Browsing by Author "Lee, Hee Yun"
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Item American Indian women cancer survivors' perceptions and experiences with conventional and non-conventional mental health care for depressive symptoms(Routledge, 2021) Burnette, Catherine E.; Liddell, Jessica; Roh, Soonhee; Lee, Yeon-Shim; Lee, Hee Yun; Tulane University; University of South Dakota; San Francisco State University; University of Alabama TuscaloosaBackground: Despite cancer and depression being disproportionately high for American Indian and Alaska Native (AI/AN) women, such cancer survivors' help-seeking practices and perceptions related to depression are absent in extant research. A broader context of historical oppression has set the stage for unequal health outcomes and access to quality services. The purpose of this article was to explore AI women cancer survivors' experiences with conventional mental health services and informal and tribally-based assistance, as well as barriers related to mental health service utilization. Methods: A qualitative descriptive study methodology, with qualitative content analysis, was used to examine the experiences of AI women cancer survivors as they related to help-seeking experiences for depressive symptoms. The sample included 43 AI women cancer survivors (n = 14 breast cancer, n = 14 cervical cancer, and n = 15 colon and other types of cancer survivors). Results: Since receiving a cancer diagnosis, 26 (62%) participants indicated they had feelings of depression. Some participants (n = 13) described mixed perceptions of the mental health service system. Generally, participants viewed families and informal support systems as primary forms of assistance, whereas conventional services were reported as a supplementary or 'as needed' forms of support, particularly when the informal support system was lacking. Participants received help in the forms of psychotropic medications and psychotherapy, as well as help from family and AI-specific healing modalities (e.g. sweat lodges and healing ceremonies). Stigma and confidentiality concerns were primary barriers to utilizing conventional services as described by 12 (29%) participants. Discussion: Participants' help primarily came from family and tribally-based entities, with conventional mental health care being more salient when informal supports were lacking. The mixed perceptions espoused by participants may be related to a broader context of historical oppression; family and social support and tribally-based services may be protective factors for cancer survivors with depression.Item Analyzing factors associated with decisional stage of adopting breast cancer screening among Korean American women using precaution adoption process model(Routledge, 2021) Jin, Seok Won; Lee, Jongwook; Lee, Hee Yun; University of Memphis; University of Minnesota Twin Cities; University of Alabama TuscaloosaBackground: Korean American (KA) women have experienced higher prevalence and lower survival rates of breast cancer (BC) than other ethnic groups in the United States. However, BC screening rates for KA women remain significantly lower than the national target (81.1%) specified by Healthy People 2020. Few studies have explained how the decision to adopt BC screening occurs and progresses and what factors contribute to this decision among KA women. This study used Weinstein's Precaution Adoption Process Model (PAPM) as a theoretical framework to examine characteristics and factors associated with the decisional stage of mammography adoption. Methods: A cross-sectional self-report survey was administered among KA women (N = 308) ages 50-80 from the Atlanta metropolitan area. A total of 281 KA women completed the survey, answering questions about socio-demographics, health-related information, mammography history, doctor recommendation, BC screening knowledge, self-efficacy for BC screening, decisional balance scores on attitudes and beliefs pertaining to mammography, and the seven-stage PAPM. Results: KA women reported a low rate of mammography uptake with about 24% and 35% of the participants undergoing mammography within the last year and two years, respectively. KA women in stages 5 (decided yes), 6 (action), and 7 (maintenance) were likely to have increased screening-related knowledge, positive decisional balance, and regular medical check-up compared to those in stages 1 (unaware), 2 (unengaged), and 3 (deciding). Conclusion: This study highlights important factors that could potentially facilitate BC screening among KA women in Georgia. The findings also provide implications for interventions and practice for increasing mammography screening among medically underserved populations.Item Analyzing factors enabling colorectal cancer screening adherence in Korean Americans using the Andersen's Behavioral Model of Health Services Utilization(Routledge, 2019) Jin, Seok Won; Lee, Hee Yun; Lee, Jongwook; University of Memphis; University of Alabama Tuscaloosa; University of Minnesota Twin CitiesPurpose/objectives: Korean Americans (KAs) report suboptimal colorectal cancer (CRC) screening adherence. This study investigated factors that enable KAs to adhere to CRC screening guidelines using the Andersen's Behavioral Model of Health Services Utilization. Design: Cross-sectional survey using self-reported measures of CRC screening behaviors. Sample and methods: Purposive sampling was used to recruit 433 KAs aged 50-75 from the Atlanta metropolitan area who completed questionnaires measuring predisposing (i.e., gender, age, marital status, and educational attainment), enabling (income, health insurance, regular annual health checkups, doctor's recommendation English proficiency, CRC knowledge, self-efficacy for CRC screening, and decisional balance in CRC screening), and need (family cancer history and self-reported health status) factors associated with CRC screening. Findings: A multiple logistic regression model including all 14 predictor variables revealed that several enabling factors (i.e., income, regular annual health checkups, doctor's recommendation, self-efficacy, and decisional balance) independently predicted increased CRC screening adherence in KAs. No predisposing or need factors independently predicted CRC screening.Item ANALYZING FACTORS OF BREAST CANCER SCREENING ADHERENCE AMONG KOREAN AMERICAN WOMEN USING ANDERSEN'S BEHAVIORAL MODEL OF HEALTHCARE SERVICES UTILIZATION(Ethnicity & Disease, 2019) Jin, Seok Won; Lee, Hee Yun; Lee, Jongwook; University of Memphis; University of Alabama Tuscaloosa; University of Minnesota Twin CitiesObjectives: Regular uptake of mammography screening reduces the risk of advanced stage diagnosis of breast cancer (BC). However, BC screening rates remain suboptimal among Korean American (KA) women. Using the Andersen's Behavioral Model of Healthcare Services Utilization, this study examined factors associated with mammography screening among KA women aged 50 to 80 years in the state of Georgia, USA. Methods: We used purposive sampling to recruit study participants in the Atlanta metropolitan area from May 2015 to February 2016. A total of 303 KA women completed a cross-sectional, self-report survey about their sociodemographics, health care access information, knowledge, self-efficacy, decisional balance, and mammography history. Results: Descriptive analyses confirmed low rates of mammography screening in the participants. Multiple logistic regression analyses showed that having a mammogram within the past year was associated with greater BC knowledge, higher scores of decisional balance and fewer annual health check-ups among KA women without any cancer history. Conclusions: The findings offer implications for health policy aimed at increasing BC screening by leveraging enabling factors among medically underserved KA women at both structural and cultural levels.Item Breast cancer literacy and health beliefs related to breast cancer screening among American Indian women(Routledge, 2018) Roh, Soonhee; Burnette, Catherine E.; Lee, Yeon-Shim; Jun, Jung Sim; Lee, Hee Yun; Lee, Kyoung Hag; University of South Dakota; Tulane University; San Francisco State University; Wichita State University; University of Alabama TuscaloosaThe purpose of this article is to examine the health beliefs and literacy about breast cancer and their relationship with breast cancer screening among American Indian (AI) women. Using the Health Belief Model (HBM) and hierarchical logistic regression with data from a sample of 286 AI female adults residing in the Northern Plains, we found that greater awareness of breast cancer screening was linked to breast cancer screening practices. However, perceived barriers, one of the HBM constructs, prevented such screening practices. This study suggested that culturally relevant HBM factors should be targeted when developing culturally sensitive breast cancer prevention efforts.Item Comprehensive Senior Technology Acceptance Model of Daily Living Assistive Technology for Older Adults With Frailty: Cross-sectional Study(JMIR Publications, 2023) Shin, Hye Ri; Um, Sa Rang; Yoon, Hee Jeong; Choi, Eun Young; Shin, Won Chul; Lee, Hee Yun; Kim, Young Sun; Kyung Hee University; New York University; Kyung Hee University Hospital; University of Alabama TuscaloosaBackground: There are considerable gaps between the need for assistive technologies and the actual adoption of these technologies among older adults, although older adults are among the groups that most need assistive technologies. Consequently, research is needed in this area because older adults' technology acceptance and influencing factors may differ depending on their level of frailty. Objective: The objective of this study was to compare frail, prefrail, and robust groups of South Korean adults regarding their behavioral intention to use daily living assistive technologies and the affecting factors-namely, technological context factors, health contexts and abilities, and attitudinal factors-based on a comprehensive senior technology acceptance model.Methods: A nationwide sample of 500 older South Korean adults (aged 55-92 years) was analyzed, and multivariate linear regression analyses of the robust, prefrail, and frail groups were performed. The independent and dependent variables consisted of 3 factors based on previous studies. First, technological context factors consisted of gerontechnology self-efficacy, gerontechnology anxiety, and facilitating conditions. Second, health contexts and abilities consisted of self-reported health conditions, cognitive ability, social relationships, psychological function, and physical function. Third and last, attitudinal factors consisted of behavioral intention to use assistive technologies, attitude toward use, perceived usefulness (PU), and perceived ease of use (PEOU).Results: The results of the analyses showed that technological context factors such as gerontechnology self-efficacy, health contexts and abilities such as self-reported health conditions and psychological function, and attitudinal factors such as attitude toward use, PU, and PEOU had significant effects on behavioral intention to use daily living assistive technologies. In particular, gerontechnology self-efficacy had a significant relationship with behavioral intention to use these technologies in the robust (r=0.120; P=.03) and prefrail (r=0.331; P<.001) groups. Psychological function (life satisfaction) had a significant relationship with behavioral intention to use these technologies in the robust group (r=-0.040; P=.02). Self-reported health conditions had a significant relationship with behavioral intention to use these technologies in the prefrail group (r=-0.169; P=.01). Although each group had a different significant relationship with the variables, attitudinal factors such as attitude toward use affected all groups (robust group: r=0.190; P=.03; prefrail group: r=0.235; P=.006; and frail group: r=0.526; P=.002). In addition, PU and PEOU in the attitudinal factors had a significant relationship with behavioral intention to use assistive technologies in the robust (PU: r=0.160; P=.01; and PEOU: r=0.350; P<.001) and prefrail (PU: r=0.265; P<.001; and PEOU: r=0.120; P=.04) groups.Conclusions: This study found that the comprehensive senior technology acceptance model of daily living assistive technologies had different associations according to the frailty group. These findings provided insights into the consideration of interventions with daily living assistive technologies for older adults with varying levels of frailty.Item Development and Evaluation of Culturally and Linguistically Tailored Mobile App to Promote Breast Cancer Screening(MDPI, 2018) Lee, Hee Yun; Lee, Mi Hwa; Gao, Zan; Sadak, Karim; University of Alabama Tuscaloosa; University of North Carolina; East Carolina University; University of Minnesota Twin CitiesBackground: While a significant breast cancer burden exists for Korean American immigrant women, their cancer screening behavior is strikingly poor, and few interventions have focused on this population. To promote breast cancer screening behavior in Korean American immigrant women, a mobile phone multimedia messaging intervention (mMammogram) was developed. Objective: The current study explores the impact of mMammogram on changes to study participants' screening behavior and proposes suggestions for how the intervention can be improved for wide dissemination and implementation in the Korean American community. Material and Methods: Data were collected through qualitative research methods. Three focus groups were conducted with 14 Korean immigrant women who completed the mMammogram. Findings: Three themes emerged: (1) better understanding of breast cancer and screening through mMammogram (e.g., increased knowledge on breast cancer and screening methods, increased understanding of the importance of regular mammography, and reduced anxiety about mammography); (2) health navigators as a trigger to promote mammography (e.g., providing resources for free or low-cost mammograms and scheduling mammogram appointments); and (3) suggestions for mMammogram (e.g., technical issues and program period). Conclusions: Mobile app intervention that is culturally tailored, along with health navigation services, can be a feasible, effective, and acceptable tool to promote breast cancer screening behaviors in underserved immigrant women. A mobile app can cover a broad range of breast cancer health topics and the health navigator can further help women overcome barriers to screening. A health navigation service is critical in overcoming language, transportation, and health accessibility barriers and triggering a positive change in their health screening behavior, especially for newly arrived immigrant populations.Item Development of a Mobile Health Intervention to Promote Papanicolaou Tests and Human Papillomavirus Vaccination in an Underserved Immigrant Population: A Culturally Targeted and Individually Tailored Text Messaging Approach(JMIR Publications, 2019) Lee, Hee Yun; Lee, Mi Hwa; Sharratt, Monica; Lee, Sohye; Blaes, Anne; University of Alabama Tuscaloosa; University of North Carolina; East Carolina University; University of Minnesota Twin Cities; University of MemphisBackground: Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. Objective: The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. Methods: Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke's thematic analysis was used to identify core themes. Results: Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). Conclusions: This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population's perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups.Item Does health literacy affect the uptake of annual physical check-ups?: Results from the 2017 US health information national trends survey(BMC, 2021) Lee, Hee Yun; Kim, Sooyoung; Neese, Jessica; Lee, Mi Hwa; University of Alabama Tuscaloosa; Catholic University Pusan; University of North Carolina; East Carolina UniversityBackground Little is known about how health literacy is linked to physical check-ups. This study aimed to examine the levels of physical check-ups (self-reported check-ups within the last year) by age group (those aged 18-59 years and those aged = >= 60 years) and the role of health literacy regarding physical check-ups in the United States. Methods Data for the study were obtained from the 2017 Health Information National Trends Survey. The original sample included 3,285 respondents, but only 3,146 surveys were used for this study. Andersen's Behavioral Model of Health Services Use guided this study, and a binomial logistic regression model was conducted using Stata 12.0 software package. Results While 82.0 % of the older group had an annual check-up, 67.3 % of the younger group had one. Both groups had similar ratios for health literacy-related item reporting. Study results show that annual check-up was positively associated with confidence in getting health information, having health insurance, and having a primary doctor for both age groups. However, getting a regular check-up was negatively associated with frustration while searching for information among the younger group. In comparison, it was positively associated with difficulty understanding information for the older group. Conclusions To increase annual physical check-ups, health literacy-related interventions should be developed and address the barriers most associated with health check-ups. One way of addressing this barrier is to improve communication from healthcare professionals to consumers through the use of easy-to-understand explanations appropriate for the consumer.Item Does Perceived Ageism Widen the Digital Divide? And Does It Vary by Gender?(Oxford University Press, 2020) Choi, Eun Young; Kim, Youngsun; Chipalo, Edson; Lee, Hee Yun; University of Southern California; Kyung Hee University; University of Alabama TuscaloosaBackground and Objectives: Existing literature presents a widening digital divide among older adults in addition to the consideration of the potential adverse impacts of ageism on internet use among the older adult population. Our study aimed to investigate (a) whether older adults' perceived ageism will be associated with their use of the internet and (b) whether the relationship between perceived ageism and internet use will be moderated by age groups and binary gender. Research Design and Methods: Using the data from the 2016 Health and Retirement Study, regression analyses were separately performed by gender. Two measures of perceived ageism were considered: (a) self-perception of aging and (b) perceived age discrimination. Results: Our findings suggested that greater exposure to ageism is generally related to less use of the internet. In addition, we found divergent patterns in the relationship between ageism and internet use by gender. For women, a lower level of internet use was predicted by more negative perceptions of aging, whereas men's internet use was associated with the experience of age discrimination. Furthermore, interaction effects between age groups and ageism varied across gender. The negative perception of aging was more strongly associated with less internet use in older women than middle-aged women. In comparison, the perceived age discrimination predicted less internet use in middle-aged men than older men. Discussion and Implications: Our findings suggest that perceived ageism is significantly associated with internet use, and its association differs by gender.Item Effectiveness of Combined Smartwatch and Social Media Intervention on Breast Cancer Survivor Health Outcomes: A 10-Week Pilot Randomized Trial(MDPI, 2018) Pope, Zachary C.; Zeng, Nan; Zhang, Rui; Lee, Hee Yun; Gao, Zan; University of Minnesota Twin Cities; University of Alabama TuscaloosaPhysical activity (PA) among breast cancer survivors (BCS) can improve this population's health and quality of life (QoL). This study evaluated the effectiveness of a combined smartwatchand social media-based health education intervention on BCS's health outcomes. Thirty BCS (X-age = 52.6 +/- 9.3 years; (X) over bar (Wt) = 80.2 +/- 19.6 kg) participated in this 10-week, 2-arm randomized trial, with BCS randomized into: (1) experimental group (n = 16): received Polar M400 smartwatches for daily PA tracking and joined a Facebook group wherein Social Cognitive Theory-related PA tips were provided twice weekly; and (2) comparison group (n = 14): only joined separate, but content-identical Facebook group. Outcomes included PA, physiological, psychosocial, and QoL variables. Specifically, PA and energy expenditure (EE) was assessed by ActiGraph GT3X+ accelerometers while physiological, psychosocial, and QoL were examined via validated instruments at baseline and post-intervention. No baseline group differences were observed for any variable. Ten BCS dropped out of the study (experimental: 4; comparison: 6). Compared to completers, dropouts differed significantly on several outcomes. Thus, a per-protocol analysis was performed, revealing significant group differences for changes in social support (t = -2.1, p = 0.05) and barriers (t = -2.2, p = 0.04). Interestingly, the comparison group demonstrated improvements for both variables while the intervention group demonstrated slightly decreased social support and no change in barriers. Notably, both groups demonstrated similarly increased daily light PA, moderate-to-vigorous PA, EE, and steps of 7.7 min, 5.1 min, 25.1 kcals, and 339 steps, respectively, over time. Despite extensive user training, several experimental BCS found the Polar M400 use difficult-possibly decreasing intervention adherence. Future interventions should utilize simpler smartwatches to promote PA among middle-aged clinical/non-clinical populations.Item Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study(JMIR Publications, 2023) Lee, Hee Yun; Xiong, Serena; Sur, Aparajita; Khang, Tounhia; Vue, Bai; Culhane-Pera, Kathleen A.; Pergament, Shannon; Torres, M. Beatriz; Koopmeiners, Joseph S.; Desai, Jay; University of Alabama Tuscaloosa; Washington University (WUSTL); University of Minnesota Twin Cities; Minnesota Department of Health (MHD)Background: Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans.Objective: We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations.Methods: Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website's effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability.Results: Participants' HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents' average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers' self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website's content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders.Conclusions: This theory-driven, community-based participatory action research-designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents' and adolescents' knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website's impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools).Item Existing Mobile Phone Apps for Self-Care Management of People With Alzheimer Disease and Related Dementias: Systematic Analysis(JMIR, 2020) Guo, Yuqi; Yang, Fan; Hu, Fei; Li, Wei; Ruggiano, Nicole; Lee, Hee Yun; University of North Carolina; University of North Carolina Charlotte; Dongbei University of Finance & Economics; University of Alabama Tuscaloosa; University of Alabama BirminghamBackground: Alzheimer disease and related dementias (AD/RD) are progressive neurocognitive disorders that currently affect approximately 50 million people worldwide. Mobile phone apps have been well-integrated into daily lives and can be used to deliver and promote health care. There is an increase in the use of technology to provide care and support to AD/RD patients and their families. Objective: This study aimed to review apps designed for AD/RD patients and analyze the benefits of, and challenges to, such technological solutions. Methods: A systematic approach was applied to review the availability, content, features, and quality of mobile phone apps to support self-care among AD/RD patients. Results: The initial search for this review was conducted in January 2019, and the screening and analysis of the included apps were completed in May 2019. A total of 14 apps were included from an initial search of 245 apps. The top 3 features were alert (9/14, 64%), self-care tips (6/14, 42%), and social networking capacity (5/14, 35%). On average, the readability of the apps was a tenth-grade reading level (SD 3.06). The overall quality was 3.71 out of 5 (SD 1.37). Conclusions: Our findings suggest that currently available apps for AD/RD patients may not meet complex needs and may be challenging to use, given the possible impaired communication ability associated with AD/RD. Therefore, high-quality apps need to be developed and rigorously evaluated for feasibility and efficacy.Item Existing Mobile Phone Apps for Self-Care Management of People With Alzheimer Disease and Related Dementias: Systematic Analysis (May, 2020)(JMIR, 2020) Guo, Yuqi; Yang, Fan; Hu, Fei; Li, Wei; Ruggiano, Nicole; Lee, Hee Yun; University of North Carolina; University of North Carolina Charlotte; Dongbei University of Finance & Economics; University of Alabama Tuscaloosa; University of Alabama BirminghamItem Exploring determinants of community led total sanitation (clts) on latrine adoption among rural cambodians utilizing the diffusion of innovation theory: a pragmatic approach(University of Alabama Libraries, 2020-12) Hendrix, Sara; Ross, Levi; University of Alabama TuscaloosaOpen defecation is a global health problem in which 90% of the cases observed occur in rural settings among developing countries. Individuals exposed to open defecation may face higher risks of diarrheal diseases and health consequences. Basic sanitation facilities may mitigate adverse health effects associated with open defecation. In Cambodia, the lowest percentage of basic sanitation (48.3%) has been reached compared to neighboring countries. This dissertation research explored determinants of Community Led Total Sanitation on latrine construction and usage among rural Cambodians. This exploration was guided by diffusion of innovation theory. This multi-site study included a stratified sample of six community meetings (n=61) conducted across six villages in two districts of Pursat Province, Cambodia in August 2019. Small connected community methodology was employed to gather qualitative data and semi-structured community meetings were utilized to collect data. Thematic analysis and diffusion of innovation theory was used to analyze data derived from this study. Qualitative findings identified the following facilitators of latrine construction: relative advantage (overall health and well-being, convenience, and environmental awareness); complexity (perceived level of simplicity); compatibility (obligation to others); and observability (demonstrations, observable improved health of others). Latrine construction barriers included complexity (lack of resources) and compatibility (interferences to daily life). Facilitators of latrine construction included: relative advantage (overall health and well-being, convenience, economic advantages, and environmental impacts), complexity (ease of use); compatibility (obligation to others); and observability (demonstrations). The latrine uptake barrier was compatibility (misalignment with current practices). Compared to neighboring countries, basic sanitation within Cambodia continues to be a challenge. Rural Cambodians lack resources pertaining to knowledge (of how to build latrines) and cost (of materials). The development and implementation of health education and health promotion programs may effectively address the sanitation challenges in rural communities in low income and developing countries, while simultaneously enhancing the quality of life and well-being of communities.Item Factors associated with HPV vaccination initiation among United States college students(Taylor & Francis, 2021) McLendon, Lane; Puckett, Jesse; Green, Chelsea; James, Jenna; Head, Katharine J.; Lee, Hee Yun; Pierce, Jennifer Young; Beasley, Mark; Daniel, Casey L.; University of South Alabama; Indiana University-Purdue University Indianapolis; University of Alabama Tuscaloosa; University of Alabama BirminghamHuman papillomavirus (HPV) remains the most common sexually transmitted infection (STI) in the U.S. despite widespread availability of a safe, effective vaccine. Although young adults are at greatest risk of HPV infection, extensive vaccine promotion and intervention efforts has been directed toward 11-12-year-olds. College students represent an ideal audience for HPV vaccine "catch-up;" however, research indicates inconsistent HPV vaccination rates within this demographic. An online survey assessing HPV and HPV vaccine knowledge and behaviors was distributed to all undergraduate college students at a large, public university in the Deep South region of the U.S. The primary outcome was receipt of HPV vaccination (binary response options of Yes/No). Logistic regression analyses were performed to determine predictors of HPV vaccination. Of the 1,725 who completed the survey, 47.0% reported having received at least one dose of HPV vaccine; overall series completion (series = 3 doses for this population) was 17.4%. The primary outcome was HPV initiation among college students, defined as having received at least one dose of the HPV vaccine. Results indicated substantial gaps in participants' knowledge of their vaccination status. Provider and parental recommendations as well as social influences were shown to significantly impact student vaccination status, emphasizing the importance of incorporating these elements in future interventions, potentially as multi-level strategies. Future college interventions should address HPV and vaccination knowledge and the importance of provider and parental recommendations.Item Factors associated with receipt of mammogram among caregivers: a comparison with non-caregivers(BMC, 2020) Kim, Soo Young; Guo, Yuqi; Won, Chorong; Lee, Hee Yun; Catholic University Pusan; University of North Carolina; University of North Carolina Charlotte; University of Alabama TuscaloosaBackground caregiving responsibilities significantly impact females' decisions on adhering to preventive mammography. The purpose of this study is to examine (1) the levels of mammogram receipt, (2) the role of caregiving factors on the receipt of mammogram in caregiving group, and (3) the role of cancer beliefs on mammogram screening in caregivers and non-caregivers. Methods the 2017 Health Information National Trends Survey (HINTS) provides samples of 1228 women aged 40 to 75 years old for this secondary analysis. By using Andersen's Behavioral Model of Health Services Use, a binomial logistic regression model was used to analyze associations between mammography and socioeconomic factors, caregiving factors, and cancer belief factors. Results caregivers who provided more caregiving hours per week (OR = 0.749, 95% CI = 0.564-0.94) and caregivers who had the belief of rather not knowing the likelihood of getting cancer (OR = 0.673, 95% CI = 0.496-0.914) were less likely to use mammogram. However, caregivers who believed cancer is more common than heart disease (OR = 1.490, 95% CI = 1.302-2.151) were more likely to use a mammogram. Non-caregivers who worried about getting cancer (OR = 1.158, 95% CI = 0.793-1.691) were more likely to use mammogram, but non-caregivers who had the belief of rather not know the likelihood of getting cancer (OR = 0.825, 95% CI = 0.713-0.955) were less likely to use mammogram. Conclusions to support caregivers' breast cancer prevention, caregiving-related policies based on caregiving hours should be developed. Particularly, effort to promote breast cancer screening education and care support among older primary caregivers will likely increase their adherence to preventive mammography uptake. The development of targeted cancer prevention interventions on specific cancer beliefs held by both groups are also urgently needed to promote mammography.Item A Longitudinal Analysis of Disparities of Depression and Anxiety Among U.S. Older Adults with Chronic Conditions within Different Age Groups(University of Alabama Libraries, 2021) Hao, Zhichao; Ruggiano, Nicole; University of Alabama TuscaloosaSuffering chronic conditions greatly contribute to mental health problems like depression and anxiety among older adults. Although an array of literature has focused on this field of study, little research has examined how depression and anxiety change over time or differs from each age group from a developmental and comprehensive view. Purpose This study aims to understand the disparities of depression and anxiety of older adults with chronic conditions among different age groups. A longitudinal study will provide a holistic understanding of risk and protective factors associated with depression and anxiety to tailor and provide supportive services for older adults according to their changing needs. Methods This study applied the latest rounds (round 5 to round 9) of the National Health and Aging Trends Study (NHATS). In total, 3,541 older adults who were sample persons, had at least one chronic condition, and participated in all 5 rounds were included. The Transactional Theory of Stress and Coping (TTSC) model was utilized to select predictors. Descriptive analysis was conducted for all predictors, and generalized estimating equation (GEE) was applied to explore and identify the risk and protective factors. Results Age, race and ethnicity, self-rated health, number of chronic conditions, cognitive capacity, frequency of negative feelings, self-realization, self-efficacy and resilience, activity participation, and technology use were significantly associated with depression and anxiety. Besides, demographic factors like gender, marital status, and income were significantly associated with anxiety. Furthermore, depression may decrease over time but only happens in a relatively short time, and the extent of decline also slows down gradually. However, anxiety did not change over time. Conclusions The findings highlight the need to provide support and link resources to caregivers and call for efficient chronic condition management to provide early screening, assessment, and diagnosis. Recommendations from healthcare providers, proper education of healthy lifestyle and the dissemination of related information, and prompting older adults to engage in more physical activities can also make a difference in helping older adults gain better physical and mental health to prevent them from suffering depression and anxiety. Detailed implications are discussed.Item A longitudinal analysis of factors associated with adherence to preventive Pap test recommendations among middle-age Chinese American women(University of Alabama Libraries, 2019) Guo, Yuqi; Hopson, Laura M.; Noh, Hyunjin; University of Alabama TuscaloosaBackground: Pap tests can prevent cervical cancers by allowing for the early detection and removal of precancerous lesions. In the US, Chinese American women (66%) have a lower rate of obtaining Pap tests within the past three years than non-Hispanic white women (83%), Filipino women (83%), and Asian Indians (70%). Predictors of adherence to repeated Pap tests among Chinese American women are not well understood in the current literature. Purpose: The purpose of this longitudinal study is to analyze factors associated with adherence to preventive Pap tests among middle-aged Chinese American women. This longitudinal study will: (a) estimate annual uptake of Pap testing and examine changes over a seven-year period among middle-aged Chinese American women and (b) determine which factors are associated with middle-aged Chinese American women’s adherence to Pap testing for cervical cancer prevention in the U.S. health care system. Method: The Study of Women's Health across the Nation (SWAN) Series provides the data from Chinese females for this secondary analysis. In total, the present study analyzed data from 498 individuals (1,326 person-time-waves). By using the Systems Model of Clinical Preventive Care, Generalized Estimating Equation (GEE) was applied to explore associations between the likelihood of having a pap test and explanatory factors. Result: Of the 1,326 person-time-waves, 61% (n= 824) had a Pap test in seven waves. The likelihood of adhering to Pap test among Chinese American women was significantly and positively associated with having a physician for female health care (PFH), time spent by the PFH, having cancer(s), and having fibroids. However, patients who were too busy to visit healthcare providers and patients who did not have a primary health care provider were less likely to adhere to a Pap test. Discussion and Implications: The findings highlighted the importance of the availability of healthcare resources and education about Pap testing for Chinese American women to encourage them to have preventive Pap tests. It is important for health care providers and social workers to emphasize the benefits of using preventive Pap tests for Chinese American women. Implications for practice are discussed.Item A Mixed Methods Approach to Korean-Youth Mental Health First Aid (K-YMHFA): a Pilot Study(University of Alabama Libraries, 2024) Won, Cho Rong Claudia; Lee, Lewis H.; Lee, Hee YunKorean immigrant families are growing in the Southern United States due to the increasing employment opportunities distributed by the South Korea-based auto industry. On top of navigating the resettlement in the new home, Korean immigrant families encounter stress, including parent-child conflict due to cultural incongruency, the youth's dual identity as Korean and American, and the parents' limited understanding of the American school and healthcare system. These stressors contribute to the youth's mental distress, but cultural stigma impedes discussion within the family. As an alternative solution, Youth Mental Health First Aid (YMHFA) can be a vital tool. This study aimed to (1) evaluate the feasibility of Korean-YMHFA (K-YMHFA) among Korean immigrants residing in the South and (2) assess the experience with K-YMHFA among participants and its use to address the Korean immigrant youth's mental health service needs in the South. Following Bowen and colleagues' (2009) feasibility framework, a mixed methods approach was used. Also, following a community-based participatory research approach, a community liaison was identified to support the study. A total of 24 participants who are (1) 18 years or older, (2) can write, speak, and understand Korean, and (3) born outside of the U.S. were recruited. Before implementing the 8-hour K-YMHFA program, a quantitative pre-survey was distributed followed by a post-survey. Individual interviews (N=12) were conducted among interested participants to discuss the experience with K-YMHFA and its use to address the needs for youth mental health services. Quantitative analysis used a t-test to compare the means between pre-and post-surveys, while inductive thematic and deductive content analysis was performed for qualitative data. Joint displays were developed for mixed methods analysis.Results indicated the feasibility of K-YMHFA among Korean immigrants in the South. Qualitative analysis revealed that K-YMHFA is a vital tool to address identified youth's mental health service needs: (1) youth stress from cultural ambiguity; (2) limited conversation between youth and adults; (3) lack of access to services; and (4) community empowerment via cultural-specific holistic approach in care. This study provides implications for social work practice, policy, and research, including further modification and studies with larger sample size.