Behavioral & Community Health

Permanent URI for this communityhttp://hdl.handle.net/1903/2271

Prior to January 24, 2011, this unit was named the Department of Public & Community Health.

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The Relative Efficacy of Progressive Muscle Relaxation, EMC Biofeedback and Music for Reducing Stress Arousal of Internally Vs. Externally Controlled Individuals
(1978) Prager-Decker, Iris J.; Girdano, Daniel; Behavioral & Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)
The purpose of this study was to test the relative efficacy of four relaxation techniques (music listening skills, progressive muscle relaxation (PMR), EMG biofeedback and EMG facilitated PMR) in reducing tension levels of internally or externally controlled individuals who were experimentally exposed to a psychosocial stressor. The study utilized 81 college aged males randomly assigned to one of four relaxation training groups or to a control group based on their locus of control - (Rotter's I-E Scale). EMG pre-training baseline measurements were taken via an ASI A1700 and all training groups were given seven 20 minute relaxation training sessions. Three days later each subject was exposed to the six repetitions of a 92 second segment of It Didn't Have to Happen (an industrial accident film). Baseline EMG levels were obtained prior to and following the exposure to the stressor. Data was also collected during the six repetitions. STAI (state) and MAACL (today form) were administered before, after the second exposure to the film and following the post stressor relaxation period. The results of the statistical analyses indicated that the film was able to elevate EMG levels, that biofeedback training produced significantly lower EMG levels during a resting period than music or PMR training, that externally controlled subjects trained with biofeedback reduced their resting EMC levels more than their internal counterparts, that externally controlled individuals trained with biofeedback reduced their EMG levels at a faster rate than internals and that initial muscle tension during exposure to the stressor seemed to be uneffected by the type of relaxation training the subject received or whether he received training at all.
A Confirmatory Study on the Motivational Orientations of Older Adults Involved in Formal Education at the University of Maryland
(1988) McMahon, Megan Catherine; Riddick, Carol Cutler; Behavioral & Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)
The purpose of this study was two-fold. One objective was to confirm Pritchard's (1978) typology of older adults' motives for education participation. Another purpose was to examine the influence that selected demographic variables (age, gender, socioeconomic status, and marital status) had on motivations of older students to participate in the "Golden Identification" (Golden I.D.) Program at the University of Maryland, College Park, Maryland. The sample consisted of 160 participants from the Golden I.D. Program who were selected through a systematic probability sampling procedure. A mailed questionnaire comprised of three instruments was used for conducting this research. The first part of the questionnaire measured motivational orientations for participation in education by older adults and consisted of the Education Participation Scale for Older Adults and the Older Learner Participation Scale. The third instrument measured demographic characteristics of the study participants. The results revealed that the motivation of the Golden I.D. students to participate in education can be divided into the following six factors (in decreasing order of importance): "cognitive interest," "self actualization," "adaptation/self-understanding," "social contact," "social contribution," and "escape/stimulation . " Furthermore, significant relationships emerged between the socioeconomic status of the participant, and the motives "social contribution," "escape/stimulation," and "self actualization." The implications of these findings and recommendations for further research are discussed.
Resting Metabolic Rates in Child-Onset and Adult Obese Women
(1989) Summerfield, Liane M.; Gold, Robert; Health Education; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)
This study investigated differences in resting metabolic rate (RMR) between obese nonobese females and between females with adult and childhood onset of obesity. Subjects were 18 healthy, Caucasian women, ages 20-38 (M=28.16), 6 from each of 3 groups: nonobese with no history of obesity (M-18.53% fat), child-onset obese (COO) (M=41.00% fat), and adult-onset obese (AOO) (M=37.8% fat). Subjects were nonsmokers, weight-stable for at least 3 months prior to the study, and not following a low-calorie diet. All obese subjects had lower-body obesity (waist/hip girth ratio < .80). Subjects underwent three measures: RMR by indirect calorimetry, residual lung volume, and hydrostatic weighing. In addition, a questionnaire elicited information about weight history, educational level, occupation, frequency of exercise, and activity level. When data from the 12 obese subjects were combined, RMR per kg body weight (RMR/BW) was significantly lower in the obese (18.47 kcal/kg/day) than the nonobese (22.94 kcal/kg/day). The obese subjects also had significantly lower RMR per kg fat mass (RMR/FM) than the nonobese. When data from COO and AOO subjects were analyzed separately, COO were found to have significantly lower RMR/FM than the nonobese. COO and AOO subjects did not differ statistically in absolute RMR, RMR/BW, RMR/FM, or RMR/FFM, although COO had lower values on all measures. Multiple regression analysis indicated that, in all groups, more of the variance in RMR was explained when the variables, FM and FFM. However, the effect of activity and exercise on explained variance in RMR was much smaller in COO women.
AIDS AND THE COLLEGE STUDENT: KNOWLEDGE, BELIEFS, AND INFORMATION SEEKING
(1989) Shelnutt, Emily Houston; Beck, Kenneth H.; Behavioral & Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)
A questionnaire on knowledge, beliefs, and information-seeking behavior about Acquired Immune Deficiency Syndrome (AIDS) was administered to a total of 1,300 university students, and 1,001 were completed and returned. The aim of the study was to investigate the relationship between college students' knowledge and beliefs about AIDS and their information-seeking behavior about AIDS. Students were found to be knowledgeable about the disease, but the majority (50.5%) were not worried about contracting AIDS. The findings revealed that students who are more knowledgeable about AIDS seek more information than those less knowledgeable about AIDS. It was also found that students who feel more highly susceptible to AIDS are more likely to seek information about the disease. The primary sources of student information on AIDS were television, newspapers, magazines, and radio; however, doctors and health-care professionals were considered the most trust-worthy sources of AIDS information. The data suggest that medically supported information on AIDS should be provided to college students by health educators via the popular media sources.
Meditation, Flow, and Heavy Social Alcohol Use among College Students
(1992) Francis, Timothy Lewis; Iso-Ahola, Seppo; Recreation; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)
The basis for this study was an experiment designed to explore the effectiveness of various meditation practices and choice and combination of such, regardless of focus, in achieving more drug-free flow experiences, longer periods of meditation adherence, and decreases in heavy social alcohol use among college students. The study also examined the hypothesis that higher frequencies of reported flow in meditation were associated with lower levels of reported alcohol use and higher frequencies of post-training meditation practice, regardless of meditation focus. The interaction of several critical intervening variables not comprehensively addressed in previous studies on meditation and substance abuse, including experimental expectancy and demand, previous alcohol use, hypnotic susceptibility, and personality was checked and controlled for in this experiment. After receiving basic meditation training, 53 subjects with drinking rates typical of heavy social alcohol users were randomly assigned to one of four meditation groups or to a control group. Three groups practiced only one of three foci--object focused, visualization, or mindfulness. The fourth group chose their meditation foci each day from any of the above three types. The fifth (control) group practiced an attention Placebo activity. Four weeks of daily diaries following meditation were used to determine the level of the dependent variables--frequency of flow and amount of alcohol use. Subjects then reported post-required meditation frequency and alcohol use through four weekly phone interviews. MANOVA, ANOVA, and zero-order correlations were employed to analyze the relationships between the variables. No one specific meditation focus nor having choice and combination of foci, was indicated to result in significantly more flow, less alcohol use, or longer mediation adherence. There was a slight indication that higher frequencies of flow were related to higher frequencies of meditation practice, but no indication that more flow was related to less alcohol use. These results should be interpreted with caution for several reasons, including the short meditation training and practice period, low reliability and validity of subject reports, and problems associated with large variations in drinking rates. Future research on these issues should refine training and testing methods so that better treatment methods can be found.
Mature Humor or Immature Wit?: The Interaction Effects of Laughter Humor Production, Humor Aprreciation, and Defensive Coping Strategies on Emotional and Physical Stress Symptoms
(1993) Carey, Coral Sue; Beck, Kenneth; Health Education; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)
The purpose of this study was to investigate the use of humor and mirth in stress management by an adult population with the potential for high occupational stress. The primary objective was to test the efficacy of each of the humor components (laughter, humor appreciation, and humor production) in mediating the stress response while controlling for other coping strategies. Two new instruments were developed for use in this study; (1) the Emotional Coping Scale to assess laughter and humor production, (2) the Stress Mediators Inventory to measure mature coping and immature defense strategies. Over 2,000 employees of the University of Maryland College Park campus were surveyed, using random probability sampling, stratifying by the 9 EEO occupational categories, such as administration and professionals. Questionnaires were dispersed through inter-campus mail. Results from the 754 returned questionnaires were analyzed with the appropriate multivariate techniques. Males, minorities, faculty skilled crafts, service maintenance, and fellowship students were under-represented. With these limitations in mind, results suggest: (1) men scored significantly higher than women on all three components of humor, as measured by this study; (2) humor appreciation and laughter, but not humor production were significantly related to emotional stress, while only laughter was related to physical stress symptoms, such that those with higher humor scores showed lower stress scores; (3) the type of humor response (self directed, other directed, or neutral) as related to stress symptoms; (4) the interaction effect between humor variables and immature defense strategies for coping with stress did not significantly predict stress; (5) there appears to be a stress and coping profile that is significantly different for many of the 9 occupational groups, such that those with high demand and low control jobs show higher stress scores.
College Student Stress: Who Is Resilient? Who Is Vulnerable?
(1994) Yeaman, Jan; Alexander, Linda L.; Health Education; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)
This study explored and described the pervasive stress on college campuses. It focused on what it is that distinguished those students who did and those who did not develop physical, psychological and/or academic sequelae in response to exposure to stressors during their college experience. A comprehensive model of stress and coping, based on a review of the literature, was presented. The model was affirmed by the data analysis. To conduct the research, 672 participants were randomly selected from those attending a Christian liberal-arts college in south central Pennsylvania. Of those who were selected and participated, 317 completed usable questionnaires. Data collection occurred over a one week period, using a self-report questionnaire. Subjects were categorized into Resilient (n = 43, 13.6%), Average (n = 96, 30.3%) and Vulnerable (n = 178, 56.1%) groups prior to data analysis. Incorporated into the 192 item questionnaire was the Brief Personal Survey (Webb, 1988). It contains 88 items on nine subscales: denial, health distress, pressure-overload, anger-frustration, anxiety, depression, social support, philosophical-spiritual resources and coping confidence. Subjects also indicated their magnitude of stress on 78 items. The remaining items focused on demographics. The data showed that Resilient subjects experienced less pressure-overload, anger-frustration, anxiety and depression than either Average or Vulnerable groups. Males and females were not found to differ with regard to pressure-overload, anger-frustration or depression. Females experienced higher levels of anxiety, stressor magnitude, health distress, social support and philosophical-spiritual resources. Correlations between stressors were also reported, as were the rankings of stressors. These were presented on the basis of variables such as gender, academic year and academic major. Because of the nature of the stressors identified, this study has shown the mutual importance of the curricular and cocurricular in the lives of college students. The findings of this research pointed out the clear and urgent need for various types of prevention and intervention programs. These were discussed from the perspective of institutional concerns, for curricular and cocurricular faculty, as well as for health educators.
Psychometric Assessment of Two New Self-Rating Depression Scales: The Correa-Barrick Depression Scale
(1994) Barrick, Christina Barrett; Clearwater, Harvey E.; Health Education; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)
Depression is a prevalent condition that is responsive to treatment. Efforts to screen and educate the public on depression are beneficial. The purpose of this investigation was to assess the psychometric properties of two new self-rating depression scales, the Schiraldi Depression Check-up (DC) and the Correa-Barrick Depression Scale (CBDS), based upon classical test theory and comparisons to published scales: the Beck Depression Inventory (BDI) and the Inventory for Depressive Symptomatology, Self-Report (IDS-SR). The study was conducted on a total of 387 participants. There were two convenience samples used. Sample I was composed of 337 faculty and staff from a metropolitan comprehensive university. A subset of Sample I was composed of 203 faculty and staff. Sample II included 50 outpatients diagnosed with depression under the treatment of a board certified psychiatrist. Correlation coefficients for the DC and CBDS with the BDI were r = . 75 and r = . 71, respectively. Cronbach alpha coefficients for the DC and CBDS in the patient sample were r = .95 and r = .96, respectively. Correlation coefficients for the IDS-SR with the DC and the CBDS in the patient sample were r = .85 and r = .81, respectively. Two-week test-retest correlation coefficients in the university sample for the DC and CBDS were r = .81 and r = . 70, respectively. Factor analysis for the DC revealed a threefactor structure: "Cognitive-Emotional Disturbance," " Psychophysiological Symptoms," and "Physiological Symptoms." Factor analyses for the CBDS revealed a four-factor structure: "Cognitive-Emotional Disturbance," "General Outlook," "Physiological Symptoms," and "Sensory/Perceptual Disturbance." Discriminant analysis did not support the Depression Check-up or the Correa-Barrick Depression Scale in discriminating between the university and patient samples. There were several conclusions from this study. Findings provided preliminary evidence for the validity and reliability of the Depression Check-up and the Correa-Barrick Depression Scale in measuring depression in an adult population. The findings that sensory-perceptual disturbance may be an additional variable in depression and that a single-factor structure emerged for "emotional-cognitive disturbance" was discussed as well as implications for health education theory, practice, and research.
PREDICTING UNIVERSITY FRESHMEN'S PERCEPTIONS OF THE OCCURRENCE OF DATE RAPE AS DEPICTED IN TWO VIDEOTAPED SCENARIOS
(1994) Reynolds, Martha Sue; Beck, Kenneth H.; Behavioral & Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)
The purpose of this study was to investigate the degree to which certain variables (social context of drinking, alcohol use intensity, experience of sexually aggressive behavior, level of dating skills and social assertiveness, and perceived susceptibility related to date rape) predict university freshmen's perception of whether or not date rape occurred as depicted in two videotaped scenarios. Freshmen students enrolled in an orientation course (N = 232) during Fall semester 1993 completed a voluntary and anonymous pretest questionnaire. The questionnaire consisted of six scales developed to measure the variables listed above; in addition to, demographic variables and items related to sexual behavior. Within two class periods of completing the pre-test questionnaire, students viewed a 15-minute videotape depicting two potential date rape scenarios (one scenario presented the situation from the male character's point of view [MARK], the other scenario was from the female character's point of view [SUZANNE]). Immediately following the videotape, students completed a brief post-video questionnaire to assess their perceptions of the occurrence of date rape in the two scenarios. Multivariate and univariate analyses of variance were completed to assess differences in independent measures based, on perception of the occurrence of date rape. Of the variables explored, the only one which provided any consistent significant findings was gender. For both scenarios, females were more likely than males to perceive the situation as date rape. With regard to social context of drinking, some ,of the results hinted at a possible link between social context of drinking and the perceptions of the occurrence of date rape. Subjects who reported SUZANNE as being "date rape with some doubt'" were more likely to use alcohol 1) to provide relief from external pressures; 2) in the context of close family members or friends; and 3) to conform to the norms of the group. Further analyses suggested that males who drink in certain social contexts reported more doubt regarding the occurrence of date rape for SUZANNE. This exploratory research study provides a broad foundation for future research related to predicting college students' perceptions of the occurrence of date rape.
African American Patient Perceptions Regarding Pre- and Post-Dialysis Education and Treatment
(2003-12-10) Greene, Revenda Ann; Desmond, Sharon; Public and Community Health
Kidney disease is common in the United States. It occurs with more frequency and more complications among African Americans than in the general population. Patients with end stage renal disease (ESRD) are at that point in the progression of kidney disease where death is imminent if treatment is not performed to replace the limited kidney function. Hemodialysis is a replacement treatment for ESRD. This study used ecological theory to examine pre-and post-dialysis education and treatment in a convenience sample of African American ESRD patients. A pilot study of 29 patients and a final sample of 98 patients were used. Patient age, income, education and length of time on dialysis were the independent variables examined. Dependent variables included knowledge, satisfaction, treatment intervention, and quality of life. Oneway analyses of variance (ANOVA) were used to analyze the data. The following research questions were examined: 1) Are African American ESRD patient adequately educated about the disease, its causes, possible complications and range of treatments available? 2) Will African American ESRD patient with higher income and education levels score higher on the knowledge and pre-dialysis education subscale, when compared to patient with lower income and education levels? 3) Is the degree of satisfaction with pre-dialysis information and education positively related to age, level of education and income of African American ESRD patients? 4) Do African American ESRD patients with disparate income and education levels receive different treatment interventions? 5) What are the perceptions of African American dialysis patients regarding their quality of life? When the data were analyzed, the research hypotheses related to questions one and three were not supported (p > .05). While the hypotheses for questions two and four were supported (p < .05). A significant relationship was found between patient satisfaction with pre-dialysis education and treatment and level of education. Other significant relationships were also found when examining the quality of life subscales with income and education.
Evaluating the Disparity of Female Breast Cancer Mortality Among Racial Groups - a Spatiotemporal Analysis
(International Journal of Health Geographics, 2004-02) Hsu, Chiehwen Ed
BACKGROUND: The literature suggests that the distribution of female breast cancer mortality demonstrates spatial concentration. There remains a lack of studies on how the mortality burden may impact racial groups across space and over time. The present study evaluated the geographic variations in breast cancer mortality in Texas females according to three predominant racial groups (non-Hispanic White, Black, and Hispanic females) over a twelve-year period. It sought to clarify whether the spatiotemporal trend might place an uneven burden on particular racial groups, and whether the excess trend has persisted into the current decade. METHODS: The Spatial Scan Statistic was employed to examine the geographic excess of breast cancer mortality by race in Texas counties between 1990 and 2001. The statistic was conducted with a scan window of a maximum of 90% of the study period and a spatial cluster size of 50% of the population at risk. The next scan was conducted with a purely spatial option to verify whether the excess mortality persisted further. Spatial queries were performed to locate the regions of excess mortality affecting multiple racial groups. RESULTS: The first scan identified 4 regions with breast cancer mortality excess in both non-Hispanic White and Hispanic female populations. The most likely excess mortality with a relative risk of 1.12 (p = 0.001) occurred between 1990 and 1996 for non-Hispanic Whites, including 42 Texas counties along Gulf Coast and Central Texas. For Hispanics, West Texas with a relative risk of 1.18 was the most probable region of excess mortality (p = 0.001). Results of the second scan were identical to the first. This suggested that the excess mortality might not persist to the present decade. Spatial queries found that 3 counties in Southeast and 9 counties in Central Texas had excess mortality involving multiple racial groups. CONCLUSION: Spatiotemporal variations in breast cancer mortality affected racial groups at varying levels. There was neither evidence of hot-spot clusters nor persistent spatiotemporal trends of excess mortality into the present decade. Non-Hispanic Whites in the Gulf Coast and Hispanics in West Texas carried the highest burden of mortality, as evidenced by spatial concentration and temporal persistence.
Psychological Distress in Adolescents: The Role of Coping Response And Perceived Emotional Support
(2004-02-10) Allen, Frances; Desmond, Sharon; Public and Community Health
ABSTRACT Title of dissertation: PSYCHOLOGICAL DISTRESS IN ADOLESCENTS: THE ROLE OF COPING RESPONSE AND PERCEIVED EMOTIONAL SUPPORT Frances D. Allen, Doctor of Philosophy, 2003 Dissertation directed by: Professor Sharon Desmond Department of Public and Community Health Adolescence is the developmental period that serves as the bridge between childhood and adulthood. It is a time of rapid physical and psychological growth and provokes changes in social functioning. The adolescent faces increased demands and stress and must learn to successfully and positively adapt to a variety of increasingly complex situations. The purpose of this study was to examine the role of the type of coping and the level of perceived emotional support in mediating the relationship between levels of stress and symptoms of psychological distress. A secondary data analysis was carried out on data gathered from the administration of a confidential questionnaire (N=889) at an urban high school with a predominantly African-American population (77%). Frequency distributions were used to place subjects into high and low categories for levels of perceived stress related to school, levels of perceived stress outside of school, symptoms of psychological distress, type of coping and perceived emotional support. Chi-square analyses involving gender, ethnicity and grade level and each of the five variables produced six statistically significant findings (p < .05). Levels of perceived stress outside of school differed by gender and grade level, symptoms of psychological distress and level of perceived emotional support differed significantly by gender with females reporting higher levels of both. Problem-focused coping was also associated with gender (more females used problem-focused coping than males) and with grade level (12th graders used more problem-focused coping than all other grade levels). Subjects were then placed into adjustment groups based upon levels of perceived stress and symptoms of psychological distress. Four adjustment levels were identified (“adapters”, “at risk”, “positively adjusted” and “negatively adjusted”) in an effort to examine differences in the type of coping and level of perceived emotional support used by each group. Chi square analyses were performed with adjustment groups and type of coping and adjustment groups and perceived level of emotional support. No significant relationship was found for either adjustment group with type of coping or with level of perceived emotional support. Possible explanations for the findings were discussed along with recommendations for future research.
Evaluating the disparity of female breast cancer mortality among racial groups - a spatiotemporal analysis
(International Journal of Health Geographics, 2004-02-26) Hsu, Chiehwen Ed; Jacobson, Holly; Soto Mas, Francisco
Background: The literature suggests that the distribution of female breast cancer mortality demonstrates spatial concentration. There remains a lack of studies on how the mortality burden may impact racial groups across space and over time. The present study evaluated the geographic variations in breast cancer mortality in Texas females according to three predominant racial groups (non-Hispanic White, Black, and Hispanic females) over a twelve-year period. It sought to clarify whether the spatiotemporal trend might place an uneven burden on particular racial groups, and whether the excess trend has persisted into the current decade. Methods: The Spatial Scan Statistic was employed to examine the geographic excess of breast cancer mortality by race in Texas counties between 1990 and 2001. The statistic was conducted with a scan window of a maximum of 90% of the study period and a spatial cluster size of 50% of the population at risk. The next scan was conducted with a purely spatial option to verify whether the excess mortality persisted further. Spatial queries were performed to locate the regions of excess mortality affecting multiple racial groups. Results: The first scan identified 4 regions with breast cancer mortality excess in both non- Hispanic White and Hispanic female populations. The most likely excess mortality with a relative risk of 1.12 (p = 0.001) occurred between 1990 and 1996 for non-Hispanic Whites, including 42 Texas counties along Gulf Coast and Central Texas. For Hispanics, West Texas with a relative risk of 1.18 was the most probable region of excess mortality (p = 0.001). Results of the second scan were identical to the first. This suggested that the excess mortality might not persist to the present decade. Spatial queries found that 3 counties in Southeast and 9 counties in Central Texas had excess mortality involving multiple racial groups. Conclusion: Spatiotemporal variations in breast cancer mortality affected racial groups at varying levels. There was neither evidence of hot-spot clusters nor persistent spatiotemporal trends of excess mortality into the present decade. Non-Hispanic Whites in the Gulf Coast and Hispanics in West Texas carried the highest burden of mortality, as evidenced by spatial concentration and temporal persistence.
THE EFFECT OF TWO DEATH EDUCATION PROGRAMS ON EMERGENCY MEDICAL TECHNICIANS
(2004-03-29) Smith-Cumberland, Tracy Lynne; FELDMAN, ROBERT H.L.; Public and Community Health
This study examined the changes in behavioral intent of EMTs in six EMS agencies in Wisconsin after exposure to 1 of 2 death education programs. The effectiveness of the programs was evaluated by a comparison of pretest and posttest scores on behavioral intent of on-scene death-related behaviors using non-equivalent control group design. One intervention group participated in a 2 day workshop using the Emergency Death Education and Crisis Trainingsm (EDECTsm) curriculum. A second intervention group participated in a 2 hour didactic Continuing Medical Education (CME) session on making death notifications. A third group served as a control group and participated in a 2 hour CME session not related to death. Prior to this research, no formal evaluations existed on the impact of these two programs. Ajzen's (1985) Theory of Planned Behavior was used to predict participant's death-related behavioral intentions, attitudes, subjective norms, and perceived behavioral control towards a behavior. Evaluation included comparisons on multiple measures, which stemmed from the goals of the programs. Study results indicated that the majority of EMTs intend to change their behaviors at the scene of a death after receiving either training program. Changes were greatest for the group exposed to the EDECTsm curriculum. In addition to testing the hypothesis, several questions explored EMTs' attitudes toward their role on-scene and their previous death-related training. Analysis of these questions show that most EMTs feel that death notifications and helping bereft families are part of their roles as an EMT. The need for death-related programs to help emergency responders manage bereaved families and the lack of methodologically rigorous evaluation studies of such programs were the principal factors that led to this study. Although there were limitations suggesting caution when interpreting the results, the evaluation showed these programs to be effective in changing the behavioral intent of EMTs. The effectiveness of these programs on EMTs and other emergency providers warrants further study.
AN EXAMINATION OF THE RE-INVENTION PROCESS OF A HEALTH PROMOTION PROGRAM: THE CHANGES AND EVOLUTION OF "FOCUS ON KIDS" HIV PREVENTION PROGRAM.
(2004-04-27) Galbraith, Jennifer Scott; Boekeloo, Bradley; Public and Community Health
Behavioral prevention programs remain one of our most powerful tools in slowing the human immunodeficiency virus (HIV) epidemic. However, questions persist on balancing fidelity of these programs and adapting them to a different target population or setting. The current study explored the extent to which "Focus on Kids," an HIV prevention program with efficacious results from a carefully conducted study, was re-invented when adopted by other agencies and implemented in new settings. This study investigated the quality of re-invention by using a proxy variable of adherence to the core components of the curriculum thought to be responsible for the positive behavior change. The use of a snowball sampling technique identified 34 service providers who had utilized the curriculum. After conducting a telephone survey with the participants, an ex post facto design was used to determine the relationship between reasons for re-invention and other variables thought to be associated with re-invention quality. Results indicated that considerable re-invention occurred. Organizations frequently changed and deleted activities and over half of respondents added new activities. The research allowed the construction of a model of re-invention with factors that were both positively and negatively associated with quality re-invention. Decreasing re-invention quality was associated with citing certain reasons for re-invention: time constraints or the host agency required change. Factors associated with quality implementation included an adopter organization being a national non-governmental organization, having a researcher on the team, or citing expanding to new topics as a reason for re-invention. The results of this study demonstrate the need for curriculum developers to understand the real world environment in which HIV prevention curricula are used. Developers must facilitate practitioners' understanding of the theory and core components of the curriculum thought to be responsible for behavior change.
The Impact Of Social Marketing On A Web-Based Behavioral Risk Factor Surveillance Survey
(2004-05-18) Finley, Patrick; Desmond, Sharon; Public and Community Health
The potential exists for Web-based health survey methods to collect, analyze, and disseminate increasing amounts of health risk factor and health behavior data. There is a need to establish Web-based survey methodologies that produce results equivalent to current health survey modes. This study examined the impact a social marketing campaign had on a Web-based Behavioral Risk Factor Surveillance Survey. It had three dependent variables, response rate, response time, and item completion rate. An explanatory model of response was also developed using logistic regression analysis. Both qualitative and quantitative data collection methods were used in this study. Qualitative data were used to develop the social marketing promotional framework. Quantitatively, an experimental design was used, with a random sample of 847 participants randomly assigned to control and experimental groups. A Web-based version of the 2001 Behavioral Risk Factor Surveillance System questionnaire was adapted to create a 70 item Web-based Behavioral Risk Factor Surveillance Survey (WBRFSS). The control group had the WBRFSS delivered without any intervention. The experimental group was exposed to a social marketing campaign prior to delivery of the WBRFSS. Of the 770 who were mailed participation requests, 70 completed the survey representing an overall response rate of 9.1 percent. Response rates were 5.96 percent for the control group and 12.24 percent for the experimental group. Chi-Square analysis showed that the response rate for the experimental group was significantly higher than that of the control group. The mean response times for the control group was 96.09 hours (SD=49.41) and for the experimental group was 124.53 hours (SD=112.75).The item response rates were 99.50 percent for the control group and 99.82 percent for the experimental group. The t-test for independent means found no significant difference between mean response times or item response rates. The regression model included the dependent variable, response, and the independent variables, exposure to social marketing promotions, age, sex, ethnicity, county of residence, education, perceived Internet literacy, and availability of an Internet connection at home. The overall model was significant (p<.05). Exposure to the social marketing campaign promotions increased WBRFSS response by more than two-and-one-half times.
Detecting Spatiotemporal Clusters of Accidental Poisoning Mortality among Texas Counties, U.S., 1980-2001
(International Journal of Health Geographics, 2004-10-27) Hsu, Chiehwen Ed; Nkhoma, Ella T; Hunt, Victoria I; Harris, Ann Marie
Background Accidental poisoning is one of the leading causes of injury in the United States, second only to motor vehicle accidents. According to the Centers for Disease Control and Prevention, the rates of accidental poisoning mortality have been increasing in the past fourteen years nationally. In Texas, mortality rates from accidental poisoning have mirrored national trends, increasing linearly from 1981 to 2001. The purpose of this study was to determine if there are spatiotemporal clusters of accidental poisoning mortality among Texas counties, and if so, whether there are variations in clustering and risk according to gender and race/ethnicity. The Spatial Scan Statistic in combination with GIS software was used to identify potential clusters between 1980 and 2001 among Texas counties, and Poisson regression was used to evaluate risk differences. Results Several significant (p < 0.05) accidental poisoning mortality clusters were identified in different regions of Texas. The geographic and temporal persistence of clusters was found to vary by racial group, gender, and race/gender combinations, and most of the clusters persisted into the present decade. Poisson regression revealed significant differences in risk according to race and gender. The Black population was found to be at greatest risk of accidental poisoning mortality relative to other race/ethnic groups (Relative Risk (RR) = 1.25, 95% Confidence Interval (CI) = 1.24 – 1.27), and the male population was found to be at elevated risk (RR = 2.47, 95% CI = 2.45 – 2.50) when the female population was used as a reference. Conclusion The findings of the present study provide evidence for the existence of accidental poisoning mortality clusters in Texas, demonstrate the persistence of these clusters into the present decade, and show the spatiotemporal variations in risk and clustering of accidental poisoning deaths by gender and race/ethnicity. By quantifying disparities in accidental poisoning mortality by place, time and person, this study demonstrates the utility of the spatial scan statistic combined with GIS and regression methods in identifying priority areas for public health planning and resource allocation.
Detecting spatiotemporal clusters of accidental poisoning mortality among Texas counties, U.S., 1980 – 2001
(International Journal of Health Geographics, 2004-10-27) Nkhoma, Ella T; Hsu, Chiehwen Ed; Hunt, Victoria I; Harris, Ann Marie
Background: Accidental poisoning is one of the leading causes of injury in the United States, second only to motor vehicle accidents. According to the Centers for Disease Control and Prevention, the rates of accidental poisoning mortality have been increasing in the past fourteen years nationally. In Texas, mortality rates from accidental poisoning have mirrored national trends, increasing linearly from 1981 to 2001. The purpose of this study was to determine if there are spatiotemporal clusters of accidental poisoning mortality among Texas counties, and if so, whether there are variations in clustering and risk according to gender and race/ethnicity. The Spatial Scan Statistic in combination with GIS software was used to identify potential clusters between 1980 and 2001 among Texas counties, and Poisson regression was used to evaluate risk differences. Results: Several significant (p < 0.05) accidental poisoning mortality clusters were identified in different regions of Texas. The geographic and temporal persistence of clusters was found to vary by racial group, gender, and race/gender combinations, and most of the clusters persisted into the present decade. Poisson regression revealed significant differences in risk according to race and gender. The Black population was found to be at greatest risk of accidental poisoning mortality relative to other race/ethnic groups (Relative Risk (RR) = 1.25, 95% Confidence Interval (CI) = 1.24 – 1.27), and the male population was found to be at elevated risk (RR = 2.47, 95% CI = 2.45 – 2.50) when the female population was used as a reference. Conclusion: The findings of the present study provide evidence for the existence of accidental poisoning mortality clusters in Texas, demonstrate the persistence of these clusters into the present decade, and show the spatiotemporal variations in risk and clustering of accidental poisoning deaths by gender and race/ethnicity. By quantifying disparities in accidental poisoning mortality by place, time and person, this study demonstrates the utility of the spatial scan statistic combined with GIS and regression methods in identifying priority areas for public health planning and resource allocation.
The influence of parental communication about the negative effects of alcohol on college students' alcohol use
(2004-12-08) Boyle, Jennifer Rebecca; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Many college students experience negative effects of excessive and underage drinking. Parental influences have been found capable of delaying adolescent drinking and reducing riskier adolescent drinking behaviors. However, there has been little investigation regarding the influence of parents on the drinking behaviors of college students while students are at school. A web-based survey was conducted with 265 University of Maryland first-year students who were18-19 years old and living in residence halls. Focus groups (n=12), observed pre-tests and in-depth interviews (n=5), pilot tests (n=4), an alpha test, and expert review (n=5) were conducted to assist in the development of the web-based survey. It was hypothesized that: 1) students who report greater parental communication regarding the negative effects of alcohol are less likely to report problem drinking than students who report less communication, 2) the association between communication and problem drinking is mediated by constructs borrowed from the Theory of Reasoned Action (TRA), 3) the association between communication and problem drinking is mediated by constructs borrowed from the Health Belief Model (HBM), 4) the association between communication and problem drinking is mediated by constructs borrowed from both the TRA and HBM, 5) the association between communication and problem drinking is best explained by the model incorporating constructs from both the TRA and the HBM. Logistic regression was conducted to test the first hypothesis. Path analysis and structural equation modeling were used to test hypotheses two through four. Models were qualitatively compared to test hypothesis five. Results of logistic regression indicated that there was no significant direct relationship between parent-child alcohol communication and problem drinking. Structural equation modeling revealed that the relationship between communication and problem drinking was mediated by attitude toward alcohol. Students whose parents talked with them more about the negative effects of alcohol held more favorable attitudes toward alcohol (p = -0.13, p < 0.05). In turn, students holding more favorable attitudes toward alcohol experienced more drinking problems (p = 0.19, p < 0.05). The TRA model was determined to be the model that best explained the relationship between communication and problem drinking. Possible explanations for unexpected findings are discussed.
Tobacco control: are we appropriately training future professionals?
(American Journal of Health Studies., 2005-04) Soto Mas, Francisco; Alberola, Julia Valderrama; Brogger, Jan; Hsu, Chiehwen Ed
Information on how health professionals perceive tobacco use as well as their attitudes toward tobacco control is scarce. This study assessed the attitudes and perceptions of public health students toward tobacco use and tobacco control, which constitutes a necessary first step in designing effective training strategies. Although the majority of respondents agreed that tobacco use constitutes a relevant public health problem, they did not perceive tobacco control to be a public health priority. Academic institutions may not be properly training public health students, and may therefore be missing the opportunity to advance tobacco control at the national and global levels.