Factors influencing older adults to complete advance directives.

OBJECTIVE: The purpose of this study was to determine the factors which influence advance directive (AD) completion among older adults. METHOD: Direct interviews of hospitalized and community-dwelling cognitively intact patients > 65 years of age were conducted in three tertiary teaching settings in New York. Analysis of AD completion focused on its correlation with demographics, personal beliefs, knowledge, attitudes, and exposure to educational media initiatives. We identified five variables with loadings of at least 0.30 in absolute value, along with five demographic variables (significant in the univariate analyses) for multiple logistic regression. The backward elimination method was used to select the final set of jointly significant predictor variables. RESULTS: Of the 200 subjects consenting to an interview, 125 subjects (63%) had completed ADs. In comparing groups with and without ADs, gender (p < 0.0002), age (p < 0.0161), race (p < 0.0001), education (p < 0.0039), and religion (p < 0.0104) were significantly associated with having an AD. Factors predicting AD completion are: thinking an AD will help in the relief of suffering at the end of life, (OR 76.3, p < 0.0001), being asked to complete ADs/ or receiving explanation about ADs (OR 55.2, p < 0.0001), having undergone major surgery (OR 6.3, p < 0.0017), female gender (OR 11.1, p < 0.0001) and increasing age (76-85 vs. 59-75: OR 3.4, p < 0.0543; < 85 vs. 59-75: OR 6.3, p < 0.0263). SIGNIFICANCE OF RESULTS: This study suggests that among older adults, the probability of completing ADs is related to personal requests by health care providers, educational level, and exposure to advance care planning media campaigns.

Randomized Controlled Trial of Healthy Harlem's Get Fit Program: An After-School Intervention for Childhood Overweight and Obesity in the Harlem Children's Zone.

Background: Although the increases in overweight and obesity observed for several decades have appeared to have leveled off, the prevalence of overweight and obesity remains exceptionally high among children of color. This article estimates the effect of Healthy Harlem's Get Fit-a 12-week after-school program aimed at helping students improve physical activity and eating habits-on BMI and weight status of adolescents. Methods: Participants were 436 students who had overweight or obesity in 12 Harlem Children's Zone after-school programs in New York. The evaluation was a randomized controlled trial where students were assigned to an intervention group that received Get Fit plus Prevention services or a control group that only received Prevention services in 2013 or 2014. Impacts were assessed on BMI z-score, percentage with overweight or obesity, and percentage with obesity using regression analysis. Results: Relative to the control group, students randomized to Get Fit experienced a decrease in BMI z-score (mean difference = -0.04; p = 0.02). The percentage of students with overweight or obesity was also lower (mean difference = -5.3; p = 0.02), but there was no effect on the percentage of students with obesity. Get Fit had an impact on BMI for girls, but not boys. Conclusions: Get Fit improved middle- and high-school students' BMI outcomes and weight status. Schools continue to face pressure to allocate time for physical education and activity while meeting their academic demands, underscoring the importance of after-school student-level interventions like Get Fit.

Toward a smoke-free Harlem: engaging families, agencies, and community-based programs.

The aim of this collaborative public health study was to engage families, agencies, and programs in reducing secondhand smoke exposure in Central Harlem, New York City. Baseline interviews (n=657) and focus groups (n=4) were conducted with adult members of households with children who had asthma and asthma-like symptoms in the Harlem Children's Zone Asthma Initiative. The interviews concerned the prevalence and determinants of exposure of enrolled children to secondhand smoke. Key findings were that participants: (1) were generally aware of the hazards of secondhand smoke; (2) used strategies to reduce exposure to secondhand smoke in their homes; (3) believed that outdoor pollutants are sometimes just as bad for the health of their children as secondhand smoke; and (4) used smoking to provide stress relief and help diffuse otherwise volatile situations in their homes. The Harlem Smoke-Free Home Campaign was launched in October 2007 based in part on these findings.

Hand hygiene in long-term care facilities: a multicenter study of knowledge, attitudes, practices, and barriers.

An anonymous survey of 1143 employees in 17 nursing facilities assessed knowledge of, attitudes about, self-perceived compliance with, and barriers to implementing the 2002 Centers for Disease Control and Prevention hand hygiene guidelines. Overall, employees reported positive attitudes toward the guidelines but differed with regard to knowledge, compliance, and perceived barriers. These findings provide guidance for practice improvement programs in long-term care settings.

Childhood asthma and extreme values of body mass index: the Harlem Children's Zone Asthma Initiative.

To examine the association between body mass index (BMI) percentile and asthma in children 2-11 years of age, we performed a cross-sectional analysis of 853 Black and Hispanic children from a community-based sample of 2- to 11-year olds with measured heights and weights screened for asthma by the Harlem Children's Zone Asthma Initiative. Current asthma was defined as parent/guardian-reported diagnosis of asthma and asthma-related symptoms or emergency care in the previous 12 months. Among girls, asthma prevalence increased approximately linearly with increasing body mass index (BMI) percentile, from a low of 12.0% among underweight girls (BMI 95th percentile). After adjusting for age, race/ethnicity, and household smoking, among girls, having asthma was associated with being at risk for overweight (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4-5.0) and being overweight (OR, 2.1; 95% CI, 1.2-3.8) compared to normal weight; among boys, having asthma was associated both with overweight (OR, 2.4; 95% CI, 1.4-4.3) and with underweight (OR, 2.9; 95% CI, 1.1-7.7). Large, prospective studies that include very young children are needed to further explore the observed association between underweight and asthma among boys. Early interventions that concomitantly address asthma and weight gain are needed among pre-school and school-aged children.

Addressing the childhood asthma crisis in Harlem: the Harlem Children's Zone Asthma Initiative.

OBJECTIVES: We determined the prevalence of asthma and estimated baseline asthma symptoms and asthma management strategies among children aged 0-12 years in Central Harlem. METHODS: The Harlem Children's Zone Asthma Initiative is a longitudinal, community-based intervention designed for poor children with asthma. Children aged 0-12 years who live or go to school in the Harlem Children's Zone Project or who participate in any Harlem Children's Zone, Inc, program were screened for asthma. Children with asthma or asthma-like symptoms were invited to participate in an intensive intervention. RESULTS: Of the 1982 children currently screened, 28.5% have been told by a doctor or nurse that they have asthma, and 30.3% have asthma or asthma-like symptoms. To date, 229 children are enrolled in the Harlem Children's Zone Asthma Initiative; at baseline, 24.0% had missed school in the last 14 days because of asthma. CONCLUSION: The high prevalence of asthma among children in the Harlem Children's Zone Project is consistent with reports from other poor urban communities. Intensive efforts are under way to reduce children's asthma symptoms and improve their asthma management strategies.