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Ensuring the wellbeing and stability of children with foster care experiences is critical. Between 5% and 20% of children experience post-permanency instability, a reentry into foster care after ad...

Targeted prevention efforts after adoption or guardianship from foster care are intended to help families most at-risk and prior to the onset of significant issues. Most adoptive and guardianship f...

Objectives (a) To examine associations between public health nurse (PHN) workforce factors (PHNs' highest education and PHNs' mean years of employment) and health-risk behaviors (smoking and physical inactivity rates), and (b) to investigate the associations between PHN workforce factors and premature mortality rates across all counties of the United States. Design Secondary analysis. Sample A total of 5,705 PHNs from the 2015 National Nursing Workforce Survey and 2,977 U.S. counties from the 2016 County Health Rankings & Roadmaps data were included. Methods Multilevel linear regression was used. Results Bachelor's, and master's or doctorate-prepared PHNs accounted for 41.5% and 17.0%, respectively. The mean year of employment among PHNs was 17.3. The percentages of PHNs with bachelor's, master's, and doctoral degrees were significantly associated with decreased physical inactivity rates. The PHNs' mean year of employment was significantly associated with decreased physical inactivity rates and reduced premature age-adjusted mortality rates. Conclusions The findings indicated that PHNs with higher levels of education and more years of employment were important in improving health outcomes (health-risk behavior and premature mortality). Policymakers need to consider strategies to encourage more PHNs to obtain advanced degrees and to retain PHNs longer in the public health field.

Social media platforms are home to large volumes of ambiguous hashtag-based claims about the health, modified-risk, and cessation benefits of electronic cigarette products (e.g., #Vapingsavedmylife). The objective of this study was to qualitatively explore how young adults interpret these hashtags on the popular platform Instagram. Specifically, we sought to identify if they view these hashtags as making health-related claims, and if they find these claims to be credible and valid. We conducted 12 focus groups in 2018 with non–tobacco users, smokers, dual users, and vapers between the ages of 18 and 24 ( n = 69). Using real Instagram posts to guide discussion, participants reflected on the meaning of potentially claims-making hashtags. Participants interpreted the majority of the hashtags as making health-related claims. However, many participants felt that the claims were too exaggerated to be entirely valid. Some participants, including dual users and vapers, argued that smoking and vaping were largely equivalent. Smokers were particularly skeptical of claims. Findings suggest that the U. S. Food and Drug Administration should consider hashtag-based claims in their regulatory efforts. However, further research is needed on how to pragmatically address claims taking the form of hashtags given legal and practical constraints.

Introduction Effective August 2018, the U.S. Food and Drug Administration (FDA) required that nicotine addiction warnings be placed on ads for nicotine containing e-liquids. As per FDA comments, this provision pertains to visual ads communicated via social media, raising questions about compliance within the large e-liquid promotion community on Instagram. Aims and Methods This study examines use of warnings on promotional Instagram posts before and after provisions took effect on August 10, 2018. Netlytic was used to gather a sample of 500 promotional #eliquid and #ejuice posts from: May 2017, October 2017, March 2018, August 2018, and September 2018. The 1500 prewarning and 1000 postwarning posts were coded using content analysis. Changes in products and marketing strategies were also considered. Post volume was tracked monthly between May 2017 and February 2020. Results In the prewarning period, nicotine warning statements were absent on all posts. Following August 10, 2018, FDA compliant warnings were present on 13.6% of posts. Among US-based posts, 36.4% used the warnings, with warnings more common on posts made by e-liquid brands (52.3%) and posts promoting e-liquids with nicotine (40.0%). Promotional strategies and products did not significantly change. The share of posts made by US Instagram users decreased by 11%, although total post volume continued to grow. Conclusions Many e-liquid promotion posts on Instagram remained noncompliant with nicotine warnings after FDA provisions took effect. The large volume of international users also limited the impact of FDA-mandated warnings on the social media environment. Implications Further guidance and enforcement are needed to ensure that US e-liquid marketers on visual social media platforms adhere to current provisions, particularly for individual social media users who are sponsored by industry. The inherently global span of social media also indicates the importance of a shared approach to marketing regulations. Further work is needed to assess enforcement strategies viable for the social media environment.

When processing free-living accelerometer data, invalid days are typically discarded, potentially resulting in loss of valuable information. The purpose of this semi-simulation study was to compare...

Aim: Pilot study of a novel caregiving training and support intervention for children and youth

Background The rapid global spread of the coronavirus disease (COVID-19) has compelled national governments to issue guidance on the use of face masks for members of the general public. To date, no work has assessed how this guidance differs across governments. Objective This study seeks to contribute to a rational and consistent global response to infectious disease by determining how guidelines differ across nations and regions. Methods A content analysis of health agency mask guidelines on agency websites was performed in late March 2020 among 25 countries and regions with large numbers of COVID-19 cases. Countries and regions were assigned across the coding team by language proficiency, with Google Translate used as needed. When available, both the original and English language version of guidance were reviewed. Results All examined countries and regions had some form of guidance online, although detail and clarity differed. Although 9 countries and regions recommended surgical, medical, or unspecified masks in public and poorly ventilated places, 16 recommended against people wearing masks in public. There were 2 countries that explicitly recommended against fabric masks. In addition, 12 failed to outline the minimum basic World Health Organization guidance for masks. Conclusions Online guidelines for face mask use to prevent COVID-19 in the general public are currently inconsistent across nations and regions, and have been changing often. Efforts to create greater standardization and clarity should be explored in light of the status of COVID-19 as a global pandemic.

Advance care planning (ACP) is understudied among American Indian individuals. A cross-sectional, self-administered survey was conducted with a convenience sample of 200 American Indian and 436 non-Hispanic White older adults from two Midwestern states to identify correlates of ACP. Compared with their White peers, American Indian older adults were significantly less likely to have an end-of-life (EOL) care plan or to have completed a durable power of attorney for health care (DPAHC) or a living will. Multivariate logistic regression showed that having an EOL plan was associated with older age, having some college education or more, and having a greater number of chronic conditions, but not with race. Having a DPAHC was associated with being White, older age, having lower levels of depressive symptoms, and having a greater number of chronic conditions, whereas completing a living will was associated with being White, older age, having some college education or more, and having a greater number of chronic conditions. Nurses need to engage in targeted culturally sensitive approaches to promote ACP, grounded in indigenous cultures' health beliefs and practices. [Res Gerontol Nurs. 2019; 12(1):34–43.]

Poor health outcomes of chronically ill low-income adults are costly in both fiscal and human terms. One-third of Americans have hypertension and 43%) with high rates of exacerbations and complications [28, 10]. Low-income African American adults face life situations complicated by limited resources, high environmental and social risks, a high burden of stress and limited access to healthcare, all of which contribute to a substantial risk for multiple chronic conditions [10, 11, 19]. These factors may also contribute to a low sense of trust in the healthcare system, low self-efficacy regarding self-management behaviors to control hypertension, poor chronic disease management and costly sequelae [6, 19]. Thus, new intervention models and systems of care that are consumer-driven must be developed to improve outcomes. Client self-management of chronic diseases has emerged as a key factor in improved health outcomes [8]. We tested the effect of an innovative Ecological Nurse Case Management (ENCM) intervention on perceived stress, self-efficacy, self-management behaviors (SMB), and health status of low-income, chronically ill, African American adults. We hypothesized ENCM would reduce stress and increase self-efficacy and positively impact health status. We expected that that clients receiving this intervention would show decreased blood pressure (B/P), body mass index (BMI) and waist circumference (WC).

Introduction This study examined the relationships between experiences of childhood and adulthood victimization and current smoking among heterosexual and sexual minority women. The main hypothesis was that victimization experiences would predict current smoking status. Further, we hypothesized that the effect of childhood victimization on self-reported smoker status would be mediated by adult victimization. Methods Data are from two studies conducted in the United States that used similar methods and questionnaires in order to conduct a comparative analysis of women based on sexual orientation. Data from Wave 1 (2000-2001) of the Chicago Health and Life Experiences of Women (CHLEW) study and from Wave 5 (2001) of the National Study of Health and Life Experiences of Women (NSHLEW) study were used in these analyses. Results Twenty-eight percent of the sample reported current smoking. Victimization experiences were common, with 63.4% of participants reporting at least one type of victimization in childhood and 40.2% reporting at least one type in adulthood. Women who identified as heterosexual were less likely to be victimized during childhood than were women who identified as lesbian or bisexual. Adult victimization had a significant effect on current smoker status, and the effect of childhood victimization on smoker status was mediated by adult victimization. When examined by sexual orientation, this indirect relationship remained significant only among bisexual women in the sample. Conclusions Study findings make a valuable contribution to the literature on victimization and health risk behaviors such as smoking. Given the negative and long-term impact of victimization on women, strategies are needed that reduce the likelihood of victimization and subsequent engagement in health risk behaviors such as smoking. Implications The study findings make a valuable contribution to the literature on sexual minority women's health on the influence of victimization on health risk behaviors. With the goal of reducing the likelihood of adult victimization and subsequent engagement in health risk behaviors, programs and policies aimed at preventing victimization of women are warranted. Providers and community health agencies should assess and target physically and sexually abused sexual minority youth for mental health intervention with the goal of interrupting the progression from childhood victimization to adult victimization and subsequent engagement in health risk behaviors.

Background While marketing for electronic cigarette refill liquids (e-liquids) is widespread on Instagram, little is known about the post elements that create appeal among young adult Instagram users. Further information is needed to help shape regulatory strategies appropriate for social media. Objective This study examined young adult Instagram user perceptions of actual e-liquid marketing posts and US Food and Drug Administration (FDA)–mandated nicotine addiction warning statements on Instagram. Methods A series of 12 focus groups (n=69) were held with non–tobacco users, vapers, smokers, and dual users in Wisconsin between September and December 2018. Participants discussed the elements of posts that they found appealing or unappealing, in addition to completing a survey about each post and e-liquid. Focus group transcripts were analyzed by smoking status using a framework analysis approach. Results Although willingness to try e-liquids was highest among nicotine users, focus group discussions indicated that Instagram posts promoting e-liquids held appeal for individuals across smoking statuses. The primary elements that created appeal were the perceived trustworthiness of the Instagram account, attractive design and flavor visuals, and promotion of flavors and nicotine levels that met personal preferences. Post appeal was reduced by references to vaping subcultures, indicators that the post creator did not take nicotine addiction seriously, and FDA-mandated nicotine warning statements. Non–tobacco users were particularly drawn to posts featuring nicotine-free e-liquids with attractive visual designs and flavors known from foods. Conclusions Young adults consider a broad range of elements in assessing the appeal of e-liquid marketing on Instagram, with minor but notable distinctions by smoking status. Non–tobacco users are uniquely drawn to nicotine-free e-liquids and are more deterred by the FDA’s mandated nicotine addiction warning statements than those from other smoking statuses. This suggests that it may be possible to tailor policy interventions in a manner that helps to reduce novel uptake of vaping without significantly diminishing its potential harm-reduction benefits.

The purpose of this study was to explore the feasibility and acceptability of a seated pedaling device to reduce sedentary behavior (SB) in the homes of older adults. Methods: Each participant (N = 20) was outfitted with an activity monitor and seated pedaling device in the home for 7 days and randomly assigned to one of four light-intensity pedaling groups (15, 30, 45, and 60 min/day). Results: There was 100% adherence in all groups and significant group differences in the minutes pedaled per day (p p = .241). The 15-, 30-, 45-, and 60-min groups experienced a 4.0%, 5.4%, 10.6%, and 11.3% reduction in SB on the days pedaled, respectively. Conclusion: Clinically relevant reductions in SB time were achievable in this 1-week trial. Long-term adherence and the impact of replacing SB with seated light activities on geriatric-relevant health outcomes should be investigated.

The aim of this study is to determine changes in sedentary behaviour in response to extensive aerobic exercise training. Participants included adults who self-selected to run a marathon. Sedentary behaviour, total activity counts and physical activity (PA) intensity were assessed (Actigraph GT3X) for seven consecutive days during seven assessment periods (−3, −2, and −1 month prior to the marathon, within 2 weeks of the marathon, and +1, +2, and +3 months after the marathon). Models were fitted with multiple imputation data using the STATA mi module. Random intercept generalized least squares (GLS) regression models were used to determine change in sedentary behaviour with seven waves of repeated measures. Results: Twenty-three individuals (mean ± Sx: 34.4 ± 2.1y, 23.0 ± 1.9% fat, 15 women, 8 men) completed the study. Marathon finishing times ranged from 185 to 344 minutes (253.2 ± 9.6 minutes). Total counts in the vertical axis were 1,729,414 lower one month after the race, compared with two mont...

The growth of social networking services has enabled the sharing of electronic cigarette opinions and experiences via user-generated content.This exploratory study analyzed electronic cigarette content found on the visual social networking service, Instagram, in order to highlight public health challenges created by this content and support understanding of electronic cigarette promotion and usage.A qualitative content analysis was performed on Instagram posts made with the hashtags #ecig or #vape in October 2014. Images, text, and hashtags from 85 posts (43 #ecig, 42 #vape) were analyzed. In addition, the total number of posts made with eight key electronic cigarette hashtags was recorded at four points between March 2014 and October 2015.The total number of #vape posts on Instagram grew by 4,163,274 during the study period, while #ecig posts increased by 741,916. Of the posts examined in-depth, corporate users made up over half of posts. No posts were critical of electronic cigarettes. Few mentioned electronic cigarettes in the context of health benefits. No posts included major brands, and mod style electronic cigarettes were mentioned or depicted in over half of posts. A majority of posts included hashtags expressing vaping identity and community. In addition, users mentioned novel practices such as sub-ohming. Conclusions/Importance: Instagram users in our sample characterized electronic cigarettes primarily as novel devices rather than equivalents to cigarettes. Further, hashtag communities and identities appear to be forming around vaping. Future research should consider the public health implications of these hashtags, as well as novel electronic cigarette practices.

Cultural differences in the relations between perceived stress and mental and physical health, and the role of social support in buffering these relations, are examined in a survey of multiple U.S. cultural/ethnic groups. Findings from a health survey of N = 603 adults comprising approximately equal numbers of non-Hispanic Whites, Mexican Americans, Korean Americans, and African Americans show that perceived stress is negatively correlated with one’s perceived mental and physical health, in line with previous research. However, the role of social support in mitigating this relationship is culturally contingent. A buffering effect of social support on the relation between perceived stress and both mental and physical health was only observed for Mexican Americans, not for the other cultural/ethnic groups. These patterns are discussed in the context of research on differences in social help seeking among distinct types of collectivistic cultural groups. The findings are consistent with recent research on horizontal versus vertical collectivism that highlights the importance of sociability and benevolence in Latin American cultural contexts. The results affirm the importance of distinguishing between collectivistic cultures in understanding how social support may impact mental and physical health.

Introduction With the growing popularity of refillable e-cigarettes and recent FDA regulatory action on e-liquid warning labels, e-liquids are an increasingly important area of study. At present, however, little is known about how e-liquids are marketed. This study examined e-liquid marketing on the visual social media platform Instagram, on which users have created significant amounts of e-cigarette related content. Methods A systematic, random sample of Instagram posts with either #eliquid or #ejuice was collected from the Instagram API during one week in May 2017 and in October 2017 using the Netlytic application. A final sample of 1000 posts was analyzed using qualitative content analysis to discern e-liquid themes, claims, promotions, and products promoted. Results Of the 1000 posts, 61.1% promoted e-liquid. These posts were most frequently made by vape shops and ambassadors/representatives. Almost 80% of promotional posts featured a flavored e-liquid. Posts focused largely on e-liquids tasting good (35.4%) or being cool/edgy (19.0%). Many posts made use of Instagram's visual nature to share creative label designs. Just over a third of posts made some claim about e-liquid benefits or quality, with smokeless tobacco claims being most common. Although posts most commonly originated from the United States, posts made from Indonesia and the United Kingdom were also common. Conclusions E-liquid marketing on Instagram emphasizes positive experiences, personalization, and aspirational identities rather than explicit health and cessation claims. Appeal to youth is a significant concern based both on marketing strategies and the demographics of Instagram users.

Purpose – The purpose of this paper is to investigate cultural variations in the qualities that White Americans and Hispanic Americans believe power-holders should embody, and the situations in which these norms influence consumer satisfaction. Design/methodology/approach – Two experimental studies (n1=130 and n2=121) and one field study (n=241) were conducted with White American and Hispanic participants. Results were analysed using ANOVA and regression. Findings – White Americans are predisposed to apply to power-holders injunctive norms of treating others justly and equitably, whereas Hispanics are predisposed to apply injunctive norms of treating others compassionately. These cultural variations in the use of injunctive norms were more evident in business or service contexts in which power was made salient, and emerged in the norms more likely to be endorsed by White American and Hispanic participants (Study 1), their approval of hypothetical negotiators who treated suppliers equitably or compassionat...

Cross-cultural variability in respondent processing of survey questions may bias results from multiethnic samples. We analyzed behavior codes, which identify difficulties in the interactions of respondents and interviewers, from a discrimination module contained within a field test of the 2007 California Health Interview Survey. In all, 553 (English) telephone interviews yielded 13,999 interactions involving 22 items. Multilevel logistic regression modeling revealed that respondent age and several item characteristics (response format, customized questions, length, and first item with new response format), but not race/ethnicity, were associated with interactional problems. These findings suggest that item function within a multi-cultural, albeit English language, survey may be largely influenced by question features, as opposed to respondent characteristics such as race/ethnicity.

Response heaping (also referred to as rounding or digit preference) occurs when respondents show a preference for rounded numbers (often those divisible by five or 10). Conventional wisdom is that this is the result of taking cognitive shortcuts to make question answering easier, and as such, that it may be a form of survey satisficing. In four studies, we test this conventional wisdom for the first time by exploring whether response heaping occurs for five types of survey questions (behavioral frequency questions, questions that ask about an individual�s personal characteristics, questions that ask about an individual�s age at the time of an event, questions that ask the respondent to report a percentage, and feeling-thermometer attitude reports) under the conditions thought to foster survey satisficing (e.g., among respondents lower in ability and motivation, when the task of question-answering is difficult, and later in a long questionnaire) and whether heaped responses show effects of survey satisficing (e.g., shorter response latencies, less accuracy, and lowered predictive validity). We also examine the prevalence of response heaping and the extent to which heaping is associated across questions. Heaping above chance levels was found for most types of questions (although the prevalence of heaping varied systematically across different types of questions), but we found little evidence that heaping for most types of questions is more common under conditions thought to foster satisficing. In fact, heaping for some questions may actually reflect more thoughtful processes and result in higher data quality.

Background The purpose of this study was to determine the responsiveness of two motion sensors to detect change in sedentary behaviour (SB) and physical activity (PA) during an occupational intervention to reduce sitting time. Methods SB and PA were assessed using a hip-worn Actigraph GTX3 (AG) and a thigh-worn activPAL (AP) during three consecutive workdays throughout baseline and intervention periods. Mean scores at baseline and intervention were estimated by hierarchical linear models (HLM) with robust SEs, adjusting for random variance of average scores between participants. Change scores (mean baseline minus mean intervention) were calculated for each device. Response to change was assessed for each device using the standardised response mean. Results 67 adults (45±11 years; 29.3±7.7 kg/m 2 ) wore the acceleration-based motion sensors for 8.3 (SD=1.2) and 8.3 (SD=1.1) h during the baseline and intervention periods, respectively. HLM showed that AP sitting/lying time (−16.5 min, −5%), AP stepping (+7.5 min, 19%), AP steps/day (+838 steps/day, +22%), AP sit-to-stand transitions (+3, +10%), AG SB (−14.6 min, −4%), AG lifestyle moderate-intensity PA (LMPA, +4 min, +15%) and AG MPA (+3 min, 23%) changed significantly between the baseline and the intervention period. Standardised response means for AP sitting/lying time, stepping, steps/day, sit-to-stand transitions and AG SB, LMPA and MPA were above 0.3, indicating a small but similar responsiveness to change. Conclusions Responsiveness to change in SB and PA was similar and comparable for the AP and AG, indicating agreement across both measurement devices.

Surveys involving health care providers are characterized by low and declining response rates (RRs), and researchers have utilized various strategies to increase survey RRs among health professionals. Based on 48 studies with 156 subgroups of within-study conditions, a multilevel meta-regression analysis was conducted to summarize the effects of different strategies employed in surveys of health professionals. An estimated overall survey RR among health professionals was 0.53 with a significant downward trend during the last half century. Of the variables that were examined, mode of data collection, incentives, and number of follow-up attempts were all found to be significantly related to RR. The mail survey mode was more effective in improving RR, compared to the online or web survey mode. Relative to the non-incentive subgroups, subgroups receiving monetary incentives were more likely to respond, while nonmonetary incentive groups were not significantly different from non-incentive groups. When number of follow-ups was considered, the one or two attempts of follow-up were found to be effective in increasing survey RR among health professionals. Having noted challenges associated with surveying health professionals, researchers must make every effort to improve access to their target population by implementing appropriate incentive- and design-based strategies demonstrated to improve participation rates.

Sexual-minority women are at heightened risk for a number of mental health problems, including hazardous alcohol consumption, depression, and anxiety. We examined self-medication and impaired-functioning models of the associations among these variables and interpreted results within a life course framework that considered the unique social stressors experienced by sexual-minority women.Data were from a sample of 384 women interviewed during the first two waves of the Chicago Health and Life Experiences of Women (CHLEW) study.Covariance structure modeling revealed that (a) consistent with a self-medication process, anxiety was prospectively associated with hazardous drinking and (b) consistent with an impaired-functioning process, hazardous drinking was prospectively associated with depression.Our findings support a life course perspective that interprets the mental health of adult sexual-minority women as influenced by adverse childhood experiences, age at drinking onset, first heterosexual intercourse, and first sexual identity disclosure, as well as by processes associated with self-medication and impaired functioning during adulthood.

Women with breast or cervical cancer abnormalities can experience barriers to timely follow-up care, resulting in delays in cancer diagnosis. Patient navigation programs that identify and remove barriers to ensure timely receipt of care are proliferating nationally. The study used a systematic framework to describe barriers, including differences between African American and Latina women; to determine recurrence of barriers; and to examine factors associated with barriers to follow-up care.Data originated from 250 women in the intervention arm of the Chicago Patient Navigation Research Program (PNRP). The women had abnormal cancer screening findings and navigator encounters. Women were recruited from a community health center and a publicly owned medical center. After describing proportions of African American and Latina women experiencing particular barriers, logistic regression was used to explore associations between patient characteristics, such as race/ethnicity, and type of barriers.The most frequent barriers occurred at the intrapersonal level (e.g., insurance issues and fear), while institutional-level barriers such as system problems with scheduling care were the most commonly recurring over time (29%). The majority of barriers (58%) were reported in the first navigator encounter. Latinas (81%) reported barriers more often than African American women (19%). Differences in race/ethnicity and employment status were associated with types of barriers. Compared to African American women, Latinas were more likely to report an intrapersonal level barrier. Unemployed women were more likely to report an institutional level barrier.In a sample of highly vulnerable women, there is no single characteristic (e.g., uninsured) that predicts what kinds of barriers a woman is likely to have. Nevertheless, navigators appear able to easily resolve intrapersonal-level barriers, but ongoing navigation is needed to address system-level barriers. Patient navigation programs can adopt the PNRP barriers framework to assist their efforts in assuring timely follow-up care.

Background Among women in the general population, childhood physical abuse (CPA) is associated with poor adult health status and engagement in health risk behaviors. Sexual minority women (SMW) are at elevated risk of CPA, have higher rates of smoking, and may be at higher risk for poorer general health. In this study, we examined the influences of CPA on health status in a diverse sample of SMW. We hypothesized that SMW with a history of CPA would report poorer health than those without such histories and that early onset of smoking—an important health risk behavior—would mediate the relationship between CPA and current health status. Methods Structural equation modeling was used to evaluate the influence of CPA on early health risk behavior (i.e., age of smoking onset) and current perceived health status in a community based sample of 368 SMW. Results More than one fifth of the sample (21.5%) reported a history of CPA. One fourth of the sample was current smokers; the average age of smoking onset was 19 to 20 years old. The mean level of self-rated health status was between “fair” and “good.” When relationships were simultaneously estimated, the effect of CPA on health status was mediated by two sequential smoking factors: CPA was associated with earlier age of smoking onset, and age of smoking onset was associated with current smoker status. Being a current smoker had a negative effect on perceived health status. Implications for Practice and/or Policy These results suggest that tobacco use is an important pathway by which CPA influences current health status. Prevention and early intervention initiatives should focus on the reduction of CPA among SMW to eliminate the long-term health consequences of adverse childhood events among SMW.

The current study focuses on three dimensions of treatment neighborhood environments that may influence treatment retention: neighborhood disadvantage, stability, and concentrated immigration. We examined treatment outcomes for a total of 9,319 individuals who were admitted for initial treatment in 56 outpatient clinics in Cook County, Illinois. Census-tract-level data were used to measure facility neighborhood environment. We found that neighborhood disadvantage was unrelated to individual treatment completion. Immigrant concentration was found to increase the likelihood of substance abuse treatment completion, although it was attenuated after controlling for patient problem severity and referral sources. Neighborhood stability was found to be positively related to treatment completion. These results suggest that knowledge of neighborhood context should be an important consideration when making placement decisions of new treatment facilities. Knowledge of neighborhood impact on treatment attrition should also be considered essential information to be used for client placement, treatment program design, and discharge protocols.

Patient-delivered partner therapy (PDPT) is the practice of providing patients diagnosed with a bacterial sexually transmitted infection (STI) medication to give directly to their partner for treatment without requiring the partner to participate in diagnostic testing and counseling. Despite a growing body of evidence in support of PDPT, literature is limited to date on the influence of perceived risk of intimate partner violence (IPV) on PDPT use. We analyzed mixed-method data from 196 quantitative surveys (61% male, M age = 31.2, 92% Black or African-American) and 25 qualitative interviews to better understand the barriers and facilitators associated with PDPT delivery for patients attending a Midwestern, publicly funded STI clinic in the U.S. Nearly a third of surveyed patients (29; 34% of women, 26% of men) expressed worry about IPV when delivering PDPT. Patients had concerns about infidelity worry, embarrassment, and anxiety (referred to as IWEA hereafter) associated with partner notification and PDPT delivery. We found IWEA was highly correlated with IPV concerns in a fully adjusted logistic regression model. Women had 2.43 (95% CI = 1.09–5.42) times greater odds of worrying about IPV than men; other significant factors associated with IPV worry included higher condom use, no prior STI diagnosis, and being uninsured (as compared to having Medicare/Medicaid insurance). Encouraging communication between healthcare providers and their patients about the potential for IPV could facilitate patient triaging that results in the consideration of alternative partner referral mechanisms for patients or partners at risk of harm and better outcomes for patients and their partners.

Although research has documented cultural variability in respondent comprehension and interpretation of survey questions, little information is currently available on the role that acculturation might play in minimizing cross-cultural differences in the comprehension or interpretation of survey questions. To investigate this problem, we examine the potential effects of acculturation to host culture on respondent comprehension of a set of health survey questions among two distinct Latino populations on the US mainland: Mexican-Americans and Puerto Ricans. Specifically, comprehension-related respondent behaviors coded from 345 face-to-face interviews conducted with Mexican-American, Puerto Rican, African American, and non-Latino White adults living in Chicago are examined. Findings indicate that Latino respondents who were born outside of the US and who have a preference for communicating in Spanish, relative to English, were more likely to express comprehension difficulties. These findings suggest that pretest survey instruments with immigrant populations may be a useful strategy for identifying problematic questions.

Survey response rates have decreased over time, particularly in the developed nations of North America and Western Europe (Battaglia et al. 2008; Curtin et al. 2005; de Leeuw and de Heer 2002). Since nonresponse can affect the quality of survey data, it has become an overarching research topic among survey methodologists (

Racial differences in adherence to prescribed medication regimens have been reported among the elderly. It remains unclear, however, whether these differences persist after controlling for confounding variables.The objective of this study was to determine whether racial differences in medication adherence between African American and white seniors persist after adjusting for demographic characteristics, health literacy, depression, and social support. We hypothesized that differences in adherence between the 2 races would be eliminated after adjusting for confounding variables.A survey on medication adherence was conducted using face-to-face interviews with Medicare recipientsor=65 years of age living in Chicago. Participants had to have good hearing and vision and be able to speak English to enable them to respond to questions in the survey and sign the informed-consent form. Medication adherence measures included questions about: (1) running out of medications before refilling the prescriptions; (2) following physician instructions on how to take medications; and (3) forgetting to take medications. Individual crude odds ratios (CORs) were calculated for the association between race and medication adherence. Adjusted odds ratios (AORs) were calculated using the following covariates in multivariate logistic regression analyses: race; age; sex; living with a spouse, partner, or significant other; income; Medicaid benefits; prescription drug coverage; having a primary care physician; history of hypertension or diabetes; health status; health literacy; depression; and social support.Six hundred thirty-three eligible cases were identified. Of the 489 patients who responded to the survey, 450 (266 African American [59%; mean age, 78.2 years] and 184 white [41%; mean age, 76.8 years]; predominantly women) were included in the sample. The overall response rate for the survey was 77.3%. African Americans were more likely than whites to report running out of medications before refilling them (COR = 3.01; 95% CI, 1.72-5.28) and not always following physician instructions on how to take medications (COR = 2.64; 95% CI, 1.50-4.64). However, no significant difference between the races was observed in forgetting to take medications (COR = 0.90; 95% CI, 0.61-1.31). In adjusted analyses, race was no longer associated with low adherence due to refilling (AOR = 1.60; 95% CI, 0.74-3.42). However, race remained associated with not following physician instructions on how to take medications after adjusting for confounding variables (AOR = 2.49; 95% CI, 1.07-5.80).Elderly African Americans reported that they followed physician instructions on how to take medications less frequently than did elderly whites, even after adjusting for differences in demographic characteristics, health literacy, depression, and social support.

The study examines whether social support interacts with health literacy in affecting the health status of older adults. Health literacy is assessed using the short version of the Test of Functional Health Literacy in Adults. Social support is measured with the Medical Outcome Study social support scale. Results show, unexpectedly, that rather than buffering the negative effect of low health literacy, social support has a more positive impact on physical health in older adults with high health literacy. Implications for improving the health status of older adults through health literacy and social support are discussed.

Background: Survey data used to study trends in cancer screening may overestimate screening utilization while potentially underestimating existing disparities in use. Methods: We did a literature review and meta-analysis of validation studies examining the accuracy of self-reported cancer-screening histories. We calculated summary random-effects estimates for sensitivity and specificity, separately for mammography, clinical breast exam (CBE), Pap smear, prostate-specific antigen testing (PSA), digital rectal exam, fecal occult blood testing, and colorectal endoscopy. Results: Sensitivity was highest for mammogram, CBE, and Pap smear (0.95, 0.94, and 0.93, respectively) and lowest for PSA and digital rectal exam histories (0.71 and 0.75). Specificity was highest for endoscopy, fecal occult blood testing, and PSA (0.90, 0.78, and 0.73, respectively) and lowest for CBE, Pap smear, and mammogram histories (0.26, 0.48, and 0.61, respectively). Sensitivity and specificity summary estimates tended to be lower in predominantly Black and Hispanic samples compared with predominantly White samples. When estimates of self-report accuracy from this meta-analysis were applied to cancer-screening prevalence estimates from the National Health Interview Survey, results suggested that prevalence estimates are artificially increased and disparities in prevalence are artificially decreased by inaccurate self-reports. Conclusions: National survey data are overestimating cancer-screening utilization for several common procedures and may be masking disparities in screening due to racial/ethnic differences in reporting accuracy. (Cancer Epidemiol Biomarkers Prev 2008;17(4):748–57)

Introduction Physical activity is known to significantly impact cardiometabolic health. Accelerometer data, as a measure of physical activity, can be used to objectively identify a disparity in movement (movement discordance) between healthy and unhealthy adults. The purpose of this study was to examine the Movement Discordance between healthy and unhealthy adults in a large US population sample. Methods Demographic, health and accelerometer data from the National Health and Nutrition Examination Study (NHANES) 2003–2004 and 2005–2006 cohorts were used for this study. Participants were classified as either having a “normal” or “abnormal” value for each cardiometabolic health parameter examined, based on published criteria. Linear regression analyses were performed to determine significance of each abnormal health parameter (risk factor) in its unique effect on the accelerometer counts, controlling for age and gender. Average accelerometer counts per minute (cpm) by gender and age categories were estimated separately for the groups of normal and abnormal cardiometabolic risk. Results Average cpm for those with healthy levels of each individual cardiometabolic health parameter range from 296 cpm (for C reactive protein) to 337 cpm (for waist circumference), while average cpm for those with abnormal levels of each individual cardiometabolic health parameter range from 216 cpm (for insulin) to 291 cpm (for LDL-cholesterol). After controlling for age and gender, waist circumference, HbA1c, Insulin, Homocysteine, and HDL-Cholesterol were the cardiometabolic health parameters that showed significant, unique and independent effects on cpm. Overall, individuals who have abnormal values for all significant cardiometabolic health parameters (“unhealthy”) averaged 267 cpm (SE = 15 cpm), while the healthy sample of this study averaged 428 cpm (SE = 10 cpm). The difference in cpm between the unhealthy and healthy groups is similar between males and females. Further, for both males and females, the cpm gap between unhealthy and healthy is largest in the 30s (males: 183 cpm; females 144 cpm) and lessens as age increases, with the lowest gap seen in those 80+ years (males, 81 cpm; females, 85 cpm). Conclusion This Movement Discordance between healthy and unhealthy adults represents a gap in movement that needs to be closed to improve the health of individuals with, or at risk for cardiometabolic disease.

Behavior coding is one technique researchers use to detect problems in survey questions, but it has been primarily explored as a practical tool rather than a source of insight into the theoretical understanding of the cognitive processes by which respondents answer survey questions. The latter is the focus of the current investigation. Using data from a large study in which face-to-face interviews were taped and extensive behavior coding was done, we tested whether sets of respondent behavior codes could be used to distinguish respondent difficulties with comprehension of the question from difficulties associated with mapping a judgment onto the response format provided, and whether characteristics of the survey questions and respondents could be used to predict when and for whom such difficulties would occur. Sets of behavior codes were identified that reflected comprehension and mapping difficulties, and these two types of difficulties were associated with different question and respondent characteristics. This evidence suggests that behavior coding shows promise as a tool for researchers studying the cognitive processes involved in answering survey questions.

Background Nonresponse is a potentially serious source of error in epidemiologic surveys concerned with injury control and risk. This study presents the findings of a records-matching approach to investigating the degree to which survey nonresponse may bias indicators of violence-related and unintentional injuries in a random-digit-dialed (RDD) telephone survey. Methods Data from a statewide RDD survey of 4155 individuals aged 16 years and older conducted in Illinois in 2003 were merged with ZIP code–level data from the 2000 Census. Using hierarchical linear models, ZIP code–level indicators were used to predict survey response propensity at the individual level. Additional models used the same ZIP code measures to predict a set of injury-risk indicators. Results Several ZIP code measures were found to be predictive of both response propensity and the likelihood of reporting partner violence. For example, people residing in high-income areas were less likely to participate in the survey and less likely to report forced sex by partner, processes that suggest an over-estimation of this form of violence. In contrast, estimates of partner isolation may be under-estimated, as those residing in geographic areas with smaller-sized housing were less likely to participate in the survey but more likely to report partner isolation. No ZIP code–level correlates of survey response propensity, however, were found also to be associated with driving-under-the-influence (DUI) indicators. Conclusions There is evidence of a linkage between survey response propensity and one variety of injury prevention measure (partner violence) but not another (DUI). The approach described in this paper provides an effective and inexpensive tool for evaluating nonresponse error in surveys of injury prevention and other health-related conditions.

The goals of this study were to (i) determine how factors commonly implicated in smoking cessation processes influenced smoking cessation in low socio-economic status (SES) women and (ii) elucidate the pathways through which these factors may lead to quitting smoking. Secondary analysis was conducted on data from 644 women smokers aged 18-45 years who had participated in an earlier experimental evaluation of a smoking cessation program, were still smokers at the 2-month post-intervention survey and completed an interview 6 months later. Path analysis (LISREL 8) was used to test a conceptual model in which (i) factors considered as precursors to quitting (motivation, self-efficacy, confidence, action and intention to quit) directly predicted subsequent quitting and (ii) health concerns, social pressure to quit and daily stress influenced quitting indirectly through their effects on the precursor factors and (iii) mediated the effects of background characteristics (race, education, single motherhood, pregnancy and exposure to the earlier smoking cessation intervention) on quitting. Overall, results supported this conceptual model and its applicability to low-SES women smokers and indicated significant pathways among specific factors. In particular, (i) only plans to quit, confidence and social pressure to quit directly predicted quitting; (ii) both health concerns and social pressure increased motivation to quit and (iii) the negative effect of daily stress on quitting was mediated through decreased self-efficacy.

Purpose The aim is to identify the characteristics of common health survey questions that may be associated with cross-cultural variability in question comprehension. Methods Interviews with respondents representing four cultural subgroups in the United States were analyzed through behavior coding to identify survey question characteristics that may be associated with cross-cultural variability in comprehension. Using survey responses as the unit of analysis, nested within survey respondents and survey questions, hierarchical linear modeling was used to examine the effects of four questionnaire design features on cultural variations in comprehension difficulties. Results Respondent culture was found to moderate the effects of response format, question length, and reading levels. Conclusions Several question design strategies that reduce overall comprehension difficulty appear to also increase cross-cultural disparities.

Understanding the relationship between nonresponse processes and key research variables is central to evaluating if and how nonresponse introduces bias into survey estimates. In most tele- phone surveys, however, little information is available with which to estimate these effects. We report a procedure for examining the potential effects of nonresponse via analyses that (1) investigate the linkages between community-level (zip code) variables and survey nonresponse and (2) examine the associations between these community-level variables and key survey measures. We demon- strate these procedures using hierarchical modeling to analyze data from a state-wide telephone survey in Illinois. One zip code-level indicator of concentrated disadvantage—the percentage of the popu- lation below poverty level—was found to be positively associated with nonresponse and, among respondents, with both current physi- cal disability status and lack of health insurance coverage, suggest- ing that both may have been underestimated in this survey. This inexpensive approach has the potential of enabling researchers to routinely evaluate nonresponse effects in their survey data.

The authors investigated at the country level the effects of four cultural orientations identified and studied by Hofstede on two commonly recognized response biases: extreme response style and acquiescent responding. Data are presented from approximately 18,000 survey questionnaires completed by employees in 19 nations on five continents (Australia, Belgium, Brazil, Czech Republic, Germany, Hungary, India, Japan, Malaysia, Portugal, Turkey, the United Kingdom, Mexico, the Philippines, Poland, Singapore, Hong Kong, France, and Italy). Hierarchical linear modeling was employed to examine the associations between person-level response styles and country-level cultural orientations. Consistent with theoretical expectations, power distance and masculinity were found to be positively and independently associated with extreme response style. Individualism, uncertainty avoidance, power distance, and masculinity were each found to be negatively associated with acquiescent response behavior. Further research is needed to identify how question characteristics might interact with cultural orientations to influence response behavior.