Taking CHARGE: A self-management program for women following breast cancer treatment

The purpose of the study was to develop and evaluate Taking CHARGE, a self-management intervention designed to facilitate successful transitions to survivorship after breast cancer treatment. The Taking CHARGE intervention involves a two-pronged approach building on self-regulation principles to (1) equip women with self-management skills to address concerns following breast cancer treatment, and (2) provide information about common survivorship topics. The program involved four intervention contacts, two small group meetings and two individualized telephone sessions, delivered by nurse/health educators. This paper focuses on the process evaluation findings from a preliminary test of the Taking CHARGE intervention conducted with 25 women, aged 34–66 years, completing breast cancer treatment, who were randomly assigned to the intervention group. The process evaluation was conducted to obtain systematic information about the relevance and usefulness of the self-regulation approach, informational aspects, and program delivery. The findings indicated that intervention group participants found the Taking CHARGE program to be timely, relevant, and to have high utility in dealing with concerns that exist following breast cancer treatment. The process evaluation findings provide early evidence of the usefulness of the Taking CHARGE intervention for successful transition to survivorship following breast cancer treatment. Copyright © 2005 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/48695/1/891_ftp.pd

Persistent differences in asthma self-efficacy by race, ethnicity, and income in adults with asthma

OBJECTIVE: The objective of this population-based study was to determine if and to what extent there are differences in asthma self-efficacy by race/ethnicity and income, and whether health status, levels of acculturation, and health care factors may explain these differences. METHODS: We conducted a secondary data analysis of asthma self-efficacy using the 2009 and 2011-2012 California Health Interview Survey, in adults with asthma (n = 7874). In order to examine if and how the effect of race /ethnicity and income on asthma self-efficacy may have been altered by health status, acculturation, and health care factors, we used staged multivariable logistic regression models. We conducted mediation analyses to evaluate which of these factors might mediate disparities in self-efficacy by race/ethnicity and income. RESULTS: 69.8% of adults reported having high asthma self-efficacy. Latinos (OR 0.66; 95% CI 0.51–0.86), African-Americans (OR 0.50; 95% CI 0.29–0.83), American Indian/Alaskan Natives (OR 0.55; 95% CI 0.31–0.98), and Asian/Pacific Islanders (OR 0.34; 95% CI 0.23–0.52) were less likely to report high self-efficacy compared to Whites. Individuals with income below the federal poverty level (OR 0.56; 95% CI 0.40-0.78) were less likely to report high self-efficacy compared to higher income individuals. The relationship between income and self-efficacy was no longer significant after further adjustment for health care factors; however, the differences in race and ethnicity persisted. Receiving an asthma management plan mediated the relationship in certain subgroups. CONCLUSIONS: Addressing modifiable health care factors may play an important role in reducing disparities in asthma self-efficacy

PIONEER IN BEHAVIORAL PHARMACOLOGY: A TRIBUTE TO JOSEPH V. BRADY

The contributions of Joseph V. Brady to behavioral pharmacology span more than 50 years and range from early studies using the Estes-Skinner (conditioned emotional response) procedure to examine drug effects and various physiological processes in experimental animals to the implementation of mobile methadone treatment services and to small group behavioral analyses in simulated space environments. This expansive range of activities is based on Brady's insight and innovative use of behavioral procedures, his spirited and unabashed enthusiasm for the discipline and its philosophical underpinnings, together with a collegiality and commitment to the experimental analysis of behavior that is both legendary and inspirational. These contributions are summarized and highlighted in this tribute that focuses primarily on Brady's contributions to behavioral pharmacology but which also acknowledges his conceptual and technical contributions spanning multiple disciplines

Antihypertensive Medication Nonadherence in Black Men: Direct and Mediating Effects of Depressive Symptoms, Psychosocial Stressors, and Substance Use

Black men suffer disproportionately from hypertension (HTN). Antihypertensive medication non-adherence is a major contributor to poor blood pressure control, yet few studies consider how psychosocial functioning may impact Black men’s medication adherence. We examined direct and mediating pathways between depressive symptoms, psychosocial stressors, and substance use on antihypertensive medication non-adherence in 196 Black men enrolled in a clinical trial to improve HTN care and control. We found that greater depressive symptoms was associated with more medication non-adherence (β= 0.05, SE 0.01; p<.001). None of the psychosocial stressor variables were associated with antihypertensive medication non-adherence. Alcohol misuse was associated with more medication non-adherence (β=0.81, SE 0.26; p<.01), but it did not mediate the association between depressive symptoms and medication non-adherence. Clinicians should consider screening for depressive symptoms and alcohol misuse if patients are found to be non-adherent and should treat or refer patients to appropriate resources to address those issues