Department of Health Science

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Effective media communication of disasters: Pressing problems and recommendations
(BMC, 2007) Lowrey, Wilson; Evans, Williams; Gower, Karla K.; Robinson, Jennifer A.; Ginter, Peter M.; McCormick, Lisa C.; Abdolrasulnia, Maziar; University of Alabama Birmingham; University of Alabama Tuscaloosa; University of Florida
Background: Public health officials and journalists play a crucial role in disseminating information regarding natural disasters, terrorism and other human-initiated disasters. However, research suggests that journalists are unprepared to cover terrorism and many types of natural disasters, in part because of lack sufficient expertise in science and medicine and training. The objective of this research was to identify solutions to problems facing journalists and public health public information officer (PIOs) of communicating with the public during natural and human-initiated disasters. Methods: To assist in identifying the most pressing problems regarding media response to health-related risks such as terrorism and large-scale natural disasters, 26 expert advisors were convened, including leaders representing journalists and public information officers, state health officials, experts in terrorism and emergency preparedness, and experts in health, risk, and science communication. The advisory group participated in prearranged interviews and were asked to identify and review bioterrorism educational resources provided to journalist. All advisory group members were then invited to attend a day long meeting January 29, 2004 to review the findings and reach consensus. Results: The most pressing problems were found to be a lack of coordination between PIO's and journalists, lack of resources for appropriately evaluating information and disseminating it efficiently, and a difference in perception of PIO's and journalist towards each others role during emergency situations. The advisory board developed a list of 15 recommendations that may enhance communication plans between PIO's, journalist and the public. The solutions were meant to be feasible in terms of costs and practical in terms of the professional and organizational realities in which journalists and PIO's work. Conclusion: It is clear that PIO's and journalists play crucial roles in shaping public response to terrorism and other disasters. The findings from this formative research suggest that perspectives and organizational processes often limit effective communication between these groups; though practical solutions such as participation of journalists in drills, scenario exercises, sharing of informational resources, and raising awareness at professional trade meetings may enhance the timely dissemination of accurate and appropriate information.
Application of the diffusion of innovations theory and the health belief model to describe EMR use among Alabama family medicine physicians: a rural and urban analysis
(University of Alabama Libraries, 2009) Tucker, Melanie Tara; Higginbotham, John C.; University of Alabama Tuscaloosa
The Alabama Black Belt region consists of twelve counties which are characterized by a high percentage of African Americans, acute poverty, rural decline, inadequate education programs, and significantly poor health outcomes. The Alabama Black Belt region suffers significantly with health disparities which, in part, may be attributed to low physician/patient ratio and physician isolation. These physicians tend to practice in private, solo establishments, which often lead to limited communication with other physicians and medical educators. Without continued communication and continuing medical education, rural physicians could lag behind their urban counterparts. In fact it has been shown that some physician practices lag as far as two decades behind their urban counterparts due to such things as limited access to new technologies. With the advent of the electronic medical record (EMR) this lag is likely to decrease exponentially for those in rural areas and could lead to an increase in quality of care for the rural communities. The purpose of this study was to evaluate the adoption and implementation of electronic medical records (EMR) by rural and urban Alabama Family Medicine physicians. The Diffusion of Innovations Theory and Health Belief Model were used to guide the study and develop the survey questions. EMR adoption was assessed in rural areas and compared to their urban counterparts while evaluating the individual characteristic (gender, race, age, and years of practice), organizational characteristics (practice size, patients seen per day, practice location) and individual perceptions regarding adoption (perceived threat, perceived barriers and self-efficacy). Thirty percent (30%) of the 1,205 Alabama Family Medicine physicians responded to the electronic or paper survey. Almost half (49.3%) of the physicians surveyed reported having EMR in their practice; however, 16.3% reported using it to its fullest capacity. Significant differences emerged with respect to EMR use among physicians based on age, years in practice, patients seen per day, practice size and with respect to elements of perceived threat, barriers to adoption and the self-efficacy. Throughout the analysis, differences emerged between Family Medicine physicians from urban Alabama settings and their counterparts from rural and Black Belt region practices.
Osteoporosis knowledge, beliefs, and behaviors of college students: utilization of the Health Belief Model
(University of Alabama Libraries, 2009) Edmonds, Ellen; Turner, Lori W.; University of Alabama Tuscaloosa
The purpose of this study is to determine the level of osteoporosis knowledge, beliefs and behavior among college students. In addition, this study will examine perceived susceptibility, severity, benefits, barriers and self-efficacy related to osteoporosis prevention. Women and men of all ethnicities at the University of Central Arkansas were asked to participate in the study. The Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale, Osteoporosis Self-Efficacy Scale, and Osteoporosis Preventing Behaviors Survey were utilized. Correlations were used to determine the degree of relationship between variables. After determining which independent variables were significant, a multiple regression was completed to determine prediction. Participants did not perceive themselves as susceptible to osteoporosis and perceived minimal barriers to physical activity and calcium intake. Their knowledge was minimal concerning alternate sources of calcium and less traditional forms of physical activity. Physical activity was correlated with perceived barriers, health motivation, and calcium intake. Calcium intake was correlated with perceived barriers, health motivation, and knowledge. Prevention programs should aim to increase osteoporosis knowledge of risk factors and preventing behaviors and to decrease high risk factor behaviors in adolescence when bone health can be increased. Health professionals can attempt to decrease perceived barriers to physical activity in college age individuals by providing comprehensive programs based on supported factors shown to influence behavior, including social support and self-efficacy.
Association of IL4R single-nucleotide polymorphisms with rheumatoid nodules in African Americans with rheumatoid arthritis
(BMC, 2010) Burgos, Paula I.; Causey, Zenoria L.; Tamhane, Ashutosh; Kelley, James M.; Brown, Elizabeth E.; Hughes, Laura B.; Danila, Maria I.; van Everdingen, Amalia; Conn, Doyt L.; Jonas, Beth L.; Callahan, Leigh F.; Smith, Edwin A.; Brasington, Richard D., Jr.; Moreland, Larry W.; van der Heijde, Desiree M.; Alarcon, Graciela S.; Bridges, S. Louis, Jr.; University of Alabama Tuscaloosa; Pontificia Universidad Catolica de Chile; Leiden University; Leiden University Medical Center (LUMC); Leiden University - Excl LUMC; Emory University; University of North Carolina; University of North Carolina Chapel Hill; Medical University of South Carolina; Washington University (WUSTL)
Introduction: To determine whether IL4R single-nucleotide polymorphisms (SNPs) rs1805010 (I50V) and rs1801275 (Q551R), which have been associated with disease severity in rheumatoid arthritis (RA) patients of European ancestry, relate to the presence of rheumatoid nodules and radiographic erosions in African Americans. Methods: Two IL4R SNPs, rs1805010 and rs1801275, were genotyped in 749 patients from the Consortium for Longitudinal Evaluation of African-Americans with Early Rheumatoid Arthritis (CLEAR) registries. End points were rheumatoid nodules defined as present either by physical examination or by chest radiography and radiographic erosions (radiographs of hands/wrists and feet were scored using the modified Sharp/van der Heijde system). Statistical analyses were performed by using logistic regression modeling adjusted for confounding factors. Results: Of the 749 patients with RA, 156 (20.8%) had rheumatoid nodules, with a mean age of 47.0 years, 84.6% female gender, and median disease duration of 1.9 years. Of the 461 patients with available radiographic data, 185 (40.1%) had erosions (score >0); their mean age was 46.7 years; 83.3% were women; and median disease duration was 1.5 years. Patients positive for HLA-DRB1 shared epitope (SE) and autoantibodies (rheumatoid factor (RF) or anti-cyclic citrullinated peptide (CCP)) had a higher risk of developing rheumatoid nodules in the presence of the AA and AG alleles of rs1801275 (odds ratio (OR)(adj) = 8.08 (95% confidence interval (CI): 1.60-40.89), P = 0.01 and ORadj = 2.97 (95% CI, 1.08 to 8.17), P = 0.04, respectively). Likewise, patients positive for the HLA-DRB1 SE and RF alone had a higher risk of developing rheumatoid nodules in presence of the AA and AG alleles of rs1801275 (ORadj = 8.45 (95% CI, 1.57 to 45.44), P = 0.01, and ORadj = 3.57 (95% CI, 1.18 to 10.76), P = 0.02, respectively) and in the presence of AA allele of rs1805010 (ORadj = 4.52 (95% CI, 1.20 to 17.03), P = 0.03). No significant association was found between IL4R and radiographic erosions or disease susceptibility, although our statistical power was limited by relatively small numbers of cases and controls. Conclusions: We found that IL4R SNPs, rs1801275 and rs1805010, are associated with rheumatoid nodules in autoantibody-positive African-American RA patients with at least one HLA-DRB1 allele encoding the SE. These findings highlight the need for analysis of genetic factors associated with clinical RA phenotypes in different racial/ethnic populations.
A theory-based investigation of leisure time physical activity among college students
(University of Alabama Libraries, 2010) Beville, Jill Marie; Umstattd, M. Renee; Turner, Lori W.; University of Alabama Tuscaloosa
This study examined the leisure time physical activity behavior of college students using the Theory of Planned Behavior (TPB) and two constructs, descriptive norm and self-efficacy, from the Integrated Behavioral Model (IBM). A sample of college students (n = 621) from a large, public university in the southeastern United States participated. Data were collected via a self-report class-room based assessment battery. The assessment battery contained questions related to leisure time physical activity, TPB constructs descriptive norm and self-efficacy and demographic information. In general, the results of this research indicate the utility of the TPB in examining leisure time physical activity among college students. In addition, this study supports the inclusion of the IBM constructs descriptive norm and self-efficacy in examining leisure time physical activity. The TPB constructs; attitude, subjective norm and perceived behavioral control were positively associated with intention to engage in leisure time physical activity among this sample of college students. The results of the final hierarchical regression model indicated that subjective norm was negatively associated with leisure time physical activity and intention was positively associated with leisure time physical activity behavior. In addition, the two IBM constructs descriptive norm and self-efficacy were positively associated with leisure time physical activity behavior. Finally, the results also found gender differences in the TPB and IBM constructs. For males, intention and subjective norm were significantly related to leisure time physical activity. For the females, intention, attitude and self-efficacy were significantly related to leisure time physical activity. This research has several implications for researchers and other college health professionals, with an interest in promoting leisure time physical activity. This research provides a better understanding of the leisure time physical activity behaviors of college students with regard to the TPB and IBM constructs (descriptive norm and self-efficacy). This examination of leisure time physical activity among college students should be of interest to those fostering programs, services and facilities to support this behavior, and particularly campus recreation professionals.
An investigation of materialistic values and physical activity participation, location, and experience
(University of Alabama Libraries, 2010) Baller, Stephanie L.; Usdan, Stuart L.; University of Alabama Tuscaloosa
In spite of clear and much publicized health benefits, the majority of American adults do not participate in enough physical activity to satisfy established public health recommendations. In recent years, attention has been paid to social position and consumption as they are related to health and well-being. In light of increases in chronic disease and health risks associated with insufficient activity, as well as increased consumptive patterns associated with decreased well-being, studies aimed at understanding the confluence of these trends are essential. The purpose of this study was to gain a better understanding of how materialistic values interact with the social and physical environments to influence physical activity participation, location, and the experience of being active. The present study utilized a mixed method, cross sectional design (n = 487). Increased materialism was associated with greater physical activity and appears to influence the selection of activity location, experience, and norms. The findings of this study suggest that this line of inquiry is timely, culturally relevant, and worthy of further investigation.
Development of a theory based instrument to predict the influence of sexually-oriented music lyrics on the sexual attitudes, beliefs, and intentions of African-American adolescents
(University of Alabama Libraries, 2010) Gordon, Brian C.; Perko, Mike; Turner, Lori W.; University of Alabama Tuscaloosa
Early sexual initiation among American adolescents represents a major public health problem. African-American adolescents (AAas) report earlier age of sexual initiation, which places them at an increased risk of ill health outcomes. Approximately 3 million adolescents are infected with a STI yearly, with the highest incidence occurring in African Americans from impoverished, inner city environments. A relationship among media exposure and media's influence on adolescents' sexual perceptions, attitudes, and intentions has been suggested. However, answers as to whether sexually-oriented music lyrics influence adolescent sexual initiation are unclear. The purpose of this study was to develop a reliable and valid instrument based on the Theory of Reasoned Action to enable researchers to predict the influence of sexually-oriented music lyrics on the sexual attitudes, beliefs, and intentions of AAas. A nine step process was followed to develop a survey to enable researchers to predict the influence of sexually-oriented music lyrics on the sexual attitudes, beliefs, and intentions of African-American adolescents. The steps were: 1) identify the attitudinal object, 2) collect a pool of opinion items, 3) submit pool of items to expert panel for review, 4) pilot test draft of the survey, 5) administer item pool to a group of respondents, 6) score each item for each respondent, 7) sum respondents' item scores, 8) correlate item scores with total scale scores for all respondents, and 9) apply statistical criteria for elimination of test items. One hundred eighty-five (n =185) AAas in grades 6-8 residing in rural and urban communities in Alabama participated in the study. An initial pool of items (n =95) was developed based on the TRA, a review of the literature, and input received through focus group interviews with the target audience. Items were eliminated through expert panel review (n =49), item response discrimination, factor analysis (1), and Cronbach's alpha (3). Four subscales were identified with reliability statistics ranging from .722-.940. The final instrument consisted of 44 items with a Cronbach's alpha of .846. Future research should utilize this survey to determine the influence sexually-oriented music lyrics may have on the sexual attitudes, beliefs, and intentions of African-American adolescents.
Relationships between religiosity, spirituality and health behaviors among college students
(University of Alabama Libraries, 2010) Harcrow, Michelle Senter; Turner, Lori W.; University of Alabama Tuscaloosa
The influence of religion and spirituality on factors relating to an individual's health behaviors has emerged as an area of interest for researchers, in recent years. Religiosity (formal and informal religious practice, both public and private) and spirituality (individual's relationship to something sacred; meaning and values of one's purpose) are regarded as having extensive influence on an individual's cognitions, emotions and behaviors. The purpose of this study was to examine the association between religion, spirituality, and social support in relation to physical activity and intakes of dietary fat among a sample of college students (n = 914) from a large, public university in the southeastern United States. Data of interest were collected via a classroom-based assessment battery and analyzed. Most relationships between religiosity, spirituality, physical activity and dietary fat intake were not statistically significant. Intakes of dietary fat were found to be higher in students that reported greater levels of behavioral and functional religiosity. Greater levels of reported social support were found to be significantly related to higher levels of both moderate and vigorous physical activity. The magnitude of the relationships between the variables did not appear to be affected after controlling for demographics and social support. Overall, a few significant relationships were identified between religiosity, spirituality, physical activity and dietary fat intake, suggesting that the influence and function of religiosity and spirituality on the development and maintenance of health behaviors among college students may be small. This research has several implications for researchers and other college health professionals, with an interest in promoting chronic disease prevention through physical activity and dietary behaviors. This research provides a better understanding of the religious and spiritual landscape, as well as, the physical activity behaviors and intakes of dietary fat of college students. Thus, this examination of religiosity, spirituality, physical activity, and dietary fat intake among college students should be of interest to researchers of chronic disease prevention and to entities fostering programs to support these health-promoting behaviors.
Knowledge, engagement, and perceptions of the American College of Sports Medicine guidelines for cardiovascular physical activity: a university undergraduate comparison
(University of Alabama Libraries, 2010) Brown, George Milton; Usdan, Stuart L.; Turner, Lori W.; University of Alabama Tuscaloosa
Background: The early onset of chronic disease is a major health concern facing the nation. Leading health indicators support physical activity to reduce the mortality and morbidity rates among individuals. The college years represent a time of transition and potential for improved adherence to positive health behaviors. As institutions of higher education seek to improve retention through positive health behavior, an increase in attention to physical activity is warranted. Purpose: The purpose of this study was to evaluate the knowledge, engagement and perceptions of the American College of Sports Medicine (ACSM) guidelines for cardiovascular physical activity among university freshmen and seniors. Methods: A cross-sectional study design was used to survey all University of Alabama undergraduate students (N=21,775). A 26-question electronic survey was used to collect data. Results: A total of 877 surveys were returned representing a four percent (4.0%) response rate. The mean knowledge scores were 4.26 (out of possible 8.0). Students engaged in moderate intensity physical activity on less (M=3.73) days per week than recommended by the ACSM. For vigorous intensity physical activity students reported engagement on more (M=4.06) days per week than recommended by the ACSM. Knowledge of physical activity guidelines was a significant predictor of engagement in vigorous intensity physical activity for both freshmen (n=216, p=.040) and seniors (n=211, p=.016). Significant differences (p=.047) by year in school were found with respect to walking activity where freshman walked more often than seniors. Age (p=.012), race (p<.001) and year in school (P=.047) were all significant with respect to moderate intensity physical activity. Males engaged in more vigorous intensity physical activity than females (p=.003). When examining physical among classes, freshman students reported significant differences in engagement to vigorous intensity physical activity based on the constructs of perceived self-efficacy (p<.001) and perceived barriers (p=.006). Seniors reported significant differences in engagement to vigorous intensity physical activity based on perceived benefits (p=.002) and perceived severity (p=.019). Discussion: University freshman and seniors vary in reasons for engagement in physical activity. While knowledge is not synonymous with engagement it does have an impact on a student's overall decision and understanding of the health benefits of physical activity.
Development and validation of an instrument to assess college students' oral health knowledge, beliefs, and behavior
(University of Alabama Libraries, 2010) Aubuchon, Stellina Marie; Turner, Lori W.; University of Alabama Tuscaloosa
Oral health education emphasizes the importance of brushing, flossing, and getting regular dental exams. Some examples of oral health problems that can occur without proper oral hygiene and dental care are dental caries and gingivitis. Research has shown that a relationship exists between oral health and other health related problems. The lack of awareness, education, and services regarding oral health and hygiene can cause severe unfavorable outcomes later in life. Unique oral health issues that affect today's college students include the use of smokeless tobacco, sexually transmitted diseases, and oral piercing. Although there are many studies conducted on oral health, few are targeted towards the college aged population. The purpose of this study was to develop a valid instrument based on constructs from the Health Belief Model to measure the knowledge, beliefs, and behaviors of college students' regarding oral health and hygiene. The present study utilized a review of the literature and an eight-step process to develop and validate College Students Oral Health Knowledge, Beliefs, and Behaviors (OHKBB). The most effective way to treat oral health related problems is through prevention. Oral health education is needed to ensure that college students are aware of not only the risks but also the prevention of oral diseases. The proposed research will pave the way for programs to help individuals improve their oral hygiene and reduce their risks of oral health related problems through education by identifying the specific oral health related knowledge, beliefs, and behaviors that affect college students oral health.
A Qualitative Analysis of a Randomized Controlled Trial Comparing a Cognitive-Behavioral Treatment With Education
(Churchill Livingstone, 2011) Day, Melissa A.; Thorn, Beverly E.; Kapoor, Shweta; University of Alabama Tuscaloosa
Cognitive behavioral therapy (CBT) is a widely accepted psychosocial treatment for chronic pain. However, the efficacy of CBT has not been investigated within a rural setting. Furthermore, few studies have utilized first-person accounts to qualitatively investigate the key treatment elements and processes of change underlying the well-documented quantitative improvements associated with CBT. To address these gaps, we conducted a randomized controlled trial (RCT) investigating the efficacy of group CBT compared to an active education condition (EDU) within a rural, low-literacy population. Posttreatment semistructured interviews of 28 CBT and 24 EDU treatment completers were qualitatively analyzed. Emerging themes were collated to depict a set of finalized thematic maps to visually represent the patterns inherent in the data. Patterns were separated into procedural elements and presumed change processes of treatment. Key themes, subthemes, and example extracts for CBT and EDU are presented; unique and shared aspects pertaining to the thematic maps are discussed. Results indicate that while both groups benefited from the program, the CBT group described more breadth and depth of change as compared to the EDU group. Importantly, this study identified key treatment elements and explored possible processes of change from the patients' perspective. Perspective: This qualitative article describes patient-identified key procedural elements and change process factors associated with psychosocial approaches for chronic pain management. Results may guide further adaptations to existing treatment protocols for use within unique, under-served chronic pain populations. Continued development of patient-centered approaches may help reduce health, treatment, and ethnicity disparities. (C) 2011 by the American Pain Society
Sleep Disturbance and Risk Behaviors among Inner-City African-American Adolescents
(Springer, 2011) Umlauf, Mary Grace; Bolland, John M.; Lian, Brad E.; University of Alabama Tuscaloosa
Adolescents tend to experience more problems with sleep loss as a natural consequence of puberty, whereas teens from impoverished urban areas are likely to witness neighborhood violence and/or engage in risk behaviors that may affect sleep. Data from the Mobile Youth Survey, a longitudinal study of impoverished inner-city African-American adolescents (1998-2005; N = 20,716; age range = 9.75-19.25 years), were used to compare paired years of annual surveys elicited by questions about how sleep was affected when bad things happen to friends or family. Using a cross-lagged panel multivariate approach comparing reports for two sequential years and controlling for age/gender plus exposure to traumatic stress and violence, prior sleep disturbance was associated with carrying a knife/gun, brandishing a knife/gun, using a knife/gun, quick temperedness, warmth toward mother, worry, and belief in the neighborhood street code in the latter year. Conversely, seeing someone cut, stabbed, or shot, using alcohol, worry, and internalized anger were associated with sleep disturbance in a latter year. Although a limited measure of sleep disturbance was used, these findings support further research to examine sleep disturbance and risk behaviors among low-income adolescents.
A web-based diabetes intervention for physician: a cluster-randomized effectiveness trial
(Oxford University Press, 2011) Estrada, Carlos A.; Safford, Monika M.; Salanitro, Amanda H.; Houston, Thomas K.; Curry, William; Williams, Jessica H.; Ovalle, Fernando; Kim, Yongin; Foster, Pamela; Allison, Jeroan J.; US Department of Veterans Affairs; Veterans Health Administration (VHA); Veterans Affairs Medical Center - Birmingham; University of Alabama Birmingham; VA Tennessee Valley Healthcare System; Geriatric Research Education & Clinical Center; Vanderbilt University; University of Alabama Tuscaloosa; University of Massachusetts Worcester
To determine the effectiveness of a provider-based education and implementation intervention for improving diabetes control. Cluster-randomized trial with baseline and follow-up cross sections of diabetes patients in each participating physicians practice. Eleven US Southeastern states, 200608. Two hundred and five rural primary care physicians. Multi-component interactive intervention including Web-based continuing medical education, performance feedback and quality improvement tools. oAcceptable control' [hemoglobin A1c 9, blood pressure (BP) 140/90 mmHg, low-density lipoprotein cholesterol (LDL) 130 mg/dl] and ooptimal control' (A1c 7, BP 130/80 mmHg, LDL 100 mg/dl). Of 364 physicians attempting to register, 205 were randomized to the intervention (n 102) or control arms (n 103). Baseline and follow-up data were provided by 95 physicians (2127 patients). The proportion of patients with A1c 9 was similar at baseline and follow-up in both the control [adjusted odds ratio (AOR): 0.94; 95 confidence interval (CI): 0.61, 1.47] and intervention arms [AOR: 1.16 (95 CI: 0.80, 1.69)]; BP 140/90 mmHg and LDL 130 mg/dl were also similar at both measurement points (P 0.66, P 0.46; respectively). We observed no significant effect on diabetes control attributable to the intervention for any of the primary outcome measures. Intervention physicians engaged with the Website over a median of 64.7 weeks [interquartile range (IQR): 45.481.8) for a median total of 37 min (IQR: 1666). A wide-reach, low-intensity, Web-based interactive multi-component intervention did not improve control of glucose, BP or lipids for patients with diabetes of physicians practicing in the rural Southeastern US.
Sleep duration change across breast cancer survivorship: associations with symptoms and health-related quality of life
(Springer, 2011) Alfano, Catherine M.; Lichstein, Kenneth L.; Vander Wal, Gregory S.; Smith, Ashley Wilder; Reeve, Bryce B.; McTiernan, Anne; Bernstein, Leslie; Baumgartner, Kathy B.; Ballard-Barbash, Rachel; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI); University of Alabama Tuscaloosa; University of North Carolina; University of North Carolina Chapel Hill; Fred Hutchinson Cancer Center; University of Washington; University of Washington Seattle; City of Hope; University of Louisville
Sleep duration among breast cancer survivors correlates with fatigue, depression, and health-related quality of life (HRQOL); however, this has not been studied longitudinally. This study investigated patterns of sleep duration change across the early breast cancer survivorship period, their demographic and clinical predictors, and their relationships with subsequent cancer-related symptoms and HRQOL. Breast cancer survivors (n = 572), were assessed 6 months post-diagnosis (current sleep & retrospective reports of pre-diagnosis sleep), 30 months post-diagnosis (sleep), and 39 months post-diagnosis (symptoms, HRQOL). Sleep duration change was determined by examining sleep at each time point in relation to published norms. Analysis of variance and logistic regression models tested demographic and clinical differences between the sleep change groups; linear regression models tested differences in symptoms and HRQOL. Half of the survivors reported no sleep duration change over time; however, 25% reported sleep changes indicating a temporary (5.6%), late-occurring (14%), or sustained (5.9%) change. Survivors reporting sustained or temporary sleep changes were more likely to have been treated with chemotherapy (OR = 2.62, P < 0.001) or gained weight after diagnosis (OR = 1.82, P = 0.04) than those with no sleep change. Sustained sleep changes were related to greater subsequent severity, affective, and sensory aspects of fatigue (beta s = 2.0, 2.3, 1.8; all P < 0.0001) and lower vitality (beta = -10.8, P = 0.005). Survivors treated with chemotherapy and those who gain weight after diagnosis may have increased risk for sustained sleep duration changes, which may increase their fatigue. These results point to the need for routine assessment of sleep as part of survivorship care.
Breast cancer knowledge, beliefs, and screening behaviors of college women: utilization of the health belief model
(University of Alabama Libraries, 2011) Guilford, Kendra; Turner, Lori W.; University of Alabama Tuscaloosa
Aside from skin cancer, breast cancer is currently considered the most common cancer and the second leading cause of cancer death among women in the U.S. It is unique from other cancers in that it presents extreme financial costs, coupled with both physiological and psychological consequences for the impacted women and their families. Lifestyle factors are known contributors to rates of breast cancer, and knowledge is essential to its prevention. Women who are classified as "emerging adults" offer a vital window of opportunity for intervention, as lifestyle patterns are often set during this time. This cross-sectional, descriptive study examined the level of breast cancer knowledge, beliefs, and screening behaviors among a sample of emerging adult college women (n = 342) in the southeastern U.S. by measuring participants' confidence, health motivation, perceived susceptibility, perceived severity, perceived benefits, and perceived barriers, in addition to their degree of worry in relation to breast cancer. Participants responded to a written, self-report 86-item questionnaire. All analyses were conducted using SAS® 9.0. Results of the study showed participants had a low level of perceived susceptibility towards breast cancer, as well as relatively low overall breast cancer knowledge. Findings also revealed a significant association between ethnicity, year in school, and family history of breast cancer and participants' general degree of breast cancer-related worry. Of the Health Belief Model constructs, confidence and perceived barriers were found to significantly predict breast self-examination. The college years provide a great opportunity for health intervention strategies. Health program planners should aim to develop interventions that are adapted to address the unique needs of women who are transitioning from adolescence to adulthood. These interventions should center on enhancing self-efficacy of breast cancer screening and reducing barriers. Education-based programs are also needed to increase women's overall knowledge and awareness of breast cancer-related issues. Such strategies have great potential to enhance women's quality of life and positively influence those with whom they closely interact.
Aging Prisoners' Treatment Selection: Does Prospect Theory Enhance Understanding of End-of-Life Medical Decisions?
(Oxford University Press, 2011) Phillips, Laura L.; Allen, Rebecca S.; Harris, Grant M.; Presnell, Andrew H.; DeCoster, Jamie; Cavanaugh, Ronald; University of Alabama Tuscaloosa
Purpose: With the rapid growth in the older inmate population and the economic impact of end-of-life treatments within the cash-strapped prison system, consideration should be given to inmate treatment preferences. We examined end-of-life treatment preferences and days of desired life for several health scenarios among male inmates incarcerated primarily for murder. Design and Methods: Inmates over the age of 45 who passed a cognitive screening completed face-to-face interviews (N = 94; mean age = 57.7; SD = 10.68). Results: We found a 3-way interaction indicating that the effect of parole expectation on desire for life-sustaining treatment varied by race/ethnicity and treatment. Minority inmates desired cardiopulmonary resuscitation or feeding tubes only if they believed that they would be paroled. The model predicting desire for palliative care was not significant. Future days of desired life were related to prospective health condition, fear of death, negative affect, and trust in prison health care. Caucasian inmates expressed a desire for more days of life out of prison, whereas minority inmates did not differ in days of desired life either in or out of prison. Minorities wanted more days of life than Caucasians but only if they believed that they would be paroled. Implications: End-of-life care for the burgeoning inmate population is costly, and active life-sustaining treatments may not be desired under certain conditions. Specifically, expectation of parole but not current functional ability interacts with future illness condition in explaining inmates' desire for active treatment or days of desired life in the future.
Exploring personal values, attitudes, perceived injunctive and descriptive norms, and intrapersonal value-attitude relationships in relation to alcohol use and alcohol-related problems among college students
(University of Alabama Libraries, 2011) Sheppard, Meg E.; Usdan, Stuart L.; University of Alabama Tuscaloosa
Alcohol use among college students continues to be a public health issue in spite of health promotion activities and programming. College alcohol use literature regularly examines the impact of perceived norms on alcohol use; however, little research has been done on the influence of personal values on alcohol use and alcohol-related problems. The purpose of this study was to examine the relationships between personal values, attitudes, perceived injunctive and descriptive norms, alcohol, and alcohol-related problems. The study also conceptualized and tested an idea termed intrapersonal value-attitude relationship, which was an interaction between values and attitudes. The current study employed a cross-sectional design utilizing a paper-and pencil survey administered to college students (n=910) within the classrooms. Personal attitudes and perceived descriptive norms of alcohol-related problems consistently predicted alcohol use and alcohol-related problems even after controlling for potential confounding variables. The exploration of the innovative concept of intrapersonal value-attitude relationship is a first step to examine the complex relationships between values and attitudes. Findings from this study suggest that the examination of values, attitudes, injunctive and descriptive norms are relevant and worth investigating further in regard to alcohol use and other health behaviors.
A survey examining the nonmedical use and diversion of prescription stimulant medications among college students using the theory of planned behavior
(University of Alabama Libraries, 2011) Gallucci, Andrew Robert; Usdan, Stuart L.; University of Alabama Tuscaloosa
The purpose of this study was two-fold. First, the proposed study aimed to create a reliable survey instrument designed to examine the nonmedical use of prescription stimulants (NMUPS) and diversion behaviors using the Theory of Planned Behavior (TPB) among undergraduate students aged 18-24. Second, this study examined the utility of the TPB in predicting NMUPS and diversion behaviors. The study utilized a cross-sectional design (n=1,026) to administer an 88-question survey assessing the nonmedical use and diversion of prescription stimulants. As part of this survey, students responded to theory-based questions for both behaviors. Results of a principal components analysis suggested strong reliability in the survey's ability to measure the theoretical constructs of diversion and NMUPS. Further statistical analyses found utility for TPB in predicting NMUPS. However, TPB had limited ability in predicting the diversion behavior.
Nutrient intake and adequacy and consumption of food away from home of adults with children
(University of Alabama Libraries, 2011) Williams, Carolyn; Knol, Linda L.; Turner, Lori W.; University of Alabama Tuscaloosa
The dietary intake of Americans does not meet current recommendations. A greater desire for quick, convenient food options and food prepared outside the home (FAFH) may be two contributors to poor intake patterns. The Food Choice Process Model suggests that life changes such as becoming a parent may place additional time constraints on adults that in turn will impact on their food choices. Therefore, the purpose of this study was to examine differences in dietary intake of U.S. adults by (a) child presence in the household and (b) child presence plus frequency of FAFH. A sample of 4,904 adults, 18 to 50 years, was selected from the National Health and Nutrition Examination Survey (2005 to 2008). Using linear regression and logistic regression models, dietary intake was compared based on child presence in the household while controlling for variables that represented constructs of the Food Choice Process Model. When compared to females without children, females with children consumed significantly less fiber and were less likely to meet their fiber requirements. When examined by child presence and FAFH frequency, females with low FAFH frequency (1 or fewer FAFH meals per week) without children in the household had significantly lower total fat, saturated fat, and sodium intakes compared to high frequency users regardless of child presence. Females with children with high FAFH frequency (2 or more FAFH meals per week) were less likely to meet the recommendations for fiber intake and more likely to exceed the recommendations for sodium intake compared to females with children with low FAFH frequency. There were no clinically relevant findings for men. Dietary intake of women but not men changes based on whether a child is present in the household and meals are consumed away from home.
Association between stroke risk factors and access to care
(University of Alabama Libraries, 2011) Parton, Jason Michael; Higginbotham, John C.; University of Alabama Tuscaloosa
A number of medically diagnosed risk factors are associated with an increased risk of having a stroke. Individuals recognized with hypertension, diabetes, and dyslipidemia all show greater probability of experiencing a stroke. Rural inhabitants are often considered to have limited access to health care, thus frequently decreasing the likelihood of their being aware of, treated, or controlled for these and other stroke-risk factors. This investigation provides an avenue for exploration into the association nontraditional risk factors for stroke, rural/urban designation, and travel time to a usual source of health care have on awareness, treatment, and control of hypertension, diabetes, and dyslipidemia. The association between awareness, treatment, and control of stroke-risk factors and an individual's rural/urban status was investigated to identify geographic disparities. Furthermore, travel time to a participant's usual source of medical care was explored for its relationship to these stages of stroke-risk factors and to investigate how travel time might influence the association between these factors and rural/urban status. No associations were identified for the main effects between the likelihood of being aware of, treated, or controlled for stroke-risk factors, and living in rural and urban settings. Drive time showed no relationship with these stages of stroke-risk factors, nor did it modify the effect rural or urban status had on the dependent variables. Disparities were noted for demographic, socioeconomic, and health behavioral traits for all three risk factors. This project made use of REGARDS study data sources to provide an understanding of stroke disparities for a certain geographic dimension. However, these data alone are unable to specifically identify rural and urban differences in stroke-risk factors and assess what effects access to health care has on the management of stroke-risk factors. The results from this investigation specify limited variability for management of these conditions by this study's measures of access to care.

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