted., Results: Findings indicate participants' lack of confidence in the COVID-19 vaccine's efficacy, with those not up-to-date expressing greater doubt. Participants were also concerned about vaccine benefits versus risks, safety, and side effects. Distrust in medicine, confusion about public health guidelines, and conspiracy theories were often reported. Younger unvaccinated individuals cited low health risk as reason to remain unvaccinated. Many participants felt that health education, especially through medical professionals, was beneficial., Conclusion: There is great need for more data to make informed decisions given ongoing lack of understanding of the public health benefits of COVID-19 vaccination. Identifying drivers of vaccine uptake, particularly boosters, in communities of color and developing age-appropriate and culturally responsive interventions to increase vaccination rates are of utmost importance., (© 2024. W. Montague Cobb-NMA Health Institute.)

Objective: Self-Determination Theory posits that everyone has a basic need for autonomy that needs to be fulfilled to establish autonomous motivation for health behavior (change). Regardless, individual differences exist in health communication style preferences. This paper outlines the development and validation of the Health Communication Orientations Scale (HCOS), a new measure to assess these preferences., Methods: Nationally representative online panels from the US (n = 603) and the Netherlands (n = 737) completed a survey containing the HCOS, established motivational measures, and demographic questions., Results: Factor analyses identified five subscales valid for both populations: HCOS (1) Expert, (2) Others, (3) Self, (4) Oppositional, and (5) Internet. Scores for Expert and Internet were higher in the US sample; Others, Self, and Oppositional were higher in the Dutch sample. Internal reliability for the five factors was high across samples (range 0.84-0.91). Many significant correlations with established measures were observed in both samples indicating the construct validity of the scale., Conclusion: The HCOS subscales have strong psychometric properties., Practice Implications: The HCOS represents a novel approach to assessing communication style preferences for general and patient populations. Further investigation in how the HCOS may be used to tailor health messaging is warranted., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)