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Climate change is currently and will continue impacting human health, however, beliefs about the level of threat vary by demographics, region, and ideology. The purpose of this study was to assess factors related to climate change and health beliefs using cross-sectional data from the Health Information National Trends Survey (HINTS). Data from 5,075 respondents in the 2022 iteration of HINTS was used for this study. Chi-square tests were used to evaluate demographic differences among those who believe climate change will harm health a lot compared to some, a little, or not at all. Generalized ordinal logistic regression models were used to examine the relationship between the belief that climate change will harm health and independent variables regarding trust in scientists, health recommendations from experts, and demographic characteristics. Female, Black, Hispanic, and college graduate respondents had higher odds and people in the Southern U.S. those aged 35-49, 50-64, and 75years or older had significantly lower odds of believing climate change would harm their health. Those who trust information about cancer from scientists and those that believe health recommendations from experts conflict or change had higher odds of believing climate change would harm health. Our analysis highlights factors that impact climate change and health beliefs, which may provide targets for tailoring public health messages to address this issue.

Background: Clinical trial diversity is critical to advance health and health equity. Research addressing the discrepancy between goals of achieving clinical trial diversity and realities of study enrollment remains underdeveloped., Objective: This study aims to examine the association between race/ethnicity and clinical trial invitation, participation, knowledge, and sources of influence on clinical trial participation., Design and Participants: A cross-sectional, observational study using nationally representative data from 3689 US adults (≥ 18 years of age) who responded to the Health Information National Trends Survey fielded from February 24 to June 15, 2020., Main Measures: Primary outcomes included clinical trial invitation, participation, knowledge, and sources of influence on participation. The independent variable of interest is self-reported race/ethnicity., Key Results: Respondents identifying as non-Hispanic Black (relative to non-Hispanic White) had higher odds of being invited into a clinical trial (adjusted odds ratio: 2.0, 95% confidence interval (CI): 1.1, 3.7), but no differences in odds of participation were observed by race/ethnicity. Respondents from all races/ethnicities reported that personal healthcare providers were the most trusted source of clinical trial information. Hispanic (marginal effect (ME): - 0.09; 95% CI: - 0.16, - 0.03), non-Hispanic Black (ME: - 0.11; 95% CI: - 0.18, - 0.04), and non-Hispanic other (ME: - 0.11; 95% CI: - 0.19, - 0.02) respondents had lower odds than non-Hispanic White respondents of saying they would be influenced "a lot" by their doctor encouraging participation. Non-Hispanic Black respondents had significantly lower odds (relative to non-Hispanic White) of indicating family encouragement would influence their clinical trial participation decision "a lot" (ME: - 0.09; 95%: CI: - 0.14, - 0.03)., Conclusion: While personal healthcare providers were trusted sources of information, racial/ethnic minority populations noted lower odds of clinical trial participation influence from providers and family. Thus, it is imperative for the healthcare, government, and industry organizations to build trust in medicine and science., (© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.)

The purpose of this study was to examine the trends in who obtains genetic tests, and opinions about how genes affect health. Cross-sectional survey data from Health Information National Trends Survey (HINTS) 5, Cycle 4 was used. This data was collected from adults 18 years of age or older who completed mailed surveys sent by the National Cancer Institute between January and April 2020. The sample consisted of 2,947 respondents who answered the question 'Have you ever had a genetic test'? 727 had a test and 2,220 did not have a test. The measures used included survey questions that asked whether respondents obtained certain kinds of genetic tests, who they shared test results with, whether they believed genes affect health status, and their demographic and cancer status information. Multivariate logistic regression models were developed to assess which demographic variables were associated with having different kinds of genetic tests, and whether those who had genetic tests had different opinions about genetic testing and the influence of genes on health. We found that female respondents [OR: 1.9; CI: (1.2-3.1)] had higher odds of having any genetic tests while Hispanic [OR: 0.5; CI: (0.2-1.0)] respondents had lower odds. Our findings indicate that there are demographic disparities in who received genetic tests, and that cancer risk alone does not explain the differences in prevalence of genetic testing., (© 2022 The Authors. Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.)

Background: Efforts to address infant mortality disparities in Ohio have historically been adversely affected by the lack of consistent data collection and infrastructure across the community-based organizations performing front-line work with expectant mothers, and there is no established template for implementing such systems in the context of diverse technological capacities and varying data collection magnitude among participating organizations., Methods: Taking into account both the needs and limitations of participating community-based organizations, we created a data collection infrastructure that was refined by feedback from sponsors and the organizations to serve as both a solution to their existing needs and a template for future efforts in other settings., Results: By standardizing the collected data elements across participating organizations, integration on a scale large enough to detect changes in a rare outcome such as infant mortality was made possible. Datasets generated through the use of the established infrastructure were robust enough to be matched with other records, such as Medicaid and birth records, to allow more extensive analysis., Conclusion: While a consistent data collection infrastructure across multiple organizations does require buy-in at the organizational level, especially among participants with little to no existing data collection experience, an approach that relies on an understanding of existing barriers, iterative development, and feedback from sponsors and participants can lead to better coordination and sharing of information when addressing health concerns that individual organizations may struggle to quantify alone., (© 2021. The Author(s).)

Purpose: Assessed socioeconomic factors in health information seeking behavior and trust of information sources from 2007 to 2017., Design: Pooled cross-sectional survey data., Setting: Health Information National Trends Survey., Participation: Data included 6 iterations of U.S. adults (Pooled: N = 19,496; 2007: N = 3,593; 2011: N = 3,959; 2013: N = 3,185; FDA 2015: N = 3,738; 2017: N = 3,285; and FDA 2017: N = 1,736)., Measures: Outcome variables were health information seeking, high confidence, and high trust of health information from several sources. Independent variables were education and income group, controlling for other sociodemographic variables., Analysis: Weighted descriptive and multivariate logistic regression for the pooled sample assessed associations by education and income. Fully interacted models with education/income-survey year interactions compared differences in outcomes between years., Results: We found information seeking, confidence, and trust were associated with income and education, which supported previously reported findings. Additionally, our findings indicated low-and medium-income groups had significantly lower odds of seeking health information compared to those in a high-income group. Regarding trust of information, a high school education was associated with higher odds of trust in family and friends. We also found that, over time, information seeking, confidence, and trust behavior differed by income and education, with some differences persisting., Conclusion: Disparities by income and education in trust of information sources remained across time. Understanding optimal information sources, their reach, and their credibility among groups could enable more targeted interventions and health messaging. We also describe the implications for our findings in the context of COVID-19.

Background: Patients who use patient portals may be more engaged and empowered in their care; however, differences in who accesses patient portals remain. The characteristics of who uses patient portals more frequently and who perceives them as useful may also differ, as well as which functions people use., Objective: We assessed the characteristics of patient portal users to examine who uses them more frequently and who perceives them as useful. In addition, we wanted to see if those who use them more frequently or perceive them to be more useful use different functions or more functions of patient portals., Methods: Pooled cross-sectional data from 2017 to 2018 Health Information National Trends Survey (HINTS) were used. Ordinal regression models were developed to assess frequency of use and perceived usefulness by demographics, and multivariable logistic regression models were used to examine the association between the use of 10 patient portal functions and frequency of use and perceived usefulness of patient portals., Results: The odds of using patient portals more frequently were higher among those with Bachelor's degrees, incomes between $35,000 and $75,000, and those with two or more chronic conditions. Respondents with three or more chronic conditions had higher odds of rating patient portals as useful. Those who used their patient portal 10 or more times in the past year had higher odds of using all functions except for viewing test results compared with those who used their patient portal one to two times per year. Those who rated patient portals as "very useful" had higher odds of using seven of the functions compared with those who rated them "not very"/"not at all useful.", Conclusion: It is important to continue to assess usefulness, frequency of use, and overall patient portal function use to identify opportunities to increase patient engagement with patient portals., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: In the United States, all 50 state governments deployed publicly viewable dashboards regarding the novel coronavirus disease 2019 (COVID-19) to track and respond to the pandemic. States dashboards, however, reflect idiosyncratic design practices based on their content, function, and visual design and platform. There has been little guidance for what state dashboards should look like or contain, leading to significant variation., Objectives: The primary objective of our study was to catalog how information, system function, and user interface were deployed across the COVID-19 state dashboards. Our secondary objective was to group and characterize the dashboards based on the information we collected using clustering analysis., Methods: For preliminary data collection, we developed a framework to first analyze two dashboards as a group and reach agreement on coding. We subsequently doubled coded the remaining 48 dashboards using the framework and reviewed the coding to reach total consensus., Results: All state dashboards included maps and graphs, most frequently line charts, bar charts, and histograms. The most represented metrics were total deaths, total cases, new cases, laboratory tests, and hospitalization. Decisions on how metrics were aggregated and stratified greatly varied across dashboards. Overall, the dashboards were very interactive with 96% having at least some functionality including tooltips, zooming, or exporting capabilities. For visual design and platform, we noted that the software was dominated by a few major organizations. Our cluster analysis yielded a six-cluster solution, and each cluster provided additional insights about how groups of states engaged in specific practices in dashboard design., Conclusion: Our study indicates that states engaged in dashboard practices that generally aligned with many of the goals set forth by the Centers for Disease Control and Prevention, Essential Public Health Services. We highlight areas where states fall short of these expectations and provide specific design recommendations to address these gaps., Competing Interests: None declared., (Thieme. All rights reserved.)

People who seek health information frequently may be more likely to meet health behavior goals; however, people use many different information sources. The purpose of this paper is to assess how different sources of health information influence likelihood of meeting cancer prevention behavior guidelines. Logistic regression of cross-sectional data from 6 years of the Health Information National Trends Survey (HINTS) was conducted. Independent variables included first source of health information, gender, age, race, education level, income, cancer history, general health, and data year; dependent variables were fruit and vegetable intake, exercise, smoking, mammography, Pap test, and colon cancer screening. Those who seek health information from doctors, the internet, or publications had higher odds of meeting more cancer prevention guidelines than those who do not seek health information. Those who used healthcare providers as an initial information source had higher odds of meeting diet, cervical, and colon cancer screening recommendations, while using the internet as an initial source of health information was associated with higher odds of meeting diet, smoking, and colon cancer screening recommendations. No health information source was associated with meeting either exercise or mammography recommendations. People should be encouraged to seek health information to help them meet their behavior goals, especially from sources that are more likely to be accurate and encourage cancer prevention behavior. Future research is needed to understand the accuracy of health information and what kinds of health information have positive influences on cancer prevention behavior.

Purpose: Prior research on the use of the internet among cancer survivors indicates a digital divide. The online landscape and patterns of information consumption, however, have notably changed over the past decade necessitating an updated examination of health-related internet use (HRIU) among cancer survivors., Methods: Using survey data from 2003, 2005, 2007, 2011, 2013, 2017, and 2018 Health Information National Trends Survey (HINTS) iterations, the objectives of this study were to report prevalence, trends, and user profiles in HRIU in terms of emailing doctors, buying medicine online, and support group participation. Descriptive analyses and weighted multivariate logistic regression analyses were performed., Results: Cancer survivors who reported not using the internet were more likely to be older, belong to ethnic minorities, be less educated, and reside in rural areas as compared with those who reported using the internet. Except for participation in online support groups, all other types of HRIU increased in prevalence across the years., Conclusions: Consistent with the increased penetration of the internet and the altered online health communication landscape, we found increased prevalence of HRIU among cancer survivors. However, the digital divide persists in terms of internet access. These findings can inform initiatives to bridge the gap among survivors of varying profiles in using the internet for their health needs., Implications for Cancer Survivors: There is increased reliance on online platforms to obtain and communicate health-related information. The risk with this approach is potential oversight of ensuring equity in terms of internet access and technology literacy among survivors.

Purpose: Assessed racial disparities in health information-seeking behavior and trust of information sources from 2007 to 2017., Design: Pooled cross-sectional survey data., Setting: Health Information National Trends Survey (HINTS)., Participation: Data included 6 iterations of HINTS (pooled: N = 19 496; 2007: n = 3593; 2011: n = 3959; 2013: n = 3185; Food and Drug Administration [FDA] 2015: n = 3738; 2017: n = 3285; and FDA 2017: n = 1736)., Measures: Outcome variables were health information seeking, high confidence, and high trust of health information from several sources. Independent variable was race group, controlling for other sociodemographic and socioeconomic variables., Analysis: Weighted descriptive and multivariate logistic regression for the pooled sample assessed associations by race. Fully interacted models with race-survey year interactions compared differences in outcomes between years., Results: Black respondents, relative to white, had greater odds of having high confidence in their ability to attain health information, trust of health information from newspapers and magazines, radio, internet, television, government, charitable organizations, and religious organizations. Hispanic respondents, relative to white, had lower odds of seeking health information and trusting health information from doctors. They had higher odds of trusting health information from the radio, the internet, television, charitable organizations, and religious organizations., Conclusion: Disparities between races in trust of information sources remained across time. Understanding optimal information media, their reach, and credibility among racial groups could enable more targeted approaches to developing interventions. Our analytical approach minimized limitations present in the HINTS.

Background: An area deprivation index (ADI) is a geographical measure that accounts for socioeconomic factors (e.g., crime, health, and education). The state of Ohio developed an ADI associated with infant mortality: Ohio Opportunity Index (OOI). However, a powerful tool to present this information effectively to stakeholders was needed., Objectives: We present a real use-case by documenting the design, development, deployment, and training processes associated with a dashboard solution visualizing ADI data., Methods: The Opportunity Index Dashboard (OID) allows for interactive exploration of the OOI and its seven domains-transportation, education, employment, housing, health, access to services, and crime. We used a user-centered design approach involving feedback sessions with stakeholders, who included representatives from project sponsors and subject matter experts. We assessed the usability of the OID based on the effectiveness, efficiency, and satisfaction dimensions. The process of designing, developing, deploying, and training users in regard to the OID is described., Results: We report feedback provided by stakeholders for the OID categorized by function, content, and aesthetics. The OID has multiple, interactive components: choropleth map displaying OOI scores for a specific census tract, graphs presenting OOI or domain scores between tracts to compare relative positions for tracts, and a sortable table to visualize scores for specific county and census tracts. Changes based on parameter and filter selections are described using a general use-case. In the usability evaluation, the median task completion success rate was 83% and the median system usability score was 68., Conclusion: The OID could assist health care leaders in making decisions that enhance care delivery and policy decision making regarding infant mortality. The dashboard helps communicate deprivation data across domains in a clear and concise manner. Our experience building this dashboard presents a template for developing dashboards that can address other health priorities., Competing Interests: C.M.S reports grants from Ohio Department of Education and Medicaid, during the conduct of the study. N.F. reports grants from Ohio Department of Education and Medicaid, during the conduct of the study. A.A. reports grants from Ohio Department of Education and Medicaid, during the conduct of the study. T.G. reports grants from Ohio Department of Education and Medicaid, during the conduct of the study. P.J. reports grants from Ohio Department of Education and Medicaid, during the conduct of the study., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Provision of cancer treatment summaries to patients is recommended to improve patient-centered communication (PCC). The objective of this study is to assess relationships between cancer treatment summary receipt, PCC, and quality of care (QOC)., Methods: Linear and logistic regression of cross-sectional data from the Health Information National Trends Survey (HINTS) was conducted using data from years 2012, 2014, and 2017. The independent variable was receipt of treatment summary; the dependent variables were overall PCC score, six domains of PCC, and QOC., Results: In the pooled sample, 36.9% of patients with cancer treatment history reported receiving a treatment summary. There was a significant positive association between overall PCC score and treatment summary receipt, and higher odds of high scores for the PCC domains "responding to emotions" and "managing uncertainty." We did not observe significant associations between treatment summary receipt and other PCC domains or QOC., Conclusion: Providing patients cancer treatment summaries may improve PCC, but fewer than half of patients reported receiving one of these summaries., Practice Implications: Providing cancer treatment summaries is important, however, providing them without engaging in additional communication may be insufficient to improve all patient-centered care domains or quality of care., Competing Interests: Declaration of Competing Interest The authors have no other financial disclosures and declare no conflicts of interest., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Cancer survivors are at high risk for cancer reoccurrence, highlighting the importance of managing behavioral risk factors for cancer. Despite this risk, many cancer survivors continue to smoke cigarettes. This article describes the relationship between smoking behavior and demographic and clinical factors in cancer survivors., Methods: Multinomial logistic regression of cross-sectional data from the Health Information National Trends Survey was conducted using combined data from years 2003, 2005, 2007, 2011, 2012, 2013, and 2014. Independent variables included age, cancer history, race, education level, marital status, insurance status, and data year; the dependent variable was smoking status (current vs. former or never)., Results: Cancer survivors were less likely to be current smokers but more likely to be former smokers than those with no history of cancer. Cancer survivors that currently smoked were more likely to have lower education levels, be divorced, separated, or single, or not have health insurance. Older cancer survivors, Hispanic, and non-Hispanic black survivors were less likely to smoke. Among cancer subgroups, prostate cancer survivors had the lowest rate (8.8%) of current smoking from 2011 to 2014, and cervical cancer survivors had the highest rate (31.1%)., Conclusions: Although those with no history of cancer had higher rates of current smoking, many subgroups of cancer survivors continued to smoke at higher rates than average cancer survivors. Cancer survivors that were younger, had lower education levels, were any marital status other than married or widowed, were uninsured, or survived cervical cancer were more likely to be smokers than other survivors., Implications: It is important to understand which types of cancer survivors are at high risk of continued smoking to better inform tobacco dependence treatment interventions among those at high risk of cancer reoccurrence. Our findings suggest targeted tobacco dependence treatment efforts among cancer survivors should focus on survivors of cervical cancer and survivors that are young, unmarried, uninsured, or have lower education levels., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: The Ohio Infant Mortality Reduction Initiative (OIMRI) is a home-visiting program that aims to reduce infant mortality among infants of high-risk black women. This study examined birth outcomes among OIMRI participants and compared program participants to matched non-OIMRI women., Design: Program data were linked to birth records, death records, and Medicaid claims data. Propensity score matching was used to match program participants with like women in Ohio., Sample: The sample consisted of 2,837 black mothers from 14 counties in Ohio., Measurements: Infant mortality, causes of death, and birth weight were examined., Results: There were 25 deaths among 2,837 OIMRI participants from 2010 to 2015, for an infant mortality rate of 8.8 deaths per 1,000 live births (95% CI 5.4-12.2). Among those women who participated in OIMRI, three fewer deaths per 1,000 births within the first year of life were estimated compared to those not in OIMRI; however, this was not statistically significant., Conclusions: The number of infant deaths among women enrolled in the OIMRI program was not significantly different from those who did not participate in OIMRI. Programs like OIMRI cannot singlehandedly address the infant mortality disparity but may help prevent some infant mortality risks., (© 2018 Wiley Periodicals, Inc.)

Background: People use a variety of means to find health information, including searching the Internet, seeking print sources, and talking to healthcare providers, family members, and friends. Doctors are considered the most trusted source of health information, but people may be underutilizing them in favor of searching the Internet., Methods: A multinomial logistic regression of cross-sectional data from Cycle 4 of the Health Information National Trends Survey (HINTS) was conducted. Independent variables included gender, age, rurality, cancer history, general health, income, race, education level, insurance status, veteran status, Internet use, and data year; the dependent variable was the first chosen source of health information., Results: The most frequent initial source of health information was the Internet, and the second most frequent was healthcare providers. There were significant differences in odds of using healthcare providers as the first source of health information. Those likely to use doctors as their initial source of health information were older adults, black adults, adults with health insurance, those who do not use the Internet, and adults who do not have a college degree., Conclusions: People who use healthcare providers as the first source of health information may have better access to health care and be those less likely to use the Internet. Doctors may have to provide more information to those who do not use the internet and spend time verifying information for those who do use health information from the internet.

Background: Underage alcohol use and depression remain public health concerns for Hispanic adolescents nationwide., Objectives: The study purpose was to identify the profiles of depression among Hispanic adolescents who reported experiencing depressive symptoms in their lifetime and classify them into groups based on their symptoms. Based on classifications, we examined the relationship between past year alcohol use and severity of depressive symptoms while controlling for sex and age., Methods: A secondary analysis of the 2013 NSDUH was conducted among Hispanic adolescents from 12 to 17 years of age (n = 585) who reported experiencing depressive symptoms. Latent class analysis was used to identify latent classes of depressive symptoms among Hispanic adolescents. A zero-inflated negative-binomial regression model was used to examine the relationship between alcohol use and depressive symptoms., Results: "High depressive" and "moderate depressive" classes were formed. The items that highly differentiated among the groups were felt worthless nearly every day, others noticed they were restless or lethargic, and had changes in appetite or weight. There was a significant difference (p = 0.03) between the classes based on alcohol use; those in the moderate depressive class were 1.71 times more likely to be identified as not reporting past alcohol use. Results indicated the high depressive class was estimated to have 1.62 more days of past year alcohol use than those in the moderate depressive class for adolescents who used alcohol (p < 0.001). Conclusions/Importance: Study findings can be used to address these significant public health issues impacting Hispanic adolescents. Recommendations are included.

IN BRIEF Participants with type 2 diabetes established personalized dietary and physical activity goals as behavioral strategies to reduce cardiovascular risk during a 16-week telephone coaching intervention. People were most likely to attain dietary goals that involved altering the intake of specific foods rather than certain nutrients and were more successful at physical activity goals to increase activity levels rather than to add new types of activity. Barriers to goal success included time management, physical limitations/illness, and social/cultural activities.

Social policies that are not specifically aimed at impacting health can still have health consequences. State education reforms, such as standardized testing and stringent accountability for schools and teachers, may affect teacher health by changing their working conditions. This study explores associations between state education initiatives and teachers' sleep, an important predictor of productivity and chronic health conditions. The Behavioral Risk Factor Surveillance System 2013 and 2014 data sets provided sleep and demographic data for 7836 teachers in 29 states in the United States. We linked the teacher data to state education reform data from the U.S. Department of Education. Logistic regression was used to estimate odds ratios (ORs) of reporting inadequate sleep (i.e., <6.5 h and <5.5 h) associated with state education policies after adjusting for demographic characteristics. Teachers had significantly higher odds of reporting inadequate sleep if their state financed professional development, sanctioned or rewarded schools based on student performance, and regulated classroom materials for state-wide common core standards (ORs ranging from 1.25 to 1.84). More strictly defined inadequate sleep (<5.5 h) had generally higher ORs than less strict definition (<6.5 h). The Race-to-the-Top award, a US federal grant designed to encourage states to implement reforms through regulations and legislations, was also associated with inadequate sleep (OR = 1.41, p < 0.01, for <6.5 h; OR = 1.55, p < 0.01, for <5.5 h). Although this exploratory study did not have district- and school-level implementation data, the results suggest that some state education policies may have impacts on teacher sleep. Consequences of education reform for teacher health deserve more attention., (Published by Elsevier Ltd.)

Objective: Evaluate a 16-week decision support and goal-setting intervention to compare diet quality, decision, and diabetes-related outcomes to a control group., Methods: Adults with type 2 diabetes (n=54) were randomly assigned to an intervention or control group. Intervention group participants completed one in-person motivational interviewing and decision support session followed by seven biweekly telephone coaching calls. Participants reported previous goal attempts and set diet- and/or physical activity-related goals during coaching calls. Control group participants received information about local health care resources on the same contact schedule., Results: There was a significant difference between groups for diabetes empowerment (p=0.045). A significant increase in diet quality, diabetes self-efficacy, and diabetes empowerment, and a significant decrease in diabetes distress and depressive symptoms (all p≤0.05) occurred in the intervention group. Decision confidence to achieve diet-related goals significantly improved from baseline to week 8 but then declined at study end (both p≤0.05)., Conclusions: Setting specific diet-related goals may promote dietary change, and telephone coaching can improve psychosocial outcomes related to diabetes self-management., Practice Implications: Informed shared decision making can facilitate progressively challenging yet attainable goals tailored to individuals' lifestyle. Decision coaching may empower patients to improve self-management practices and reduce distress., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The extant literature has largely ignored a potentially significant source of variance in multiple mini-interview (MMI) scores by "hiding" the variance attributable to the sample of attributes used on an evaluation form. This potential source of hidden variance can be defined as rating items, which typically comprise an MMI evaluation form. Due to its multi-faceted, repeated measures format, reliability for the MMI has been primarily evaluated using generalizability (G) theory. A key assumption of G theory is that G studies model the most important sources of variance to which a researcher plans to generalize. Because G studies can only attribute variance to the facets that are modeled in a G study, failure to model potentially substantial sources of variation in MMI scores can result in biased estimates of variance components. This study demonstrates the implications of hiding the item facet in MMI studies when true item-level effects exist. An extensive Monte Carlo simulation study was conducted to examine whether a commonly used hidden item, person-by-station (p × s|i) G study design results in biased estimated variance components. Estimates from this hidden item model were compared with estimates from a more complete person-by-station-by-item (p × s × i) model. Results suggest that when true item-level effects exist, the hidden item model (p × s|i) will result in biased variance components which can bias reliability estimates; therefore, researchers should consider using the more complete person-by-station-by-item model (p × s × i) when evaluating generalizability of MMI scores.

Purpose: The purpose of this study was to evaluate a 4-month telephone-based goal-setting and decision support intervention among adults with type 2 diabetes mellitus (T2DM) and multiple risk factors for cardiovascular disease (CVD)., Methods: A randomized pretest-posttest control group design was employed. Overweight or obese adults aged 40 to 75 years with T2DM and ≥1 additional CVD risk factor were provided with individualized CVD risk information. At baseline and each biweekly telephone call, the multiple-goal group self-selected both diet- and physical activity-related goals, the single goal group set a single goal, and the control group received information about community health resources. Dietary intake was assessed via a food frequency questionnaire, physical activity via questionnaire, and A1C and blood lipids via fasting fingerstick sample. Between-group differences for clinical (ie, A1C, blood pressure, and blood lipids), physical activity, and dietary variables were evaluated using Kruskal-Wallis, Mann-Whitney U, analysis of variance, and t tests., Results: From pre- to postintervention, the single-goal group demonstrated significant improvement in systolic blood pressure and intake of servings of fruits, vegetables, and refined grains (all P < .05). The multiple-goal group reported significant reduction in percent energy from total, saturated, monounsaturated, and trans fat intake and significant increase in leisure time walking (all P < .05)., Conclusion: A multiple-goal approach over 4 months can improve dietary and physical activity outcomes, while a single-goal approach may facilitate improvement in one behavioral domain. Additional research is needed to evaluate maintenance of the achieved changes., (© 2016 The Author(s).)

This study tested whether life history strategy (LHS) and its intergenerational transmission could explain young adult use of common psychoactive substances. We tested a sequential structural equation model using data from the National Longitudinal Survey of Youth. During young adulthood, fast LHS explained 61% of the variance in overall liability for substance use. Faster parent LHS predicted poorer health and lesser alcohol use, greater neuroticism and cigarette smoking, but did not predict fast LHS or overall liability for substance use among young adults. Young adult neuroticism was independent of substance use controlling for fast LHS. The surprising finding of independence between parent and child LHS casts some uncertainty upon the identity of the parent and child LHS variables. Fast LHS may be the primary driver of young adult use of common psychoactive substances. However, it is possible that the young adult fast LHS variable is better defined as young adult mating competition. We discuss our findings in depth, chart out some intriguing new directions for life history research that may clarify the dimensionality of LHS and its mediation of the intergenerational transmission of substance use, and discuss implications for substance abuse prevention and treatment.

Objective. This study provides information about children's learning and goal attainment related to change in their self-management skills during a diabetes camp. Design and methods. One hundred and thirty-one children completed an evaluation for the first year (year 1), and 68 children completed an evaluation for the second year (year 2). All of the children had type 1 diabetes. During both years, parents provided information about goals for their child before camp started. Children's learning about diabetes self-management, as well as their satisfaction with camp, was assessed at the end of the camp session. In the evaluation for year 2, a goal-setting intervention was also developed, and its effectiveness was assessed through both physicians' and children's reports. Results. Children learned new information during camp about recognizing and managing the signs of hypo- and hyperglycemia and about counting carbohydrates and rotating insulin pump sites. Children were better able to recall their self-management goals in year 2. In terms of benefiting from camp, boys reported learning more than girls about diabetes management, whereas girls were more likely than boys to report that greater opportunities to express feelings were of value. Conclusions. Goal-setting was successful in improving children's recall of their self-management goals. Children benefited from the supportive and educational camp atmosphere. Future research should assess the benefits of camp across multiple camp settings and determine whether educational benefits have long-term effects on children's goal-setting and knowledge and whether these benefits lead to psychosocial improvements.

Little is known about the effective elements of Interactive Cancer Communication Systems (ICCSs). A randomized trial explored which types of services of a multifaceted ICCS benefited patients and the nature of the benefit. Women with breast cancer (N=450) were randomized to different types of ICCS services or to a control condition that provided internet access. The Comprehensive Health Enhancement Support System (CHESS), served as the ICCS. ICCS services providing information and support, but not coaching such as cognitive behavior therapy, produced significant benefits in health information competence and emotional processing. Provision of Information and Support ICCS services significantly benefited women with breast cancer. More complex and interactive services designed to train the user had negligible effects.