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.

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.

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.

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.

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.

Medical Education to Improve Rural Population Health: A Chain of Evidence From Alabama.

PURPOSE: To provide evidence that medical education is associated with population health in order to support adaptation of medical school programs to address populations with health disparities. We explored medical education efforts, local physician supply, and life expectancy in Alabama. METHODS: County-level public data of the number of students accepted to medical schools in 2008 and 2011, primary care physicians, life expectancy, and demographic/contextual variables were analyzed to develop a model for hypothesized associations. Correlational analysis, ANCOVA modeling, and path analysis were employed to identify, reduce, and organize significant variables in this cross-sectional ecologic study. FINDINGS: The path model, which met criteria for goodness of fit, found significant relationships among medical students per 10,000 population, primary care physicians per 10,000 population, life expectancy, and contextual variables for rurality and poverty. ANCOVA models showed that geographic region was significant. CONCLUSIONS: Within limitations of the study design, these findings support the proposition that the number of medical students produced in a county is related to the number of primary care physicians, which is related to life expectancy. Recommendations are to confirm the findings in other populations and inform public health policy concerning the utility of medical education to address population health by producing local medical students.

The influence of hydration on anaerobic performance: a review.

This review examines the influence of dehydration on muscular strength and endurance and on single and repeated anaerobic sprint bouts. Describing hydration effects on anaerobic performance is difficult because various exercise modes are dominated by anaerobic energy pathways, but still contain inherent physiological differences. The critical level of water deficit (approximately 3-4%; mode dependent) affecting anaerobic performance is larger than the deficit (approximately 2%) impairing endurance performance. A critical performance-duration component (> 30 s) may also exist. Moderate dehydration (approximately 3% body weight; precise threshold depends on work/recovery ratio) impairs repeated anaerobic bouts, which place an increased demand on aerobic metabolism. Interactions between dehydration level, dehydration mode, testing mode, performance duration, and work/recovery ratio during repeated bouts make the dehydration threshold influencing anaerobic performance mode dependent.

Admission factors predicting family medicine specialty choice: a literature review and exploratory study among students in the Rural Medical Scholars Program.

PURPOSE: The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural interventions. We examine whether admission factors can predict family medicine specialty choice among students recruited from rural Alabama. METHODS: We developed a questionnaire to study the ability of admission factors to predict family medicine specialty choice among Rural Medical Scholars (RMS). Eighty RMS graduates were surveyed by mail and 64 (80%) responded. FINDINGS: Student characteristics of humanitarian outlook with commitment to rural or underserved populations, family medicine decision or intention made before or at medical school admission, and community influence were positive associations with RMS choosing family medicine residencies; shadowing in an urban hospital was a negative association. CONCLUSIONS: Statements of interest, intentions, plans, and decisions regarding family medicine should be elicited at the time of RMSP admission interview. Strong attachment to home community and commitment to serving and living in a rural area are also important. Students whose introduction to medicine was informed through shadowing or observing in urban hospitals should be considered less likely to become family physicians. Larger sample size studies are needed to assess the role of gender, race, marital status, size of rural town, and MCAT score of candidates in affecting residency choices of students selected for this rural medical education track.

Attitude and knowledge changes in collegiate dancers following a short-term, team-centered prevention program on eating disorders.

Eating knowledge, nutritional knowledge, and psychological changes among female collegiate dancers were examined before and after a 4-wk. team-centered program on sport nutrition, exercise, and disordered eating consequences. Collegiate female dancers from two NCAA Division I institutions participated in a control (n = 19; M age = 19.1 yr., SD = 1.0) or intervention (n = 21; M age = 19.2 yr., SD = 1.2) group. Measures were administered to both groups before and after intervention to assess eating disorders, depression, and nutritional and disordered eating knowledge. There was a statistically significant increase in scores on nutritional and overall eating disorder knowledge in the intervention group compared to the control group. Mean scores on depression, drive for thinness, body dissatisfaction, and maturity fears decreased in the intervention group.

Knowledge of eating disorders among collegiate administrators, coaches, and auxiliary dancers.

Knowledge of eating disorders, confidence in knowledge, and attendance of eating disorder educational programs were assessed among NCAA Division I and II university administrators (n = 61), coaches (n = 44), and dancers (n = 53). A questionnaire assessed knowledge in 5 domains: etiology, signs and symptoms, management and treatment, risk factors, and prevention and education. Overall, dancers' knowledge and previous attendance were significantly lower than administrators' and coaches'. There was inconsistency between participants' confidence in answers and the correctness of their answers. Education is necessary for improving knowledge and reducing risky behaviors in auxiliary dancers.

Undergraduate rural medical education program development: focus group consultation with the NRHA Rural Medical Educators Group.

CONTEXT: Over a decade ago, leaders in rural medical education established the Rural Medical Educators (RME) Group, an interest group within the National Rural Health Association, to support faculty in rural medical education programs. This group has convened an annual RME conclave since 2006. In 2008, this conclave convened 15 national leaders in rural medical education at The University of Alabama. METHODS: In preparation for the conclave, potential participants were e-mailed a set of questions regarding their respective medical education program's initiating motivation, support, resistance, resources, accomplishments, and continuation plans. Analysis of participants' responses resulted in a question guide that was used at a focus group conducted at the conclave. PURPOSE: The purpose of the focus group was to explore the experiences of established rural medical educators related to program development and maintenance. The focus group was recorded and transcribed, and then analyzed using the constant comparative method. FINDINGS: Five essential elements for rural medical education programs emerged from the analysis. The elements were: admit the right student, include curricular elements that occur and are required in rural training sites, establish a cadre of rural physicians who are dedicated to education of their successors, secure financial and relational support for the program, and evaluate program progress. DISCUSSION AND CONCLUSIONS: Discussion about these 5 elements can provide program guidance to neophyte rural medical education programs. Five recommendations are presented in an effort to continue discussion about the essential elements and identify actions that rural medical educators can take to further assist developing programs.

The rural medical scholars program study: data to inform rural health policy.

INTRODUCTION: medical education to produce rural physicians hinges on the characteristics of students, educational programs, and rural experiences. Family physicians are key components of rural medicine. This study tested the effectiveness of multiple, combined strategies of the Rural Medical Scholars Program to produce family medicine residents. METHODS: we compared the relative effectiveness of the Rural Medical Scholars Program, family medicine-oriented branch campuses, and a traditional urban campus to produce family medicine residents using a prospective quasi-experimental design. Logistic regression was used to account for covariates. RESULTS: the relative effectiveness of 3 educational modalities to produce family medicine residents was examined: Rural Medical Scholars Program (44.0%; odds ratio [OR], 15.6), family medicine-oriented branch campuses (18.9%; OR, 5.8), and a traditional urban campus (3.9%; OR, 1). These differences were significant (P < .05) after controlling for sex, race, Medical College Admission Test scores, and graduation rate. CONCLUSIONS: the findings are consistent with the literature, which recommends multiple strategy interventions to produce rural physicians (e.g., admit rural students who have an interest in family medicine, use family medicine faculty, and provide rural experiences). Further study will determine whether rural practice follows training in family medicine among Rural Medical Scholars.

Effects of heat exposure and 3% dehydration achieved via hot water immersion on repeated cycle sprint performance.

This study examined effects of heat exposure with and without dehydration on repeated anaerobic cycling. Males (n = 10) completed 3 trials: control (CT), water-bath heat exposure (∼39°C) to 3% dehydration (with fluid replacement) (HE), and similar heat exposure to 3% dehydration (DEHY). Hematocrit increased significantly from pre to postheat immersion in both HE and DEHY. Participants performed 6 × 15s cycle sprints (30s active recovery). Mean Power (MP) was significantly lower vs. CT (596 ± 66 W) for DEHY (569 ± 72 W), and the difference approached significance for HE (582 ± 76 W, p = 0.07). Peak Power (PP) was significantly lower vs. CT (900 ± 117 W) for HE (870 ± 128 W) and approached significance for DEHY (857 ± 145 W, p = 0.07). Postsprint ratings of perceived exertion was higher during DEHY (6.4 ± 2.0) and HE (6.3 ± 1.6) than CT (5.7 ± 2.1). Combined heat and dehydration impaired MP and PP (decrements greatest in later bouts) with HE performance intermediate to CT and DEHY.

Half-marathon and full-marathon runners' hydration practices and perceptions.

CONTEXT: The behaviors and beliefs of recreational runners with regard to hydration maintenance are not well elucidated. OBJECTIVE: To examine which beverages runners choose to drink and why, negative performance and health experiences related to dehydration, and methods used to assess hydration status. DESIGN: Cross-sectional study. SETTING: Marathon registration site. PATIENTS OR OTHER PARTICIPANTS: Men (n = 146) and women (n = 130) (age = 38.3 ± 11.3 years) registered for the 2010 Little Rock Half-Marathon or Full Marathon. INTERVENTION(S): A 23-item questionnaire was administered to runners when they picked up their race timing chips. MAIN OUTCOME MEASURE(S): Runners were separated into tertiles (Low, Mod, High) based on z scores derived from training volume, expected performance, and running experience. We used a 100-mm visual analog scale with anchors of 0 (never) and 100 (always). Total sample responses and comparisons between tertile groups for questionnaire items are presented. RESULTS: The High group (58±31) reported greater consumption of sport beverages in exercise environments than the Low (42 ± 35 mm) and Mod (39 ± 32 mm) groups (P < .05) and perceived sport beverages to be superior to water in meeting hydration needs (P < .05) and improving performance during runs greater than 1 hour (P < .05). Seventy percent of runners experienced 1 or more incidents in which they believed dehydration resulted in a major performance decrement, and 45% perceived dehydration to have resulted in adverse health effects. Twenty percent of runners reported monitoring their hydration status. Urine color was the method most often reported (7%), whereas only 2% reported measuring changes in body weight. CONCLUSIONS: Greater attention should be paid to informing runners of valid techniques to monitor hydration status and developing an appropriate individualized hydration strategy.

Coping strategies and caregiving outcomes among rural dementia caregivers.

We studied the coping styles by which family caregivers living in rural areas of Alabama deal with the demands of caring for an older relative with dementia. Data were obtained from a sample of 141 caregivers through the random-digit dialing telephone survey. Two coping styles were identified: deliberate coping and avoidance coping. Deliberate coping was related to higher life satisfaction scores and, avoidance coping was related to lower life satisfaction scores and higher caregiver burden scores. Avoidance coping appeared to moderate the effects of caregiver health on caregiver burden. Social workers should pay greater attention to caregivers with dysfunctional coping styles.

Social support, caregiver burden, and life satisfaction in a sample of rural African American and White caregivers of older persons with dementia.

This article reports the findings of a study of African American and White dementia caregivers (n = 141) living in rural areas of Alabama that examined the relations between the participants' receipt of informal social support, and their levels of caregiver burden and life satisfaction. The sample, as a whole, reported high levels of social support with no reported differences in social support by race. Female caregivers reported higher mean scores on 3 of the 4 dimensions of social support than their male counterparts. Two of the 4 dimensions of social support accounted for 32% of the variance of the caregivers' reported level of life satisfaction.