Adults' perceptions of genetic counseling and genetic testing.

PURPOSE: This study described the perceptions of genetic counseling and testing of adults (N = 116) attending a genetic education program. Understanding perceptions of genetic counseling, including the importance of counseling topics, will contribute to patient-focused care as clinical genetic applications for common, complex disorders evolve. METHODS: Participants completed a survey addressing: the importance of genetic counseling topics, benefits and negative effects of genetic testing, and sharing test results. RESULTS: Topics addressing practical information about genetic conditions were rated most important; topics involving conceptual genetic/genomic principles were rated least important. The most frequently identified benefit and negative effect of testing were prevention/early detection/treatment and psychological distress. Participants perceived that they were more likely to share test results with first-degree than other relatives. CONCLUSIONS: Findings suggest providing patients with practical information about genetic testing and genetic contributions to disease, while also determining whether their self-care abilities would be enhanced by teaching genetic/genomic principles.

Knowledge and beliefs about genetics and smoking among visitors and staff at a health care facility.

OBJECTIVES: The primary purpose of this study was to describe individuals' knowledge and beliefs about genetics and smoking. Secondary purposes were to describe (a) differences in knowledge and beliefs based on smoking status, gender, and education and (b) relationships among perceived genetic predisposition for smoking, background characteristics, and knowledge and beliefs about genetics and smoking. Because genetics influences smoking, genetic information will likely be used to individualize future cessation treatment. DESIGN: Questionnaire data were collected about knowledge and beliefs about genetics and smoking, smoking history, and demographics from visitors and staff at a nursing care facility. Data were analyzed with bivariate statistics and logistic regression. SAMPLE: Participants (N=92), ages 19-82, were classified by smoking status. RESULTS: Participants had little knowledge about genetics and smoking or mechanisms of heredity. Most did not believe that genetics caused smoking or influenced cessation. Predictors of perceived genetic predisposition for smoking were smoking status (current/former smoker), education (

Self-efficacy scale for Pap smear screening participation in sheltered women.

BACKGROUND: Sheltered, homeless women disproportionately experience cervical dysplasia and cervical cancer. Low rates of Pap smear screening contribute to late diagnosis with accompanying increased morbidity and mortality. Self-efficacy (SE) has been demonstrated to be predictive of several health behaviors, but limited evidence about SE for Pap smear screening exists. OBJECTIVES: To develop, test, and refine the conceptually based Self-Efficacy Scale for Pap Smear Screening Participation (SES-PSSP). METHODS: This correlational, descriptive study included a purposive sampling of sheltered women (N = 161). RESULTS: The 20-item SES-PSSP demonstrated acceptable initial validity and reliability. Reliability estimates of stability (>or=84%) and internal consistency (alpha = .95) exceeded criteria. Content validity and construct validity were supported (e.g., common factor analysis and predictive model testing that included SE, decisional balance, knowledge regarding Pap smear screening, demographics, health-related behaviors, health status, and personal beliefs about risks for cervical cancer and dysplasia). Self-efficacy, decisional balance, illicit drug usage, and age predicted 28% of the variance in stages of change (precontemplation, contemplation, preparation, action, and maintenance) for Pap smear screening participation. DISCUSSION: The SES-PSSP provides a new scale for measuring SE pertinent to Pap smear screening participation in a vulnerable, ethnically diverse sample of sheltered, inner-city women. Validity testing demonstrated that the SE concept was predictive of Pap smear screening behavior, suggesting that SE-based interventions tailored to the SES-PSSP subscale or total scores could increase screening. A 10-minute completion time supports feasibility for use in the clinic setting.

Reliability, validity, and scoring of the Health Status Questionnaire-12 version 2.0.

Measuring health status as an indicator of individual, population, and community health is critical in reducing health disparities in populations. The purpose of this study was to test the psychometric properties of the Health Status Questionnaire-12 (HSQ-12) Version 2.0, a brief self-reported health status instrument available within the public domain, in a low-income sample (N = 7,793). The internal consistency reliability was .88. Initial and confirmatory factor analysis revealed two factors explaining 67% of the variance, interpreted as super scales of physical and mental health. Second order factor analysis isolated one factor explaining 82% of the variance, interpreted as a total health status. Comparison of subjects with and without disabilities using t tests and the Mann-Whitney U Test showed that the scale, super scale, and total scale scores differentiated significantly. The HSQ-12 is a reliable, valid, and low-cost measure of health status.

A conceptual model for understanding effective coalitions involved in health promotion programming.

Funding agencies are increasingly focused on community coalitions as effective entities for promoting public health programs. Yet, there has been no conceptual model for understanding how effective coalition infrastructure works to facilitate a learning environment, wherein coalition members and leaders receive ongoing training and technical assistance needed to accomplish their external programming goals. This article presents a conceptual model for measuring the internal effectiveness of coalitions [Internal Coalition Outcome Hierarchy (ICOH)]. The ICOH model served as the basis for development of the evaluation instrument, Internal Coalition Effectiveness, which measures internal coalition effectiveness based on achievement of organizational outcomes at each of the model's seven hierarchical levels. The ICOH conceptual model has broad application for public health nurses who are frequently called on to serve as evaluators for community coalitions engaged in health programming. The model has implications for evaluators to use in teaching coalition members and leaders about their internal strengths and areas for improvement, so that coalitions can develop more effective internal structures and thereby promote long-term sustainability.

Measuring community coalition effectiveness using the ICE instrument.

This article presents the development and psychometric testing of the Internal Coalition Effectiveness (ICE) instrument, which was based on the conceptual model Internal Coalition Outcome Hierarchy. Sixty-one items were derived from literature about successful coalitions, and the ICE instrument was tested for reliability and validity. A national panel of eight experts conducted content validity. Remaining tests involved a sample of 61 members and leaders of a large midwestern coalition (77% response rate, n=47). Content validity involved a two-stage process for rigorous item development and quantification (0.88, p<0.05). Internal consistency was based on bivariate Pearson's correlation of 0.30-0.70 for two-item scales and Cronbach's alpha(alpha=0.70). Construct validity was assessed by correlation analysis, independent Student's t tests, and informal coalition feedback. The final 30-item version of ICE is psychometrically sound. Findings were shared with the local coalition, and, in support of the instrument's validity, members and leaders found this information useful for promoting coalition sustainability by identifying internal strengths and areas for improvement. The ICE instrument adds to the body of literature by measuring critical constructs of coalition effectiveness and has significant application for public health nurses working as evaluators for coalitions engaged in community health programming.

Plasma carotenoid and vitamins a and e concentrations in older African American women after wheat bran supplementation: effects of age, body mass and smoking history.

OBJECTIVE: This study investigated the relationships of plasma vitamins A, E, and carotenoids with age, BMI and former/non-smoking history after adjusting for wheat bran supplementation. METHODS: All 39 African American women in the church-based, volunteer sample, 40-70 years old, supplemented their daily diets for 5-6 wks. with 1/2 cup of a riboflavin-spiked wheat bran cereal. RESULTS: Urinary riboflavin concentrations increased from 0.8 +/- 0.1 mg/day at baseline to 7.5 +/- 0.5 mg/day after supplementation, confirming the 99.2 +/- 10.5% self-reported adherence. Plasma nutrient concentrations did not change significantly with supplementation nor was never/former smoking history related to diet. Plasma retinol and serum cholesterol were significantly higher (p < 0.0002) in persons older than 55 years compared to younger adults. Plasma retinol (microg/dL) but not serum cholesterol was associated significantly with menopausal status and hormone replacement therapy (HRT; p = 0.05); progressive increases in retinol concentrations were found in the women after adjusting for pre/post supplementation: lowest in pre-menopause (47.7 +/- 4.8); intermediate concentrations in post-menopause on HRT (54.6 +/- 3.0); highest level in post-menopause without HRT (61.1 +/- 3.0). Similarly, a progressive increase was found in lipid-unadjusted alpha-tocopherol concentrations and menopausal status with or without HRT. Vitamin A and cholesterol intakes were not significantly different by age group. Plasma carotenoids were not significantly different by age or fiber supplementation, but alpha- and beta-carotene and beta-cryptoxanthin were significantly lower with BMI > or = 30. In contrast to carotenoids, both plasma levels of gamma-tocopherol and lipid-adjusted gamma-tocopherol were significantly higher with obesity compared to those with BMI < 30. CONCLUSION: Plasma alpha- and beta-carotene and beta-cryptoxanthin were negatively associated with obesity, whereas gamma-tocopherol measures were consistently elevated with high BMI. The increase in age-associated plasma retinol in postmenopausal women was likely related to decreased estrogen concentrations in the African American women. Smoking history was not influential in this study.

Mediator analysis of Moms on the move.

This study examined whether improvements in physical activity discovered in a test of Moms on the Move were mediated by the behavioral constructs from which the intervention was derived. Identifying mediator variables is vital for intervention planning. The intervention was derived from the Transtheoretical Model (TTM) of behavior change and promoted moderately intense activities like walking. Sedentary mothers with children enrolled in the Women, Infants, and Children program (N = 44) were randomly assigned to the experimental intervention or attention control. Large effect sizes were reported for improvements in physical activity and changes in TTM constructs. This study examined whether the physical activity improvements were mediated by the behavioral constructs. Statistical analyses used bivariate correlation coefficients and two-stage multiple linear regression. These exploratory findings did not support the hypothesis that increased physical activity, which was associated with the experimental intervention, was mediated by the TTM constructs.

Effects of a physical activity intervention for women.

Physical activity is associated with health and reduced mortality risk, yet only 15% of U.S. adults achieve adequate activity. This study is an experimental repeated measures nested design randomizing two similar rural communities to investigate the effectiveness of the Heart and Soul Physical Activity Program (HSPAP) (Peterson, 2002) in promoting physical activity in midlife women (n=42) aged 35 to 65 years. The HSPAP, an innovative church-based health promotion intervention, is conceptualized in social support and designed to increase physical activity, energy expenditure (EE), and cardiorespiratory fitness (VO2 max), measured over time. A significant interaction (p<.001) was found for EE in one HSPAP group increasing their EE by 1,010 kcals/week. HSPAP participants increased their VO2 max level by 75% (p<.001) and 10%; comparison groups stayed the same or declined 16%. Study results provide preliminary support for the HSPAP intervention as an effective treatment to improve physical activity levels in sedentary, rural, midlife women.

A randomized pilot test of "Moms on the Move": a physical activity intervention for WIC mothers.

BACKGROUND: Sedentary mothers are important to reach with physical activity promotion. PURPOSE: This study pilot tested "Moms on the Move," a Transtheoretical Model (TTM)-derived physical activity (PA) intervention for low-income mothers enrolled in the Women, Infants, and Children (WIC) program. METHOD: Sedentary mothers (N = 44) were randomized to (a). Moms on the Move (PA intervention) or (b). counseling on self-breast examination (control). Pre- and posttest measurement (baseline and 2 weeks after the 8-week interventions) included (a). stage of PA behavior change, (b). PA behavior, (c). selected TTM constructs, and (d). social support. Pre- and postdifference scores, chi-square, and one-way analyses of variance (ANOVAs) were used. RESULTS: The experimental group progressed in stage of change more than control, chi2(1, N = 44) = 20.50, p <.001. The experimental group had greater PA behavior: weekly minutes of PA, F(1, 42) = 46.85, p <.001; daily energy expenditure (EE), F(1, 42) = 23.01, p <.001; and weekly moderate PA EE, F(1, 42) = 32.63, p <.001. Experimental subgroup (n = 11) step counts increased pre-post, t(10) = 6.16, p <.001. An ANOVA showed that the experimental group had greater improvements in all TTM constructs and social support, ps <.001. CONCLUSIONS: WIC mothers are at risk for sedentary living and have not been targeted for PA behavior change using a provider-counseled approach. Although further testing is needed, Moms on the Move appears to be efficacious.

Genetic susceptibility to lung cancer: implications for smoking cessation.

Lung cancer is the leading cause of cancer death in the United States. As information from the Human Genome Project becomes integrated into clinical practice, knowledge of genetic susceptibility for lung cancer will be used to identify persons at risk and to individualize treatments, such as prescribing chemoprevention. Nurses who assimilate genetic information into their practice can help patients to understand the implications of genetic susceptibility to lung cancer for their health and to reduce their disease risk with adaptive behaviors.

A randomized controlled trial of a public health nurse directed treatment program for rural patients with high blood cholesterol.

BACKGROUND: Many rural residents do not have access to high-quality nutrition counseling for high blood cholesterol. The objective of this study was to assess the effectiveness of an intervention program designed to facilitate dietary counseling for hypercholesterolemia by rural public health nurses. METHODS: Eight health departments (216 participants) were randomized to give the special intervention (SI) and nine (252 participants) to give the minimal intervention (MI). The SI consisted of three individual diet counseling sessions given by a public health nurse, using a structured dietary intervention (Food for Heart Program), referral to a nutritionist if lipid goals were not achieved at 3-month follow-up, and a reinforcement phone call and newsletters. Diet was assessed by the Dietary Risk Assessment (DRA), a validated food frequency questionnaire, at baseline, 3-, and 12-month follow-up; blood lipids and weight were assessed at baseline, 3-, 6-, and 12-month follow-up. RESULTS: Participants were largely female (71%), older (mean age 55), and white (80%). At 3-month follow-up, the average reduction (indicating dietary improvement) in total Dietary Risk Assessment score was 3.7 units greater in the SI group (95% confidence interval [CI] 1.9 to 5.5, P = 0.0006), while both groups experienced a similar reduction in blood cholesterol, 14.1 mg/dL (0.37 mmol/L) for SI and 14.5 mg/dL (0.38 mmol/L) for minimal intervention group (difference -0.4 mg/dL [-0.010 mmol/L], 95% CI -12.5 to 11.7 [-0.32 to 0.30], P = 0.9). At 12-month follow-up, the reduction in total Dietary Risk Assessment score was 2.1 units greater in the SI group (95% CI 0.8 to 3.5, P = 0.005), while the reduction in blood cholesterol was similar in both groups, 18.4 mg/dL (0.48 mmol/L) for SI and 15.6 mg/dL (0.40 mmol/L) for minimal intervention group (difference 2.8 mg/dL [0.07 mmol/L], 95% CI -7.5 to 13.1 [-0.19 to 0.34], P = 0.6). During follow-up, weight loss was greater in the SI group; the difference between groups was statistically significant at 3 (1.9 lb [0.86 kg], 95% CI 0.3 to 3.4 [0.14 to 1.55], P = 0.022) and 6 months (2.1 lb [0.95 kg], 95% CI 0.1 to 4.1 [0.04 to 1.86], P = 0.04). At 12 months, the difference was not significant (1.6 lb [0.73 kg], 95% CI -0.05 to 3.7 [-0.02 to 1.68], P = 0.13). CONCLUSIONS: Improvement in self-reported dietary intake was significantly greater in the SI group, while reduction in blood cholesterol was similar in both groups.

Determinants of Medicare home healthcare service use among Medicare recipients.

BACKGROUND: Medicare reimbursement for home healthcare (HHC) services has changed dramatically in recent years. A clear understanding of the determinants of Medicare HHC services use is needed so that HHC agencies can meet the demand for services from an aging population while remaining financially sound. OBJECTIVES: The purpose of the study was to identify the determinants of Medicare HHC service within the framework of the Andersen Behavioral Model. METHODS: This cross-sectional secondary analysis used data from the 1996 Medical Expenditures Panel Survey to examine characteristics of 239 subjects who had received Medicare reimbursed HHC services. Predisposing characteristics, enabling resources, and need characteristics were examined to explain Medicare HHC service use. Two criterion measures, annual Medicare expenditures and days of care, were employed in hierarchical regression analyses. RESULTS: Variance in annual Medicare expenditures was explained by both the predisposing (R(2) =.16, <.001) and need characteristics (R(2) =.09, <.001). Variance in days of care was explained by predisposing characteristics (R(2) =.12, <.001) and need characteristics (R(2) =.15, <.001). The adjusted for the total model was.21 for annual Medicare expenditures and.25 for days of care. CONCLUSIONS: While Andersen's Behavioral Model is useful in explaining Medicare HHC service use, it may be important to use multiple measures as criterion variables since the amount and proportion of variance explained differs with the variable used.

Key elements for church-based health promotion programs: outcome-based literature review.

Although not a new concept, church-based health promotion programs have yet to be widely researched. Few of the initial studies used randomized and controlled designs. Dissemination of study results has been sporadic, with findings often reported in church periodicals. A renewed interest in church-based health promotion programs (CBHPP) is emerging. The purpose of this article is to propose seven key elements found in a literature review to be beneficial in establishing church-based community health promotion programs that demonstrated desired health promotion outcomes. Based on the outcomes of successful CBHPP, the following key elements have been identified: partnerships, positive health values, availability of services, access to church facilities, community-focused interventions, health behavior change, and supportive social relationships. An example of one program that embodies these elements is presented. The Heart and Soul Program, designed to increase physical activity in midlife women to reduce their risk of cardiovascular disease with advancing age, is discussed within the context of the elements for successful church-based programs. CBHPP have effectively promoted health behaviors within certain communities. To promote health and wellness in light of our diverse society and health needs, health promotion professionals and churches can be dynamic partners.

Development of a self-efficacy instrument for coronary artery bypass graft patients.

Research related to self-efficacy has demonstrated that measures of this concept need to be specific to the behavior of interest. Self-efficacy is the degree of confidence one has to perform an activity. This article describes the development and testing of the Barnason Efficacy Expectation Scale (BEES). The instrument is a 15-item tool that uses a Likert scale to determine the coronary-artery-bypass-graft (CABG) patient's self-efficacy related to the risk-reduction-related aspects of recovery and lifestyle adjustment following CABG surgery (physical functioning, psychosocial functioning, coronary artery disease risk factor modification and self-care management). Internal consistency reliability of the instrument was 0.93, and principal components analysis revealed a single factor (Eigenvalue = 10.59, percent variance = 70.61%). Three phases of tool development are described in the article that document satisfactory reliability and validity (face, content, criterion, and construct).