Interview Of Dr. Ken Warner, Dean Of The School Of Public Health

Articlehttp://deepblue.lib.umich.edu/bitstream/2027.42/96995/1/UMURJ-Issue07_2010-AProgovac.pd

The relationship between psychological attitudes, health behaviors, and health care utilization in older women

Understanding the role of psychological attitudes in health behaviors and health care utilization has important implications for improving health and reducing health care costs. This is particularly important among the elderly, who require more and costlier health services. This dissertation explores the relationship between optimism (positive future expectation) and cynical hostility (mistrust of others) on smoking cessation, physical activity, and preventive service use in post-menopausal women. Chapter one assesses the relationship between optimism and cynical hostility on smoking cessation. Women with higher cynical hostility were less likely to quit smoking over time. Smoking cessation programs may consider incorporating attitudes measures to better target smokers who are less likely to quit on their own. Chapter two focuses on understanding the role of optimism and cynical hostility in use of screening mammograms and lipid screenings and in particular how these attitudes mediate or moderate the established relationships with race/ethnicity, and socioeconomic status. Optimism predicts screening mammograms for some, but not all, racial/ethnic groups even when adjusting for various demographic, social, and health factors. Incorporating psychological factors such as optimism scores into health risk modeling may prove useful especially among specific racial and ethnic minority groups. Chapter three investigates the link between optimism and cynical hostility on strenuous physical activity. Women with higher optimism report higher levels of strenuous physical activity across the lifespan. Modeling reveals that much of this relationship is explained by other variables such as demographics and health status. Higher cynical hostility is associated with increased post-menopausal strenuous physical activity only in fully corrected models. This attitude may therefore play a particularly important role in activity levels depending on the presence or absence of barriers to physical activity. The public health relevance of this dissertation rests in identifying individuals at higher risk of developing illness burden due to health behaviors such as smoking and physical activity and potential under-use of preventive health services. Understanding how attitudes influence these behaviors may pave the way for physicians and health systems to employ novel approaches to improve health-related quality of life and ultimately reduce costs by reducing disease burden

The genetic link between depression and cardiovascular disease

Honors (Bachelor's)NeuroscienceUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/79447/1/anapro.pd

Optimism may moderate screening mammogram frequency in Medicare: A longitudinal study

Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women\u27s Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for \u3e /=2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p \u3c .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p \u3c .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment

Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences

As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino (n = 4), non-Hispanic/Latino Black (n = 8), or non-Hispanic/Latino White (n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient–provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes

Barriers And Facilitators To Community-Based Participatory Mental Health Care Research For Racial And Ethnic Minorities

People with serious mental illnesses, particularly members of racial and ethnic minority groups, are rarely included in prioritizing research topics or developing the tools and measures important for improving their care. Community-based participatory research holds promise toward reducing mental health disparities. However, initiating research partnerships with community stakeholders is challenging and does not always lead to sustainable community health improvements. Using lessons learned from a project to improve understanding of patients\u27 preferences and discrimination in depression and diabetes treatment, we describe barriers and facilitators to initiating a meaningful partnership with disenfranchised groups. Barriers fell within four domains: trepidation of community stakeholders, complex research methods, uncertainty among academic partners, and unclear partnership decision-making protocols. Primary facilitators included the meaningfulness of the research topic to the community, the presence of a well-established community-based organization, academic financial investment, co-learning activities, and flexibility. Successful initiation of these partnerships holds significant potential for addressing health care disparities

University of Michigan Undergraduate Research Journal presents: The Zine, Winter 2010

Articlehttp://deepblue.lib.umich.edu/bitstream/2027.42/97011/1/UMURJ-Zine_2010.pd

Barriers And Facilitators To Community-Based Participatory Mental Health Care Research For Racial And Ethnic Minorities

People with serious mental illnesses, particularly members of racial and ethnic minority groups, are rarely included in prioritizing research topics or developing the tools and measures important for improving their care. Community-based participatory research holds promise toward reducing mental health disparities. However, initiating research partnerships with community stakeholders is challenging and does not always lead to sustainable community health improvements. Using lessons learned from a project to improve understanding of patients\u27 preferences and discrimination in depression and diabetes treatment, we describe barriers and facilitators to initiating a meaningful partnership with disenfranchised groups. Barriers fell within four domains: trepidation of community stakeholders, complex research methods, uncertainty among academic partners, and unclear partnership decision-making protocols. Primary facilitators included the meaningfulness of the research topic to the community, the presence of a well-established community-based organization, academic financial investment, co-learning activities, and flexibility. Successful initiation of these partnerships holds significant potential for addressing health care disparities

Novel Use of Natural Language Processing (NLP) to Predict Suicidal Ideation and Psychiatric Symptoms in a Text-Based Mental Health Intervention in Madrid

Natural language processing (NLP) and machine learning were used to predict suicidal ideation and heightened psychiatric symptoms among adults recently discharged from psychiatric inpatient or emergency room settings in Madrid, Spain. Participants responded to structured mental and physical health instruments at multiple follow-up points. Outcome variables of interest were suicidal ideation and psychiatric symptoms (GHQ-12). Predictor variables included structured items (e.g., relating to sleep and well-being) and responses to one unstructured question, “how do you feel today?” We compared NLP-based models using the unstructured question with logistic regression prediction models using structured data. The PPV, sensitivity, and specificity for NLP-based models of suicidal ideation were 0.61, 0.56, and 0.57, respectively, compared to 0.73, 0.76, and 0.62 of structured data-based models. The PPV, sensitivity, and specificity for NLP-based models of heightened psychiatric symptoms (GHQ-12 ≥ 4) were 0.56, 0.59, and 0.60, respectively, compared to 0.79, 0.79, and 0.85 in structured models. NLP-based models were able to generate relatively high predictive values based solely on responses to a simple general mood question. These models have promise for rapidly identifying persons at risk of suicide or psychological distress and could provide a low-cost screening alternative in settings where lengthy structured item surveys are not feasible