Racial Disparities in Employment Status After Moderate/Severe Traumatic Brain Injuries in Southeast Michigan.

OBJECTIVE: To examine the progress made in recent decades by assessing the employment rates of Black and non-Hispanic White (NHW) patients after traumatic brain injury (TBI), controlling for pre-TBI employment status and education status. DESIGN: Retrospective analysis in a cohort of patients treated in Southeast Michigan at major trauma centers in more recent years (February 2010 to December 2019). SETTING: Southeastern Michigan Traumatic Brain Injury Model System (TBIMS): 1 of 16 TBIMSs across the United States. PARTICIPANTS: NHW (n=81) and Black (n=188) patients with moderate/severe TBI (N=269). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Employment status, which is separated into 2 categories: student plus competitive employment and noncompetitive employment. RESULTS: In 269 patients, NHW patients had more severe initial TBI, measured by percentage brain computed tomography with compression causing >5-mm midline shift (P<.001). Controlling for pre-TBI employment status, we found NHW participants who were students or had competitive employment prior to TBI had higher rates of competitive employment at 2-year (P=.03) follow-up. Controlling for pre-TBI education status, we found no difference in competitive and noncompetitive employment rates between NHW and Black participants at all follow-up years. CONCLUSIONS: Black patients who were students or had competitive employment before TBI experience worse employment outcomes than their NHW counterparts after TBI at 2 years post TBI. Further research is needed to understand better the factors driving these disparities and how social determinants of health affect these racial differences after TBI.

Outcome Expectancies, Health Information Seeking, and Cancer Beliefs Associated with Multivitamin/Mineral Use in a National Sample, HINTS-FDA 2015.

BACKGROUND: Dietary supplements, including multivitamins/minerals, are commonly reported by adults, yet little is known about multivitamin/mineral use in relation to information seeking, cancer-specific outcome expectancies, and cancer beliefs. OBJECTIVE: To examine the relationship of heath information seeking, beliefs about cancer, and outcome expectancies with multivitamin/mineral use within a national sample. DESIGN: A secondary analysis of data collected by The Health Information National Trends Survey (HINTS) and the US Food and Drug Administration (FDA) (HINTS-FDA 2015) was conducted. HINTS-FDA 2015 evaluated information seeking, beliefs about cancer, and health behaviors and was a self-administered, two-stage mail survey sent to a random sample of US postal addresses stratified by county smoking rates. PARTICIPANTS: Adult household residents were invited to participate, resulting in a 33% response rate (n=3,738). MAIN OUTCOME MEASURES: Participants self-reported use of multivitamin/mineral products. STATISTICAL ANALYSES: Adjusting for covariates (demographics, single-ingredient and herbal supplement use) weighted stepwise binary logistic regression was used to examine correlates of self-reported multivitamin/mineral use. RESULTS: Intake was associated with less than a high school education, having health insurance, and single-ingredient and herbal supplement use. Trust in health organizations (odds ratio [OR]=1.67, P<0.001) and the expectancy that cancer could be avoided with dietary supplements (OR=1.76, P<0.001) correlated with use. Agreement that supplements labeled as "anticarcinogenic" could treat (OR=3.07, P<0.001) or prevent cancer (OR=6.06, P<0.001) correlated with multivitamin/mineral use. Fatalistic beliefs (P<0.001) and negative information-seeking experiences (P<0.001) were associated with slightly lower odds of use. CONCLUSIONS: Despite leading health organizations' discouragement of dietary supplements for cancer prevention, this study found that trust in health organizations and outcome expectancies were associated with multivitamin/mineral use. This divergence presents a need to explore how dietary supplement evidence based recommendations can be translated and disseminated for the public.

Affective determinants of physical activity in cancer survivors.

Objective: Research with non-cancer survivor populations finds affective variables to be important determinants of physical activity. This study assessed the ability of explicit and implicit affective variables to predict the physical activity of cancer survivors, above that accounted for by cognitive variables. The study also tested whether the affective variables were connected to physical activity directly or indirectly through their association with behavioural intentions. Design: In a cross-sectional design, cancer survivors (n = 122) completed questionnaires and an implicit affect task. Main outcome measures: Self-report measures assessed three affective variables (e.g. positive affective associations), five cognitive variables (e.g. cognitive beliefs), physical activity estimates, behavioural intentions and participants also completed an implicit affect task regarding physical activity. Results: Two of the three explicit affect variables and the implicit affect variable accounted for significant variability in physical activity estimates beyond that accounted for by the cognitive variables. Positive affective associations were the strongest predictor in multivariate analyses. Behavioural intentions did not mediate the link between the affect variables and physical activity estimates. Conclusions: Explicit and implicit affective variables are direct and unique predictors of physical activity in cancer survivors. Physical activity interventions for cancer survivors should target both explicit affect and implicit affect.

Affective associations as predictors of health behavior in urban minority youth.

OBJECTIVE: Affective associations are key predictors of health-relevant action that can mediate the relationships between cognitive variables and health behavior. Little data, however, has examined affective associations in high-risk groups, the individuals with the greatest need for intervention. Further, few studies have examined the unique predictive ability of positive and negative affective associations. METHODS: The present study assessed positive affective associations, negative affective associations, cognitive beliefs, subjective norms, and reports of 4 obesity-related behaviors (physical activity, fruit consumption, vegetable consumption, and soft drink consumption) across a cross-sectional (n = 1,499) and a longitudinal sample (n = 104) of predominantly African American adolescents of low socioeconomic status from the inner city of urban Detroit. RESULTS: In both samples, positive (not negative) affective associations were the strongest and most consistent predictor of health behavior. Analyses also suggested that positive affective associations mediate the relationships between cognitive beliefs, subjective norms, and health behavior. Interaction tests revealed no evidence that the link between positive affective associations and health behavior is moderated by negative affective associations, cognitive beliefs, subjective norms, sex, or age. CONCLUSIONS: The results are consistent with affective association research and support the development of health interventions for urban minority youth aimed at changing positive (rather than negative) affective associations. The consistency across behaviors and the lack of reliable interactive effects suggests that changing positive affective associations may benefit urban youth regardless of behavior domain, age, sex, negative affective associations, subjective norm, and cognitive beliefs. (PsycINFO Database Record

Advocacy and Public Policy Perceptions and Involvement of Master Certified Health Education Specialists.

Master Certified Health Education Specialists (MCHES; n = 186) participated in a mail survey on advocacy and public policy. Over half of participants reported that they had contacted a public official or provided policy-related information to consumers or other professionals. Participants identified barriers and benefits to influencing public policy. The greatest benefit was identified as improving the health or welfare of the public while the greatest barrier was that they were busy with other priorities. Participants also described their level of involvement, knowledge, training in advocacy, and their self-efficacy in performing various advocacy activities. Most MCHES reported voting and other basic advocacy functions while far fewer had participated in more advanced advocacy activities. Although nearly 73% had formal training on advocacy and policy, only 26% received it through college coursework. Factors predictive of advocacy and policy involvement were determined through a stepwise regression analysis. Five independent variables predicted the total number of advocacy activities and when combined accounted for nearly 61% of the variance. Government-level health educators' misconception that they cannot participate in advocacy and public policy issues should be dispelled. Health education specialists with the MCHES credential need coursework and additional training on how to effectively influence public health policy.

Public Policy Involvement by Certified Health Education Specialists: Results of a National Study.

BACKGROUND: Advocating for health-related activities is an essential part of being a health educator and knowing how to advocate is an important part of the Certified Health Education Specialist (CHES) exam. However, based on previous research, there may be a gap between knowing how to and actually participating in public policy activities. The purpose of this study was to determine public policy involvement of CHES. METHOD: Surveys were mailed to a random sample of 500 CHES (41% response rate). RESULTS: The highest selected public policy activities by CHES were the following: voting at an election (88.9%), contacting a public office (49%), and providing policy-related information (42.9%). The number of locations CHES individuals selected in having training on advocacy was a predictive factor in their confidence to perform advocacy. Positive correlations between perceived knowledge and effectiveness of the public policy process and self-reported involvement in public policy were found. CONCLUSION: Although there is moderate self-reported involvement in public policy activities, more emphasis needs to be placed on raising the confidence of CHES to perform advocacy-related activities in the field.