Factors associated with intentions to seek formal and informal mental health help among college students with suicidal thoughts and behaviors.

OBJECTIVE: Identify factors associated with formal and informal mental health help-seeking intentions among college students reporting suicidal thoughts and behaviors (STBs). PARTICIPANTS: College students with STBs in the 2018-2020 Healthy Minds Study. METHODS: Cross-sectional secondary analysis using logistic regressions to determine whether demographic (age, sex, race, religion, and finances) and psychosocial factors (mental health, perceptions about mental health help, and barriers) are associated with (in)formal help-seeking intentions. RESULTS: Positive significant factors for all help-seeking intentions included being in a romantic relationship, Christian, symptoms of anxiety, or positive beliefs and knowledge about therapy efficacy. Depressive symptoms, Black/African American, psychological inflexibility, low perceived need, and barriers were negatively associated. Informal help-seeking was negatively associated with Hispanic/Latinx and personal stigma toward mental health. Formal help-seeking was positively associated with Asian/Asian American and negatively associated with financial stress. CONCLUSIONS: Unique factors were associated with formal or informal help-seeking intentions in college students with STBs.

Enhancing Patient-Provider Breastfeeding Conversations: Breastfeeding Intention and Prenatal Breastfeeding Self-Efficacy among a Sample of Pregnant Women.

OBJECTIVES: The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women. METHODS: Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors. RESULTS: The participants in the final analysis (N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women (P ≤ 0.05), those with a high school education or less (P ≤ 0.019), single women (P ≤ 0.028), and those who had no breastfeeding experience (P ≤ 0.035). CONCLUSIONS: Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.

Homemade infant formula recipes may contain harmful ingredients: a quantitative content analysis of blogs.

OBJECTIVE: When breast-feeding is not possible, commercially made human milk substitute is recommended. Some consumers would prefer to make their own homemade infant formula (HIF) and may seek information on this practice from internet sources. The purpose of the current study was to investigate the content of blogs posting HIF recipes. DESIGN: Blog postings were identified through a comprehensive search conducted using the Google search engine and the following search terms along with the term 'blog': 'Make Your Own Baby Formula', 'Homemade Baby Formula', 'Do It Yourself (DIY) Baby Formula', 'DIY Baby Formula', 'Baby Formula Recipe' and 'All Natural Baby Formula'. A quantitative content analysis of blogs offering recipes for HIF was completed. Blogs that met the inclusion criteria were reviewed for disclaimers, blogger's credentials, rationale for HIF use, advertisement or sale of recipe ingredients and recipe ingredients. SETTING: Worldwide Web. RESULTS: Fifty-nine blogs, featuring one hundred forty-four recipes, met inclusion criteria. Among reviewed blogs, 33·9 % did not provide a disclaimer stating breast milk is the preferred option, 25·4 % recommended consulting a healthcare professional before using, and 76·3 % and 20·3 % either advertised or sold ingredients or recipe kits, respectively. Credentials of bloggers varied and only seven bloggers identified themselves as 'nutritionists'. The three most frequently mentioned recipe ingredients were whole raw cow's milk (24·3 %), raw goat's milk (23·6 %) and liver (14·5 %). CONCLUSIONS: Clinicians should be aware of this trend, discuss source of formula with parents, advocate for appropriate infant feeding practices and monitor for side effects.

Nutrition Provider Isolation Is Related to Increased Preference for Enteral Nutrition-Support in Patients With Advanced Dementia.

BACKGROUND: Current guidelines advise against using enteral nutrition (EN) support for patients with advanced dementia (AD) because of negative outcomes. However, research suggests that some registered dietitian nutritionists (RDNs) in acute-care settings still recommend EN for this patient population. The purpose of this study was to identify workplace characteristics that influence the EN recommendations of acute-care RDNs who care for patients with AD. METHODS: A random sample of 5000 RDNs in the United States were invited to participate in a web-based survey in which RDNs self-reported the likelihood that they would recommend EN for a patient with AD. Inclusion criteria specified that participants were at least 18 years of age, were an RDN in the United States, and currently provide nutrition care to older adults with dementia. χ2 tests compared RDN recommendations by workplace characteristics. Logistic regression was used to determine factors associated with recommending EN for patients with AD. RESULTS: Respondents included 204 acute-care RDNs. RDNs in rural or suburban locations were 2.4 times more likely to recommend EN compared with those in urban facilities (95% CI, 1.1-5.1). RDNs who were the only nutrition provider at their facility were 3.3 times more likely to recommend EN than those in facilities with multiple RDNs (95% CI, 1.4-7.9). CONCLUSION: Acute-care RDNs who are isolated either in rural facilities or because they lack other RDN colleagues at their facility may benefit from targeted interventions to increase knowledge and promote adherence to evidence-based guidelines.

Practitioner Knowledge, Personal Values, and Work Setting Influence Registered Dietitians' Feeding Tube Recommendations for Patients With Advanced Dementia.

BACKGROUND: Current guidelines discourage tube-feeding older adults with advanced dementia (AD), as this practice does not improve nutrition status or survival and decreases quality of life in these patients. Because registered dietitians (RDs) often provide feeding recommendations for patients with AD, this study aimed to identify factors that influenced RDs' feeding tube recommendations for older adults with AD. METHODS: A random sample of RDs who work with older adults in the United States completed a validated, electronic survey. Logistic regression analysis was used to identify factors related to the likelihood of RDs recommending a feeding tube for patients with AD. Independent variables included participant demographics and the 6 subscales of the Attitudes Toward Tube-Feeding in Advanced Dementia Questionnaire, which measured individual and environmental influences on RDs' recommendations. RESULTS: Among the 662 RDs who responded, 72.2% were unlikely to recommend a feeding tube in patients with AD, and 15.4% were likely to do so (with the remaining being "neutral"). Factors associated with avoiding recommending a feeding tube include significantly higher total knowledge [odds ratio (OR) = 1.47, 95% CI (1.30, 1.66)] and personal values scores [OR = 7.51, 95% CI (3.96, 14.24)] and employment in long-term care settings [OR 3.29, 95% CI (1.38, 7.80)]. CONCLUSION: In this survey, most RDs were likely to make recommendations that are consistent with current guidelines for tube feeding patients with AD. RDs who work outside the long-term care setting may benefit from additional training. Future research is needed to understand how personal values may influence recommendations.

The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale: A New Measurement Instrument for Prenatal Breastfeeding Self-efficacy.

BACKGROUND:: Breastfeeding self-efficacy and breastfeeding intention are two modifiable factors that influence rates of breastfeeding initiation. RESEARCH AIMS:: (1) To develop a scale to measure prenatal breastfeeding self-efficacy, and (2) test its psychometric properties by determining the internal consistency and reliability, and (3) assess the relationships between prenatal breastfeeding self-efficacy and breastfeeding intention. METHODS:: Cross-sectional prospective one-group survey design was used. A convenience sample of pregnant patients attending an obstetrics and gynecology clinic ( N=124) completed a survey at the recruitment site that assessed demographics, breastfeeding intention, and breastfeeding self-efficacy theory constructs. Retest surveys ( n=14) were taken home and returned to the researcher by mail after completion. RESULTS:: Cronbach's alpha for the 39-item scale was .98 (test) and .97 (retest) with an item-to-total correlation range of .54 to .78. A four-factor solution for the scale was retained. Test-retest indicated each factor was significant and highly correlated: Individual Processes (.88, p < .001), Interpersonal Processes (.893, p < .001), Professional Advice (.919, p < .001), and Social Support (.880, p < .001). Overall prenatal breastfeeding self-efficacy score was highly correlated (.610, p <.001) with breastfeeding intention scores. CONCLUSIONS:: The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale is a valid and reliable measure of a prenatal women's self-efficacy in preparation to breastfeed. Measuring the level of self-efficacy could alert prenatal women and health professionals to individual skill sets.

The Attitudes Toward Tube-Feeding in Advanced Dementia (ATT-FAD) Questionnaire: A Valid and Reliable Tool.

Registered Dietitians (RDs) should participate in interdisciplinary feeding discussions for patients with advanced dementia, but research on how RDs make such feeding recommendations is scarce. This study developed and validated a theory-based questionnaire to assess the knowledge, beliefs, and attitudes of RDs regarding feeding tube use among older adults with advanced dementia. The instrument was drafted based on the Social Ecological Model, and face and content validity were established through an expert panel review. Pilot testing with 70 RDs provided an initial measure of internal consistency reliability and reduced the number of items in the survey. Efficacy testing with 662 RDs allowed for a second analysis of internal consistency reliability and eliminated additional items. Construct validity was then established using validation by extreme groups and exploratory factor analysis, yielding six subscales, each with adequate internal consistency and test-retest correlation coefficients: (I) Total Knowledge, (II) Knowledge Self-Efficacy, (III) Religion/Spirituality/Culture, (IV) Personal Values, (V) Perceived Organization and Training, and (VI) Perceived Policy. The survey, based on the Social Ecological Model, was deemed a valid and reliable tool to assess RDs' knowledge and attitudes regarding feeding tube use among older adults with advanced dementia.

Social Ecological Perspectives of Tube-Feeding Older Adults with Advanced Dementia: A Systematic Literature Review.

Dementia is a progressive, debilitating disease that often results in weight loss, malnutrition, and dehydration. Feeding tubes are often prescribed; however, this practice can lead to complications. The purpose of this systematic review was to examine the use of feeding tubes in elderly demented patients from a social ecological perspective. Results indicated that family members often receive inadequate decision-making education. Many health care professionals lack knowledge of evidence-based guidelines pertaining to feeding tube use. Organizational and financial reimbursement structures influence feeding tube use. Feeding practices for patients with advanced dementia is a complex issue, warranting approaches that target each level of the Social Ecological Model.

College Students Must Overcome Barriers to Use Calorie Labels in Fast-Food Restaurants.

OBJECTIVE: To explore predictors of intention of college students to use calorie labels on fast-food menus and differences in calories ordered after viewing calorie information. DESIGN: Quasi-experimental design. Participants selected a meal from a menu without calorie labels, selected a meal from the same menu with calorie labels, and completed a survey that assessed demographics, dietary habits, Theory of Planned Behavior constructs, and potential barriers to use of calorie labeling. SETTING: A southern university. PARTICIPANTS: Undergraduate university students (n = 97). MAIN OUTCOME MEASURES: Predictors of intention to use calorie labels and whether calories selected from the nonlabeled menu differed from the labeled menu. ANALYSIS: Confirmatory factor analysis, exploratory factor analysis, multiple regression, and paired t tests. RESULTS: Participants ordered significantly fewer calories (P = .02) when selecting from the labeled menu vs the menu without labels. Attitudes (P = .006), subjective norms (P < .001), and perceived behavioral control (P = .01) predicted intention to use calorie information but did not predict a difference in the calories ordered. Hunger (P = .03) and cost (P = .04) were barriers to using the calorie information. CONCLUSIONS AND IMPLICATIONS: If students can overcome barriers, calorie labeling could provide information that college students need to select lower-calorie items at fast-food restaurants.

Gender differences in college leisure time physical activity: application of the theory of planned behavior and integrated behavioral model.

OBJECTIVE: National data consistently report that males participate in leisure time physical activity (LTPA) at higher rates than females. This study expanded previous research to examine gender differences in LTPA of college students using the theory of planned behavior (TPB) by including 2 additional constructs, descriptive norm and self-efficacy, from the integrated behavioral model. PARTICIPANTS: Participants were college students (N = 621) from a large public university in the southeastern United States. METHODS: A self-report, classroom-based assessment with validated and reliable measures of LTPA, TPB constructs, descriptive norm, self-efficacy, and demographics was conducted in fall 2009. RESULTS: Regression analyses revealed attitude (ß = .119), intention (ß = .438), self-efficacy (ß = .166), body mass index (BMI) (ß = -.084), and sports participation (ß = .081) as significantly associated with LTPA for females (R (2) = .425, p < .001), whereas intention (ß = .371) was significant for males (R (2) = .202, p < .001). CONCLUSIONS: Practitioners should consider tailoring promotional materials to address these gender differences in efforts to increase LTPA participation among college students.

Mandating nutrient menu labeling in restaurants: potential public health benefits.

RATIONALE: Many Americans have replaced home-cooked meals with fast food and restaurants meals. This contributes to increased incidences of overweight and obesity. Implementing policies that require restaurants to disclose nutrition information has the potential to improve nutrition knowledge and food behaviors. The purpose of this paper was to examine the potential health benefits of nutrient menu labeling in restaurants, the progress of this legislation and to provide results regarding the implementation of these policies. METHOD: Data sources were obtained from a search of multiple databases including PubMed, Science Direct, Academic Search Premier, and Google Scholar. Study inclusion criteria were publication in the past ten years, obesity prevention, and utilization of nutrition labeling on menus in restaurants. RESULTS: The initial policies to provide consumers with nutrition information in restaurant settings began at the state levels in 2006. These laws demonstrated success, other states followed, and a national law was passed and is being implemented. DISCUSSION: Mandating nutrient menu disclosure has the potential to influence a large number of people; this legislation has the opportunity to impact Americans who dine at a fast food or chain restaurant. Given the growing obesity epidemic, continued research is necessary to gauge the effectiveness of this new law and its effects on the health status of the American people.

Physical Activity and Social Cognitive Theory Outcomes of an Internet-Enhanced Physical Activity Intervention for African American Female College Students.

BACKGROUND: African American women report low levels of physical activity (PA) and are disproportionately burdened by related chronic diseases. This pilot study tested a 6-month theory-based (Social Cognitive Theory, SCT) culturally-relevant website intervention to promote PA among African American female college students. MATERIALS AND METHODS: A single group pre-post test design (n=34) was used. PA and associated SCT constructs (outcome expectations, enjoyment, self-regulation, social support) were assessed at baseline, 3 months and 6 months. RESULTS: The sample was comprised of mostly obese (M BMI= 35.4, SD=6.82) young adults (M age= 21.21 years, SD=2.31). Fifty percent of the sample completed all assessments. Intent-to-treat analyses showed that participants reported a significant median improvement in moderate-to-vigorous physical activity from 82.5 minutes/week (M=81.76, SD=76.23) at baseline to 115.0 minutes/week (M=122.44, SD=97.93) at 3 months (Wilcoxon z=2.39, p=.02). However these gains appear to have attenuated by 6 months (Median= 82.5 minutes/week, M=96.73, SD=84.20; Wilcoxon z=1.02, p=.31). Significant increases from baseline to 6 months were found in self-regulation for PA (p=.02) and social support for PA from friends (p=.02). Changes in the SCT variables were not significantly associated with changes in PA; however, this may have been due to small sample size. CONCLUSIONS: Future studies with larger samples and more aggressive retention strategies (e.g., more frequent incentives, prompts for website use) are needed to further explore the applicability of web-based approaches to promote PA in this at-risk population.

Comparison of bone mineral density measurements at different sites: applications for primary care providers.

Bone densitometry is an effective screening tool for osteoporosis; however, problems may exist when patients present with high variability between readings at different sites. The purpose of this study was to compare bone mineral density measures of the femur, spine and whole body using dual-energy x-ray absorptiometry. While correlations between anatomic regions were high, substantial variability existed for participants which presents the potential for misdiagnosis and confusion. Densitometry screening using both spine and femur is recommended; information regarding readings that are variable are provided. Applications for bone mineral density screening and counseling are presented for primary care physicians.

Application of ecological models to risks related to being overweight among nurses.

This paper provides a discussion of environmental strategies to improve health behaviors of nurses. Behavioral choices, partly due to social and environmental factors, influence risk of chronic disease. Strategies that modify environments are critical components of public health interventions, particularly those concerned with improving diet and physical activity. Nurses' health behaviors may be especially important, due to their influence as models when caring for patients. Modifications in work environments may enable nurses to acquire and maintain healthy behaviors.

Suitability of written supplemental materials available on the Internet for nonprescription medications.

PURPOSE: The suitability, readability, and cultural appropriateness of written supplemental materials available on the Internet for nonprescription medications were examined. METHODS: We videotaped 48 hours of television programming, recording a total of 152 advertisements highlighting 37 unique nonprescription medications. The supplemental materials corresponding to each advertised medication were downloaded and printed in their entirety from each product-specific Web site. These materials were assessed using the Suitability Assessment of Materials (SAM) instrument. Total SAM scores were grouped as follows: not suitable (0-39%), adequate (40-69%), and superior (70-100%). The Fry readability formula was used to determine the reading grade level for the materials assessed with the SAM instrument. RESULTS: The mean +/- S.D. SAM score of all materials was 54.9% +/- 0.1% (range, 38-76%). Materials for the majority of drugs (86.5%, n = 32) were rated adequate. Materials for four drugs (10.8%) were rated superior, and the material for one drug was not suitable. While the total SAM scores were adequate for most of the materials evaluated, the majority of materials scored particularly poorly for their reading level (the materials for 81.1% of drugs were not suitable). The materials for 40.9% of drugs used uncommon words. CONCLUSION: Evaluation of the suitability, readability, and cultural appropriateness of written supplemental materials for nonprescription medications available on manufacturer-sponsored Web sites and intended for consumers or patients revealed that SAM scores were adequate for most of the materials; however, many scored poorly in the areas of reading level and used uncommon words.

Evaluation of web-based osteoporosis educational materials.

BACKGROUND: Many women are unaware of risk factors for and consequences of osteoporosis. Hence, patient education is an essential step in preventing and managing osteoporosis. Unfortunately, numerous studies have demonstrated a mismatch between the reading difficulty of typical patient education materials and the reading ability of many American adults. METHODS: We examined the readability and quality of web-based information on osteoporosis using the Suitability Assessment of Materials (SAM) and DISCERN instruments. The three most widely used Internet search engines, Google, Yahoo, and MSN, were selected based on popularity according to Nielsen/Net Ratings. The search term osteoporosis was entered to generate the first 30 websites listed by each of the three search engines. Several websites appeared on all three search engines; we identified 27 unique websites. RESULTS: Overall, 51.9% of materials were rated by the SAM as not suitable. Most materials scored poorly for their reading level (82.6% were rated not suitable), with an average reading level at grade 11.5 +/- 2.8. The mean DISCERN score for overall description of treatment options was 35.7 +/- 18.0, indicating inadequate quality. Most materials had low quality in a number of indicators, including accuracy and biased presentation of information. CONCLUSIONS: Web-based osteoporosis information is written above the reading ability of most American adults, and much of it lacks adequate quality.

Predictors of patient education by bone densitometry technologists.

OBJECTIVE: This study investigated which factors predict the likelihood of densitometry technologists counseling their patients about osteoporosis prevention. METHOD: Predictors of osteoporosis prevention patient education by bone densitometry technologists were analyzed in a sample of 417 radiologic technologists with ARRT advanced certification in bone densitometry and 158 densitometry technologists, none of whom were ARRT certified in bone densitometry. RESULTS: The regression model accounted for 41% of the variation in reports of bone health counseling. Densitometry technologists with high internal motivation and low personal barriers reported educating their patients about osteoporosis prevention. CONCLUSION: Recommendations for increasing bone health promotion include increasing personal interest through sensitivity training, expanding delivery by promoting models for clinical implementation and creating educational opportunities to strengthen counseling skills.

Non-equipment exercise-related injuries among US women 65 and older: emergency department visits from 1994-2001.

The objective of this study was to estimate the relative frequency, types of injury, types of exercise, and mechanism of non-equipment exercise-related injury among women 65 and older. Methods included a descriptive analysis of emergency department (ED) visits to hospitals participating in the National Electronic Injury Surveillance System (NEISS). Researchers identified 851 exercise-related injuries to women 65 and older. Estimates are that 37729 older women were treated in emergency departments for injuries related to non-equipment type exercise activity from 1994-2001. Although there are many benefits to exercise, injuries due to overuse and existing physical conditions such as osteoporosis are a concern for active older women. Promotion of safe exercise activities and programs for older women are recommended.

Past and recent physical activity and bone mineral density in college-aged women.

Low bone mineral density (BMD) has been determined as an independent factor of osteoporosis. The purpose of this study was to assess physical activity's effect on BMD in college-aged women. Bone density measurements were obtained. A survey was administered to assess past and recent physical activity levels. Logistic regression revealed high school sports participation and lean tissue were significant predictors of femoral BMD, whereas present physical activity and lean tissue were significant predictors of spinal BMD. Women in the present study who did not participate in high school sports were 7 times more likely to have low BMD than were those who participated. This study revealed a protective effect of past and present physical activity on BMD in college-aged women. Children and young adults should be encouraged to participate in physical activity because it helps reduce their risk factors for osteoporosis later in life.

Risk factors for osteoporosis among middle-aged women.

OBJECTIVE: To investigate the risk factors for osteoporosis among a sample of middle-aged women. METHODS: Adipose tissue and bone mineral density levels at the left femur, lumbar spine, and total body were assessed using dual-energy x-ray absorptiometry (DXA). Subjects (n=342) were surveyed regarding a variety of osteoporosis-related risk factors. Forward stepwise multiple regression procedures were utilized. RESULTS: Menstrual status, hormone replacement therapy, adipose tissue, and dairy product intake were retained in the regression models. CONCLUSIONS: Osteoporosis prevention programs need to emphasize the importance of hormonal status and body composition in addition to obtaining adequate calcium intake.