Adolescents' Communication Styles for Learning About Birth Control from Mass Media

This article is an exploratory study to identify discrete factors which predict the way in which adolescents are likely to communicate about birth control after receiving information from a mass medium is described. First, we discuss styles of interacting with others regarding information from mass media which have been described in previous research. Five styles are identified: media-oriented, peer-oriented, home-oriented, professionally-oriented, and multi-source oriented. Next, we discuss categories of factors which theoretically should distinguish among the five communication styles. These factors are drawn from theories and previous research in communication and social learning. Using data collected from a random sample of 100 adolescents, we then test the predictive ability of categories of factors. Discriminant analysis is used to determine which factors within categories are most predictive of style and which best discriminate between styles. Eight factors are identified which predict 75% of all communication styles. The factors are sex, race, giving advice about sex, seeking information about birth control, dating rules regarding where one can go, dating rules regarding behavior on dates, feelings of pride, and feelings of popularity. Finally, we discuss the significance for practitioners of study findings and of predicting adolescents' communication styles.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68207/2/10.1177_109019818301000203.pd

Exploring Self-Efficacy as a Predictor of Disease Management

Self-efficacy is posited in social cognitive theory as fundamental to behavior change. Few health behavior studies have examined self-efficacy prospectively, viewed it as part of a reciprocal behavioral process, or compared self-efficacy beliefs in the same population across different behaviors. This article first discusses self efficacy in its theoretical context and reviews the available prospective studies. Second, it explores self-efficacy as a predictor of disease management behaviors in 570 older women with heart disease. Although the R2 statistics in each case were modest, the construct is shown to be a statistically significant (p < .05) predictor at both 4 and 12 months postbaseline of several disease management behaviors: using medicine as prescribed, getting adequate exercise, managing stress, and following a recommended diet. Building self-efficacy is likely a reasonable starting point for interventions aiming to enhance heart disease management behaviors of mature female patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66639/2/10.1177_109019819902600107.pd

Sustaining School‐Based Asthma Interventions Through Policy and Practice Change

BACKGROUND Schools are an ideal setting for implementation of asthma interventions for children; however, sustaining school‐based programs can be challenging. This study illustrates policy and practice changes brought about through the Childhood Asthma Linkages in Missouri ( CALM ) program to sustain such programs. METHODS Researchers analyzed caregiver‐reported quantitative data regarding asthma‐related outcomes in preintervention and postintervention surveys and qualitative data regarding sustainability efforts in schools reported by CALM grantees. A grounded theory approach was used to identify key concepts and themes that emerged. RESULTS In 330 children, significant improvements were seen in asthma symptoms, rescue inhaler use, health care utilization, school absenteeism, and activity limitations. Overall, 27 school‐based policy and practice changes supporting program sustainability were reported, with policy changes most often concerning the assessment and/or monitoring of children with asthma in the school setting, and practice changes most often regarding institution of regular asthma education programs for students and school personnel. CONCLUSIONS Sustaining school‐based asthma programs is challenging, but can be realized through the participation of diverse partners in enacting policy and practice changes that support the institutionalization of programs into the day‐to‐day processes of the schools.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101775/1/josh12104.pd

A Bayesian model for longitudinal count data with non-ignorable dropout

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73907/1/j.1467-9876.2008.00628.x.pd

Focusing on outcomes: Making the most of COPD interventions

A number of excellent intervention studies related to clinical and psychosocial aspects of chronic obstructive pulmonary disease (COPD) have been undertaken in the recent past. A range of outcomes have been examined including pulmonary function, health care use, quality of life, anxiety and depression, ambulation, exercise capacity, and self-efficacy. The purpose of this narrative review was to a) consider clinical, psychosocial, and educational interventions for people living with COPD in light of the health related outcomes that they have produced, b) identify the type of interventions most associated with outcomes, c) examine work related to COPD interventions as it has evolved regarding theory and models compared to work in asthma, and d) explore implications for future COPD research. Studies reviewed comprised large scale comprehensive reviews including randomized clinical trials and meta-analysis as these forms of investigation engender the greatest confidence in clinicians and health care researchers. Extant research suggests that the most significant improvements in COPD health care utilization have been realized from interventions specifically designed to enhance disease management by patients. A range of interventions have produced modest changes in quality of life. Evidence of impact for other outcomes and for a particular type of intervention is not strong. Research in other chronic diseases, particularly asthma, suggests that interventions grounded in learning theory and models of behavior change can consistently produce desired results for patients and clinicians. Use of a model of self-regulation may enhance COPD interventions. Although the extent to which COPD efforts can benefit from the experience in other conditions is a question, more outcome focused intervention studies using more robust theoretical approaches may enhance COPD results, especially regarding health care use and quality of life

Progression of Symptoms and Functioning Among Female Cardiac Patients With and Without Diabetes

Objective: To determine if older women with both heart disease and diabetes experience worse physical and psychosocial functioning and higher symptom burden over an 18-month period compared with those with heart disease alone. Methods: Data from older women with heart disease (>=60 years, n = 1008, 18% with diabetes) were used to assess the impact of diabetes on physical functioning (Sickness Impact Profile [SIP]-Physical and Six-Minute Walk test [6MWT]), psychosocial functioning (SIP-Psychosocial and depressive symptoms), and physical symptom burden (cardiac and general) at baseline and 4, 12, and 18 months later. Generalized estimating equation models compared trends in outcomes over time between groups with and without diabetes. Results: Across all four time points, women with heart disease and diabetes had greater functional impairment, as indicated by higher SIP scores, than those without diabetes (43%-71% higher SIP-Physical scores and 32%-65% higher SIP-Pyschosocial scores; all p<=-0.002). 6MWT distance was 17%-30% less in the diabetes group across time points (all p<=-0.002). Depressive symptoms were 27%-39% higher in the diabetes group (all p-<-0.03) except at month 4. Women with diabetes scored 15%-29% higher on a physical symptom index across time points (all p-<-0.05) than those without diabetes; no significant differences were observed in cardiac symptoms until month 18 (diabetes group 29% higher, p = 0.02). Subgroups with and without diabetes in this sample experienced significantly different trends over time in SIP-Physical scores (p = 0.02) and 6MWT distance (p = 0.05), such that the disadvantage of the diabetes group at baseline was greater 18 months later. Conclusions: Women with comorbid diabetes and heart disease are vulnerable to poor health-related quality of life, particularly in terms of physical functioning and symptoms, and require special efforts from clinical care providers to ameliorate a potential downward trend in these outcomes over time.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90452/1/jwh-2E2010-2E2123.pd

A Randomized Controlled Trial of a Self‐Regulation Intervention for Older Adults with Asthma

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98408/1/jgs12218.pd

Parent Perception of Their Child’s Asthma Control and Concurrent Complementary and Alternative Medicine Use

We conducted a cross-sectional survey of 1322 parents of children with asthma to measure the prevalence and factors associated with complementary and alternative medicine (CAM) use for pediatric asthma. Multivariate regression techniques were used to determine factors associated with CAM use. Eleven percent (141/1322) of children were given CAM. Parents of children on daily medications who were perceived to have poor asthma control were almost three times more likely to use CAM than parents of children on no daily medications who were perceived to have high asthma control (risk ratio: = 2.81; confidence interval: 1.72, 4.60); age, gender, race, income, and education level were not significant independent predictors. Parent perception of asthma control is significantly associated with CAM use. It is important for providers to elicit information regarding CAM use in the clinic, as this may imply that the asthma symptoms may not be well controlled.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63130/1/pai.2008.0503.pd

Self-management of the health care regimen: a comparison of nurses' and cardiac patients' perceptions

This study compared perceptions of 129 elderly cardiac patients regarding their health status and self-management skills with corresponding assessments by outpatient nursing staff members. Nurse-patient perceptions were most congruent on general questions regarding the heart condition. Differences were most apparent regarding how aware patients were of being asked to follow a regimen for managing their heart problems; what specific components comprised the regimens the patients were to follow; and how much confidence patients had in their ability to comply with specific components of the regimen. Congruence in perceptions of nurses and patients varied by the sex of the patient. Findings suggest that careful and continuous assessment of patients' perceptions about their condition and ongoing instruction regarding specifics of the therapeutic regimen are key elements in efforts to enhance elderly patients' selfmanagement skills.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31512/1/0000434.pd