Obesity, hope, and health: findings from the HOPE Works community survey.

According to hope theory, hope is defined as goal-directed thinking in which people perceive that they can find routes to desired goals and the motivation to use those routes. The purpose of this study was to explore relationships between hope and body mass index and hope and self-rated health among women completing a community survey conducted in four rural counties in eastern North Carolina. The survey was administered as part of Hope Works, a participatory, community-led intervention program to improve weight, health and hope among low-income women in rural North Carolina. Survey data from 434 women were analyzed. In multivariate models adjusting for age, race, education and income, higher hope was positively related to self-reported health (OR:0.92; 95% CI: 0.89-0.95) and negatively related to BMI (P < 0.01). These results indicated that women who reported better self-rated health also had higher hope scores and women who were heavier had lower hope scores. While these findings are exploratory, they suggest directions for further research. State-based hope is considered to be a characteristic that is malleable and open to development. Future interventions should examine the importance of hope as a construct to examine in weight loss studies. For example, programs could be designed to increase hope by focusing on goal setting and providing support, information and resources to help women work toward their goals.

Patient perceptions about illness self-management in ANCA-associated small vessel vasculitis.

OBJECTIVES: To characterize patient perceptions, related to eight self-management behaviours relevant for adults with ANCA-associated small vessel vasculitis (ANCA-SVV), and to determine if these perceptions were associated with performance of each behaviour. METHODS: Adults with ANCA-SVV (n = 202) completed a self-administered questionnaire that assessed eight self-management behaviours (adherence to recommendations for medication, health service use, diet, exercise, infection avoidance and symptom monitoring; prompt reporting of symptoms and side effects; and adjusting activities in response to symptoms), perceptions about these behaviours, socio-demographics, clinical factors and social desirability bias. Descriptive statistics were generated to characterize patients' perceptions about difficulty of, importance of, and specific barriers to performing each behaviour. Regression analyses explored whether these variables were associated with performing each behaviour, controlling for potential confounders. RESULTS: With few exceptions, higher perceived importance and lower perceived difficulty of each behaviour were associated with more frequent performance of the behaviour. For each behaviour, several specific barriers were frequently endorsed by patients and a number of these were associated with lower levels of self-management. CONCLUSION: This study reveals that patient perceptions about the illness and its treatment influence ANCA-SVV self-management. Perceived barriers to medication, health services, diet and exercise adherence were similar to those in other illnesses. This study also provides insight into barriers experienced by patients in performing behaviours (infection avoidance, symptom monitoring, reporting symptoms and side-effects and adjusting activities) not often previously studied. How the identification of these barriers can help inform future interventions for ANCA-SVV patients is to be discussed.

Genetic testing for colorectal carcinoma susceptibility: focus group responses of individuals with colorectal carcinoma and first-degree relatives.

BACKGROUND: Colorectal carcinoma (CRC) may be the most frequent form of hereditary cancer. Genetic counseling and testing for heritable CRC is a promising approach for reducing the high incidence and mortality rates associated with the disease. Patients with CRC or those with at least one family member with the disease are the most likely persons to request or be offered genetic testing in the clinical or research setting. Currently, however, little is known about the behavioral, psychosocial, ethical, legal, and economic outcomes of CRC genetic counseling and testing. METHODS: Eight focus group interviews, four for CRC patients (n = 28) and four for first-degree relatives (n = 33), were conducted to obtain insights into attitudes, beliefs, and informational needs about genetic testing for hereditary CRC. RESULTS: Focus group interviews revealed a general lack of knowledge about cancer genetics and genetic testing; worry about confidentiality issues; strong concern for family members, particularly children; and a need for primary care providers to be informed about these issues. Major perceived advantages of genetic testing included improving health-related decisions, guiding physicians in making recommendations for surveillance, and informing relatives about risk potential. Disadvantages included potential discrimination, adverse psychologic effects, and financial costs associated with testing. CONCLUSIONS: As knowledge and media coverage of genetics continue to expand, it becomes increasingly important to continue efforts on behalf of, and in partnership with, those individuals most affected by genetic testing for hereditary cancer syndromes. These findings provide data needed to develop and implement informational, educational, counseling, and research-oriented programs that are sensitive to individuals' concerns and preferences.

Effects of educational materials concerning osteoporosis on women's knowledge, beliefs, and behavior.

PURPOSE: This study examined the effects of brief written educational materials on osteoporosis-related knowledge, beliefs, and behaviors. The study also examined whether observed effects varied as a function of one's stage in the precaution adoption process. DESIGN: The study used an experimental research design. SETTING: Participants were identified from North Carolina driver's license records. SUBJECTS: Of the 1476 women in the initial sample, 536 (36.3%) enrolled in the study and 307 completed all follow-up assessments. INTERVENTION: Participants were randomly assigned to one of four groups. One group received an information packet containing general information about osteoporosis. One group received an action plan packet containing instructions on how to increase one's level of exercise and calcium intake. One group received both packets. The final group received neither packet. MEASURES: Primary study variables were beliefs related to osteoporosis, calcium, and exercise; osteoporosis knowledge; calcium and exercise stage; calcium intake; and exercise level. RESULTS: Overall, receipt of the information packet was associated with changes in knowledge and beliefs (F[18,283] = 2.11, p < .01) irrespective of participants' stage of change. No effects on behavior were observed. CONCLUSIONS: These findings suggest that brief written educational materials can facilitate knowledge and belief change but that they do not promote behavior change. The generalizability of these findings is limited by the low study response rate.

Threat to Parental Role: A Possible Mechanism of Altered Self-Concept Related to Carrier Knowledge.

Researchers and clinicians have suggested that learning one is a carrier for a genetic disorder has the potential to alter self-concept. Concerns about self-concept have influenced the development of policies regarding the availability of carrier testing for minors and the informed-consent process. A literature review identified three mechanisms through which self-concept has been proposed to be affected: altered perception of genetic identity, diminished social identity, and an altered perception of health. This paper presents a conceptual framework developed from identity theory and the "self's response to threat" to propose a fourth mechanism: threat to the parental role. Clarification of the role of self-concept, the threat to self-concept related to carrier knowledge, and coping behaviors activated in response to this threat would help to target appropriate genetic counseling interventions.

Correlates of changes in mood following a mood induction in osteoarthritis patients.

OBJECTIVE: To determine the relationship of mood management skills, and affective and cognitive states to changes in moods following mood induction among people with osteoarthritis. METHODS: After completing questionnaires, participants underwent a negative mood induction. Momentary moods were assessed prior to, immediately following, and several minutes after the mood induction. RESULTS: A specific mood management skill, mood clarity, consistently predicted changes in positive mood following the mood induction: people who scored high on mood clarity experienced less diminution in positive affect. In contrast, changes in negative affect were unrelated to mood management skills. However, people who scored higher on measures of depressive symptoms and pessimism rebounded from the negative induced mood less strongly than others. CONCLUSION: Positive and negative emotional states operate largely independently and are differentially influenced by mood clarity, depressive symptoms, and pessimism. High levels of mood clarity may be adaptive in illnesses such as osteoarthritis because negative affective experiences that may be unavoidable need not preclude positive affective states.

Effect of satisfaction with one's abilities on positive and negative affect among individuals with recently diagnosed rheumatoid arthritis.

OBJECTIVE: The purpose of this study was to examine the effect that self-evaluation processes have on psychologic well-being among individuals with rheumatoid arthritis (RA). METHODS: The study used a longitudinal research design with 4 data collection points. Participants were 227 adults with recently diagnosed RA. Data were collected via mailed questionnaire and telephone interview. Two dimensions of psychologic well-being were assessed--positive affect and negative affect. RESULTS: We found that, among participants who viewed the abilities being evaluated as very important, greater satisfaction at time 1 was associated with less negative affect at time 2 and time 4. Satisfaction was not associated with positive affect at any of the time points, however. CONCLUSION: Study findings indicate that dissatisfaction with illness-related abilities can exacerbate psychologic distress. The findings also highlight the need for research examining the role that positive affect plays in adaptation to RA.

Psychosocial and educational outcomes associated with home- and clinic-based pretest education and cystic fibrosis carrier testing among a population of at-risk relatives.

We report on the psychosocial and knowledge outcomes of two different approaches to cystic fibrosis (CF) gene pretest education and carrier testing offered to 288 proactively recruited first-, second-, and third-degree relatives of people with CF. One group received pretest education and gene testing in a clinical setting from a certified genetic counselor. The other group received pretest education in their homes from a specially prepared pamphlet and were asked to send in a buccal cell sample for genotyping. No statistically significant differences between groups were noted on measures of CF knowledge, anxiety, and positive or negative affect, either while waiting for their test results or within a few weeks after they had learned their results. At both measurement points, participants who had received home education and testing reported that the testing was more convenient, but that they had received less information than they would have liked, and they were more likely to report being confused by the testing, although their level of CF knowledge was comparable to that of people who had been seen by a genetic counselor. In light of the increasing interest in home-based medical testing of all kinds, this study suggests that CF carrier testing in the home warrants further consideration as one possible approach to facilitating access to testing.

Do people with rheumatoid arthritis develop illness-related schemas?

OBJECTIVE: To assess, using both qualitative/inductive and quantitative data, whether people with rheumatoid arthritis (RA) have schemas related to arthritis. METHODS: Themes identified from interview and focus group transcripts were used to develop 1) questionnaire items, and 2) statements participants were asked to recall during home interviews. Two hundred one people with RA completed questionnaires and recall tasks of the type used in cognitive research, followed 10 days later by another recall assessment by telephone. RESULTS: Qualitative methods, item-level questionnaire data, and category-level recall data yielded convergent results supporting 4 final categories: mastery, support, loss of independence, and depression. Regression analyses indicated that category of earlier recollections predicted subsequent recollections assessed via phone. CONCLUSIONS: Results from widely different methods offer at least partial support for arthritis schemas and suggest that the concepts identified are meaningful to patients as well as to researchers.

Date and acquaintance rape. Development and validation of a set of scales.

PIP: Increasing recognition of the prevalence of date/acquaintance rape (DAR) in the US, especially among college women, has led to an understanding that the techniques needed to fend off attacks from friends and acquaintances differ from those used to prevent rape by strangers. This study developed and tested the reliability and validity of the following DAR constructs: perceived vulnerability (underestimation of vulnerability discourages adequate self-protection), self-efficacy, relational priority (neglecting self-interest to save a relationship), rape myth acceptance (subscribing to myths about rape allows women to avoid facing their own vulnerability), and commitment to self-defense. These constructs were also correlated with scales measuring masculinity, self-esteem, and degree of belief in a "just world." Data were gathered to test these constructs via a questionnaire administered to 800 female undergraduate dormitory residents (47% response rate). Analysis of the data allowed refinement of 50 items into 25 items that constitute reliable scales of perceived vulnerability, self-efficacy, and self-determination and a marginally reliable scale of victim-blaming (rape myth). Support was found for 5/6 predicted correlates between DAR scales and 3/5 hypothesized correlations between DAR scales and convergent/discrimination validity scales. Research into this rape prevention tool will continue.^ieng

Osteoporosis prevention in premenopausal women: using a stage model approach to examine the predictors of behavior.

The precaution adoption process model was used to examine the predictors of 2 behaviors recommended to reduce the risk of developing osteoporosis: calcium consumption and weight-bearing exercise. A total of 452 premenopausal women completed a mailed questionnaire assessing stage in the precaution adoption process and 12 knowledge and attitudinal variables. Participants were also given an opportunity to request information about osteoporosis. In all, 11 of the 12 knowledge and attitudinal variables were associated with calcium stage; 8 were associated with exercise stage. Information requests were associated with both calcium and exercise stage. Findings provide substantial support for the precaution adoption process model and suggest that the model can be usefully applied in this area to increase understanding of why many women do not practice behaviors that could reduce their risk of developing osteoporosis.

Prescribing of schedule II pain medications in ambulatory medical care settings.

Based on the Federal Controlled Substances Act of 1970, Schedule II (C-II) pain medications have a high potential for abuse. By identifying areas of prevalent prescribing, this research lays a foundation for future studies to examine issues such as underuse, overuse, and abuse associated with these medications.We identified variables in the 1990 National Ambulatory Medical Care Survey data set (N=43,469) theoretically associated with prescribing of controlled medications. Logistic regression analysis was employed to examine the univariate relationship of each selected variable with the likelihood of a C-II pain medication prescription and to develop a multivariable model examining the joint effects of the univariately significant factors.Geographic region, prescribing physician's specialty, patient's presenting complaint, physician's diagnosis, and diagnosis status (new versus previously diagnosed) were each associated with the likelihood of a C-II prescription. The odds of receiving a C-II pain medication increased with increasing age and with increasing duration of visit in minutes. The multivariable model included the factors, physician's specialty, duration of the visit, and physician's diagnosis.Prescribing practice does not imply drug misuse or abuse. Results of this study, however, underscore the need to consider patient-related and practice-related variables when addressing such issues.

The physiological impact of arthritis: prevalence of depression.

Attempts to estimate the prevalence of depression in people with arthritis are complicated by conceptual, definitional, and measurement problems and inconsistencies. Following a description of these methodologic problems, recent studies of depressive disorders and depressive symptoms in clinical and community samples are reviewed. The review suggests that although most people with rheumatic diseases do not experience them, depressive disorders and symptoms are probably more prevalent among people with rheumatic diseases than among people with no chronic diseases. This somewhat increased prevalence is probably no greater than that found in other serious chronic diseases, however. Additional research is needed.

Arthritis and perceptions of quality of life: an examination of positive and negative affect in rheumatoid arthritis patients.

The utility of measuring both positive and negative affective states for assessing rheumatoid arthritis (RA) patients was examined in 3 independent samples of male and female RA patients (Sample A: 179 women, 48 men; Sample B: 177 women, 24 men; Sample C: 134 women, 38 men). Confirmatory factor analyses of each sample indicated that positive and negative affect constituted separate, negatively correlated factors. The relations among disease variables, coping, and affects were consistent with a model in which coping mediates the relationship between disease variables and positive and negative affect. Patients with higher pain and limitation from RA had higher levels of maladaptive coping, and maladaptive coping was associated with lower positive affect and higher negative affect. Those RAs with higher activity limitation also reported less adaptive coping, which was associated with less positive affect.

The relationship between coping and psychological well-being among people with osteoarthritis: a problem-specific approach.

We examined the strategies that people with osteoarthritis (OA) use to cope with illness-related problems in four areas: household activities, leisure activities, pain management, and social relationships. We also examined the relationship between the coping strategies participants reported using upon entry to the study (Time 1) and psychological well-being reported six months later. Three hundred people, aged 50 and over, with OA participated in the study. Data were collected via two mailed questionnaires, administered at six-month intervals. We found that two of the coping strategies examined, self-criticism and social withdrawal, were used more frequently for social relationship problems than for any of the other three types of problems. None of the other coping strategies (i.e. problem solving, cognitive restructuring, social support, emotional expression, problem avoidance, turning to religion, information seeking) were used differentially across problem areas. Multivariate analyses revealed that the coping strategies people used at Time 1 significantly predicted psychological well-being, as assessed by measures of positive affect, negative affect, and depressive symptoms, six months later. However, the specific strategies that predicted positive affect were different from those that predicted negative affect and depressive symptoms. Implications of these findings for future research on coping with chronic illness are discussed.

CF carrier testing: Experience of relatives.

Consensus exists that genetic counseling and CF carrier testing should be offered to individuals with a positive family history of CF. To learn more about their experience with genetic counseling and testing we conducted a series of structured telephone interviews and focus group discussions with individuals and couples who had undergone genetic counseling and carrier testing because of a family history of CF. Traditional genetic counseling appears to have been effective for this population. Subjects generally report having a positive counseling experience and few difficulties upon learning their carrier status. Subjects were quite knowledgeable about CF and their carrier risk and were highly motivated to seek testing. They may not be representative of all individuals with a family history of CF however. For carriers, concerns about whether and when to have children tested, and concerns about insurance implications of carrier status may emerge sometime after the initial counseling. Strategies for addressing these concerns and for providing efficient and effective education and genetic counseling for people with a family history of CF need to be developed.

Improving dietary behavior: the effectiveness of tailored messages in primary care settings.

OBJECTIVES: To achieve the Healthy People 2000 objectives, public health professionals must develop effective dietary interventions that address psychosocial and behavioral components of change. This study tested the effect of individually computer-tailored messages designed to decrease fat intake and increase fruit and vegetable intake. METHODS: Adult patients from four North Carolina family practices were surveyed at baseline and then randomly assigned to one of two interventions or to a control group. The first intervention consisted of individually computer-tailored nutrition messages; the second consisted of nontailored nutrition information based on the 1990 Dietary Guidelines for Americans. Patients were resurveyed 4 months postintervention. RESULTS: The tailored intervention produced significant decreases in total fat and saturated fat scores compared with those of the control group (P < .05). Total fat was decreased in the tailored group by 23%, in the nontailored group by 9%, and in the control group by 3%. Fruit and vegetable consumption did not increase in any study group. Seventy-three percent of the tailored intervention group recalled receiving a message, compared with 33% of the nontailored intervention group. CONCLUSIONS: Tailored nutrition messages are effective in promoting dietary fat reduction for disease prevention.

Appraisal of and coping with arthritis-related problems in household activities, leisure activities, and pain management.

PURPOSE: We examined whether or not there are systematic differences in how people appraise different types of illness-related problems and in how they cope with these problems. METHODS: Two hundred thirty-five adults with recently diagnosed rheumatoid arthritis completed a mailed questionnaire followed by a telephone interview. A series of stress appraisal and coping variables were assessed in relation to three areas: household activities, leisure activities, and pain management. RESULTS: Pain differed significantly from household and leisure activities with regard to several appraisal and coping variables. Participants reported the least control over problems with pain, while attaching the most importance to pain control. Leisure activities also stood out as unique on several variables. Participants perceived greater ability and were more satisfied with their ability in relation to leisure activities. CONCLUSION: These findings show that, at least early in the disease, appraisal and coping strategies differ across the areas of household activities, leisure activities, and pain management.