Youth Assets, Neighborhood Factors, Parental Income, and Tobacco Use: A Longitudinal Study of Health Disparities.

This study aimed to assess how the relationship between youth assets and future no-tobacco use among youth might differ according to race/ethnicity, neighborhood factors and socio-economic status. Five waves of annual data were collected from 1111 youth/parent pairs living in Oklahoma, USA who were randomly selected to participate in the Youth Asset Study (YAS). A marginal logistic regression model using all five waves of no-tobacco use, demographics, and their interaction was used to compare the change in tobacco use over time. Among 1111 youth, (Mean age = 14.3; 53% female; 39% White, 28% Hispanic, 24% Black, and 9% other), the percentage of youth tobacco use increased significantly from baseline to wave 5 (4 years after baseline) for all racial/ethnic groups and all parental income groups. Assets were prospectively associated with no tobacco use in the past 30 days for Black, White and Hispanic youth and for youth in all income categories (adjusted odds ratio range = 1.9-2.7). There was one statistically significant association between the neighborhood environment and future no tobacco use. To conclude, the protective effects of youth assets in terms of prevention of tobacco use among youth do not differ by youth race/ethnicity or parental income in the presence of neighborhood environmental factors.

Thrombotic thrombocytopenic purpura patients' attitudes toward depression management: A qualitative study.

BACKGROUND AND AIMS: Thrombotic thrombocytopenic purpura (TTP) is a rare disorder characterized by acute episodes of systemic microvascular thrombosis; TTP is more common in adults, women, and African-Americans (Blacks). Our Oklahoma TTP Registry documented that survivors have an increased prevalence of depression compared with the general population; however, many patients' depression remains untreated. Moreover, studies identifying attitudes toward depression management are lacking. The objective of this study was to identify TTP patients' attitudes towards pharmacotherapy. As a secondary question, we explored attitudes towards counseling. METHODS: We interviewed TTP patients with major depression who had experience with different management strategies (previous/current pharmacotherapy treatment versus no pharmacotherapy treatment). Eligibility criteria included (a) age > 18 years, (b) ADAMTS13-deficient TTP, (c) enrolled in the Oklahoma Registry, and (d) moderate/major depression on either the Beck Depression Inventory II or Patient Health Questionnaire from 2004 to 2012. Qualitative purposive sampling was used to interview patients with a range of experiences with TTP and depression symptom management. Our study was based on the theoretical framework of the Theory of Reasoned Action. Patients were asked about their views on depression (attitudes), their family and friends' views (social norms), and ways they cope with depression. RESULTS: Semi-structured interviews were conducted between June and October 2013. Data saturation was achieved after interviewing 16 patients (nine, pharmacotherapy and seven, no pharmacotherapy). The majority (88%) were women; 56% were Black, and the median age was 49 years. Patients in both groups believed TTP was life altering and traumatic and that counseling improved depressive symptoms. However, the pharmacologic group believed medication improved one's quality of life, whereas the no pharmacotherapy group was not sure pharmacotherapy was effective and expressed fears related to potential addiction and side effects. When asked about cultural views to depression management, many Black patients stated that in the Black community, a person is taught to deal with his/her emotional issues instead of asking strangers for help. CONCLUSION: Ensuring effective depression management is a critical part of TTP care. Understanding attitudes toward management will assist in tailoring patient discussions.

Conducting a formative evaluation of an intervention promoting mammography screening in an American Indian community: The Native Women's Health Project.

BACKGROUND: Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women. However, there are very few published studies describing the evaluation of breast health promotion programs among AI/AN women. PURPOSE: To describe the formative evaluation of a multi-component intervention to promote mammography screening in an AI community in rural Oklahoma. METHODS: A comprehensive process evaluation plan with emphasis on context, reach, dose received, dose delivered, and fidelity was developed. Data collection included mixed research methodology and impact was assessed via one group pre/post research design. Data analysis consisted of descriptive statistical analysis and content analysis. The study utilized a community-based participatory research (CBPR) approach. RESULTS: Process evaluation revealed a relatively high reach within the priority population for both components (clinic and community) and a moderate implementation. Focus group research showed that participants were overall satisfied with program implementation. The intervention was feasible to implement in real-world settings. TRANSLATION TO HEALTH EDUCATION PRACTICE: Community-based evaluation of breast health promotion programs among AI communities is challenging, as one has to balance methodological rigor with practical constraints. The use of an evaluation plan, mixed methods and a collaborative approach are useful tools in conducting the evaluation.

Community pharmacists' beliefs regarding improvement of Star Ratings scores using the Theory of Planned Behavior.

OBJECTIVES: The Centers for Medicare and Medicaid Services (CMS) is moving toward a value-based model, which includes the Five-Star Quality Rating System (Star Ratings). Prescription Drug Plans include multiple pharmacy measures associated with adherence and patient safety that contribute to CMS Star Ratings scores. This study, using the Theory of Planned Behavior (TPB), explored factors associated with community pharmacists' beliefs to improve Star Ratings scores. DESIGN: Exploratory, qualitative, use of focus groups, and the TPB. SETTING AND PARTICIPANTS: Focus groups were performed in conference rooms at the College of Pharmacy main and satellite campuses. Participants were community retail pharmacists with an active Oklahoma license and 1 year of work experience. MAIN OUTCOME MEASURES: Each focus group was audio recorded and the recording transcribed to documents and analyzed with the use of a hybrid deductive and inductive qualitative approach rooted in a constant comparative framework. Coding of the data back to the TPB constitutes a deductive approach. The generation of themes and subthemes from other coded nodes constitutes an inductive approach. Analysts agreed on common themes, differences in findings, and saturation of the data gathered. RESULTS: Four focus groups were conducted with 26 participants in 2 categories: pharmacists with and without experience improving Star Ratings. Pharmacists shared and contrasted in salient, normative, and control beliefs about patient outcomes, data, financial implications, staff, technology, and other stakeholders associated with performance of improving Star Ratings. Themes regarding medication adherence, patient safety, and intention were also found. CONCLUSION: The TPB was used to explore beliefs of community pharmacists about improving Star Ratings scores. Themes that were identified will assist in future research for measuring intention to improve CMS Star Ratings scores and the development of training and education programs.

The use of think-aloud protocols to identify a decision-making process of community pharmacists aimed at improving CMS Star Ratings scores.

BACKGROUND: The Center for Medicare and Medicaid Services (CMS) created the Star Rating system based on multiple measures that indicate the overall quality of health plans. Community pharmacists can impact certain Star Ratings measure scores through medication adherence and patient safety interventions. OBJECTIVE: To explore methods, needs, and workflow issues of community pharmacists to improve CMS Star Ratings measures. METHODS: Think-aloud protocols (TAPs) were conducted with active community retail pharmacists in Oklahoma. Each TAP was audio recorded and transcribed to documents for analysis. Analysts agreed on common themes, illuminated differences in findings, and saturation of the data gathered. Methods, needs, and workflow themes of community pharmacists associated with improving Star Ratings measures were compiled and organized to exhibit a decision-making process. Five TAPs were performed among three independent pharmacy owners, one multi-store owner, and one chain-store administrator. RESULTS: A thematically common 4-step process to monitor and improve CMS Star Ratings scores among participants was identified. To improve Star Ratings measures, pharmacists: 1) used technology to access scores, 2) analyzed data to strategically set goals, 3) assessed individual patient information for comprehensive assessment, and 4) decided on interventions to best impact Star Ratings scores. Participants also shared common needs, workflow issues, and benefits associated with methods used in improving Star Ratings. CONCLUSION: TAPs were useful in exploring processes of pharmacists who improve CMS Star Ratings scores. Pharmacists demonstrated and verbalized their methods, workflow issues, needs, and benefits related to performing the task. The themes and decision-making process identified to improving CMS Star Ratings scores will assist in the development of training and education programs for pharmacists in the community setting.

Demographic Factors Predict Disparities in Number of Assets Youth Possess.

OBJECTIVES: This study's purpose was to determine if youth race/ethnicity, youth age and sex, parent income and education, household wealth, family poverty, and family structure were prospectively associated with youth assets in a community-based sample of racially/ethnically and economically-diverse youth and their parents. METHODS: Five waves of data were collected annually (2003 to 2008) from youth (N = 1111; Mean age = 14.4 years, SD = 1.6) and their parents using in-person, computer-assisted interviewing methods. Marginal logistic regression models and generalized estimating equations were conducted to assess prospective associations between the demographic factors and the number of assets the youth possessed (more than or less than the median number of 12 assets). RESULTS: Results indicated that 1-parent families (Odds Ratio = 0.62, 95% CIs = 0.50-0.76) lower parental education, (OR = 0.67, CI = 0.48-0.95 and OR = 0.77, CI = 0.61-0.97), and youth age (OR = 0.70, CI = 0.55-0.88 and OR = 0.59, CI = 0.45-0.77) were the only demographic factors that independently, prospectively, and significantly predicted which youth would possess less than the median number of assets. CONCLUSIONS: Youth assets may be 1 mechanism that explains the negative effects of some demographic factors, particularly 1-parent families and low-parent education, on youth risk behaviors and health.

The Design of a Multi-component Intervention to Promote Screening Mammography in an American Indian Community: The Native Women's Health Project.

BACKGROUND: Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women in the US. This article describes the design and implementation of a culturally sensitive intervention to promote breast health among AI/AN women through a hybrid model that incorporates clinical and community-based approaches. This is one of the first studies using this model addressing breast cancer disparities among AI/AN populations in the US. METHODS: The Theory of Planned Behavior was used as the guiding framework of the intervention and Community Based Participatory Research was the primary vehicle for the intervention planning and implementation. Three preliminary studies took place that aimed to identify qualitatively and quantitatively what deterred or encouraged AI women to get past or future mammograms. The research results were shared with community members who, through a prioritization process, identified the theoretical focus of the intervention and its corresponding activities. The priority population consisted of AI women ages 40-74, with no recent mammogram, and no breast cancer history. RESULTS: The intervention centered on the promotion of social modeling and physician recommendation. The main corresponding activities included enhancing patient-physician communication about screening mammography through a structured dialogue, receipt of a breast cancer brochure, participation in an inter-generational discussion group, and a congratulatory bracelet upon receipt of a mammogram. Environmental and policy related changes also were developed. CONCLUSION: Creating a theory-based, culturally-sensitive intervention through tribal participatory research is a challenging approach towards eliminating breast cancer disparities among hard-to-reach populations.

Prospective association between negative life events and initiation of sexual intercourse: the influence of family structure and family income.

OBJECTIVES: We examined the prospective association between negative life events and time to initiation of sexual intercourse and the influence of family structure and family income on this association. METHODS: We followed up a randomly selected sample (n=649) of ethnically diverse parents and their children aged 12 to 17 years over a 5-year period. We conducted Cox proportional hazards regression analysis to examine the relation between negative life events and time to initiation of sexual intercourse. Family structure and family income were assessed as confounders. RESULTS: Negative life events were significant predictors of time to initiation of sexual intercourse in adolescents. After controlling for demographic variables, youths reporting 1 negative life event had a hazard of initiation of sexual intercourse 1.40 times greater and youths reporting 2 or more negative life events had a hazard of initiation of sexual intercourse 1.61 times greater compared with youths reporting no negative life events. Family structure and family income were not significant confounders of the relation between initiation of sexual intercourse and negative life events. CONCLUSIONS: Interventions to prevent initiation of sexual intercourse should focus on youths with recent negative life events, regardless of family income and structure.

Prospective Associations Among Assets and Successful Transition to Early Adulthood.

Objectives. We investigated prospective associations among assets (e.g., family communication), which research has shown to protect youths from risk behavior, and successful transition to early adulthood (STEA). Methods. We included participants (n = 651) aged 18 years and older at study wave 5 (2007-2008) of the Youth Asset Study, in the Oklahoma City, Oklahoma, metro area, in the analyses. We categorized 14 assets into individual-, family-, or community-level groups. We included asset groups assessed at wave 1 (2003-2004) in linear regression analyses to predict STEA 4 years later at wave 5. Results. Individual- and community-level assets significantly (P < .05) predicted STEA 4 years later and the associations were generally linear, indicating that the more assets participants possessed the better the STEA outcome. There was a gender interaction for family-level assets suggesting that family-level assets were significant predictors of STEA for males but not for females. Conclusions. Public health programming should focus on community- and family-level youth assets as well as individual-level youth assets to promote positive health outcomes in early adulthood.

Barriers And Motivators for Smoking Cessation in Patients With Systemic Lupus Erythematosus (SLE).

UNLABELLED: Although studies have shown that smoking is detrimental to the health of patients with systemic lupus erythematosus (SLE), studies regarding barriers and motivators for smoking cessation are lacking. The purpose of this study was to generate hypotheses regarding the barriers and motivators for smoking cessation in SLE patients. METHODS: This study was based on the theoretical framework of the stages of change model. All participants met SLE classification criteria. Interviews were conducted with 16 current and 10 former smokers. RESULTS: Motivators included: medical reasons, readiness, and concern for others. Barriers included: enjoyment, coping mechanism, and an emotional connection. Participants were unsure of the impact of smoking on their medication and disease, and had mixed feelings regarding the impact on pain. CONCLUSION: The main motivator for cessation in this population was concern for one's health. Rheumatologists need to include disease specific harms and assess pain management strategies as part of cessation counseling.

Prospective associations between negative life events and youth tobacco use.

OBJECTIVE: To examine the prospective associations between commonly-occurring negative life events (NLEs) and adolescent tobacco use. METHODS: NLEs were examined prospectively over 4 years from 1111 adolescents (mean age = 15.17 years). Family structure and parent education were assessed as confounders. Fourteen NLEs were examined and categorized into none, one, 2, or 3 or more events. RESULTS: Prospective analyses indicated that NLEs were significantly associated with tobacco use in the following wave. NLEs assessed at each wave were significantly associated with tobacco use the next year. Family structure and parent education did not influence the relationship between tobacco use and NLEs. CONCLUSIONS: Interventions to prevent tobacco use should focus on youth with a recent history of NLEs, regardless of family education and family structure.

The influence of assets and environmental factors on gender differences in adolescent drug use.

For adolescents, illicit drug use remains a significant public health problem. This study explored prospectively the differential effects of 17 youth assets and 5 environmental factors on drug use in adolescent males and females (Youth Asset Study - a 5-wave longitudinal study of 1117 youth/parent pairs). Baseline analyses included 1093 youth (53% female). Mean age was 14.3 years (SD = 1.6) and the youth were 40% Non-Hispanic White, 28% Hispanic, 24% Non-Hispanic Black, and 9% Non-Hispanic other. Analyses revealed that 16 assets for males and 15 for females as well as the total asset score were prospectively associated with no drug use. No environmental factors were prospectively associated with any drug use for males, and for a subset of females, only Neighborhood Support was significant. This study confirms and extends previous work regarding youth drug use by recognizing the importance of the protective effect of assets for both males and females.

Predictors of regular mammography use among American Indian women in Oklahoma: a cross-sectional study.

BACKGROUND: There are significant disparities in breast cancer screening and survivorship between American Indian (AI) and non-Hispanic white women. This study aimed to identify the salient beliefs AI women from Oklahoma have on regular mammography screening, and to determine which beliefs and health- related practices are associated with past mammography screening behavior. METHODS: This study used an integrated model of the Theory of Planned Behavior as the guiding theoretical framework. Data were collected from 255 (mean age = 51 years, SD 7.64 years) AI women randomly selected from a rural Oklahoma medical clinic (response rate: 79%). Multivariate logistic regression was used to identify factors associated with self-reported past mammography within the last two years while controlling for demographic variables. Associations were summarized using odds ratios (OR), the ratio of the odds of past mammography per a 1-unit increase in continuous independent factor scales (subjective physician norm, cultural affiliation, fatalism, knowledge of mammography screening guidelines, and perceived behavior control barriers) or between groups defined by categorical variables, and 95% confidence intervals (CI). RESULTS: Of the participants, 65% (n = 167) reported a screening mammogram within the last two years. After adjustment for age and educational status, women with a higher total subjective-norm physician score (OR = 1.15, 95% CI: 1.06-1.24), a higher knowledge of mammography screening guidelines (OR = 1.52, 95% CI: 1.00-2.31), a family history of breast cancer (OR = 9.97, 95% CI: 3.05-32.62), or reporting an annual versus none or a single physician breast examination (OR = 5.57, 95% CI: 1.79-17.37) had a higher odds of past mammography. On the other hand, women who were more culturally affiliated (OR = 0.42, 95% CI: 0.24-0.74), perceived more barriers (OR = 0.86, 0.78-0.94), or had higher fatalistic attitudes toward breast cancer (OR = 0.90, 95% CI: 0.82-0.99) had lower odds of past mammography. CONCLUSION: In the development of culturally-appropriate interventions promoting mammography among AI communities, emphasis could be put on the following: a) promoting clinic-related practices (e.g. physician recommendation, physician breast examination); b) promoting community-related practices (e.g. knowledge about mammography while eliminating fatalistic attitudes); and c) reducing environmental barriers.

The predictive influence of family and neighborhood assets on fighting and weapon carrying from mid- to late adolescence.

Using a developmental, social-ecological approach to understand the etiology of health-risk behavior and inform primary prevention efforts, we assess the predictive effects of family and neighborhood social processes on youth physical fighting and weapon carrying. Specifically, we focus on relationships among youth and their parents, family communication, parental monitoring, as well as sense of community and neighborhood informal social control, support, concerns, and disorder. This study advances knowledge through its investigation of family and neighborhood structural factors and social processes together, employment of longitudinal models that estimate effects over adolescent development, and use of self-report and observational measures. Data from 1,093 youth/parent pairs were analyzed from the Youth Assets Study using a Generalized Estimating Equation approach; family and neighborhood assets and risks were analyzed as time varying and lagged. Similar family assets affected physical fighting and weapon carrying, whereas different neighborhood social processes influenced the two forms of youth violence. Study findings have implications for the primary prevention of youth violence, including the use of family-based approaches that build relationships and parental monitoring skills and community-level change approaches that promote informal social control and reduce neighborhood concerns about safety.

Date rape among Cypriot female college students: an explorative study.

This study examined the prevalence and reporting of date rape among female college students (aged 18-24) in Cyprus and assessed the students' attitudes and awareness regarding date rape. In addition, the study examined how date rape is perceived among representatives of related private and governmental organizations in Cyprus. This is part of a larger multi-country study. This paper will focus only on the results pertaining to Cyprus. The study was coordinated by the Mediterranean Institute of Gender Studies. This study used quantitative and qualitative methods. In total, 476 female college students responded to an anonymous questionnaire, two focus group discussions were carried out, and five key-informant interviews with relevant institutional representatives were conducted. The results of the study indicated that unwanted sexual experiences and sexual violence, including date rape, do exist among young Cypriot women. Specifically, 1.3% of the research participants reported experiencing an attempted rape by their date, and 1.9 % of the study participants reported being raped on a date. Often this was caused by their boyfriend, friend or sexual partner (54.2%). The results of the qualitative study showed that young female Cypriots agreed that many women give in to psychological pressure because they feel guilty about letting the other person down or because they 'didn't satisfy him' or fear they might lose him. Despite the explorative nature of the study, it is significant as research on date rape in Cyprus is almost non-existent. The authors anticipate that the results of the study will be useful to other researchers and policy-makers involved in this area of research.

A longitudinal study of youth assets, neighborhood conditions, and youth sexual behaviors.

PURPOSE: To prospectively determine whether individual, family, and community assets help youth to delay initiation of sexual intercourse (ISI); and for youth who do initiate intercourse, to use birth control and avoid pregnancy. The potential influence of neighborhood conditions was also investigated. METHODS: The Youth Asset Study was a 4-year longitudinal study involving 1,089 youth (mean age = 14.2 years, standard deviation = 1.6; 53% female; 40% white, 28% Hispanic, 23% African American, 9% other race) and their parents. Participants were living in randomly selected census tracts. We accomplished recruitment via door-to-door canvassing. We interviewed one youth and one parent from each household annually. We assessed 17 youth assets (e.g., responsible choices, family communication) believed to influence behavior at multiple levels via in-person interviews methodology. Trained raters who conducted annual windshield tours assessed neighborhood conditions. RESULTS: Cox proportional hazard or marginal logistic regression modeling indicated that 11 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for ISI; seven assets (e.g., educational aspirations for the future, responsible choices) were significantly associated with increased use of birth control at last sex; and 10 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for pregnancy. Total asset score was significantly associated with all three outcomes. Positive neighborhood conditions were significantly associated with increased birth control use, but not with ISI or pregnancy. CONCLUSIONS: Programming to strengthen youth assets may be a promising strategy for reducing youth sexual risk behaviors.

Parental youth assets and sexual activity: differences by race/ethnicity.

OBJECTIVES: To examine how the relationship between parental-related youth assets and youth sexual activity differed by race/ethnicity. METHODS: A random sample of 976 youth and their parents living in a Midwestern city participated in the study. Multivariate logistic regression analyses were conducted for 3 major ethnic groups controlling for the other demographics. RESULTS: Parental monitoring had the strongest association with sexual abstinence for all 3 ethnic/racial groups. Family communication and relationship with mother were also important for white and black youth respectively. CONCLUSIONS: Parental youth assets, especially parental monitoring, can be important in the decision to delay sexual intercourse.

Associations between youth assets and sexual intercourse by household income.

PURPOSE: Evaluate youth assets or potential strengths and sexual intercourse associations by household income. DESIGN: Data consisted of youth and parent responses from randomly selected households from a cross-sectional study and wave one of a longitudinal extension of that study. Youth assets and sexual intercourse were compared for four income categories. SETTING: Midwestern racially diverse, inner-city neighborhoods. SUBJECTS: One adolescent (12-19 years) and one parent (2335 pairs). MEASURES: Adjusted odds ratios (ORs) were calculated using logistic regression. Variables assessed included parent and youth demographics, youth sexual intercourse, and youth assets (adult and peer role models, family communication, use of time [religion or sports], community involvement, future aspirations, responsible choices, and health practices). RESULTS: Youths' mean age was 14.9 (± 1.8) years, and 52% were female; 44% of respondents were white. Use of time (religion) was significantly associated with never having sex for all but the lowest income youth (OR range=1.79-2.64). The variable peer role models was significant for the lowest income (O =2.01) and two upper income groups (ORs=2.52 and 4.27, respectively). The variable future aspirations was significant for the lowest income youth (OR=1.77). CONCLUSION: The youth asset variable future aspirations was critical for the lowest income households. Other asset variables, such as peer role models and use of time (religion) were critical regardless of income.

Reliability and validity of the youth asset survey: an update.

PURPOSE: Improve and expand an existing youth asset scale. DESIGN: Consisted of seven steps: (1) review of poorer-performing items and constructs, (2) literature review for relevant new asset constructs/items, (3) review of revised instrument by panel of experts, (4) qualitative review through focus group research, (5) pilot-test of instrument, (6) evaluation of the performance of the instrument in a longitudinal study, and (7) conduct of test-retest analysis. SUBJECTS/SETTING: Youth (N = 1111) recruited through canvassing of randomly selected census tracts and blocks. MEASURES: Youth Asset Survey (YAS). ANALYSIS: Factor analysis was conducted on 50% of the baseline data and repeated on the second half of the baseline data. Correlations were computed for the test-retest analysis. RESULTS: Following modifications to the YAS based upon qualitative research, the survey was administered to youth (mean age, 14.3 years; 53% female; 39% white, 28% Hispanic, 23% African-American, 9% other). Cronbach alpha = .55-.92. A majority (27 of 34) of alpha > or = .65. All items loaded on one construct at alpha > or = .40. The final results yielded 17 constructs assessed via 61 items. Spearman correlations and intraclass correlations ranged from .60 to .82 and .58 to .87, respectively. CONCLUSION: The results generally suggest that the expanded YAS is a reliable and valid measure of assets.

Designing the process evaluation for the collaborative planning of a local turning point partnership.

This study describes the design of the process evaluation of a collaborative effort among community partners to address health issues in central Oklahoma. The design is an application of a sound process evaluation planning framework that integrates the components of context, reach, dose delivered, dose received, fidelity, implementation, recruitment, barriers, and maintenance. The planning framework also provides guidance regarding the steps of designing and implementing the process evaluation. This planning process was conducted by utilizing a participatory research approach. At the end of the planning phase, the evaluation team accomplished the following: (a) development of an evaluation plan, (b) development of evaluation instruments (i.e., surveys, interview guides, observation forms), and (c) development of evaluation questions and process objectives. The information derived from this study can be valuable to practitioners and researchers involved in the planning of community partnerships or coalitions and interested in process evaluation that takes place in community settings.