Improving Secondary Stroke Prevention Among Underserved African Americans: Moving Beyond Health Attitudes

Obesity, a known risk factors for stroke, poses a great health risk for the African American community. Beliefs about health locus of control (HLOC) are predictive of many health behaviors related to both obesity and stroke prevention. Some have recommended targeting health interventions to individuals with internal HLOC, as they tend to be more amenable to changing health behaviors, but this can be exclusionary to African Americans, who tend to have higher levels of external locus of control. The present study is a pretest-posttest randomized control design examining the impact of a brief, CBT-based health management intervention developed for overweight and obese African American inpatients with primarily external HLOC recovering from TIA or ischemic stroke. Intervention participants with a predominately external HLOC demonstrated improvements in minutes per week spent exercising (M=73.87/ SD+ 29.23), daily servings of fruit (M=0.63/ SD+ 0.25) and daily servings of vegetable consumption (M=1.92/SD+ 0.93) at the four-week follow-up assessment. Significant improvements in tobacco cessation (t(19)=3.09, p\u3e.01) and medication adherence (t(19)=2.63, p\u3e.05) were also evidenced. The importance of designing a health intervention sensitive to the HLOC orientation of the population is highlighted and access to health resources is discussed as a possible mediator of the impact of HLOC on obesity-related health behavior

Self-care self-efficacy, religious participation and depression as predictors of poststroke self-care among underserved ethnic minorities

Underserved ethnic minorities have multiple chronic disease risk factors, including tobacco, alcohol and substance use, which contribute to increased incidence of stroke. Self-efficacy (self-care self-efficacy), religious participation and depression may directly and indirectly influence engagement in post stroke self-care behaviors. The primary aim of the present study was to investigate the effects of self-care self-efficacy, religious participation and depression, on tobacco, alcohol and substance use in a sample of largely ethnic minority, underserved stroke survivors (n=52). Participants previously recruited for a culturally tailored secondary stroke prevention self-care intervention were included. The treatment group received three stroke self-care sessions. The usual care group completed assessments only. Both groups were included in these analyses. Main outcome measures included tobacco, alcohol and substance use. Self-care self-efficacy, religious participation and depression were also assessed. Logistic regression analyses, using self-efficacy, religious practice and depression as the referents, were used to predict binary outcomes of tobacco, alcohol and substance use at 4-weeks post-stroke. Higher depression and self-care self-efficacy were associated with reduced odds of smoking and substance use. Greater participation in religious activities was associated with lower odds of alcohol use. We can conclude that incorporating depression treatment and techniques to increase self-care self-efficacy, and encouraging religious participation may help to improve stroke self-care behaviors for underserved and low socioeconomic status individuals. Results are discussed in the context of stroke self-management

Ill Effects of Smoking: Baseline Knowledge among School Children and Implementation of the “AntE Tobacco” Project

Introduction. Cigarette smoking contributes to the deaths of more than 400,000 Americans annually. Each day >3,000 children and adolescents become regular smokers. This paper details a new antitobacco educational program titled “AntE Tobacco” Method. Children in grades 1–3 were administered a 10-item questionnaire to ascertain their baseline knowledge about the ill effects of smoking, shown an educational cartoon video depicting the ill effects of tobacco, and given a story book based on the video. At the end of video, children were administered a questionnaire to determine short-term recall of the antitobacco educational objectives of the program. Four to 6 weeks later, the children were then administered a follow-up survey to determine long-term retention of the anti tobacco educational program. Result. Eighty two percent of the children answered the outcome questions correctly immediately following the video. At follow-up, 4–6 weeks later, 83% of children answered all questions correctly. Conclusion. The anti tobacco education program used in this study effectively conveyed most of the educational objectives. The results of this study indicate that a multimedia (i.e., video and book) educational program can be used to educate and reinforce anti tobacco messages. This program may be very useful as a part of a comprehensive anti tobacco curriculum in school systems

State of the art conference on weight management in VA: Policy and research recommendations for advancing behavioral interventions

This article summarizes outcomes of the behavioral interventions work group for the Veterans Health Administration (VHA) State of the Art Conference (SOTA) for Weight Management. Sixteen VHA and non-VHA subject matter experts, representing clinical care delivery, research, and policy arenas, participated. The work group reviewed current evidence of efficacy, effectiveness, and implementation of behavioral interventions for weight management, participated in phone- and online-based consensus processes, generated key questions to address gaps, and attended an in-person conference in March 2016. The work group agreed that there is strong evidence for efficacy and effectiveness of core behavioral intervention components and processes, but insufficient evidence to determine the comparative effectiveness of multiple clinician delivered weight management modalities, as well as technologies that may or may not supplement clinician delivered treatments. Effective strategies for implementation of weight management services in VHA were identified. The SOTA work group’s foremost policy recommendations are to establish a system-wide culture for weight management and to identify a population-level health metric to measure the impact of weight management interventions that can be tracked and clearly communicated throughout VHA. The work group’s top research recommendation is to determine how to deploy and scale the most effective behavioral weight management interventions for Veterans