Determinants of Low-Income Women's Participation in Self-Collected Samples for Cervical Cancer Detection: Application of the Theory of Planned Behavior.

BACKGROUND: Low-income women (LIW) are underrepresented in physician-provided cervical cancer screening. Providing women with an option for Human Papillomavirus (HPV) self-sampling would increase cervical cancer screening. However, little is known about LIW's attitude towards self-sampling for cervical cancer. We determined the associations between the Theory of Planned Behavior (TPB) constructs and LIW intention for participation in the HPV self-sampling. METHODS: A 44-item survey was administered among women receiving food from a food pantry in central Texas. Independent variables included TPB constructs (i.e., attitudes, subjective norms, and perceived control). The outcome variables were intentions and preference for self-sampling. Both variables were measured on a 5-point scale. Hierarchical linear regression models were used to analyze the data. RESULTS: A sample of 241 participants (age 50.13 ± 9.60 years) comprising non-Hispanic White (40%), Black/African American (27%), and Hispanic (30%) participated in the study. The participants were current with a pap test (54.8%) and preferred self-sampling (42%). The participant's attitudes and subjective norms were significantly associated with their intention for self-sampling, accounting for 38.7% of the variance (p < .001). Women who were overdue for pap testing versus current with pap testing had increased odds of preferring self-sampling (OR = 1.72, 95% CI: 1.27, 6.04). CONCLUSIONS: The key predictors for LIW's intention for self-sampling included attitudes and subjective norms. Future research should use the TPB as a framework to examine whether intention predicts self-sampling behavior among LIW.

Assessment of university policies for service animals and emotional support animals.

OBJECTIVE: Assess administrative responsibilities and experiential effects of emotional support animal (ESA) and service animal (SA) policies on college campuses. PARTICIPANTS: Students at two four-year universities participated in an emotional support animals and service animals survey. Selected students and professional personnel participated in interviews and focus groups. METHODS: This mixed-methods study included quantitative survey data from 1,363 students, qualitative individual interviews (3) and a focus group (1) regarding emotional support animal (ESA) and service animal (SA). RESULTS: Seventy-one students reported having ESAs, 18 had SAs. Barriers for ESAs on campus included no ESAs outside of dorms, while SA-owners reported fewer barriers. University administrators followed federal guidelines for SAs but lacked clear guidelines for ESAs. Qualitative themes included lack of awareness, education, support for SA, and ESA accommodations. CONCLUSIONS: ESA and SA accommodations continue to rise, on university campuses. Clear guidelines and implementation processes are imperative for future improvements.

Feasibility of Utilizing Social Media to Promote HPV Self-Collected Sampling among Medically Underserved Women in a Rural Southern City in the United States (U.S.).

BACKGROUND: Social media (Facebook, WhatsApp, Instagram, Twitter) as communication channels have great potential to deliver Human papillomavirus self-test (HPVST) intervention to medically underserved women (MUW) such as women of low income. However, little is known about MUW's willingness to participate in HPVST intervention delivered through social media. We evaluated factors that contribute to MUW's intention to participate in the social media-related intervention for HPVST. METHODS: A 21-item survey was administered among women receiving food from a local food pantry in a U.S. southern state. Independent variables were social media usage facilitators (including confidentiality, social support, cost, and convenience), and barriers (including misinformation, time-consuming, inefficient, and privacy concerns). Dependent variables included the likelihood of participating in social-driven intervention for HPVST. Both variables were measured on a 5-point scale. We used multinomial logistic regression to analyze the data. RESULTS: A total of 254 women (mean age 48.9 ± 10.7 years) comprising Whites (40%), Hispanics (29%), Blacks (27%), and Other (4%) participated in the study. We found that over 44% of the women were overdue for their pap smears for the past three years, 12% had never had a pap smear, and 34% were not sure if they had had a pap smear. Over 82% reported frequent social media (e.g., Facebook) usage, and 52% reported willingness to participate in social media-driven intervention for HPVST. Women who reported that social media provide privacy (Adjusted Odds Ratio (AOR) = 6.23, 95% CI: 3.56, 10.92), provide social support (AOR = 7.18, 95% CI: 4.03, 12.80), are less costly (AOR = 6.71, 95% CI: 3.80, 11.85), and are convenient (AOR = 6.17, 95% CI: 3.49, 10.92) had significantly increased odds of participating in social media intervention for HPVST. CONCLUSIONS: The findings underscore that the majority of the MUW are overdue for cervical cancer screening, regularly use social media, and are willing to participate in social media-driven intervention. Social media could be used to promote HPV self-testing among MUW.

Internal and External Validity of Social Media and Mobile Technology-Driven HPV Vaccination Interventions: Systematic Review Using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework.

Social media human papillomavirus (HPV) vaccination interventions show promise for increasing HPV vaccination rates. An important consideration for the implementation of effective interventions into real-world practice is the translation potential, or external validity, of the intervention. To this end, we conducted a systematic literature review to describe the current body of evidence regarding the external validity of social media HPV vaccination-related interventions. Constructs related to external validity were based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. Seventeen articles published between 2006 and 2020 met the inclusion criteria. Three researchers independently coded each article using a validated RE-AIM framework. Discrepant codes were discussed with a fourth reviewer to gain consensus. Of these 17 studies, 3 were pilot efficacy studies, 10 were randomized controlled trials (RCTs) to evaluate effectiveness, 1 was a population-based study, and 3 did not explicitly state which type of study was conducted. Reflecting this distribution of study types, across all studies the mean level of reporting RE-AIM dimensions varied with reach recording 90.8%, effectiveness (72.1%), adoption (40.3%), implementation (45.6%), and maintenance (26.5%). This review suggests that while the current HPV vaccination social media-driven interventions provide sufficient information on internal validity (reach and effectiveness), few have aimed to gather data on external validity needed to translate the interventions into real world implementation. Our data suggest that implementation research is needed to move HPV vaccination-related interventions into practice. Included in this review are recommendations for enhancing the design and reporting of these HPV vaccination social media-related interventions.

An epidemiologic study of suicide among firefighters: Findings from the National Violent Death Reporting System, 2003 - 2017.

Suicide is a significant concern among fire service due to high rates of suicide behaviors. The aim of this study was to describe suicides among firefighters using national suicide death data. Data from the National Violent Death Reporting System for 722 firefighters and 192,430 non-firefighters were analyzed to compare sociodemographics and risk factors between firefighter and non-firefighter decedents; and among firefighters based on suicide means. A greater proportion of firefighter decedents died by firearm compared to non-firefighters. Firefighter decedents were less likely to have been diagnosed with depression, but more likely to have been diagnosed with post-traumatic stress disorder compared to non-firefighters. A greater percentage of firefighter decedents had a relationship or physical health problem prior to death, but a lower percentage had a history of suicide thoughts/attempts. Among firefighter decedents, multivariate analysis showed physical health problems and disclosing suicide intent predicted death by firearm. Greater awareness of risk factors, reduced access to lethal means, and ensuring access to behavioral health services may aide in decreasing suicide mortality in this population. These findings should be interpreted with caution due to limitations concerning report accuracy, generalizability, small female sample size, and inclusion of data only for lethal suicide attempts.

Associations Between Social Capital and Depressive Symptoms Among College Students in 12 Countries: Results of a Cross-National Study.

INTRODUCTION: A mental health crisis has hit university campuses across the world. This study sought to determine the prevalence and social determinants of depressive symptoms among university students in twelve countries. Particular focus was placed on the association between social capital and depressive symptoms. METHODS: A cross-sectional study was conducted among students at their first year at university in Europe, Asia, the Western Pacific, and Latin and North America. Data were obtained through a self-administered questionnaire, including questions on sociodemographic characteristics, depressive symptoms, and social capital. The simplified Beck's Depression Inventory was used to measure the severity of depressive symptoms. Social capital was assessed using items drawn from the World Bank Integrated Questionnaire to Measure Social Capital. Multilevel analyses were conducted to determine the relationship between social capital and depressive symptoms, adjusting for individual covariates (e.g., perceived stress) and country-level characteristics (e.g., economic development). RESULTS: Among 4228 students, 48% presented clinically relevant depressive symptoms. Lower levels of cognitive (OR: 1.82, 95% CI: 1.44-2.29) and behavioral social capital (OR: 1.51, 95% CI: 1.29-1.76) were significantly associated with depressive symptoms. The likelihood of having depressive symptoms was also significantly higher among those living in regions with lower levels of social capital. CONCLUSION: The study demonstrates that lower levels of individual and macro-level social capital contribute to clinically relevant depressive symptoms among university students. Increasing social capital may mitigate depressive symptoms in college students.

Multi-Theory Model and Predictors of Likelihood of Accepting the Series of HPV Vaccination: A Cross-Sectional Study among Ghanaian Adolescents.

HPV vaccines are efficacious in preventing HPV related cancers. However, the vaccination uptake in Ghana is very low. Studies that utilize theoretical frameworks to identify contributory factors to HPV vaccination uptake in Ghana are understudied. We used multi-theory model (MTM) constructs to predict initiation and completion of HPV vaccination series in Ghanaian adolescents. Adolescents (n = 285) between the ages of 12 and 17 years old were recruited from four selected schools in Ghana to participate in the cross-sectional study. Linear regressions were used to analyze the data. Most participants were female (91.2%) and senior high school students (60.0%). Many of the participants had neither heard about HPV (92.3%) nor HPV vaccinations (95.4%). Significant predictors of adolescents' likelihood of getting the first dose of HPV vaccination were perceived beliefs and change in a physical environment (p < 0.001), with each variable accounting for 6.1%and 8.8% of the variance respectively. Significant predictors of adolescents' likelihood of completing HPV vaccination recommended series were perceived beliefs, practice for change, and emotional transformation (p < 0.001), with each variable accounting for 7.8%, 8.1%, and 1.1% of the variance respectively. Findings underscore important opportunities for developing educational interventions for adolescents in Ghana to increase the HPV vaccination uptake.

A Systematic Review of Dating Violence Risk Factors Among Undergraduate College Students.

College students are a vulnerable population for dating violence (DV) because of the social environment in which they live and interact with other students. Campus climate surveys are considered best practice for gathering information about the severity and cause of college DV; however, there are still unanswered questions as to why DV remains an alarming public health concern among college students. The aim of this systematic literature review was to examine DV risk factors specific to college students with a special focus on methodological factors and gaps in the literature. Databases EBSCO, Scopus, PsycINFO, MEDLINE, ERIC, and PubMed were searched for articles published between 2006 and 2016, resulting in 23 articles that met inclusion criteria for this review. Very few studies were conducted at private universities (n = 4). Most researchers used descriptive cross-sectional surveys (n = 22), while only one utilized a mixed-methods approach. Measurement scales used to collect DV rates were similar across studies, yet the definition of DV was inconsistent. Types and severity of DV varied across studies, but overall, females were more likely to perpetrate and/or experience DV than males. Individual risk factors (e.g., substance use, risky sexual behaviors) were identified more often than family risk factors (e.g., intergenerational violence) and peer and social risk factors (e.g., Greek-life or athletic team membership, relationship type). A better understanding of new college relationships is critical to identify modifiable risk factors for DV. Recommendations for future practice and research are also discussed.

Sex Education and HIV Testing Among Young Men Who Have Sex With Men: Findings From the 2006-2010 and 2011-2015 National Survey of Family Growth.

BACKGROUND: Young men who have sex with men (YMSM) are disproportionally affected by HIV and exhibit low levels of HIV testing. The purpose of this study was to examine the relationship between sex education and subsequent HIV testing among YMSM. METHODS: Data from sexually active men aged 15-24 years at interview in the 2006-2010 or 2011-2015 National Survey of Family Growth. Sex education included 3 contexts [formal institutions (eg, schools), parents, and health care providers] and specific topics. Outcome variables were ever- and recent-HIV testing. Multivariate models were adjusted for sociodemographics, and data were weighted to account for the complex survey sampling design. RESULTS: A total of 323 sexually active YMSM met inclusion criteria. Overall, 42.4% had ever-tested for HIV and 16.9% tested in the previous 12 months. YMSM were more likely to have ever-tested for HIV if they talked with a parent/guardian about how to prevent HIV/AIDS [adjusted prevalence ratio (aPR) = 1.48; 95% confidence interval (CI): 1.07 to 2.06], talked with a health care provider about how HIV/AIDs is transmitted (aPR = 1.64; 95% CI: 1.13 to 2.38), sexually transmitted diseases (aPR = 1.49; 95% CI: 1.02 to 2.19), condom use (aPR = 1.61; 95% CI: 1.13 to 2.30), and the importance of HIV testing (aPR = 1.83; 95% CI: 1.22 to 2.73). CONCLUSIONS: Tailored sex education by parent(s) and health care providers related to HIV/AIDS seems to significantly increase the likelihood of HIV testing among YMSM.

Simple screening tools to identify limited health literacy in a low-income patient population.

Adults with limited health literacy have difficulty managing chronic conditions, higher hospitalization rates, and more healthcare expenditures. Simple screening tools have been developed, but limited work has evaluated instruments among low-income populations. This study assessed health literacy among primary care patients of a federally qualified health center, and compared a single screening question about perceived difficulty completing medical forms.A cross-sectional survey was administered to English-speaking patients ≥40 years. Both the Newest Vital Sign (NVS), a 6-item questionnaire, and a single-item screening question about perceived difficulty with completing medical forms, assessed health literacy. Logistic regression was used to identify predictors of inadequate health literacy and receiver operator curves compared the NVS and single-item question.Participants (n = 406) were, on average, aged 58.5 years (±11.3), 72.2% female, and identified as Hispanic/Latino (19.2%), non-Hispanic white (31.0%), non-Hispanic black (40.9%), or other (8.9%). Of the 406 participants, 335 (82.5%) completed the NVS. Patients who declined NVS were more likely to be older (P < .001) and male (P = .01). Only 13.7% had adequate health literacy. Older adults, Hispanic and non-Hispanic black patients, patients with missed office visits, and those reporting less confidence completing medical forms were significantly more likely to have inadequate health literacy. Perceived confidence completing medical forms demonstrated low sensitivity but high specificity at multiple thresholds.This is the first investigation to compare the NVS and confidence completing medical forms question. Many patients declined health literacy assessments, but health literacy screening may identify patients who need additional health education and resources.

Effects of equine assisted activities on autism spectrum disorder.

Quality of life assessments were used in this study to determine the behavioral changes of children diagnosed with autism spectrum disorder (ASD) who participated in equine assisted activities. Behavioral changes of children with ASD participating in 9 weeks of equines assisted activities (EAA) (N = 10) were compared to behavioral changes of children who participated in a non-equine intervention (N = 8). Parents noted significant improvements in their child's physical, emotional and social functioning following the first 6 weeks of EAA. The children participating in the non-equine program also demonstrated improvement in behavior, but to a lesser degree. The favorable outcome of this study lends support for continuation of programs utilizing EAA in the treatment of children with ASD.

Systemic glucose level changes with a carbohydrate-restricted and higher protein diet combined with exercise.

OBJECTIVE: The authors' purpose in this study was to compare the effects of macronutrient intake on systemic glucose levels in previously sedentary participants who followed 1 of 4 diets that were either higher protein or high carbohydrate, while initiating an exercise program. PARTICIPANTS AND METHODS: The authors randomly assigned 94 sedentary participants to 1 of 4 diet groups consisting of Diet 1 (55% carbohydrate, 30% fat, 15% protein), Diet 2 (55% carbohydrate, 30% fat, 15% protein and caloric restriction), Diet 3 (40% carbohydrate, 30% fat, 25% protein), and Diet 4 (40% carbohydrate, 30% fat, 25% protein and caloric restriction) and followed recommended aerobic exercise prescriptions. RESULTS: Repeated measures analyses of variance (ANOVA) revealed a significant time factor (p=.021) but no significant differences between diet groups (p=.207). A trend was evident in the higher protein groups, with a 5.2% decrease in glucose levels with Diet 3 and 5.0% with Diet 4. Although glucose levels changed over time with the greatest changes in the 2 higher protein diets, levels were not significantly different within participants. CONCLUSIONS: The results of the study indicate that systemic glucose availability was affected by higher protein consumption in Diet 3 participants, with the same trend in Diet 4 participants, although nonsignificant. These findings demonstrate that consuming a lower carbohydrate diet for 12 weeks can possibly change systemic glucose levels.

Comparison of lipid measures and risk stratification among end-stage renal disease patients.

BACKGROUND: Abnormal lipid profiles are associated with end-stage renal disease (ESRD) which significantly contributes to an accelerated progression of coronary artery disease. The purpose of this study was to examine the relationships between cholesterol measures and differences in risk stratification when using National Cholesterol Education Program, Adult Treatment Panel, Third Report (ATP-III) guidelines, compared with cholesterol particle number and size in ESRD patients. METHODS: Lipid profiles were conducted on 541 ESRD patients who were chronic hemodialysis patients. Lipid profiles were measured using gel electrophoresis and their particle size and concentration measured using nuclear magnetic resonance (NMR) spectroscopy. Correlations and risk stratification were compared between each lipid measure. RESULTS: The findings suggest that low-density lipoprotein (LDL) size does not correlate well with LDL cholesterol and LDL particle number. The findings also suggest a "disconnect" between traditional lipid measures and cholesterol concentration and size when using ATP-III guidelines for risk stratification. CONCLUSIONS: The cholesterol risk designation variances between risk stratification guidelines and the relationships established through Pearson correlations, as illustrated within this patient pool, reveal the complex differences between measures of coronary artery disease risk. These additional patients considered at-risk using NMR technology may help to identify more patients at need for intervention and treatment.

Relations of sex, age, perceived fitness, and aerobic activity with social physique anxiety in adults sixty years and older.

Self-reported physical activity, and perceived fitness were examined to assess their effects on social physique anxiety in a sample of older individuals (N= 249; M age=70.4 yr., SD=8.2). Participants reported their fitness as "average" to "above average." There were no significant effects of perceived fitness or age on social physique anxiety scores. The women had significantly higher social physique anxiety scores than the men.