Depressed mood predicts pulmonary rehabilitation completion among women, but not men

SummaryBackgroundAs many as 30% of patients who start pulmonary rehabilitation (PR) fail to complete it, and depressed mood has been associated with PR non-completion. Depression is more common in women than men with COPD and historically women with COPD have been under studied. However, no studies to date have investigated gender-specific predictors of PR completion.MethodsThe study included 111 patients with COPD who enrolled in a community based outpatient PR program in Providence, RI. Patients who attended 20 or more sessions were designated “completers”. Depression was measured using the CES-D. Logistic regression models were evaluated to test depressed mood as a predictor of PR completion. Analyses controlled for demographic and health variables found to differ between completers and non-completers.ResultsPatients were 95% white and 49.5% women, and 74% had a GOLD stage ≥3. Sixty-eight percent of patients were PR completers. A logistic regression model, showed that lower depressed mood independently predicted PR completion across all patients (adjusted OR = 0.92, p = .002). In gender-stratified analyses, lower depressed mood was an independent predictor of PR completion for women (adjusted OR = .91, p = .024) but not men (adjusted OR = .97, p = .45). Greater 6-min walk test distance was also an independent predictor of PR completion among women.ConclusionDepressed mood is an important predictor of completion of community based PR among women. Screening and brief treatment of depression should be considered in practice

Disease Prevention without Relapse: Processes of Change for HPV Vaccination

Background: Human papillomavirus is the most prevalent sexually transmitted infection in the United States and is associated with 70% of cervical cancers as well as over 90% of genital warts. Although the HPV vaccine appears in the US immunization schedule during adolescence, a large percentage of women reach adulthood without being vaccinated. The Transtheoretical Model’s (TTM) Processes of Change (POC) construct provides an assessment of participants’ experiences with HPV vaccination and is a central component of computer-tailored interventions designed to increase compliance with medical recommendations, such as vaccination. This study describes development and validation of a POC measure for increasing HPV vaccination among young adult women. Methods: Cross-sectional measurement development was conducted using an online survey to reach a sample of 340 female college students representing vaccinated and unvaccinated women. Factor analytic structural equation modeling as well as evaluations of the stage by POC were used to evaluate the validity of the POC measure. Results: Confirmatory analyses supported the theoretically expected ten-factor, fully correlated model as the best fit for the data. Expected Stage of Change to POC relationships were also confirmed insofar as each POC was significantly associated with Stage of Change, with the exception of dramatic relief. Follow-up analyses suggested that individuals in the Precontemplation stage used all POC less frequently than individuals in all other stages. Conclusions: The POC measure was found to be internally and externally valid in a sample of college-attending women. The POC measure developed may be used to tailor stage-matched interventions that increase use of experiential and behavioral strategies important for increasing HPV vaccination in this high-risk population

Treated individuals who progress to action or maintenance for one behavior are more likely to make similar progress on another behavior: Coaction results of a pooled data analysis of three trials

Objective: This study compared, in treatment and control groups, the phenomena of coaction, which is the probability that taking effective action on one behavior is related to taking effective action on a second behavior. Methods: Pooled data from three randomized trials of Transtheoretical Model (TTM) tailored interventions (n = 9461), completed in the U.S. in 1999, were analyzed to assess coaction in three behavior pairs (diet and sun protection, diet and smoking, and sun protection and smoking). Odds ratios (ORs) compared the likelihood of taking action on a second behavior compared to taking action on only one behavior. Results: Across behavior pairs, at 12 and 24 months, the ORs for the treatment group were greater on an absolute basis than for the control group, with two being significant. The combined ORs at 12 and 24 months, respectively, were 1.63 and 1.85 for treatment and 1.20 and 1.10 for control. Conclusions: The results of this study with addictive, energy balance and appearance-related behaviors were consistent with results found in three studies applying TTM tailoring to energy balance behaviors. Across studies, there was more coaction within the treatment group. Future research should identify predictors of coaction in more multiple behavior change interventions

Integrated Primary Care Readiness And Behaviors Scale: Development And Validation In Behavioral Health Professionals

Although integrated primary care (IPC) is growing, several barriers remain. Better understanding of behavioral health professionals\u27 (BHPs\u27) readiness for and engagement in IPC behaviors could improve IPC research and training. This study developed measures of IPC behaviors and stage of change. Method: The sample included 319 licensed, practicing BHPs with a range of interests and experience with IPC. Sequential measurement development procedures, with split-half cross-validation were conducted. Results: Exploratory principal components analyses (N = 152) and confirmatory factor analyses (N = 167) yielded a 12-item scale with 2 factors: consultation/practice management (CPM) and intervention/knowledge (IK). A higher-order Integrated Primary Care Behavior Scale (IPCBS) model showed good fit to the data, and excellent internal consistencies. The multivariate analysis of variance (MANOVA) on the IPCBS demonstrated significant large-sized differences across stage and behavior groups. Discussion: The IPCBS demonstrated good psychometric properties and external validation, advancing research, education, and training for IPC practice

Population, health, and environment situational analysis for the Saadani National Park Area, Tanzania

This study provides a snapshot of the population, health, and environment situation and practices in the villages surrounding the Saadani National Park (SANAPA) and demonstrates the utility of a transdisciplinary systems perspective to evaluate population-health-environment linkages (PHE). Analyzing survey data from eight villages, this paper shows that in the SANAPA area, livelihoods are highly dependent on natural resources, but both agriculture and fisheries are experiencing a decline in productivity and profitability. Population stressors include a high population momentum, early marriages, teenage pregnancies, and migration. Women bear a heavy workload, while having little or no say in decision-making. The public health situation is severe with health facilities few and far in-between; lack of access to clean water and safe sanitation; and many households suffering from diarrhea, malaria, pneumonia, skin diseases, and HIV/AIDS. Environmental protection arrangements are in place in all sites, however, the awareness of protected areas and their benefits is low and many feel helpless in protecting the environment. Climate change-increasing periods of drought and irregular rainfall-contribute to food insecurity and health problems. The interconnectedness between these stressors reinforces the need for an integrated approach to addressing coastal conservation and community development in the SANAPA area. © 2012 Elsevier Ltd

Validation of the measures of the transtheoretical model for exercise in an adult african-american sample

Purpose. African-Americans have high rates of physical inactivity-related morbidity and mortality, thus effective interventions to increase exercise are necessary. Tailored interventions show promise, but measures need validation in this population. This study validated transtheoretical model measures for exercise in an African-American sample. Design. Cross-sectional measure development. Setting. Telephone survey of individuals in North Carolina. Subjects. 521 African-American adults. Measures. Stages of change, decisional balance (pros and cons), self-efficacy and processes of change (POC) for regular exercise. Analysis. Confirmatory factor analyses tested measurement models. Multivariate analyses examined relationships between each construct and stages of change. Results. For decisional balance, the two-factor uncorrelated model was the most parsimonious good-fitting model (x 235 5 158.76; comparative fit index [CFI], .92; average absolute standardized residual [AASR], .04), and alphas were good (pros α = .85 and cons a 5 .74). The one-factor model for self-efficacy (α = .80) revealed an excellent fit (x 29 = 45.51; CFI, .96; AASR, .03). For the POC subscales with good alphas (α = .62-.91), a 10-factor fully correlated model fit best (x 2[360] = 786.75; CFI, .91; AASR, .04). Multivariate analyses by stage of change replicated expected patterns for the pros, self-efficacy, and POC measures with medium-sized effects (n 2 = .05-.13). Results by stage of change did not replicate for the cons scale. Conclusions. The structures of these measures replicated with good internal and external validity, except for the cons scale, which requires additional development. Results support the use of these measures in tailored interventions to increase exercise among African-Americans. (Am J Health Promot 2012;26[5]:317-326.). Copyright © 2012 by American Journal of Health Promotion, Inc

Validation of decisional balance and self-efficacy measures for HPV vaccination in college women

Purpose. Women younger than 25 years are at greatest risk for human papillomavirus (HPV) infection, including high-risk strains associated with 70% of cervical cancers. Effective model-based measures that can lead to intervention development to increase HPV vaccination rates are necessary. This study validated Transtheoretical Model measures of Decisional Balance and Self-Efficacy for seeking the HPV vaccine in a sample of female college students. Design. Cross-sectional measurement development. Setting. Online survey of undergraduate college students. Subjects. A total of 340 female students ages 18 to 26 years. Measures. Stage of Change, Decisional Balance, and Self-Efficacy. Analysis. The sample was randomly split into halves for exploratory principal components analyses (PCAs), followed by confirmatory factor analyses (CFAs) to test measurement models. Multivariate analyses examined relationships between constructs. Results. For Decisional Balance, PCA indicated two 4-item factors (Pros -α= .90; and Cons -α =.66). CFA supported a two-factor correlated model, χ2(19) = 39.33; p \u3c .01; comparative fit index (CFI) = .97; and average absolute standardized residual statistic (AASR) = .03; with Pros α = .90 and Cons α = .67. For Self-Efficacy, PCA indicated one 6-item factor (α = .84). CFA supported this structure, χ2(9) = 50.87; p \u3c .05; CFI = .94; AASR = .03; and α = .90. Multivariate analyses indicated significant cross-stage differences on Pros, Cons, and Self-Efficacy in expected directions. Conclusion. Findings support the internal and external validity of these measures and their use in Transtheoretical Model-tailored interventions. Stage-construct relationships suggest that reducing the Cons of vaccination may be more important for HPV than for behaviors with a true Maintenance stage. Copyright © 2013 by American Journal of Health Promotion, Inc

Integrated primary care readiness and behaviors scale: Development and validation in behavioral health professionals

Although integrated primary care (IPC) is growing, several barriers remain. Better understanding of behavioral health professionals\u27 (BHPs\u27) readiness for and engagement in IPC behaviors could improve IPC research and training. This study developed measures of IPC behaviors and stage of change. Method: The sample included 319 licensed, practicing BHPs with a range of interests and experience with IPC. Sequential measurement development procedures, with split-half cross-validation were conducted. Results: Exploratory principal components analyses (N = 152) and confirmatory factor analyses (N = 167) yielded a 12-item scale with 2 factors: consultation/practice management (CPM) and intervention/knowledge (IK). A higher-order Integrated Primary Care Behavior Scale (IPCBS) model showed good fit to the data, and excellent internal consistencies. The multivariate analysis of variance (MANOVA) on the IPCBS demonstrated significant large-sized differences across stage and behavior groups. Discussion: The IPCBS demonstrated good psychometric properties and external validation, advancing research, education, and training for IPC practice