Development of measures for assessing asthma management behavior in adults.

Recent increases in asthma morbidity and mortality have led to considerable interest in combining medical and behavioral treatment approaches. There were two goals for this study. The first goal was to develop a questionnaire which measures patient behavior related to asthma management in adults. The questionnaire intended to improve upon previous work in the following ways: (1) to more fully address measurement of social skills needed in asthma management; (2) to include elements of self-regulation theory; and (3) to account for the patient's perspective regarding effective management behaviors. The second goal was to administer the survey to adults with asthma to assess: (1) reliability and validity of the measures; (2) differences in management behavior and health status by demographic factors; and (3) relationships between components of a self-regulation theoretical model and aspects of management using corresponding survey measures. There were two phases to the study corresponding to the goals stated above. First, collection of qualitative data using focus groups to identify important management issues, to better understand the patient's perspective, and to assist in questionnaire design. Second, a survey of 149 adults with asthma using the self administered questionnaire. The questionnaire developed in this study proved to be quite promising in terms of its reliability and validity. Nine scales had a Cronbach alpha level at or above.70, and three were above.80 on this measure of internal reliability. A high level of self-regulation was positively associated with use of behavioral strategies to manage asthma. Use of management strategies was higher in respondents with more symptoms and in those hospitalized for asthma in the past year. Generalization of results is limited in that subjects were generally well educated, mostly white, female, and patients of university based clinics staffed by specialist physicians. The cross-sectional nature of the survey also limited the testing of relationships between theoretical constructs. The value and validity of the measures of asthma management should be further assessed in interventions designed to change management behaviors to assess their sensitivity to change. In addition, the generalizability of the measures should be tested in populations of different socioeconomic backgrounds.Ph.D.Health and Environmental SciencesPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/130786/2/9811149.pd

Weight Control Behaviors of Low-Income, African American Women

Obesity is extremely common among African American women, and many women express interest in losing weight. To better understand current weight management practices in this population, this study measured behaviors and attitudes believed important to successful weight management. Data were obtained via telephone survey. The study involved 155 low-income African American women aged 30 to 69 identified through an urban primary care clinic. Results were compared between those women currently trying to lose weight (n = 80) and those who were not (n = 75). Those women trying to lose weight were more likely to engage in goal setting and dieting strategies categorized as planning and preparation, communication about diet, and cognitive strategies. Among those currently trying to lose weight, considerable room for improvement in the degree to which the women used the various strategies remained. Public health communications and health care provider interactions may need to deliver a broader, stronger message about healthy and successful weight management for this population

The Relationship between Political, Economic, Social, and Cultural Vulnerability and Food Insecurity among Adults Aged 50 Years and Older

Individuals experience food insecurity when they worry about or have limited access to nutritious foods. Food insecurity negatively impacts older adults’ health. Social exclusion is a theoretical framework describing how unequal access to rights, resources, and capabilities results in political, economic, social, and cultural vulnerability, which leads to health disparities. We used the Health and Retirement Study to cross-sectionally examine associations between vulnerability and experiencing food insecurity in adults 50 years and older using the social exclusion framework. We tested the association between experiencing food insecurity and indicators of political, economic, social, and cultural vulnerability using logistic regression controlling for demographic and health-related factors. Analyses were performed with all respondents and sub-group of respondents with incomes less than 400% of the federal poverty level (FPL). Assets (OR = 0.97 in both samples), income (OR = 0.85, 0.80 in 400% FPL sub-sample), perceived positive social support from other family (OR = 0.86, 0.84 in 400% FPL sub-sample), and perceived everyday discrimination (OR = 1.68, 1.82 in 400% FPL sub-sample) were significantly associated with food insecurity. Perceived positive social support from spouses, children, or friends and U.S. citizenship status were not significantly associated with food insecurity. Further research is needed to define and measure each dimension of vulnerability in the social exclusion framework. Interventions and policies designed to prevent food insecurity should address these vulnerabilities

Evaluating Policy, Systems, and Environmental Change Interventions: Lessons Learned From CDC's Prevention Research Centers.

IntroductionThe field of public health is increasingly implementing initiatives intended to make policies, systems, and environments (PSEs) more supportive of healthy behaviors, even though the evidence for many of these strategies is only emerging. Our objective was 3-fold: 1) to describe evaluations of PSE-change programs in which the evaluators followed the steps of the Centers for Disease Control and Prevention's (CDC's) Framework for Program Evaluation in Public Health, 2) to share the resulting lessons learned, and 3) to assist future evaluators of PSE-change programs with their evaluation design decisions.MethodsSeven Prevention Research Centers (PRCs) applied CDC's framework to evaluate their own PSE-change initiatives. The PRCs followed each step of the framework: 1) engage stakeholders, 2) describe program, 3) focus evaluation design, 4) gather credible evidence, 5) justify conclusions, and 6) ensure use and share lessons learned.ResultsEvaluation stakeholders represented a range of sectors, including public health departments, partner organizations, and community members. Public health departments were the primary stakeholders for 4 of the 7 evaluations. Four PRCs used logic models to describe the initiatives being evaluated. Their evaluations typically included both process and outcome questions and used mixed methods. Evaluation findings most commonly focused on contextual factors influencing change (process) and the adoption or implementation of PSE-change strategies (outcome). Evaluators shared lessons learned through various channels to reach local stakeholders and broader public health audiences.ConclusionFramework for Program Evaluation in Public Health is applicable to evaluations of PSE-change initiatives. Using this framework to guide such evaluations builds practice-based evidence for strategies that are increasingly being used to promote healthful behaviors

Evaluating Policy, Systems, and Environmental Change Interventions: Lessons Learned From CDC's Prevention Research Centers.

IntroductionThe field of public health is increasingly implementing initiatives intended to make policies, systems, and environments (PSEs) more supportive of healthy behaviors, even though the evidence for many of these strategies is only emerging. Our objective was 3-fold: 1) to describe evaluations of PSE-change programs in which the evaluators followed the steps of the Centers for Disease Control and Prevention's (CDC's) Framework for Program Evaluation in Public Health, 2) to share the resulting lessons learned, and 3) to assist future evaluators of PSE-change programs with their evaluation design decisions.MethodsSeven Prevention Research Centers (PRCs) applied CDC's framework to evaluate their own PSE-change initiatives. The PRCs followed each step of the framework: 1) engage stakeholders, 2) describe program, 3) focus evaluation design, 4) gather credible evidence, 5) justify conclusions, and 6) ensure use and share lessons learned.ResultsEvaluation stakeholders represented a range of sectors, including public health departments, partner organizations, and community members. Public health departments were the primary stakeholders for 4 of the 7 evaluations. Four PRCs used logic models to describe the initiatives being evaluated. Their evaluations typically included both process and outcome questions and used mixed methods. Evaluation findings most commonly focused on contextual factors influencing change (process) and the adoption or implementation of PSE-change strategies (outcome). Evaluators shared lessons learned through various channels to reach local stakeholders and broader public health audiences.ConclusionFramework for Program Evaluation in Public Health is applicable to evaluations of PSE-change initiatives. Using this framework to guide such evaluations builds practice-based evidence for strategies that are increasingly being used to promote healthful behaviors