Browsing by Author "Parton, Jason M."
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Item Disparity and Factors Associated With Internet Health Information Seeking Among US Adults Living With Diabetes Mellitus: Cross-sectional Study(JMIR Publications, 2022) Eke, Ransome; Jannat, Khadiza Tul; Yang, Xin Thomas; Parton, Jason M.; Mercer University; University of Alabama TuscaloosaBackground: Many patients with chronic medical conditions search the internet to obtain medical advice and health information to improve their health condition and quality of life. Diabetes is a common chronic disease that disproportionately affects different race and ethnicity groups in the United States. In the existing literature on the popularity of internet health information seeking among persons with a chronic medical condition, there are limited data on US adults living with diabetes. Objective: This study aims to examine the factors associated with internet health information seeking among US adults living with diabetes and whether there is a disparity in internet health information seeking stratified by race and ethnicity. Methods: We conducted a cross-sectional study using the Health Information National Trends Survey data from 2017 to 2020. We selected our study sample based on respondents' reports on whether they were told they had diabetes, and our primary outcome was internet health information-seeking behavior. We used 2 multivariable logistic regression models to examine the effects of sociodemographic factors and other covariates on the internet health information-seeking behavior of adults with diabetes. Jackknife replicate weights were used to provide bias-corrected variance estimates. Results: Our study sample included 2903 adults who self-reported that they had diabetes. In total, 60.08% (1744/2903) were non-Hispanic White individuals, 46.88% (1336/2850) were men, and 64% (1812/2831) had some college or graduate education. The prevalence of internet health information seeking in this population was 64.49% (1872/2903), and the main factors associated with internet health information seeking included education level (some college vs less than high school: odds ratio [OR] 1.42, 95% CI 1.44-1.88; and college graduate or higher vs less than high school: OR 2.50, 95% CI 1.79-3.50), age (age group >= 65 years vs age group 18-44 years: OR 0.46, 95% CI 0.34-0.63), and household income level (P<.001). In addition, we found significant differences in the effects of predictors stratified by race. Conclusions: The findings from this study suggest that internet health information seeking is common among US adults living with diabetes. Internet health information could influence the relationship between health care providers and adults living with diabetes and improve their self-management and quality of life.Item Geographic and Racial-Ethnic Differences in Satisfaction With and Perceived Benefits of Mental Health Services(American Psychiatric Publishing, 2014) Kim, Giyeon; Parton, Jason M.; Ford, Katy-Lauren; Bryant, Ami N.; Shim, Ruth S.; Parmelee, Patricia; University of Alabama Tuscaloosa; Morehouse School of MedicineObjective: This study examined whether racial-ethnic differences in satisfaction with and perceived benefits from mental health services vary by geographic region among U.S. adults. Methods: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), selected samples consisted of 2,160 adults age 18 and older from diverse racial-ethnic groups (Asian, black, Hispanic/Latino, and white) who had used mental health services in the past 12 months. Generalized linear model analysis was conducted for the United States as a whole and separately by geographic region (Northeast, South, Midwest, and West) after adjustment for covariates. Results: In the national sample, no significant main effects of race-ethnicity and geographic region were found in either satisfaction with or perceived benefits from mental health services. In the stratified analyses for geographic regions, however, significant racial-ethnic differences were observed in the West; blacks in the West were significantly more likely to report higher satisfaction and perceived benefits, whereas Hispanics/Latinos in the West were significantly less likely to do so. Conclusions: The findings suggest that there are regional variations of racial-ethnic differences in satisfaction with and perceived benefits from mental health services among U.S. adults and that addressing needs of Hispanics/Latinos in the West may help reduce racial-ethnic disparities in mental health care. Clinical and policy implications are discussed.Item Geographic Region Matters in the Relation Between Perceived Racial Discrimination and Psychiatric Disorders Among Black Older Adults(Oxford University Press, 2017) Kim, Giyeon; Parmelee, Patricia; Bryant, Ami N.; Crowther, Martha R.; Park, Soohyun; Parton, Jason M.; Chae, David H.; University of Alabama Tuscaloosa; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Pittsburgh Healthcare System; Auburn UniversityThis study examined whether the relation between perceived racial discrimination and psychiatric disorders varied by large geographic region among Black older adults in the United States. Black adults aged 55 or older who had experienced racial/ethnic-specific discrimination were drawn from the National Survey of American Life (NSAL). Logistic regression analysis was used to examine main and interaction effects. Results show that there was a significant main effect of perceived racial discrimination, indicating that greater perceived discrimination was significantly associated with increased odds of having any past-year psychiatric disorder. The interaction of region by perceived racial discrimination was significant: The effect of perceived racial discrimination on any past-year psychiatric disorder was stronger among Blacks in the West than those in the South. Findings suggest that whereas, in general, perceived racial discrimination is a risk factor for poor mental health among older Blacks, this association may differ by geographic region. Additional research examining reasons for this variation is needed.Item Geographic variations in alcohol consumption among racially/ethnically diverse older adults(University of Alabama Libraries, 2015) Bryant, Ami; Kim, Giyeon; University of Alabama TuscaloosaThis dissertation sought to examine the role of geographic location, geographic characteristics, and individual level race/ethnicity in alcohol consumption among older adults. Data were obtained from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) and the 2010 US Census. Participants aged 60 and older who were not missing data on any of the main study variables were included (n=185, 190). Data was analyzed for a total of 2,229 counties. Racial/ethnic groups examined included American Indian/Alaska Natives, Asians/Pacific Islanders, Blacks, Hispanics, and Whites. Multilevel modeling was used for main analyses in order to account for the nested structure of the data. Individuals at level 1 were nested within counties at level 2 which were nested within regions at level 3. Alcoholic drinks consumed per month was used as the dependent variable. Significant within and between county variance was found in average alcoholic drinks consumed per month. There were significant main effects of race/ethnicity, county percentage of older adults, county percentage of racial/ethnic minorities, and county median income on average alcoholic drinks consumed per month. Significant interactions were found for individual level race/ethnicity and each of the aforementioned county level variables. These results indicate that geographic location and characteristics are significantly related to the alcohol consumption of older adults. Additionally, results suggest that the role of geographic characteristics in the alcohol consumption of older adults varies by individual level race/ethnicity.Item Impact of heat stress and cooling strategies on body temperature and performance in elite tennis players(University of Alabama Libraries, 2017) Crew, Kermit Ray; Esco, Michael R.; Bishop, Phillip A.; University of Alabama TuscaloosaTennis matches are intense, of long induration, with brief recovery periods, played in hot environments. This subjects elite tennis athlete to heat stress. Whether high core temperature impacts performance, and whether performance decrements are attenuated with cooling, remains unknown. Three studies evaluated heat stress on rectal temperature (Tre), skin temperature (Tsk) and shot accuracy (SA) after performing high intensity exercise at 22 °C and 38 °C and relative humidities of 31% and 38% respectively. Study 1 compared Tre, Tsk, SA in a temperate environment (TE) and a hot environment (HOT). HOT trial Tre (38.5 ± 0.4 °C) and Tsk (35.0 ± 1.6 °C) were higher than TE (37.8 ± 0.7 °C and 32.0 ± 1.3 °C, respectively). SA decreased (p = 0.003) between TE [57.5 ± 17.9 au out of 100] and HOT (33.4 ± 4.0 au), with greatest reduction in players with highest scores. Study 2 examined cooling of abdominal walls and thighs during rest periods and recovery on Tre, SA. Tre increased between start and end of both trials (p < 0.008). Treatments didn’t mitigate increased Tre. Treatment SA increased (p < 0.05). Study 3 evaluated continuous cooling device (vest) plus ice-pack applications on thighs, during rest periods in the high intensity protocol and recovery in hot condition verses control on Tre, SA. A significant time by condition effect for Tre (p < 0.05). Tre at end of high intensity protocol in control was 38.3 ± 0.6 °C. Tre at end recovery in control was 38.4 ± 0.4 ° C. No difference between Tre at start of treatment condition (37.5 ± 0.6 °C) and end of high intensity exercise (38.0 ± 0.7 °C). Tre at the end of recovery (37.0 ± 1.4 °C) was lower than Tre at end of high intensity exercise (p < 0.008). Tre at the end of recovery in control was higher than Tre at end of recovery in treatment. SA increased in treatment condition versus control [(p < 0.05) and large effect size (Cohen’s d = 1.38)]. Combined cooling mitigated the rise of Tre and increased SA in elite tennis athletes.Item Improved Knowledge Retention Among Clinical Pharmacy Students Using an Anthropology Classroom Assessment Technique(American Association of Colleges of Pharmacy, 2014) Whitley, Heather P.; Parton, Jason M.; Auburn University; University of Alabama TuscaloosaObjective. To adapt a classroom assessment technique (CAT) from an anthropology course to a diabetes module in a clinical pharmacy skills laboratory and to determine student knowledge retention from baseline. Design. Diabetes item stems, focused on module objectives, replaced anthropology terms. Answer choices, coded to Bloom's Taxonomy, were expanded to include higher-order thinking. Students completed the online 5-item probe 4 times: prelaboratory lecture, postlaboratory, and at 6 months and 12 months after laboratory. Statistical analyses utilized a single factor, repeated measures design using rank transformations of means with a Mann-Whitney-Wilcoxon test. Assessment. The CAT revealed a significant increase in knowledge from prelaboratory compared to all postlaboratory measurements (p<0.0001). Significant knowledge retention was maintained with basic terms, but declined with complex terms between 6 and 12 months. Conclusion. The anthropology assessment tool was effectively adapted using Bloom's Taxonomy as a guide and, when used repeatedly, demonstrated knowledge retention. Minimal time was devoted to application of the probe making it an easily adaptable CAT.Item Medical decision making in patients with chronic diseases(University of Alabama Libraries, 2018) Mirghorbani, Seyedeh Saeideh; Melouk, Sharif H.; Mittenthal, John; University of Alabama TuscaloosaInefficient resource allocation and planning, expensive treatment costs, and low patient adherence to medication plans lead to undesired health outcomes in patients with chronic diseases. Operation research and stochastic decision process models have provided significant opportunities to assist physicians and healthcare providers with these complexities. Using advanced stochastic decision-making processes, this dissertation contributes to the field of medical decision making in patients with chronic diseases. We use Markov decision process and partially Markov decision process models to address our research questions. The first contribution investigates the impact of patient adherence on health outcomes and medication plans in patients with Type 2 diabetes. The second contribution, that is an extension of the first contribution, investigates the financial effects of nonadherence to medication plans in patients with Type 2 diabetes. The experimental results of these two studies reveal the importance of higher adherence to the medication in achieving desired health outcomes and expenses. Finally, the third contribution focuses on patients with a risk of Alzheimer’s disease and aims to provide observation-based screening plans that consider patient risk factors.Item Perceived control and affect: the influence of regularity in the duration of time spent on daily activities(University of Alabama Libraries, 2014) Tighe, Caitlan; Dautovich, Natalie D.; University of Alabama TuscaloosaLow perceived control is associated with adverse physical and mental health outcomes. As such, the main objective of the present study was to examine the relationship between perceived control, and its component parts, personal mastery and perceived constraints, with affect in community-dwelling adults. Additionally, the potential buffering effect of a third variable, regularity of the duration of time spent on daily activities, was examined. The sample for the current study was derived from the Midlife in the United States longitudinal follow-up study, MIDUS-II. Findings corroborated the relationship between a general sense of perceived control and positive and negative affect. Further, daily regularity was found to moderate the relationships of perceived control and both positive and negative affect, as well as perceived constraints and positive and negative affect. In each case, the findings suggest that individuals who scored lower on perceived control or higher on perceived constraints measures were more likely to have positive affective outcomes when they demonstrated greater regularity in daily activities. Implications of the findings are discussed.Item Physical and emotional symptom burden and advanced chronic illness: dyadic concordance(University of Alabama Libraries, 2013) Eichorst, Morgan Kay; Allen, Rebecca S.; University of Alabama TuscaloosaOver 40 million Americans act as an informal caregiver to someone over the age of 65. While there are many benefits to informal caregiving, research has highlighted associated challenges, such as accurately understanding the care recipient's medical and emotional symptoms. The current study aims to understand symptom reporting of informal caregivers by examining dyadic concordance of physical and emotional symptom reports. In addition to examining baseline correlations with demographic and psychosocial variables, the study examines a reminiscence and creative activity project as a possible intervention to increase concordance. Participants included 45 African American or Caucasian dyads, comprised of one chronically-ill older adult and one caregiver. Pearson correlations and six mixed ANOVAs were performed. Concordance was examined for symptom presence/absence as well as associated symptom distress. Physical and emotional symptom concordance were examined separately. Results indicated only two demographic variables (caregiver income adequacy and care recipient education) significantly related to concordance. Caregiver stress was related to lower concordance as was care recipient negative affect. Higher symptom reports by the care recipient were associated with decreased concordance for physical but not emotional symptoms and distress. Results of the ANOVAs indicated no improvement in concordance for intervention dyads compared to control dyads (N=28). Results are discussed in light of previous research on concordance as well s a model of caregiving stress. Limitations and future directions are discussed.Item Psychosocial Factors Are Associated With Blood Pressure Progression Among African Americans in the Jackson Heart Study(Oxford University Press, 2016) Ford, Cassandra D.; Sims, Mario; Higginbotham, John C.; Crowther, Martha R.; Wyatt, Sharon B.; Musani, Solomon K.; Payne, Thomas J.; Fox, Ervin R.; Parton, Jason M.; University of Alabama Tuscaloosa; University of Mississippi; University of Mississippi Medical CenterResearch that examines the associations of psychosocial factors with incident hypertension among African Americans (AA) is limited. Using Jackson Heart Study (JHS) data, we examined associations of negative affect and stress with incident hypertension and blood pressure (BP) progression among AA. Our sample consisted of 1,656 normotensive participants at baseline (2000-2004) (mean age 47 +/- 12; 61% women). We investigated associations of negative affect (cynical distrust, anger-in, anger-out, and depressive symptoms) and stress (perceived stress, weekly stress inventory (WSI)-event, WSI-impact, and major life events) with BP progression (an increase by one BP stage as defined by JNC VII) and incident hypertension by examination 2 (2005-2008). Poisson regression analysis was utilized to examine the prevalence ratios (PRs; 95% confidence interval (CI)) of BP tracking and incident hypertension with psychosocial factors, adjusting for baseline age, sex, socioeconomic status (SES), and hypertension risk factors. Fifty-six percentage of the sample (922 cases) had BP progression from 2005 to 2008. After adjustment for age, sex, and SES, a high anger-out score was associated with a 20% increased risk of BP progression compared to a low anger-out score (PR 1.20; 95% CI 1.05-1.36). High depressive symptoms score was associated with BP progression in the age, sex, and SES-adjusted model (PR 1.14; 95% CI 1.00-1.30). High WSI-event scores were associated with BP progression in the fully adjusted model (PR 1.21; 95% CI 1.04-1.40). We did not observe significant associations with any of the psychosocial measures and incident hypertension. Psychosocial factors were associated with BP progression, with the strongest evidence for number of stressful events that occurred.Item Rationale of family medicine physicians in effectively identifying patients with chronic hyperglycemia through point-of-care hemoglobin A1C screenings(Springer, 2019) Whitley, Heather P.; Hanson, Courtney; Parton, Jason M.; Smith, Warren D.; Auburn University; University of Alabama TuscaloosaPurposeMany patients are unknowingly living with chronic hyperglycemia, possibly due to low screening rates. We aimed to correlate detection of unidentified chronic hyperglycemia to practitioner reported rationale for conducting diabetes screening.MethodsPhysicians screened patients via a point-of-care A1C tests and recorded corresponding rationales. Elevated outcomes (A1C5.7%) were correlated to recorded rationales, frequency of repeat screenings, documented diagnoses, and therapeutic actions taken as a result of elevated A1C.ResultsNearly one-half (45%) of selected patients were unknowingly living with chronic hyperglycemia, having an average A1C of 7.92% for outcomes 6.5%. Most commonly recorded rationales were overweight status (71%), high-risk ethnicity (58%), and age>45years (48%); previously recorded A1C result of 5.7% ((2) 16.02, p<0.001) and hypertension diagnosis ((2) 10.37, p=0.0013) showed statistically significant correlation with elevated A1C outcomes. A1C results 6.5% versus 5.7-6.5% more frequently prompted repeat screenings (77% vs 20%), ICD-10 code documentation (91% vs 28%), lifestyle modification recommendations (78% vs 35%), and drug therapy initiation (78% vs 9%).ConclusionsReported rationales were largely impacted by visual inspections of age, race, and weight, and prediabetic A1C values garnered less attention compared to higher values. Utilization of POC A1C screening followed by conformational repeat testing is a practical approach to improve diagnostic rates and initiation of care for diabetes.Item Regional Variation of Racial Disparities in Mental Health Service Use Among Older Adults(Oxford University Press, 2013) Kim, Giyeon; Parton, Jason M.; DeCoster, Jamie; Bryant, Ami N.; Ford, Katy L.; Parmelee, Patricia A.; University of Alabama Tuscaloosa; University of VirginiaPurpose: Given the paucity of research on the role of geography in mental health care, this study examined whether racial differences in mental health service use varied across geographic regions among older adults. Design and Methods: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), blacks (n = 1,008) and whites (n = 1,870) aged 60 and older were selected for analysis. Logistic regression analyses were conducted. Results: Results showed significant racial disparities in mental health service use in the overall sample, as well as significant variation by region. Although no racial differences were observed in the Northeast, West, or Midwest regions, black elders in the South were significantly less likely than whites to use mental health services (odds ratios [OR], 2.08; 95% confidence interval [CI], 1.34-3.23). Implications: The findings suggest that improving the access to mental health care in certain regions, the South in particular, may be essential to reduce racial disparities at the national level. Policy implications are discussed.Item The rotavirus vaccine in a medicaid population: series completion and health care utilization(University of Alabama Libraries, 2018) Henderson-Mitchell, Randi J.; Higginbotham, John C.; University of Alabama TuscaloosaCoverage estimates for the complete rotavirus vaccine series are considerably lower than the Healthy People 2020 target, as well as for other vaccinations routinely recommended in early childhood. Regardless, routine rotavirus vaccination in infants has been extremely effective in reducing rotavirus-associated illness in the United States. There are racial and socioeconomic disparities in rotavirus vaccine coverage, as well as lower rates of coverage among rural children. Furthermore, there is evidence of disproportionate disease burden among Medicaid-enrolled children. Further reductions in rotavirus disease burden are possible with improvements in coverage rates, although coverage may not reflect the full of the impact of rotavirus vaccination. Both the receipt of the complete rotavirus vaccine series, as well as receipt of a partial series, have been shown effective in the prevention of severe illness. Therefore, the present study was conducted within a Medicaid-enrolled population to 1) Examine the association between rural residence and rotavirus vaccination 2) Examine demographic and provider characteristics as potential predictors of rotavirus vaccine series initiation and completion, and 3) Examine differences in rotavirus-associated health care utilization by the status of rotavirus vaccine series completion. The study population included 293,458 children enrolled in Medicaid between 2010-2017. Nearly 77% of infants received at least one rotavirus vaccine dose; however, only 56% completed the full series. Infants who resided in rural areas were more likely to initiate the vaccine series, but rurality of residence had mixed impact on series completion. The receipt of ≥1 dose of the diphtheria, tetanus, and pertussis (DTaP) vaccine was strongly associated with rotavirus vaccine series initiation. The strongest predictors of series completion were the receipt of all age appropriate doses of DTaP and receipt of the Rotarix® (RV1) (GlaxoSmithKline Biologicals) vaccine. Analysis of health care utilization found that receipt of any dose of rotavirus vaccine was effective in the prevention of severe illness; however, completion of the series maximized protection against severe cases of rotavirus-associated illness.Item Systematic Diabetes Screening Using Point-of-Care HbA(1c) Testing Facilitates Identification of Prediabetes(Annals of Family Medicine, 2017) Whitley, Heather P.; Hanson, Courtney; Parton, Jason M.; Auburn University; University of Alabama TuscaloosaThis prospective longitudinal study compares diabetes screenings between standard practices vs systematically offered point-of-care (POC) hemoglobin A1c (HbA1c) tests in patients aged 45 years or older. Systematically screened participants (n = 164) identified 63% (n = 104) with unknown hyperglycemia and 53% (n = 88) in prediabetes. The standard practice (n = 324) screened 22% (n = 73), most commonly by blood glucose (96%); 8% (n = 6) and 33% (n = 24) were found to have diabetes and prediabetes, respectively. The association between screening outcome and screening method was statistically significant (P = 0.005) in favor of HbA(1C). HbA(1c) may be the most effective method to identify patients unknowingly living in hyperglycemia. Point-of-care tests further facilitate screening evaluation in a timely and feasible fashion.