Factors associated with intentions to seek formal and informal mental health help among college students with suicidal thoughts and behaviors.

OBJECTIVE: Identify factors associated with formal and informal mental health help-seeking intentions among college students reporting suicidal thoughts and behaviors (STBs). PARTICIPANTS: College students with STBs in the 2018-2020 Healthy Minds Study. METHODS: Cross-sectional secondary analysis using logistic regressions to determine whether demographic (age, sex, race, religion, and finances) and psychosocial factors (mental health, perceptions about mental health help, and barriers) are associated with (in)formal help-seeking intentions. RESULTS: Positive significant factors for all help-seeking intentions included being in a romantic relationship, Christian, symptoms of anxiety, or positive beliefs and knowledge about therapy efficacy. Depressive symptoms, Black/African American, psychological inflexibility, low perceived need, and barriers were negatively associated. Informal help-seeking was negatively associated with Hispanic/Latinx and personal stigma toward mental health. Formal help-seeking was positively associated with Asian/Asian American and negatively associated with financial stress. CONCLUSIONS: Unique factors were associated with formal or informal help-seeking intentions in college students with STBs.

Medical education for African American communities in the rural South: A focus group approach to identify fundamental considerations.

PURPOSE: We sought to understand concerns fundamental to planning medical education specific to rural southern African Americans who are virtually nonexistent in American medical schools. METHODS: A diverse multidisciplinary research team conducted this qualitative study with 3 focus groups, including 17 rural medical educators recruited nationwide, 10 African American alumni of a rural medical education pipeline in Alabama, and 5 community and institutional associates of this pipeline. Analysis of recorded transcripts generated themes fitting an ecological model suggesting concerns and intervention foci at individual, community, and institutional levels. FINDINGS: Three major themes operating at all ecological levels were: (1) How "rural minority student" is defined, with "rural" often supplanting race to indicate minority status; (2) Multiple factors relate to rural racial minority student recruitment and success, including personal relationships with peers, mentors, and role models and supportive institutional policies and culturally competent faculty; and (3) Challenges to recruitment and retention of rural minority students, especially financial concerns and preparation for medical education. CONCLUSIONS: Our findings suggest that individuals, communities, and institutions provide intervention points for planning medical education specific to southern rural African Americans. These spheres of influence project a need for partnership among communities and rural medical educators to affect broad programmatic and policy changes that address the dire shortage of rural African American health professionals to help ameliorate health inequities experienced in their home communities. It is likely that linear thinking and programming will be replaced by integrated, intertwined conceptualizations to reach this goal.

Gendered racial microaggressions and black college women: A cross-sectional study of depression and psychological distress.

Objective: We assessed the association between gendered racism, the simultaneous experience of sexism and racism, depression, and psychological distress in Black college women using an intersectional instrument, the gendered racial microaggression scale. Participants: Black college women enrolled at a predominantly white institution (PWI) in the southeastern U.S. (N = 164, response rate = 77%, mean age 21.67). Methods: We used a cross-sectional survey to explore the impact of stress appraisal and frequency of gendered racial microaggressions on depression and psychological distress using validated scales. Results: 30% reported depression and 54% reported severe psychological distress. Correlations indicate significant relationships between gendered racism, depression and psychological distress, with the strongest relation reported between the frequency of gendered racism to depression. Regression analyses suggest significant relationships between gendered racism, depression and psychological distress. Conclusion: Gendered racism has significant bearing on the mental health of Black college women attending a PWI. Implications for interventions are discussed.

Distracted mobile device use among street-crossing college student pedestrians: an observational approach.

ObjectiveTo estimate the incidence of mobile device use among street-crossing pedestrians and explore differences by sex and intersection type at a large public South-eastern university in the United States.ParticipantsAll instances of campus pedestrians crossing the street during the observation period (N = 4,878).MethodsVideo recordings of crosswalk activity at four locations were analyzed for pedestrian use of a mobile device while crossing.ResultsDevice use while crossing was observed 1,201 (24.6%) times. Of male crossing instances, 277 (16.8%) were coded as using a device. Of female instances, 924 (28.6%) were coded as using a device. Differences in device use while crossing were found between sexes and some intersection types.ConclusionsThis study estimates mobile device use while crossing the street and suggests differences by sex and intersection type. Future research should focus on improving understanding of the problem and evaluation of interventions to address the issue.

Enhancing Patient-Provider Breastfeeding Conversations: Breastfeeding Intention and Prenatal Breastfeeding Self-Efficacy among a Sample of Pregnant Women.

OBJECTIVES: The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women. METHODS: Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors. RESULTS: The participants in the final analysis (N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women (P ≤ 0.05), those with a high school education or less (P ≤ 0.019), single women (P ≤ 0.028), and those who had no breastfeeding experience (P ≤ 0.035). CONCLUSIONS: Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.

Pipeline Programs Can Support Reforms in Medical Education: A Cohort Study of Alabama's Rural Health Leaders Pipeline to Engage Community Leaders.

PURPOSE: To demonstrate for county leaders the utility of rural pipelines to gain physicians and produce health professionals. METHODS: This cohort study, 1993-2018, aggregated 1,051 students in the Rural Health Leaders Pipeline to their home counties (N = 67) to study the relationship between county participation in pipeline programs and outcomes of family physicians gained and health professionals produced. Additional county demographics were included. We conducted descriptive, bivariate, and multivariable linear regression analyses controlling for poverty, race, and rurality. FINDINGS: All 67 Alabama counties participated with means of 9.6 Rural Health Scholars, 2.7 Rural Minority Health Scholars, 3.4 Rural Medical Scholars, 67% rural population, 29.7% Black population, and 21.5% under poverty. Best regression model for gaining family physicians included Rural Medical Scholars involved (b = 0.24, P < .001) with R2 0.30, indicating a county gained 1 family physician for 4 students. Best model for health professionals included Rural Health Scholars involved (b = 0.20, P < .001) with R2 0.31, indicating production of 1 health professional for 5 students. Best model for any professional included Rural Health Scholars involved (b = 0.23, P < .001) with R2 0.35, indicating 1 professional produced for 4 students. CONCLUSIONS: Rural pipeline programs can be useful tools in medical education reform to benefit counties with the gain of family physicians and production of health professionals. Local public officials could use these findings, eg, 1 family physician gained for every 4 students a county involved in the pipeline, to advocate that health professional education employ such pipelines.

Racial Disparities in Substance Use Treatment Completion Among Older Adults.

BACKGROUND AND OBJECTIVES: Racial disparities in substance use among young adults have been well documented in the substance use literature, but little attention has been paid to older adults. While being an older adult is positively associated with substance use treatment completion, racial disparities in treatment completion have yet to be examined. The purpose of this study was to determine to what extent racial disparities exist in substance use treatment completion among older adults (65 and older). RESEARCH DESIGN AND METHODS: This cross-sectional study utilized data from the most recent Treatment Episode Data from the Substance Abuse and Mental Health Services Administration, which documents discharges from a publicly funded substance use treatment program in the United States. A total of 17,942 older adults reported to a substance use treatment program in 2017 and 6,653 met the criteria for the study. Chi-squared tests were used to analyze group differences and a binary logistic regression was used to predict substance use treatment completion. RESULTS: Results show that Black older adults were 37% less likely to complete a substance use treatment program than Whites (OR = 0.630) while Hispanic older adults were 26% more likely to complete a substance use treatment program than Whites (OR = 1.26). DISCUSSION AND IMPLICATIONS: These results support the findings from similar studies with younger adults and support the theory that racial disparities are prevalent across the life span. Although Hispanics had a higher treatment completion rate than Whites, this is likely a reflection of familismo, where decisions about health treatments is a group process and a steady network of family members are available to provide advice and encouragement. The significant disparity observed between Black and White older adults suggest a need to consider cultural, historical, and systemic factors that affect voluntary termination of substance use treatment among Black older adults.

Prematurity and race account for much of the interstate variation in infant mortality rates in the United States.

OBJECTIVE: To assess the correlation between infant mortality and extreme prematurity by state. STUDY DESIGN: This ecological study included data on 28,526,534 infants from 2007 to 2013 in all 50 US states and DC using CDC WONDER linked birth and infant death records. Regression analyses determined the correlation between infant and neonatal mortality rates and the proportion of extremely preterm, extremely low birth weight, and black births by state. RESULTS: State infant and neonatal mortality rates were directly and highly correlated with the proportion of extremely preterm births (infant, r2 = 0.71, P < 0.001; neonatal, r2 = 0.77, P < 0.001) and extremely low birth weight births (r2 = 0.63, P < 0.001; r2 = 0.73, P < 0.001). The proportion of black births also correlated directly with infant and neonatal mortality rates. CONCLUSIONS: Interstate variation in infant and neonatal mortality rates are primarily driven by rates of extremely preterm and extremely low birth weight births which is closely related to the proportion of black births.

Teaching Medical Students in the Rural Setting Long Term: Physicians' Attitudes and Perceptions.

OBJECTIVES: The University of Alabama School of Medicine Tuscaloosa Regional Campus conducted a 2-month block in rural family practice, but committed to expanding to an 8-month longitudinal rural curriculum. We wanted to explore how rural physicians feel about teaching students in a prolonged rural preceptorship. METHODS: We brainstormed with colleagues, reviewed the literature, and conducted two focus groups supplemented by five interviews with rural physicians. The focus groups explored satisfaction and dissatisfaction in teaching, medical school and community support, evaluation of preceptors, and the sharing of information between students and preceptors. The analysis sought common themes among study participants and colleagues. RESULTS: Twenty-one study participants included 19 family physicians, 15 in private practice. Eleven had taught medical students. Our key finding, combining four themes, was that a satisfactory context within which to teach medical students long term in rural sites depends on the optimization of the roles of preceptors, students, communities, and educational institutions. There were comments addressing each of these roles. This finding cannot be generalized beyond the study group because of the qualitative methodology using a convenience sample. CONCLUSIONS: These physicians' concerns foment hypotheses about engaging rural physicians in their own unique local networks involving preceptors, students, community, and educational institutions to conduct satisfactory long-term medical education in rural sites. We recommend investigations to substantiate a prevalence among rural physicians of concern about the four roles and to describe various contexts in which these roles produce satisfactory long-term preceptorships, perhaps as best practices in different settings.

Mobile device use while crossing the street: Utilizing the theory of planned behavior.

Every year, thousands of pedestrians are killed and tens-of-thousands are nonfatally injured as a result of traffic crashes. The year 2016 holds the record for the most pedestrians killed in one year since 1990. Mobile device use while crossing the street has been associated with unsafe crossing behaviors and gait abnormalities, potentially increasing the risk of pedestrian injury or death. Expanding upon the small body of literature, the present study utilized the theory of planned behavior to guide the development of a questionnaire used to collect data from 480 adults on predictors of intentions to use a mobile device while crossing the street. Questionnaire development involved one round of expert panel review (N = 4), subsequent pilot testing of a revised questionnaire, and a test-retest reliability assessment. Results demonstrate that attitude toward the behavior, subjective norm, and perceived behavioral control significantly predicted the intention to use a mobile device while crossing the street in this population. Such a questionnaire can be used in the design and evaluation of TPB-based interventions to decrease distracted mobile device use while crossing the street.

Workplace-Related Factors Associated With Employees' Standing Time at Work: A Research Brief.

PURPOSE: The purpose of this study was to identify the relationship between work-related, individual, and environmental factors and self-reported standing time during the workday. DESIGN: Cross-sectional study design. SETTING: Participants were recruited from a large, public university in the southeastern United States. MEASURES: Data were collected through an 87-item online survey using previously validated scales that assessed workplace standing time, demographic variables, work-related psychosocial factors, and workplace environment factors. ANALYSIS: One-way analysis of variance, Pearson correlation coefficients, and nonparametric tests were used to determine univariate relationships between standing time and independent work-related variables and demographic factors. RESULTS: Mean standing time among the sample (n = 502) was 72.49 minutes (standard deviation = 73.48) daily. There was a significant relationship between standing time and barrier self-efficacy for standing at work, self-regulation strategies, social norms, local connectivity in the workplace, overall connectivity in the workplace, and proximity of coworkers. Standing time was significantly higher for men, employees with an advanced degree, employees with a standing desk, and faculty. CONCLUSION: Health promotion researchers and practitioners should consider factors at multiple levels of influence when designing studies to explore workplace sedentary behavior. The findings regarding variations in workplace behavior by employee subgroups should be taken into consideration when designing future studies in the workplace.

The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale: A New Measurement Instrument for Prenatal Breastfeeding Self-efficacy.

BACKGROUND:: Breastfeeding self-efficacy and breastfeeding intention are two modifiable factors that influence rates of breastfeeding initiation. RESEARCH AIMS:: (1) To develop a scale to measure prenatal breastfeeding self-efficacy, and (2) test its psychometric properties by determining the internal consistency and reliability, and (3) assess the relationships between prenatal breastfeeding self-efficacy and breastfeeding intention. METHODS:: Cross-sectional prospective one-group survey design was used. A convenience sample of pregnant patients attending an obstetrics and gynecology clinic ( N=124) completed a survey at the recruitment site that assessed demographics, breastfeeding intention, and breastfeeding self-efficacy theory constructs. Retest surveys ( n=14) were taken home and returned to the researcher by mail after completion. RESULTS:: Cronbach's alpha for the 39-item scale was .98 (test) and .97 (retest) with an item-to-total correlation range of .54 to .78. A four-factor solution for the scale was retained. Test-retest indicated each factor was significant and highly correlated: Individual Processes (.88, p < .001), Interpersonal Processes (.893, p < .001), Professional Advice (.919, p < .001), and Social Support (.880, p < .001). Overall prenatal breastfeeding self-efficacy score was highly correlated (.610, p <.001) with breastfeeding intention scores. CONCLUSIONS:: The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale is a valid and reliable measure of a prenatal women's self-efficacy in preparation to breastfeed. Measuring the level of self-efficacy could alert prenatal women and health professionals to individual skill sets.

Innovative utilization of pharmacist-led board review in a family medicine residency curriculum.

BACKGROUND AND PURPOSE: The Society of Teachers of Family Medicine Group on Pharmacotherapy recommends a formal curriculum during family medicine residency training and describes benefits of utilizing pharmacists. Limited literature exists on how programs have incorporated questions from family medicine board preparation sources into pharmacotherapy academic education. The primary objective was to assess the impact on family medicine residents' perceived knowledge after incorporation of board review items into pharmacotherapy sessions. EDUCATIONAL ACTIVITY AND SETTING: Pharmacists affiliated with the University of Alabama Family Medicine Residency program incorporated questions from board preparation sources into monthly interactive pharmacotherapy sessions as part of a didactic curriculum between 2014 and 2016. An anonymous survey was administered for two consecutive years in 2015 and 2016 to assess residents' perceptions of the sessions and utilization of board-type questions as an active learning component. The change in residents' perception of knowledge was quantitatively analyzed and written comments were evaluated for recurring themes. FINDINGS: The cumulative survey response was 78% (68/87). Over 80% of residents reported that pharmacotherapy sessions and the use of board-type questions was quite or very helpful. The percent of residents that rated their knowledge as good or excellent significantly increased after every session compared to baseline. Residents noted the sessions' information, applicability, interactive nature, and relevance as strengths. SUMMARY: Incorporation of board preparation questions into interactive pharmacotherapy sessions was well received and improved residents' perception of pharmacotherapy knowledge. Utilizing this model in a formal pharmacotherapy curriculum taught by pharmacists is beneficial for family medicine resident learners.

Obstetric Care by Family Physicians and Infant Mortality in Rural Alabama.

BACKGROUND: The closure of obstetrics (OB) units at rural hospitals is thought to have implications for access to prenatal care (PNC) and infant mortality rate (IMR). The objective of this study was to determine whether local availability of PNC and OB services, specifically as provided by family physicians (FPs), would be associated with a lower IMR in 1 rural Alabama county. METHODS: Data from 1986 to 2013 from Pickens County was compared with data from 2 sets of control counties: Clarke/Monroe (full OB care) and Coosa/Conecuh (no local OB care). RESULTS: From 1986 to 1991 (no local OB services; period 1), Pickens County's IMR was 17.9, which fell to 7.2 from 1993 to 2001 (with local services; period 2). After the county's OB unit closed, IMR rose to 16.0 from 2005 to 2013 (period 3). In Clarke/Monroe (continuous OB service), the IMR fell from 14.5 to 9.9 from period 1 to period 3. Coosa/Conecuh (no OB service) exhibited a consistent IMR ranging from 10.9 to 14.4. CONCLUSION: OB services provided by FPs in Pickens County resulted in improvement of the county's IMR. Local PNC was associated with a lower IMR.

Ecological Influences on Employees' Workplace Sedentary Behavior: A Cross-Sectional Study.

PURPOSE: The purpose of this study was to explore the relationship between ecological factors and occupational sedentary behavior (SB). DESIGN: Cross-sectional online survey. SETTING: Participants were employees recruited from a large, public university in the Southeastern United States from August to November 2016. PARTICIPANTS: The final sample included 527 (56% response rate) employees. MEASURES: Data were collected through an 87-item survey using previously validated scales that assessed occupational SB, perceived behavioral control, barrier self-efficacy, self-regulation strategies, organizational social norms, office environment, and worksite climate. ANALYSIS: One-way analysis of variance analyses were used to determine differences in occupational SB by demographic factors. A multivariate regression model was used to determine significant ecological determinants of occupational SB. RESULTS: Mean SB was 342.45 (standard deviation = 133.25) minutes. Significant differences in SB were found by gender, education, and employment classification. Barrier self-efficacy and workplace connectivity, which evaluates the spatial layout of the office setting that may impact mobility within the workplace, were significant predictors of SB in the multivariate model. CONCLUSION: Results from this study provide new information regarding the potential impact of workplace barriers and connectivity on occupational SB. The findings from this study support the inclusion of intervention modalities to minimize workplace barriers and increase workplace connectivity to increase workplace mobility and decrease SB.

Educating Physicians for Rural America: Validating Successes and Identifying Remaining Challenges With the Rural Medical Scholars Program.

PURPOSE: To evaluate the Rural Medical Scholars (RMS) Program's effectiveness to produce rural physicians for Alabama. METHODS: A nonrandomized intervention study compared RMS (1997-2002) with control groups in usual medical education (1991-2002) at the University of Alabama School of Medicine's main and regional campuses. Participants were RMS and others admitted to regular medical education, and the intervention was the RMS Program. Measures assessed the percentage of graduates practicing in rural areas. Odds ratios compared effectiveness of producing rural Alabama physicians. FINDINGS: The RMS Program (N = 54), regional campuses (N = 182), and main campus (N = 649) produced 48.1% (odds ratio 6.4, P < .001), 23.8% (odds ratio 2.5, P < .001), and 11.2% (odds ratio 1.0) rural physicians, respectively. CONCLUSIONS: The RMS Program, contrasted to other local programs of medical education, was effective in producing rural physicians. These results were comparable to benchmark programs in the Northeast and Midwest USA on which the RMS Program was modeled, justifying the assumption that model programs can be replicated in different regions. However, this positive effect was not shared by a disparate rural minority population, suggesting that models for rural medical education must be adjusted to meet the challenge of such communities for physicians.

Development and evaluation of a social cognitive theory-based instrument to assess correlations for physical activity among people with spinal cord injury.

BACKGROUND: People with spinal cord injury (SCI) are more susceptible to sedentary lifestyles because of the displacement of physical functioning and the copious barriers. Benefits of physical activity for people with SCI include physical fitness, functional capacity, social integration and psychological well-being. OBJECTIVE: The purpose of this study was to develop and test a social cognitive theory-based instrument aimed to predict physical activity among people with SCI. METHODS: An instrument was developed through the utilization and modification of previous items from the literature, an expert panel review, and cognitive interviewing, and tested among a sample of the SCI population using a cross-sectional design. Statistical analysis included descriptives, correlations, multiple regression, and exploratory factor analysis. RESULTS: The physical activity outcome variable was significantly and positively correlated with self-regulatory efficacy (r = 0.575), task self-efficacy (r = 0.491), self-regulation (r = 0.432), social support (r = 0.284), and outcome expectations (r = 0.247). Internal consistency for the constructs ranged from 0.82 to 0.96. Construct reliability values for the self-regulation (0.95), self-regulatory efficacy (0.96), task self-efficacy (0.94), social support (0.84), and outcome expectations (0.92) each exceeded the 0.70 a priori criteria. CONCLUSIONS: The factor analysis was conducted to seek modifications of current instrument to improve validity and reliability. The data provided support for the convergent validity of the five-factor SCT model. This study provides direction for further development of a valid and reliable instrument for predicting physical activity among people with SCI.

A Predictive Model for a Reputation-Based General Surgery Residency Match and a Novel Online Calculator.

OBJECTIVE: This study aimed to identify medical student characteristics that predict a successful categorical match into a general surgery residency and a match based upon Doximity program rankings. DESIGN: This was a retrospective study that analyzed academic and personal predictors of a successful general surgery residency match. SETTING: This study was set at the University of Alabama at Birmingham School of Medicine, a public medical school. PARTICIPANTS: This study included 173 fourth-year medical students at a public medical school who matched into general surgery residency programs. METHODS: Our cohort comprised students graduating from our institution between 2004 and 2015 that matched into preliminary or categorical general surgery positions. We collected academic variables and performed univariate analyses and logistic regression to examine the likelihood of specific match outcomes. RESULTS: Of 173 students, 132 (76%) matched into a categorical position and 41 (24%) matched into a preliminary position. Of all variables, clinical ranking quartile was most effective in predicting a categorical match (R2 = 0.35). Models for a match based upon Doximity ranking lacked the same predictive power. CONCLUSIONS: This research identifies students that are at risk for not matching into a categorical position and predicts competitiveness for certain programs. It provides a novel calculator to give applicants easily interpretable match probabilities.

Using the Theory of Planned Behavior to predict HPV vaccination intentions of college men.

OBJECTIVE: The purpose of this study was to test Theory of Planned Behavior (TPB) constructs in predicting human papillomavirus (HPV) vaccination behavioral intentions of vaccine-eligible college men. PARTICIPANTS: Participants were unvaccinated college men aged 18-26 years attending a large public university in the southeastern United States during Spring 2015. METHODS: A nonexperimental, cross-sectional study design was employed. Instrumentation comprised a qualitative elicitation study, expert panel review, pilot test, test-retest, and internal consistency, construct validity, and predictive validity assessments using data collected from an online self-report questionnaire. RESULTS: The sample consisted of 256 college men, and the final structural model exhibited acceptable fit of the data. Attitude toward the behavior (ß = .169) and subjective norm (ß = 0.667) were significant predictors of behavioral intention, accounting for 58% of its variance. CONCLUSIONS: Practitioners may utilize this instrument for the development and evaluation of TPB-based interventions to increase HPV vaccination intentions of undergraduate college men.