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A quasi-experimental design was used to test a modified Project Towards No Tobacco (TNT) use program on cigarette smoking in 380 Arab American and 236 non-Arab American 9th graders in the Midwest. Tenth grade Non-Arab American students given the intervention as 9th graders were 23% less likely to experiment (Odds Ratio = 1.31, 95% CI: 1.05, 1.64) or to have smoked cigarettes in the past 30 days (Odd Ratio = 1.43 times, 95% CI: 1.03, 2.01) compared to Arab American youth. Arab American students reported greater experimentation with water pipe smoking than cigarettes (38% vs. 22%), and more current (16% vs. 6%) and regular (7% vs. 3%) use of water pipes than cigarettes, respectively. The intervention designed to focus on cigarette smoking had non-significant effects on water pipe smoking. These findings provide support for a school-based intervention revised to focus on prevention as well as cessation and to be culturally consistent. They also call for further research and intervention tailoring to address the problem of water pipe smoking in a growing Arab American adolescent population.

Background Although depressive symptoms during pregnancy have been related to negative maternal and child health outcomes such as preterm birth, low birth weight infants, postpartum depression, and maladaptive mother–infant interactions, studies on the impact of neighborhood environment on depressive symptoms in pregnant women are limited. Pregnant women residing in disadvantaged neighborhoods reported higher levels of depressive symptoms and lower levels of social support. No researchers have examined the relationship between neighborhood environment and avoidance coping in pregnant women. Guided by the Ecological model and Lazarus and Folkman's transactional model of stress and coping, we examined whether social support and avoidance coping mediated associations between the neighborhood environment and depressive symptoms in pregnant African-American women. Methods Pregnant African-American women (n = 95) from a medical center in Chicago completed the instruments twice during pregnancy between 15 and 25 weeks and between 25 and 37 weeks. The self-administered instruments measured perceived neighborhood environment, social support, avoidance coping, and depressive symptoms using items from existing scales. Objective measures of the neighborhood environment were derived using geographic information systems. Findings Perceived neighborhood environment, social support, avoidance coping, and depressive symptoms were correlated significantly in the expected directions. Objective physical disorder and crime were negatively related to social support. Social support at time 1 (20 ± 2.6 weeks) mediated associations between the perceived neighborhood environment at time 1 and depressive symptoms at time 2 (29 ± 2.7 weeks). An increase in avoidance coping between times 1 and 2 also mediated the effects of perceived neighborhood environment at time 1 on depressive symptoms at time 2. Conclusion Pregnant African-American women's negative perceptions of their neighborhoods in the second trimester were related to higher levels of depressive symptoms in the third trimester. If these results are replicable in prospective studies with larger sample sizes, intervention strategies could be implemented at the individual level to support pregnant women in their ability to cope with adverse neighborhood conditions and ultimately improve their mental health.

Despite extensive research on defining and measuring quality of care, less attention has been given to consumers' views. The purpose of the study reported here was to identify indicators of quality of healthcare and nursing care important to clinic patients. The most important indicators of healthcare quality were getting better, getting care and services when needed, and having diagnoses and treatment options explained. The most important indicators of nursing care quality were communicating with the nurse, being treated with respect, being cared for by nurses who were up-to-date, teaching by the nurse, and not being rushed through the visit.

It was hypothesized that prenatal exposure to cocaine and other substances would be related to delayed expressive language development. Speech and language data were available for 458 6-year olds (204 were exposed to cocaine). No significant univariate or multivariate differences by cocaine exposure group were observed. Classification and regression tree modeling was then used to identify language variable composites predictive of cocaine exposure status. Meaningful cut points for two language measures were identified and validated. Children with a type token ratio of less than 0.42 and with fewer than 97 word types were classified into a low language group. Low language children (n = 57) were more likely to be cocaine exposed (63.1%), with cocaine-exposed children 2.4 times more likely to be in the low language group compared with control children after adjustment for covariates. Prenatal cigarette, but not alcohol exposure, was also significantly related to expressive language delays.

Objective/purpose: Psychosocial adjustment, coping, and quality of life for persons with a venous ulcer and a history of intravenous drug use were examined. Design: A cross-sectional design was used. Setting and subjects: Data were collected in an urban outpatient clinic. All eligible persons were asked to participate. Thirty-two patients agreed to participate, providing an 89% response rate. The mean age of participants was 44.6 years (SD = 4.3); 91% were African American, and 72% were male. Instruments: Subjects responded to questions about their health and substance abuse history and completed the Quality of Life With a Leg Ulcer Questionnaire, Psychosocial Adjustment to Illness Scale (PAIS), Ways of Coping Instrument, and Pain Questionnaire. Leg ulcer tracings were measured with the SigmaScan computer program. Methods: Questionnaires were read to participants. Leg ulcers were traced at their borders onto plastic. Results: Wound area correlated significantly with the domestic environment ( r = .43) and the psychosocial distress ( r = .38) scores of the PAIS. Wound area was negatively correlated to Quality of Life With a Leg Ulcer Questionnaire score ( r = -.52). Pain interference was significantly related to the self-controlling coping score ( r = .40), domestic environment score of the PAIS ( r = .51), and Quality of Life With a Leg Ulcer Questionnaire score ( r = -.65). Cox and Wermuth's multiple regression modeling approach was used to summarize the study's variables. Conclusions: A larger wound area was associated with greater illness-induced difficulties in the home environment, greater psychological distress, and poor quality of life. Pain interference was associated with a greater effort to regulate one's feelings and actions, difficulties in the home, and poor quality of life. (J WOCN 2000;27:227–39)

Purpose: Despite extensive research on defining and measuring health care quality, little attention has been given to consumers' perspectives of high-quality health care. The purposes of this study were to (a) identify the importance to consumers of attributes of health care quality and nursing care quality, and (b) examine the relationship of consumer perspectives to health status and selected demographic variables. Design: Exploratory. Consumers (N = 239) were recruited from waiting rooms of clinics and in neighborhoods of a large metropolitan area in the Midwestern United States that included both urban and suburban populations. Methods: Participants completed the Quality Health Care Questionnaire (QHCQ) and the SF-36 Health Survey. On the QHCQ, they rated the importance of 27 attributes of health care and nursing care quality. The SF-36 is a 36-item instrument for measuring health status in eight general areas. Findings: The most important indicators of high-quality nursing care to consumers were: being cared for by nurses who are up-to-date and well informed; being able to communicate with the nurse; spending enough time with the nurse and not feeling rushed during the visit; having a nurse teach about the illness, medications, treatments, and staying healthy; and being able to call a nurse with questions. The lowest-rated item was having an opportunity to be cared for by nurse practitioners. Ratings differed by race, age, years of education, income, and health status. Conclusions: The importance that consumers place on teaching by the nurse was emphasized, particularly among people with less education, low income levels, and chronic illnesses.

A comprehensive comparison of couples' adjustment to benign (n = 73 couples) and malignant breast disease (n = 58 couples) at the time of diagnosis and at two follow-up assessments at 60 days and 1 year is reported. Specific objectives were to: (a) compare the concurrent stress, resources, appraisal, and patterns of adjustment of couples in the benign and malignant groups; (b) compare the psychosocial responses of patients versus spouses; and (c) determine the amount of correspondence in levels of adjustment reported by patients and their husbands over time. Multiple instruments with reported reliability and validity were used to measure study variables: Smilkstein Stress Scale, Dyadic Adjustment Scale, Family APGAR, Social Support Questionnaire, Mishel Uncertainty in Illness Scale, Beck Hopelessness Scale, Brief Symptom Inventory, and Psychosocial Adjustment to Illness Scale. Mixed design analyses of covariance (ANCOVA) were used to assess differences between and among couples and examine changes in study variables over time. Significant differences were found in the resources, appraisal, and patterns of adjustment reported by couples in the benign and malignant groups. Couples facing breast cancer reported greater decreases in their marital and family functioning, more uncertain appraisals, and more adjustment problems associated with the illness. In addition, there was a high degree of correspondence between the levels of adjustment reported by women with breast cancer and their husbands over time. Couples who reported high distress or a high number of role problems at diagnosis were likely to remain highly distressed at 60 days and 1 year. Study findings underscore the importance of assisting couples, not just patients, to manage the adjustment difficulties associated with breast cancer.

The sample for this study consisted of 164 women recruited from newspaper advertisements and bulletin board postings asking for volunteers with serious problems in intimate relationships with men. Women were screened for battering using the Conflict Tactics Scale (CTS). Of 164 battered women, 28% were moderately to severely depressed and 11% were severely depressed on the Beck Depression Inventory. Significant predictors of depression (accounting for 44% of variance) by multivariate analysis were childhood physical abuse, self-care agency, physical abuse by partner, and daily hassles. In addition to these analyses, the influence of self in relationship on depression was examined. The findings from this study suggest that physical abuse is an important part of the etiology of depression in battered women and that the abuse in combination with daily hassles supports a stress explanation of depression, with a woman's ability to take care of herself a protective factor.

We present a methodology to statistically discriminate among univariate and multivariate indices to improve accuracy in differentiating schizophrenia patients from healthy controls. Electroencephalogram data from 71 subjects (37 controls/34 patients) were analyzed. Data included P300 event-related response amplitudes and latencies as well as amplitudes and sensory gating indices derived from the P50, N100, and P200 auditory-evoked responses resulting in 20 indices analyzed. Receiver operator characteristic (ROC) curve analyses identified significant univariate indices; these underwent principal component analysis (PCA). Logistic regression of PCA components created a multivariate composite used in the final ROC. Eleven univariate ROCs were significant with area under the curve (AUC)0.50. PCA of these indices resulted in a three-factor solution accounting for 76.96% of the variance. The first factor was defined primarily by P200 and P300 amplitudes, the second by P50 ratio and difference scores, and the third by P300 latency. ROC analysis using the logistic regression composite resulted in an AUC of 0.793 (0.06), p0.001 (CI=0.685-0.901). A composite score of 0.456 had a sensitivity of 0.829 (correctly identifying schizophrenia patients) and a specificity of 0.703 (correctly identifying healthy controls). Results demonstrated the usefulness of combined statistical techniques in creating a multivariate composite that improves diagnostic accuracy.

This research describes the development and evaluation of a new scale for assessing functional cervical cancer health literacy, the Cervical Cancer Literacy Assessment Tool (C-CLAT). In phase 1, 35 items in English, Spanish, and Arabic for C-CLAT were generated, taking into account three content domains-Awareness, Knowledge, and Prevention/Control. After content validation, 24 items were retained for psychometric evaluation. In phase 2, the 24-item C-CLAT was evaluated in three racial/ethnic populations of urban women (N = 543). Psychometric methods included item analysis, multifactor item response theory modeling, and concurrent correlations. The final C-CLAT consisted of 16 items, with an internal consistency reliability of 0.72. C-CLAT reliabilities in Black, Latina, and Arab women were 0.73, 0.76, and 0.60, respectively. The rank order correlations of item difficulties across racial/ethnic groups was high (r's = 0.97 to 0.98). The C-CLAT was positively related to educational level, and Arab women scored significantly higher than the Black and Latina participants. This study presents a psychometrically sound instrument that measures health literacy related to cervical cancer. The C-CLAT is a tool that can be orally administered by a lay person and used in a community-based health promotion intervention.

There is a need for health care providers and health care educators to ensure that the messages they communicate are understood. The purpose of this research was to test the reliability and validity, in a culturally diverse sample of women, of a revised Breast Cancer Literacy Assessment Tool (Breast-CLAT) designed to measure functional understanding of breast cancer in English, Spanish, and Arabic. Community health workers verbally administered the 35-item Breast-CLAT to 543 Black, Latina, and Arab American women. A confirmatory factor analysis using a 2-parameter item response theory model was used to test the proposed 3-factor Breast-CLAT (awareness, screening and knowledge, and prevention and control). The confirmatory factor analysis using a 2-parameter item response theory model had a good fit (TLI = .91, RMSEA = .04) to the proposed 3-factor structure. The total scale reliability ranged from .80 for Black participants to .73 for total culturally diverse sample. The three subscales were differentially predictive of family history of cancer. The revised Breast-CLAT scales demonstrated internal consistency reliability and validity in this multiethnic, community-based sample.

OBJECTIVES:: With aging of injection users and the high occurrence of venous disease in their legs, falls are a potential health problem. We examined falls and balance confidence in persons with (VU+) and without (VU-) injection-related venous ulcers (VUs). METHODS:: This study used a cross-sectional, retrospective, comparative design with 31 participants VU+ and 30 VU- recruited in a medical clinic. Participants' legs were assessed for clinical manifestations of venous disease. Participants completed background and fall questionnaires and the Activities-specific Balance Confidence (ABC) Scale. RESULTS:: Participants included 35 men and 26 women (mean age = 54 years); 93% were African American. Falling in the past year was reported by 65% of patients VU+ and 40% VU- (P = 0.048); 29 of these patients fell 2 or more times in the past year. Higher scores on the ABC Scale (N = 61) were significantly related to fewer falls (r = -0.68). Activities-specific Balance Confidence scores were lower/worse for the patients VU+ (P = 0.039). Area under the receiver operating curve for patients VU+ was significant; we found area under the curve of 0.84 and a cutoff score of 80.3% for ABC predictive of recurrent fallers with sensitivity of 84% and specificity of 83%. The ABC test had an internal consistency reliability of 0.97. CONCLUSIONS:: Persons VU+ reported worse balance confidence and more falls than those without these ulcers. The ABC test was related to falls. With aging of injection users and increased occurrence of VUs, examining balance confidence and falls is crucial in long-term patient safety. Language: en

Teachers report that children exposed prenatally to cocaine display unique academic, social, and conduct problems in the school setting. No measure nor data exist that specifically identify these alleged behaviors. Experienced teachers (N = 24) participated in a consensus process to identify first-grade student behaviors considered specific to prenatal cocaine exposure. The Problem Behavior Scale (PROBS-14), a 14-item, visual analogue scale, was developed from the beliavior classifications generated Teachers then recalled the behaviors of students (N = 140) from the previous semester and scored the PROBS-14 and the Conners’ Teacher Rating Scale (CTRS-39). Concurrent validity was established between the PROBS-14 and the CTRS with factor analysis. The analysis yielded a hyperactivity-impulsivity factor, composed of both CTRS and PROBS items, and a central processing factor, composed of only PROBS items. Assessment of behavioral outcomes of prenatal exposure will require specialized instruments responsive to empirical data. Ongoing instrument development is addressing predictive validity of the PROBS-14 in identifying cocaine-exposed children.

A limiting factor in the treatment of cancer with radiotherapy is the damage to surrounding normal tissue, particularly the vasculature. Vessel pathologies are a major feature of the side effects of radiotherapy and little is known about early events that could initiate subsequent diseases. We tested the hypothesis that gamma radiation has early damaging effects on the human endothelial barrier. Two models were used; Human Brain Microcapillary Endothelial Cells (HBMEC), and Human Umbilical Vein Endothelial Cells (HUVEC). Endpoints included Trans-Endothelial Electrical Resistance (TEER), barrier permeability to 10 kDa and 70 kDa tracer molecules, and the localization of F-actin, and junction proteins and the Platelet Endothelial Cell Adhesion Molecule (PECAM-1). Radiation induced a rapid and transient decrease in TEER at 3 h, with effects also seen at the radiotherapy doses. This dip in resistance correlated to the transient loss of PECAM-1 in discrete areas where cells often detached from the monolayer leaving gaps. Redistribution of PECAM-1 was also seen in 3-D human tissue models. By 6 h, the remaining cells had migrated to reseal the barrier, coincident with TEER returning to control levels. Resealed monolayers contained fewer cells per unit area and their barrier function was weakened as evidenced by an increased permeability over 24 h. This is the first demonstration of a transient and rapid effect of gamma radiation on human endothelial barriers that involves cell detachment and the loss of PECAM-1. Considering the association of cell adhesion molecules with vasculopathies, such an effect has the potential to be clinically relevant to the longer-term effects of radiotherapy.

BACKGROUND:: Fall risk is a critical component of clinical assessment and has not been examined for persons who have injected illicit drugs and are aging. OBJECTIVES:: The aim of this study was to test and develop the Fall Risk Model for Injection Drug Users by examining the relationships among injection drug use, chronic venous insufficiency, lower extremity impairments (i.e., decreased ankle range of motion, reduced calf muscle endurance, and leg pain), age and other covariates, and the Tinetti balance and gait total score as a measure of fall risk. METHODS:: A cross-sectional comparative design was used with four crossed factors. Standardized instruments were used to assess the variables. Moderated multiple regression with linear and quadratic trends in age was used to examine the nature of the relationship between the Tinetti balance and gait total and age and the potential moderating role of injection drug use. A prespecified series of models was tested. RESULTS:: Participants (n = 713) were men (46.9%) and women with a mean age of 46.26 years and primarily African American (61.7%) in methadone treatment centers. The fall risk of a 48-year-old leg injector was comparable with the fall risk of a 69-year-old who had not injected drugs. Variables were added to the model sequentially, resulting in some lost significance of some when they were explained by subsequent variables. Final significant variables in the model were employment status, number of comorbidities, ankle range of motion, leg pain, and calf muscle endurance. DISCUSSION:: Fall risk was associated with route of drug use. Lower extremity impairments accounted for the effects of injection drug use and chronic venous insufficiency on risk for falls. Further understanding of fall risk in injection users is necessary as they age, attempt to work, and participate in activities. Language: en

To evaluate the reliability and validity of the Bereaved Parent Needs Assessment, a new instrument to measure parents' needs and need fulfillment around the time of their child's death in the pediatric intensive care unit. We hypothesized that need fulfillment would be negatively related to complicated grief and positively related to quality of life during bereavement.Cross-sectional survey.Five U.S. children's hospital pediatric intensive care units.Parents (n = 121) bereaved in a pediatric intensive care unit 6 months earlier.Surveys included the 68-item Bereaved Parent Needs Assessment, the Inventory of Complicated Grief, and the abbreviated version of the World Health Organization Quality of Life questionnaire. Each Bereaved Parent Needs Assessment item described a potential need and was rated on two scales: 1) a 5-point rating of importance (1 = not at all important, 5 = very important) and 2) a 5-point rating of fulfillment (1 = not at all met, 5 = completely met). Three composite scales were computed: 1) total importance (percentage of all needs rated ≥4 for importance), 2) total fulfillment (percentage of all needs rated ≥4 for fulfillment), and 3) percent fulfillment (percentage of important needs that were fulfilled). Internal consistency reliability was assessed by Cronbach's α and Spearman-Brown-corrected split-half reliability. Generalized estimating equations were used to test predictions between composite scales and the Inventory of Complicated Grief and World Health Organization Quality of Life questionnaire.Two items had mean importance ratings3, and 55 had mean ratings4. Reliability of composite scores ranged from 0.92 to 0.94. Total fulfillment was negatively correlated with Inventory of Complicated Grief (r = -.29; p.01) and positively correlated with World Health Organization Quality of Life questionnaire (r = .21; p.05). Percent fulfillment was also significantly correlated with both outcomes. Adjusting for parent's age, education, and loss of an only child, percent fulfillment remained significantly correlated with Inventory of Complicated Grief but not with World Health Organization Quality of Life questionnaire.The Bereaved Parent Needs Assessment demonstrated reliability and validity to assess the needs of parents bereaved in the pediatric intensive care unit. Meeting parents' needs around the time of their child's death may promote adjustment to loss.

Trauma developmental theory identifies gender discrimination (GD) as a type of persistent, ongoing trauma that has the potential for serious, negative effects on mental health. This study was conducted to examine the potential role of GD in the development of cumulative trauma disorders (CTD) and symptoms of posttraumatic stress disorder (PTSD) as well as the role of GD in mediating the effects of other traumas on these disorders. The sample included 160 female torture survivors from more than 30 countries. Measures of PTSD, CTD, and types of trauma exposure were acquired as part of a larger study on refugee torture survivors. Structural equation modeling was used to test several plausible models for the direct and indirect effects of GD on PTSD and CTD, within the context of other trauma exposure. Results suggest that GD mediates the effects of identity traumas on CTD and PTSD. GD also had direct effects on CTD, including relationships with dissociation, suicidality, and deficits in executive function. GD did not appear to directly influence the development of PTSD. The implications of these results for assessment and treatment of women’s trauma-related disorders as well as strategies for their prevention are discussed.

PURPOSE The purpose of the study was to examine the symptom of itch and its relationship with chronic venous disease, pain, and quality of life. DESIGN The study used an exploratory, cross-sectional design. METHODS One hundred and sixty-one participants completed demographic, health, substance abuse, itch, and pain questionnaires and the SF-12v2 Health Survey to measure health related quality of life. RESULTS Participants were mostly men (n=95, 59%), African American (113, 70.2%), and had a mean age of 44.19 years. A history of injection drug use was reported by 91.4%. Using the clinical score of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) Classification of the worst leg, the most common classification was Class 3, edema without skin changes (45.9%); 18.6% had severe venous disease (Classes 5 and 6). Eighty-eight participants (54.7%) reported itch somewhere on their body with 74 of them (45.9%) reporting itch on the legs or feet. Fourteen participants who reported itch of their legs or feet had wounds on the legs or feet. A positive correlation between magnitude of reported itch and CEAP clinical classification was noted (0.26, P =.025). This relationship was not strictly linear with itch increasing at a faster rate at higher levels of the CEAP classification. Persons with leg or feet itch had poorer health related quality of life, more comorbidities, and higher leg pain than those without itch. Because the SF-12v2 Health Survey is norm based, persons with itch were more than 1 standard deviation below the mean for the United States for their mental and physical health scores. CONCLUSIONS Itch on the legs or feet is a clinically relevant problem that is related to the level of venous disease. Persons with lower extremity itch have higher pain ratings and lower quality of life.

The theory of planned behavior (TPB) was integrated within the theory of self-care (SCT) to explore the predictive value of extending TPB to measure attitudes and beliefs regarding a behavioral goal, and determine the ability of goal beliefs to predict engagement in the combined, multiple behaviors necessary to control BP. The hypothesized model was evaluated in a sample of 306 community-dwelling African Americans between 21 and 65 years of age. Scales developed for the study achieved acceptable reliability (α = .68–.95). Structural equation modeling analysis resulted in a second-order factor structure with attitude, subjective norm, perceived behavioral control, and intention modeled as indicators of a construct representing goal beliefs related to keeping BP within normal limits. This latent construct was conceptualized within the theory of self-care as “self-care motivation,” and predicted 18% of the variance in self-care behaviors necessary for BP control. The model achieved acceptable fit (CMIN/ df = 2.32; CFI = .95; RMSEA = .066). Final assessment of fit was done using multi-group SEM and bootstrapping techniques. In this extension of the TPB attitudes and beliefs regarding the goal of keeping BP within normal limits were found to determine one’s motivation to engage in the multiple behaviors necessary for BP control.

Injection users are at risk for vascular injuries resulting in chronic venous disease (CVD). The authors examined walking mobility in relation to CVD for 713 individuals in methadone treatment. The authors used a cross-sectional, comparative design that was stratified on age, sex, ethnicity, and drug use. CVD was present in 92.3% of participants. The structural equation model supported the causal link between leg injection and CVD (.40, P

Arab-American Muslim adolescents in immigrant families face a number of challenges that put them at risk for behavior problems. This study of Arab-American Muslim Adolescents and their relatively recent immigrant mothers tested a longitudinal family-level model of adolescent behavior problems. Mother-adolescent dyads (N = 530) completed measures of maternal and adolescent stressors, active and avoidance coping, and social support; maternal distress; quality of mother–child relationship; and adolescent behavior problems at Time 1 and approximately 18 months later. The youth were between the ages of 11 and 15 years at Time 1 and 48.7% were girls. Longitudinal analyses were conducted using latent change modeling with change scores from Time 1 and Time 2 data. Social support facilitated active coping for both mothers and adolescents. Although maternal avoidance coping mediated maternal stressors and its effect on maternal distress, maternal stressors and maternal distress were not related to adolescent behavior problems. The only factor mitigating the effects of adolescent stressors on adolescent behavior problems was the quality of the mother–child relationship. These findings suggest that adolescents are insulated from maternal stress and distress as long as there is a good mother–child relationship.

Guided by self-determination theory, the main purpose of this study was to explore demographic characteristics, attitudes toward casinos, and self-reported intrinsic and extrinsic reasons for casino gambling by urban elders. The study hypothesized that individuals would more frequently report intrinsic motivations for casino gambling (e.g., entertainment, enjoyment) rather than extrinsic motivation (e.g., financial gain). This longitudinal sample included 247 urban elders older who were 60 years and older and who had participated in surveys in 2002 and 2004. The initial survey consisted of (a) demographic items, (b) five items to measure attitudes toward casino gambling, (c) questions inquiring about motivations for casino gambling, and (d) questions about gambling frequency. The follow-up survey was an expanded questionnaire which still included these items. The sample consisted of the 247 participants, over 200 of whom were African-Americans, 188 were female, and 98 of the participants had a post graduate education. About half were widowed, and the sample generally reported a low income. The results supported the theoretical perspective underlying the project. The hypothesis that more participants would endorse intrinsic motivations for casino gambling rather than extrinsic motivations was supported. The implications of these findings represent for social workers, gambling counselors and health care services providers an important step toward understanding the attitudes, behaviors, and motivational factors involved in casino gambling among older adults.

We adapted the Multidimensional Scale of Perceived Social Support (MSPSS) for use with Arab immigrant women (MSPSS-AW) and estimated the psychometric properties of the adapted version with a sample of 539 Arab immigrant women living in the United States. Confirmatory factor analysis (CFA) supported the proposed three-factor solution. Internal consistency reliability coefficients for the three subscales ranged from good to very good. Additional evidence for construct validity of the MSPSS-AW subscales was demonstrated through relationships with theoretically related measures. We conclude that the MSPSS-AW is reliable and valid for use with Arab immigrant women.

While there is a plethora of research on the prevalence of individual chronic conditions, studies that examine the clustering of these conditions are lacking, especially among immigrant, minority groups.Cross-sectional, convenience sample.A self-administered survey was distributed at churches, mosques, and small businesses.Arabs (n = 1383), Chaldeans (n = 868), Blacks (n = 809) and Whites (n = 220) in southeast Michigan.We estimated the prevalence of hypertension, high cholesterol, heart disease, diabetes, asthma, and depression. Using a logistic regression model, we estimated odds ratios and 95% confidence intervals for the association between ethnicity and reporting one or more chronic conditions before and after adjusting for demographic, socioeconomic status, health care, chronic conditions, and health behavior variables.The overall age and sex-adjusted prevalence of having one or more chronic conditions was 44%. Estimates were lower for Chaldeans (32%) compared to Arabs (44%), Whites and Blacks (50% for each group). In the fully adjusted model, Chaldeans were less likely (OR = 0.62; 95% CI = 0.43-0.89) to report having one more chronic conditions compared to Whites.Future studies should employ probability samples, and should collect more detailed sociodemographic and acculturation data, which influence the relationship between race/ethnicity and the prevalence of chronic conditions.

We examined chronic venous disorders (CVD) in persons who injected illicit drugs. The study design was cross-sectional, comparative stratified by age, gender, ethnicity, as well as by three types of drug use (noninjection; arm or upper body injection only; and legs with or without upper body injection). Subjects completed demographic, health, and substances abuse questionnaires and were evaluated using the clinical component of the Clinical-Etiology-Anatomy-Pathophysiology Classification. Seven hundred and thirteen participants were evaluated. Those who injected in the legs +/- arms had significantly worse CVD. Thirty-nine percent of leg +/- arm injectors vs. 4.2% or noninjectors or arm only injectors had moderate to severe CVD. Persons who injected in the legs +/- arms were 9.14 times more likely to develop venous ulcers than those that injected in the arms and upper body only and 34.64 times more likely as those who never injected. CVD was associated with injecting in the groin, legs and feet as compared with other sites. The pattern of disorders associated with leg injection is consistent with the underlying pathology of chronic venous insufficiency.

Chronic venous insufficiency is a complex disease that can result in severe sequelae including venous ulceration. Though the exact progression from chronic venous insufficiency to venous ulcer remains unclear, the high cost and burden of this disease on patients and society is quite clear. Sustained ambulatory venous pressures or venous hypertension plays an integral role in the development of venous ulceration and involves the failure of the calf muscle pump system. Standard of care involves compression therapy to assist the calf muscle pump. However, several cofactors may contribute to or exacerbate this disease and understanding their impact may provide insight into new treatment modalities. Nerve involvement, which may result in neuropathic pain and muscle dysfunction, alterations in mobility and a decrease in range of motion may lead to gait alterations all affecting calf muscle pump function. In this paper, we analyze these cofactors and discuss possible treatment options to target them. Physicians treating this disease should be aware of the numerous factors involved in its development. Exploring new treatment options may 1 day lessen the burden and suffering caused by venous insufficiency.

The multidimensional scale of perceived social support (MSPSS) was revised for Arab American adolescents (MSPSS-AA). Items measuring social support from significant others were omitted and items measuring support from school personnel were added based on advice from cultural experts. The sample consisted of 635 Arab American young adolescents in metropolitan Detroit. Confirmatory factor analysis (CFA) supported the proposed three-factor solution (family, friends, and school personnel). Internal consistency coefficients for the three subscales of family (alpha = 0.63), friends (alpha = 0.75), school personnel (alpha = 0.72) were good. As predicted, perceived support from family, friends, and school personnel were inversely related to self reports of daily hassles and internalizing behavior and positively related to assistance seeking coping, which provides evidence for construct validity. Support for discriminant validity was also demonstrated with significantly larger correlations between the MSPSS-AA Family subscale and daily hassles specific to parents and the MSPSS-AA Friend subscale and daily hassles specific to peers. These finding suggest that the MSPSS-AA is reliable and valid for use with Arab-American adolescents.

OBJECTIVE—The study aim was to determine if multisystemic therapy (MST), an intensive home-based psychotherapy, could reduce hospital admissions for diabetic ketoacidosis (DKA) in youth with poorly controlled type 1 diabetes over 24 months. Potential cost savings from reductions in admissions were also evaluated. RESEARCH DESIGN AND METHODS—A total of 127 youth were randomly assigned to MST or control groups and also received standard medical care. RESULTS—Youth who received MST had significantly fewer hospital admissions than control subjects (χ2 = 11.77, 4 d.f., n = 127; P = 0.019). MST-treated youth had significantly fewer admissions versus their baseline rate at 6-month (P = 0.004), 12-month (P = 0.021), 18-month (P = 0.046), and 24-month follow-up (P = 0.034). Cost to provide MST was 6,934 USD per youth; however, substantial cost offsets occurred from reductions in DKA admissions. CONCLUSIONS—The study demonstrates the value of intensive behavioral interventions for high-risk youth with diabetes for reducing one of the most serious consequences of medication noncompliance.

This study estimates the prevalence of heart disease among Arab and Chaldean American women and examines the association between Arab and Chaldean ethnicity and heart disease among a sample of women.This was a cross-sectional study of a convenience sample of 2084 Arab, Chaldean, and African American women agedor = 18 years who completed a survey that was distributed at churches, mosques, and small businesses in southeast Michigans. Logistic regression was used to estimate odds ratios and 95% confidence intervals for the association between ethnicity and self-reported heart disease before and after adjusting for demographic, socioeconomic status, health care, chronic conditions, and health behavior variables.A sample of 2084 Arab, Chaldean, and African American women 18 years of age and older.The overall prevalence of heart disease was 5.1%. Estimates were higher for Arabs (7.1%), lower for Chaldeans (6.6%), and lowest among African Americans (1.8%). In the unadjusted model, Chaldeans and Arabs were four times more likely to have heart disease than were African Americans. However, in the fully adjusted model, the association between Chaldean or Arab ethnicity and heart disease was no longer statistically significant.Arab or Chaldean ethnicity was not significantly associated with self-reported heart disease among women, which suggests that other factors account for this relationship. Future studies should collect more detailed socioeconomic status, acculturation, and health behavior information.

Little is known about parent and peer relationships in immigrant adolescents due to a dearth of culturally sensitive measures. We adapted the Family Peer Relationship Questionnaire (FPRQ) for Arab immigrant mothers and their adolescents. Mothers and adolescents completed parallel versions of the Arab FPRQ and measures of child behavior problems, child social relations, and maternal depression. Data analyses included confirmatory factor analysis and concurrent validity. The proposed four-factor structure was replicated in both the mother and child forms. Scores from the Arab FPRQ subscales and the other measures provided evidence of concurrent and discriminant validity, suggesting that the Arab FPRQ is a viable assessment tool.

Purpose: To identify potential confounders and test a causal model of injection-site risk, chronic venous disorders (CVD), and ankle mobility. The reliability and validity of goniometry measurements of ankle mobility were also of interest because they are seldom performed in people with a history of injection-drug use. Design: The study was a test-retest design, consisting of 104 participants from a methadone maintenance treatment center. Methods: Each participant provided demographic information, health and drug histories, and underwent bilateral ankle goniometric measures of dorsiflexion, plantar flexion, inversion, and eversion. The clinical portion of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP)was used to classify CVD severity. Findings: Reliability of goniometry measurements ranged from .70 to .90. Causal modeling supported hypotheses of increased risk from leg injection and reciprocal effects involving ankle mobility and disease progression. Ankle inversion mobility was the strongest indicator of ankle mobility. Conclusions: Injury to the lower extremities from IDU affected CVD and mobility. Further research should include assessment of comorbidity and other potential confounders. Ankle inversion should remain part of the goniometry assessment.

To determine tobacco use rates (cigarette, water pipe smoking [WPS] or narghile) in Arab American compared to non-Arab youth.A convenience sample of 2,782 14- to 18-year-old high school students from a midwest community completed a 21-item tobacco use history survey.Seventy-one percent of the participants were ArA. Grades 9 through 12 were equally represented. Results included 'ever tried cigarettes [narghile]' (20%, 39%); 'smoked cigarettes [narghile] in the past 30 days' (7%, 22%); and 'regular smoking [narghile]' (3%, 15%) for ArA and non-Arab youths, respectively. Each was significantly related to grade and ethnicity. WPS for ArA and non-Arab youths was (38%, 21%); (17%, 11%); and (7%, 5%) for 'ever used,' 'used in the past 30 days,' and 'regular use,' respectively. Grade, ethnicity, and sex were significantly related to WPS.Cigarette smoking rates for non-Arab youth were lower than current national youth smoking rates but significantly higher than ArA youth. Rates for ArA youth were much lower than current national reported data. Rates of WPS for US youth, regardless of race or ethnicity, are not known. Findings from this study indicate that both ArA and non-Arab youth are experimenting and using WPS regularly. These results underscore the importance of assessing novel forms of tobacco use, particularly WPS, a growing phenomenon among US youth.

Injection drug use has devastating effects on the veins, skin, muscles, and joints of the lower extremities, thus increasing the risk of chronic venous disease (CVD). We examined the following risk factors for CVD in persons who injected drugs: health and drug use history, ankle mobility, pain, and skin and wound assessment. Because of deep venous thrombosis and injury and immobility to the calf muscle pump from injected drugs, CVD occurs at a young age. Decreased ankle joint movement, decreased walking, and increased pain are associated with worsening CVD clinical classification. Associated venous ulcers tend to be multiple and large by the time wound care is sought. Cellulitis and abscesses may also be present. Injection drug users serve as a model for the multifactorial nature of CVD including vein damage, diminished ankle range of motion, and decreased calf muscle strength. Persons who inject drugs need to have their lower extremities assessed for CVD on a routine basis.

Objective: The purpose of the study was to determine if being overweight attenuated the effect of multisystemic therapy (MST), an intensive, home-based psychotherapy, on metabolic outcomes among adolescents with type 1 diabetes and chronically poor metabolic control. As overweight is a marker of insulin resistance, it was hypothesized that weight status would limit the impact of behavioral changes in traditional aspects of adherence to the type 1 diabetes regimen on metabolic control. Methods: A randomized controlled trial was conducted with 127 adolescents with type 1 diabetes and hemoglobin A1c (HbA1c) ≥ 8% for the past year. Participants were randomly assigned to MST plus standard care (SC) or SC alone. Data were collected at baseline and 7 months post-test (i.e., treatment termination). Overweight was defined as body mass index > 85%. Results: Forty-one percent of the sample was overweight. Intent-to-treat analysis showed that adolescents in the MST group had a significant increase in frequency of blood glucose testing (BGT) [F(1,113) = 15.43, p = 0.0001] and a trend to significant improvement in HbA1c [F(1,123) = 2.99, p = 0.086] irrespective of weight. However, HbA1c decreased 0.91% (p = 0.002) for normal weight adolescents in the MST group compared with 0.20% (p = 0.570) for overweight adolescents in the MST group. Discussion: Despite improvements in adherence to BGT, overweight adolescents receiving an intensive behavioral intervention did not have a significant improvement in metabolic control compared with their normal weight peers. Overweight, an accepted marker of insulin resistance and a major public health issue, warrants increased consideration in intervention trials to improve the metabolic control of adolescents with type 1 diabetes.

Purpose Monitoring of adolescents' behavior and whereabouts has been repeatedly identified as an important predictor of adolescent behavioral outcomes. However, to date, measures of parental supervision and monitoring are lacking in the chronic illness literature. The present study describes development and initial evaluation of a measure of parental monitoring of the illness management of adolescents with diabetes: the Parental Monitoring of Diabetes Care scale (PMDC). Methods Ninety-nine parents of 12–18-year-old children with type 1 diabetes completed the PMDC. Measures of illness management and metabolic control were also obtained. Results The PMDC demonstrated good internal consistency (alpha coefficient=.81) and test–rest reliability (ICC = .80). Supporting the instrument's construct validity, confirmatory factor analysis indicated that a five subdomain structure had an acceptable fit to the data, [χ 2 (181.65)/ df (126) = 1.44, Bollen-Stine χ 2 = 165.03, p = .32, comparative fit index (CFI) = .91, and root-mean-square error of approximation=.07]. In structural equation models, parental monitoring as assessed by the PMDC had a significant direct effect on adolescent diabetes management, accounting for 38% of the variance. Parental monitoring also had a significant indirect effect on metabolic control. Conclusions The PMDC represents an important first step in the development of measures of parental monitoring for use with adolescents with chronic medical conditions.

This study compared and contrasted personal characteristics, tobacco use (cigarette and water pipe smoking), and health states in Chaldean, Arab American and non-Middle Eastern White adults attending an urban community service center. The average age was 39.4 (SD = 14.2). The three groups differed significantly (P < .006) on ethnicity, age, gender distribution, marital status, language spoken, education, employment, and annual income. Current cigarette smoking was highest for non-Middle Eastern White adults (35.4%) and current water pipe smoking was highest for Arab Americans (3.6%). Arab Americans were more likely to smoke both cigarettes and the narghile (4.3%). Health problems were highest among former smokers in all three ethnic groups. Being male, older, unmarried, and non-Middle Eastern White predicted current cigarette smoking; being Arab or Chaldean and having less formal education predicted current water pipe use.

The primary purpose of the present study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, improved regimen adherence, metabolic control, and rates of hospitalization for diabetic ketoacidosis (DKA) among adolescents with chronically poorly controlled Type 1 diabetes 6 months after the completion of treatment. A randomized controlled trial was conducted with 127 adolescents and their families. Mean participant age was 13.2 years. Sixty-three percent of participants were African American, and 51% were female. Data were collected at baseline, treatment termination, and 6-month follow-up. Changes in glycated hemoglobin (HbA1c), frequency of blood glucose testing (BGT), and rate of DKA admissions were assessed. In intent-to-treat analyses, a main effect of MST on DKA admissions was found at both treatment termination and follow-up. Improvements in BGT were moderated by family composition; only 2-parent MST families maintained improvements at follow-up. Improvements in HbA1c for the MST group at treatment termination were lost at follow-up. Results show that intensive, home-based psychotherapy created stable reductions in serious lapses in adherence, as indexed by episodes of DKA, among youth with poorly controlled diabetes.

Cancer-related pain in outpatient adult populations remains high and has a direct effect on functional status. Factors that affect functional status have been explored separately, but the inter-relatedness of those factors has not been examined. Using a cross-sectional design, the purpose of this study was to examine the relationships between pain level, beliefs about pain, symptom distress, perceived control over pain, and functional status in 304 ambulatory cancer patients who experienced cancer-related pain within the past 2 weeks. Participants completed standardized questionnaires during regularly scheduled clinic visits. Patient's pain level was positively related to increased distress and decreased perceived control over pain and functional status. Structural equation modeling indicated that symptom distress mediated the relation between pain level and functional status. Perceived control over pain had a direct effect on symptom distress and mediated the effect of beliefs about pain and pain level on symptom distress. Patients' perceived control over pain may be an important component in pain management. The direct and mediating effects of perceived control and symptom distress suggest areas of further research. Interventions to increase knowledge and decrease barriers to pain control have the potential for increasing perceived control over pain.

In this study, the authors tested a social ecological model of illness management in high-risk, urban adolescents with Type 1 diabetes. It was hypothesized that management behaviors would be associated with individual adolescent characteristics as well as family, peer, and provider relationships. Questionnaires were collected from 96 adolescents in poor metabolic control and their primary caregivers. Variables in each system were correlated with illness management. Multiple regression demonstrated that higher externalizing symptoms, poorer family relationships, lower satisfaction with providers, and greater age contributed to the variance in illness management. Internalizing symptoms and peer relationships were no longer significant in the model. Results support a social ecological model of illness management in high-risk youths. Interventions grounded in social ecological theory are discussed.

The purpose of this study was to examine ankle mobility in relation to chronic venous insufficiency (CVI) in HIV-positive persons with and without a history of injection drug use (IDU) and to examine the extent to which peripheral neuropathy further reduced ankle mobility. A cross-sectional, stratified design with quota sampling was used to recruit 27 persons with no history of IDU and 46 with a history of IDU from an infectious diseases clinic. Goniometric measurements of forefoot inversion-eversion and dorsiflexion-plantar flexion were obtained. CVI was assessed on a clinical scale. Peripheral neuropathy was identified from chart review and self-report. Injection drug users had less ankle flexion-extension right, inversion-eversion left and right, and total ankle motion than those who did not inject drugs (p.05). Neuropathy was not associated with less mobility of the ankle joint (p.01). A causal model supported the hypothesis of ankle mobility as a mediator of the effect of IDU on CVI.

The purpose of this study was to shorten a human immunodeficiency virus (HIV) stigma scale to make it less burdensome for HIV-positive (HIV+) youth without compromising psychometric properties. The shortened questionnaire showed good internal consistency and validity, suggesting that a 10-item measure of stigma has promise for assessing this important construct in HIV+ youth.

This study examined personal, psychosocial, sociocultural, and environmental predictors in tobacco use for 1671 Arab American adolescents. Cigarette smoking in past 30 days was 6.9%. This increased from 1% at age 14 to 14% at age 18. Twenty-nine percent of the youths reported ‘ever cigarette smoking.’ Experimentation with narghile was 27%; it increased from 23% at 14 years to 40% at 18 years. All trends were significant (p < .001). Logistic regression analyses found ten predictors for ‘smoked a cigarette in past 30 days’ and nine and seven, respectively, for ‘ever smoked a cigarette or narghile’. Friends and family members smoking were the strongest predictors of cigarette smoking and ‘ever narghile use.’ ‘Ever narghile use’ supported cigarette smoking.

This study piloted a brief individual motivational intervention targeting multiple health risk behaviors in HIV-positive youth aged 16-25. Interviews about sexual behavior and substance use and viral load testing were obtained from 51 HIV-positive youth at baseline and post intervention. Youth were randomized to receive a four-session motivational enhancement intervention (N = 25) or to a wait-list control (N = 26). Of the eligible youth approached, 88% agreed to participate, and 80% percent of participants completed at least three of four sessions. The treatment group showed significantly greater reductions in unprotected sex acts and in viral load compared with controls. Although change scores for substance use were not significantly different between the two groups, paired t tests demonstrated that reductions in alcohol use and marijuana use were significant for the treatment group at the trend level. There were no significant differences in substance use from baseline to posttest for the control group. Findings demonstrate the potential of a brief motivational enhancement intervention to improve health risk behaviors in HIV-positive youth. Larger randomized clinical trials are warranted. Resources required for retention should not be underestimated.

OBJECTIVE To examine chronic venous insufficiency in human immunodeficiency virus-positive persons with and without a history of injection drug use and to examine the extent to which neuropathy further increased the risk of chronic venous insufficiency. DESIGN Cross-sectional stratified design with quota sampling. SETTING Infectious diseases clinic in a large, urban midwestern city. PARTICIPANTS Human immunodeficiency virus-positive persons, 27 with no history of injection drug use and 46 with a history of injection drug use, who met the inclusion criteria, including being 30 to 65 years of age, not pregnant, and willing to respond to a questionnaire and have their lower legs examined, were enrolled until the quota for each stratum (no injection drug use and injection drug use) was filled. MAIN OUTCOME MEASURES Chronic venous insufficiency clinical classification, injection drug use history, and presence of peripheral neuropathy. MAIN RESULTS Sixty-one percent of injection drug users (28/46) presented with severe chronic venous insufficiency compared with 11% (3/27) of noninjection drug users (P< .001). The presence of lower extremity neuropathy was not significantly related to chronic venous insufficiency classification. CONCLUSIONS This is the first study to report the high risk of chronic venous insufficiency in human immunodeficiency virus-infected persons who inject drugs. Chronic venous insufficiency should be assessed in human immunodeficiency virus-positive persons when there is a history of injection drug use, and measures to protect the legs should be implemented.