A Comparison of the Process and Content of Sexual Communications Among African American Adolescent Children Living in Parent and Grandparent Headed Families.

INTRODUCTION: The process of parental sexual communication has been shown to delay the sexual debut of adolescents; however, few studies have focused on extended family members such as grandparents. The purpose of this study was to compare the process and content of sexual communications among African-American adolescent children living in parent or grandparent headed families. METHODS: A secondary analysis of two de-identified datasets from 80 African-American adolescents was conducted. RESULTS: Findings indicated that there were no significant differences in the sexual communication process in relation to facilitators p= 0.38 and barriers p =0.23 with the discussions. There were however significant differences with adolescents' attitudes (p = 0.04) and feelings regarding sexual abstinence (p =0.01), HIV prevention (p= 0.002) and teen pregnancy (p= 0.010). DISCUSSION: Researchers can use the results of this study as a beginning point in examining the sexual communication process in grandparent-headed families.

The Mecklenburg County Interlocal Agreement: An 18-Year Collaboration Between Medicine and Public Health.

CONTEXT: Better integration of public health and medical services has been a long-standing goal in the United States and has been widely discussed in the scientific literature. OBJECTIVE: To identify key lessons and outcomes of the Mecklenburg County Interlocal Agreement, one of the longest running efforts integrating health care delivery and public health services in a major metropolitan area. DESIGN: In-depth key informant interviews and brief questionnaires of leaders involved in the Mecklenburg County Interlocal Agreement. SETTING: Charlotte-Mecklenburg County, North Carolina. PARTICIPANTS: Convenience sample of 15 past and present employees and administrative leaders of the Mecklenburg County Privatization Initiative from the Mecklenburg County Health Department (N = 7) and Carolinas Healthcare System (N = 8). MAIN OUTCOME MEASURES: Attitudes reflecting the effects of the Mecklenburg County Privatization Initiative, based on 6 "synergies" for evaluating the effectiveness of health care and public health system collaboration. RESULTS: Mean scores were calculated for 21 questionnaire items, using 5-point Likert scales (1 = no impact; 5 = great impact). Mean scores were calculated by averaging the multiple-item question sets reflecting each of the 6 synergies. Synergy scores ranged from a low of 3.1 (3 items reflecting whether the collaboration "Used clinical practice to identify and address community health problems") to a high of 3.7 (3 items reflecting whether the collaboration "Improved health care by coordinating services for individuals"). The in-depth interviews indicated a clear impact for the 2 synergies linked to individual care. Increased access to care emerged as a strong theme, along with the belief that medical care services were improved and that these improvements persist. CONCLUSION: The findings of this study provide perspective from an 18-year contractual agreement for a large health care system to operate county public health functions. Implications include the need to incorporate well-defined public health principles in any collaborative agreement and to focus these efforts at the primary care level.

Multidimensional Fatigue Inventory in People With Hepatitis B Infection: Cross-cultural Adaptation and Psychometric Evaluation of the Persian Version.

There is no valid and well-established tool to measure fatigue in people with chronic hepatitis B. The aim of this study was to translate the Multidimensional Fatigue Inventory (MFI) into Persian and examine its reliability and validity in Iranian people with chronic hepatitis B. The demographic questionnaire and MFI, as well as Chronic Liver Disease Questionnaire and EuroQol-5D (to assess criterion validity), were administered in face-to-face interviews with 297 participants. A forward-backward translation method was used to develop a culturally adapted Persian version of the questionnaire. Cronbach's α was used to assess the internal reliability of the scale. Pearson correlation was used to assess criterion validity, and known-group method was used along with factor analysis to establish construct validity. Cronbach's α for the total scale was 0.89. Convergent and discriminant validities were also established. Correlations between the MFI and the health-related quality of life scales were significant (p < .01). The scale differentiated between subgroups of persons with the hepatitis B infection in terms of age, gender, employment, education, disease duration, and stage of disease. Factor analysis indicated a four-factor solution for the scale that explained 60% of the variance. The MFI is a valid and reliable instrument to identify fatigue in Iranians with hepatitis B.

Race, socioeconomic status, health-related quality of life, and self-care of type 2 diabetes mellitus among adults in North Carolina.

OBJECTIVES: The objective of this study was to examine the associations among race, education, income, and health-related quality of life (HRQoL) in self-care of type 2 diabetes mellitus among adults in North Carolina. METHODS: A secondary analysis was conducted using data from the 2009 Behavioral Risk Factor Surveillance Survey (BRFSS), a large population-based survey (N = 432,607) conducted in the United States. The data were analyzed to account for the weighted complex multistage sampling design of the Behavioral Risk Factor Surveillance Survey. Parametric testing using univariate/bivariate/multivariate analysis was performed. RESULTS: The majority of participants reported taking a class/course on diabetes mellitus management and having checked their blood glucose levels at least once per day. The majority (61.26%) of the participants did not have good self-management skills, based on the education and blood glucose-monitoring criteria established for this study. Participants with poor HRQoL had significantly increased odds of good diabetes mellitus self-care practices. CONCLUSIONS: Individuals with poor HRQoL had significantly increased odds of good diabetes mellitus self-care practices. Although findings on race, education, and income were not statistically significant, they were consistent with previous research. In the future, individuals who are nonwhite, have less than a high school level of education, and have no health insurance should be targeted to improve diabetes mellitus self-care practices through educational and informational materials. Further investigation using more comprehensive measures of diabetes mellitus self-care is warranted.

Race, socioeconomic status, and rurality influences on type 2 diabetes management among North Carolina adults.

PURPOSE: To examine the impact of race, socioeconomic status, and rurality on Type 2 diabetes education among adults in North Carolina. METHODS: Our study utilized data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) to conduct a retrospective study and secondary data analysis. To account for the multistage survey design of BRFSS, SAS/SUDAAN was used to calculate adjusted and unadjusted odds ratios and 95% confidence intervals (CIs). Univariate, bivariate, and multivariate analyses were performed to examine the association between race, socioeconomic status, and rurality and its effects on type 2 diabetes education among adults in North Carolina. MAIN FINDINGS: The majority of the participants (63%) did not have good diabetes education. Non-Whites had higher odds than Whites of good diabetes education (OR=1.56, 95%CI: 1.19, 2.03). Individuals who lived in rural North Carolina had lower odds of having good diabetes education than their urban counterparts, but the results remained insignificant (OR=.88, CI: .67, 1.15). Individuals who were of low socioeconomic status (SES) had poorer diabetes education than individuals who were identified as being high SES, but the results were insignificant (OR=.81, CI: .60, 1.09). PRINCIPAL CONCLUSIONS: Findings from the study indicate that non-White adults had higher odds than Whites of good type 2 diabetes education in North Carolina. The results of our study could be used for policies and recommendations for health organizations. Policy makers should make diabetes education mandatory for individuals who are diagnosed with this disease. Future studies should have a more accurate measurement of type 2 diabetes education.

Racial influences on diabetes management among adults in North Carolina.

OBJECTIVE: To examine the impact race and socioeconomic status (SES) has on diabetes management among adults in North Carolina. DESIGN: Our study utilized data from the 2008 BRFSS to conduct a retrospective study and secondary data analysis. To account for the multistage survey design of BRFSS, SAS/SUDAAN was used to calculate adjusted and unadjusted odds ratios and 95% confidence intervals (CIs). Multiple regression analysis was performed to examine the impact race and SES has on diabetes management among North Carolina adults. RESULTS: The majority of the participants (63.34%) did not have good diabetes management based on the education and blood glucose criteria of our study. Non-Whites had higher odds than Whites to have good diabetes management practices (OR = 1.56, CI: 1.19, 2.03). Individuals who were low SES had poorer diabetes management than individuals who were identified as being high SES (OR = .81, CI: .60, 1.09). CONCLUSIONS: Disparities in good diabetes management practices were found among the variables of race, and SES. Findings from the study indicate that non-White adults had higher odds of good diabetes management practices than Whites in North Carolina. The results of this study could be used for policies and recommendations for health organizations. If health insurance policies required diabetes education classes a reduction in diabetes complications may be observed. Future studies should have a more accurate measurement of diabetes management; proxy measures were used in this study that relied on self-report and may not have provided the best measurement for diabetes management.

Educational intervention on health related lifestyle changes among Iranian adolescents.

BACKGROUND: Healthy lifestyle habits during adolescence can prevent many of the diseases and disabilities in adulthood and later. The aim of the study was to examine the role of education in improving lifestyles among Iranian adolescents. METHODS: This group randomized controlled trial was conducted during October 2010 until January 2011 in Tehran. Participants for this study were selected through a random sampling method and divided into intervention and control groups. The intervention group received a six session course on healthy lifestyles and the control group received no intervention. The Adolescent Lifestyle Questionnaire (ALQ) was used for collecting data. Data were collected before the intervention, at a two week after participation time point, and a three month follow-up was conducted. RESULTS: Overall, 365 (male: 173, female: 192) adolescents participated in the study. There were significant differences between boys and girls in terms of physical activity and social support (P<0.001). The boys had higher levels of physical activity than girls. Girls received more social support than boys. There were significant differences in the lifestyle scores between the intervention and control groups at follow-up (P<0.001). The educational intervention indicated an improved total lifestyle score (from 123.7(SD.16.1) at baseline to 131.8 (SD.16.7) at two weeks and to 130.5(16.5) at 3 months after education) among the intervention group. CONCLUSIONS: Adolescents' behaviors may be different in some dimensions among boys and girls. Unhealthy lifestyle habits are prevalent among adolescents. Therefore sex-specified lifestyle education can bring promising results. Further research in the field can reveal the importance of lifestyle intervention programs.

Spiritual coping, religiosity and quality of life: a study on Muslim patients undergoing haemodialysis.

AIM: The number of haemodialysis patients globally is increasing and spiritual resources may help overcome adjustment problems among such patients. This study examined the relationships between spiritual/religious, demographic and clinical variables and quality of life among Iranian Muslims undergoing haemodialysis. METHODS: Using a cross-sectional design, 362 haemodialysis patients were surveyed from three general hospitals located in Tehran, Iran. Spiritual coping strategies, Duke University Religion Index, EQ-5D 3L and a demographic questionnaire were administered. Hierarchical regression was used to identify predictors of quality of life and health status. RESULTS: The distribution of reported problems across dimensions of quality of life was: mobility (59.4%), usual activities (30.4%), self-care (21.3%), pain/discomfort (47.8%) and anxiety/depression (29.3%). Univariate analysis showed that factors such as age, sex, marital status, location, number of children, body mass index, serum albumin, having diabetes mellitus or other comorbidity, as well as spiritual/religious factors that were related to quality of life, health status or both. Regression models revealed that demographics, clinical variables and especially spiritual/religious factors explained about 40% of variance of quality of life and nearly 25% of the variance in health status. CONCLUSION: Spiritual resources may contribute to better quality of life and health status among haemodialysis patients. Further longitudinal studies are needed to determine whether these associations are causal and the direction of effect.

A model-based educational intervention to increase physical activity among Iranian adolescents.

OBJECTIVE: To conduct an evaluation of an educational program based on the health promotion model (HPM) and stages of change to improve physical activity (PA) behavior among Iranian adolescents. METHODS: This was a group randomized controlled trial with 165 participants in two groups (intervention/control). Data were collected using self-reported questionnaires based upon HPM constructs (benefits and barriers of action, self-efficacy, activity-related affect, interpersonal influences, and situational influences). The stages of change scale was used to select eligible participants (were placed on precontemplation, contemplation, or preparation stages) and to assess the trend. After collecting baseline data, the intervention was administered to the participants and follow-up data was collected 3 months after intervention. RESULTS: In all, 88 males and 77 females with a mean age of 13.99±0.4 participated in the study. The differences in all HPM constructs, except activity-related affect and social influences, were significant (p < 0.01) between baseline and follow-up measurements. Adolescents in the intervention as compared to the control group were placed in action (70%) or preparation (30%) stages at follow-up. Multiple regression analysis revealed that competing preferences, social norms, role models, (p < 0.001), and commitment to action plan can significantly predict PA behavior. The model accounted for 22.5% of the variance in PA. CONCLUSIONS: The results suggest that educational interventions based on stages of change can have important implications for improving PA among adolescents in more constructs of HPM.

Intervenção educacional com base em modelo para aumentar a atividade física entre adolescentes iranianos / A model-based educational intervention to increase physical activity among Iranian adolescents

OBJETIVO: Avaliar um programa educacional com base no modelo de promoção da saúde (MPS) e nos estágios de mudança para melhorar a atividade física (AF) entre adolescentes iranianos. MÉTODOS: Este foi um ensaio randomizado controlado com 165 participantes divididos em dois grupos (intervenção/controle). Os dados foram coletados através de questionários de autopreenchimento com base em componentes do MPS (benefícios e barreiras para a ação, autoeficácia, sentimentos em relação ao comportamento, influências interpessoais e situacionais). A escala de estágios de mudança foi utilizada para selecionar participantes aptos (classificados nos estágios de pré-contemplação, contemplação ou preparação) e para avaliar a tendência. Após a coleta dos dados de base, a intervenção foi realizada nos participantes e os dados de acompanhamento foram coletados 3 meses depois. RESULTADOS: Ao todo, 88 meninos e 77 meninas com idade média de 13,99±0,4 participaram do estudo. As diferenças em todos os componentes do MPS, exceto os sentimentos em relação ao comportamento e as influências sociais, foram significantes (p < 0,01) entre os valores de base e de acompanhamento. Comparados aos do grupo de controle, os adolescentes do grupo de intervenção foram categorizados nos estágios de ação (70%) ou preparação (30%) no acompanhamento. A análise de regressão múltipla revelou que preferências concorrentes, normas sociais, modelos sociais (variáveis com p < 0,001) e o compromisso com o plano de ação podem prever consideravelmente o comportamento quanto à AF. O modelo representou 22,5% da variação da AF. CONCLUSÕES: Intervenções educacionais com base nos estágios de mudança podem ter implicações importantes na melhora da AF entre adolescentes em mais componentes do MPS.

OBJECTIVE: To conduct an evaluation of an educational program based on the health promotion model (HPM) and stages of change to improve physical activity (PA) behavior among Iranian adolescents. METHODS: This was a group randomized controlled trial with 165 participants in two groups (intervention/control). Data were collected using self-reported questionnaires based upon HPM constructs (benefits and barriers of action, self-efficacy, activity-related affect, interpersonal influences, and situational influences). The stages of change scale was used to select eligible participants (were placed on precontemplation, contemplation, or preparation stages) and to assess the trend. After collecting baseline data, the intervention was administered to the participants and follow-up data was collected 3 months after intervention. RESULTS: In all, 88 males and 77 females with a mean age of 13.99±0.4 participated in the study. The differences in all HPM constructs, except activity-related affect and social influences, were significant (p < 0.01) between baseline and follow-up measurements. Adolescents in the intervention as compared to the control group were placed in action (70%) or preparation (30%) stages at follow-up. Multiple regression analysis revealed that competing preferences, social norms, role models, (p < 0.001), and commitment to action plan can significantly predict PA behavior. The model accounted for 22.5% of the variance in PA. CONCLUSIONS: The results suggest that educational interventions based on stages of change can have important implications for improving PA among adolescents in more constructs of HPM.

Association between education and domestic violence among women being offered an HIV test in urban and rural areas in Kenya.

The objective of this study was to examine the association between education and domestic violence among women being offered an HIV test in urban and rural areas in Kenya. A sample selection of women who experienced physical (n = 4,308), sexual (n = 4,309), and emotional violence (n = 4,312) aged 15 to 49 allowed for the estimation of the association between education and domestic violence with further analysis stratified by urban and rural residence. The main outcome of interest was a three-factor (physical, sexual, and emotional) measure for violence with the main predictor being education. Nearly half of all domestic violence, physical (46%), sexual (45%), and emotional (45%) occurred among women aged 15 to 29. After adjusting for confounding variables, women who resided in urban areas and had a postprimary/vocational/secondary and college/university education were 26% (OR = 0.74, 95% CI: [0.64, 0.86]), p < .001 and 22% (OR = 0.78, 95% CI: [0.66, 0.92]), p < .01 less likely to have experienced physical violence compared to those who had a primary education respectively. This was 17% (OR = 0.83, 95% CI: [0.73, 0.94]), p < .01 and 17% (OR = 0.83, 95% CI: [0.72, 0.96]), p < .05 less likely among women who resided in rural areas. A surprising finding was that women residing in rural areas with less than a primary education were 35% less likely to have experienced sexual violence (OR = 0.65, 95% CI: [0.43, 0.99]), p < .01 compared to those who had a primary education. These findings suggest that physical, sexual, and emotional violence were prevalent in Kenya among married and formerly married women. This study indicates that more research is needed to understand factors for HIV/AIDS among Kenyan women who have specifically tested positive for HIV or identified as AIDS-positive and the implications for women's health.

Beliefs and perception of risks of HIV among women that have never been tested for HIV in the United States.

PURPOSE: To assess women's attitudes, beliefs, characteristics, the perception of risks, and their relationships with not utilizing human immunodeficiency virus (HIV) testing services. METHODS: This study is a retrospective study and secondary data analysis of the 2006 National Health Interview Survey. Parametric testing using univariate, bivariate, and multivariate analyses was performed to examine perception of HIV acquisition and the relationship with not utilizing HIV testing services among women in the United States. RESULTS: More than half of the women in this study had never been tested for HIV (52.26%). In the multivariate analysis, using SAS callable SUDAAN, women who had not been tested for HIV that believed they had no risk of getting HIV were more likely to have never been married (odds ratio [OR], 0.37; 95% CI, 0.31-28.73; p = .0013). In addition, women who had never been tested for HIV that believed they had no risk of getting HIV were more likely to have less than a high school diploma (OR, 0.35; 95% CI, 0.15-0.78; p = .0022). CONCLUSION: Findings from this study can lend themselves to the development of more efficient and sustainable interventions to prevent HIV infection and decrease high-risk behaviors among more susceptible populations and for the development of HIV testing policy.

Dietary, physical activity, and lifestyle behaviors of rural African American South Carolina children.

Overweight and obese children continue to be a growing problem, and differences exist, especially among racial and ethnic groups. Even though a poor diet and lack of physical activity are attributable factors to being overweight among children, indications exists that geographic location may also be important. In rural areas in the United States, childhood obesity is often higher than the national average. This study analyzed dietary, physical, activity, and lifestyle behaviors of rural African American children and their risk for becoming overweight. This study is a cross-sectional convenience sample of 98 students from a rural county in South Carolina in 2002. Findings showed rural female children were significantly more likely than rural male children to engage in physical activity for at least 20 minutes per day (odds ratio, 5.57; p = .0056). Given the increase in the prevalence of obesity especially among minority populations, the need exists to develop culturally appropriate nutrition and exercise interventions to assistchildren in a healthy weight loss attempt. Increased prevalence of obesity and other diseases among African Americans warrants aggressive interventions to reduce risk factors in this vulnerable population.

Disparities between asthma management and insurance type among children.

Asthma is a chronic illness among children. Minority children may be vulnerable to asthma complications since more than half are from households that are poor or near poor, and some have no health insurance. Asthma management plans are important for the long-term treatment of asthma and beneficial for self-management. This study analyzed insurance type and the relationship between having an asthma management plan among children across all races with asthma. This study utilized the 2002 and 2003 National Health Interview Survey. Findings showed that whites were significantly more likely than Non-Hispanic blacks and Hispanics to have an asthma management plan (OR, 1.66; p = .0031). In this study, children who reported Children's Health insurance Program (CHIP) coverage were twice as likely to have an asthma management plan (OR, 2.67; p = .0004). Mandating all insurers to provide an asthma management plan to children with asthma may reduce the race-based inequities and differences in asthma management plan status.

Disparities in access to care among asthmatic children in relation to race and socioeconomic status.

Asthma is one of the leading chronic illnesses among children in the United States. International epidemiological studies have also shown asthma prevalence is an increasing problem. The objective of this study was to examine the correlates of access to care among asthmatic children age 0-17 in the United States. This is a retrospective study and secondary data analysis of the 2000 National Health Interview Survey. Parametric testing using univariate, bivariate, and multivariate analyses were performed to examine health care utilization among children with asthma in the United States. It was found that Black children were highly associated with not visiting a general doctor in the past 12 months (OR 0.47; 95% CI 0.30, 0.75). Uninsured asthmatic children were associated with the risk of not seeing a general doctor in the past 12 months (OR 0.40; 95% CI 0.23, 0.69). Our study findings indicate disparities among Black children with asthma and their ability to access appropriate health care services. Additional studies are required to identify factors that contribute to the temporal trends in asthma and country of origin.

Data mining for health executive decision support: an imperative with a daunting future!

Data mining is highly profiled. It has the potential to enhance executive information systems. Such enhancement would mean better decision-making by management, which in turn would mean better services for customers. While the future of data mining as technology should be exciting, some are worried about privacy concerns, which make the future of data mining daunting. This paper examines why data mining is highly profiled - the imperative toward data mining, data mining models and processes. Additionally, the paper examines some of the benefits and challenges of using data mining processes within the health-care arena. We cast the future of data mining by highlighting two of the many data mining tools available - one commercial and one freely available. Subsequently, we discuss a number of social and technical factors that may thwart the extensive deployment of data mining, especially when the intent is to know more about the people that organizations have to serve and cast a view of what the future holds for data mining. This component is especially important when attempting to determine the longevity of data mining within health-care organizations. It is hoped that our discussions would be useful to organizations as they engage data mining, strategies for executive information systems and information policy issues.

A Human Capital Approach to Reduce Health Disparities.

OBJECTIVE: To introduce a human capital approach to reduce health disparities in South Carolina by increasing the number and quality of trained minority professionals in public health practice and research. METHODS: The conceptual basis and elements of Project EXPORT in South Carolina are described. Project EXPORT is a community based participatory research (CBPR) translational project designed to build human capital in public health practice and research. This project involves Claflin University (CU), a Historically Black College University (HBCU) and the African American community of Orangeburg, South Carolina to reduce health disparities, utilizing resources from the University of South Carolina (USC), a level 1 research institution to build expertise at a minority serving institution. The elements of Project EXPORT were created to advance the science base of disparities reduction, increase trained minority researchers, and engage the African American community at all stages of research. CONCLUSION: Building upon past collaborations between HBCU's in South Carolina and USC, this project holds promise for a public health human capital approach to reduce health disparities.

Racial influences associated with asthma management among children in the United States.

OBJECTIVE: To examine the influence of race and having an asthma management plan on the impact of experiencing asthmatic episodes. METHODS: This study utilized the 2002 and 2003 National Health Interview Survey to conduct a retrospective study and secondary data analysis. Univariate, bivariate, and multivariate analysis was performed to examine physician asthma management plan recommendations among minority and non-minority children in the United States. RESULTS: Most of the study participants (59%) reported not having an asthma management plan. Children who experienced an asthma episode in the past 12 months were less likely to have an asthma management plan (OR .51, P<.0001). In the multivariate analysis, Whites were significantly more likely than were Blacks and Hispanics to have an asthma management plan (OR 1.66, P=.0031). CONCLUSIONS: Findings from this study indicate that Black and Hispanic children with asthma are less likely to have an asthma management plan, and children with an asthma management plan are less likely to have had asthma episodes in the past 12 months. Requiring all insurers to provide an asthma management plan to children with asthma may reduce these race-based inequities.