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.

Medical education for African American communities in the rural South: A focus group approach to identify fundamental considerations.

PURPOSE: We sought to understand concerns fundamental to planning medical education specific to rural southern African Americans who are virtually nonexistent in American medical schools. METHODS: A diverse multidisciplinary research team conducted this qualitative study with 3 focus groups, including 17 rural medical educators recruited nationwide, 10 African American alumni of a rural medical education pipeline in Alabama, and 5 community and institutional associates of this pipeline. Analysis of recorded transcripts generated themes fitting an ecological model suggesting concerns and intervention foci at individual, community, and institutional levels. FINDINGS: Three major themes operating at all ecological levels were: (1) How "rural minority student" is defined, with "rural" often supplanting race to indicate minority status; (2) Multiple factors relate to rural racial minority student recruitment and success, including personal relationships with peers, mentors, and role models and supportive institutional policies and culturally competent faculty; and (3) Challenges to recruitment and retention of rural minority students, especially financial concerns and preparation for medical education. CONCLUSIONS: Our findings suggest that individuals, communities, and institutions provide intervention points for planning medical education specific to southern rural African Americans. These spheres of influence project a need for partnership among communities and rural medical educators to affect broad programmatic and policy changes that address the dire shortage of rural African American health professionals to help ameliorate health inequities experienced in their home communities. It is likely that linear thinking and programming will be replaced by integrated, intertwined conceptualizations to reach this goal.

Gendered racial microaggressions and black college women: A cross-sectional study of depression and psychological distress.

Objective: We assessed the association between gendered racism, the simultaneous experience of sexism and racism, depression, and psychological distress in Black college women using an intersectional instrument, the gendered racial microaggression scale. Participants: Black college women enrolled at a predominantly white institution (PWI) in the southeastern U.S. (N = 164, response rate = 77%, mean age 21.67). Methods: We used a cross-sectional survey to explore the impact of stress appraisal and frequency of gendered racial microaggressions on depression and psychological distress using validated scales. Results: 30% reported depression and 54% reported severe psychological distress. Correlations indicate significant relationships between gendered racism, depression and psychological distress, with the strongest relation reported between the frequency of gendered racism to depression. Regression analyses suggest significant relationships between gendered racism, depression and psychological distress. Conclusion: Gendered racism has significant bearing on the mental health of Black college women attending a PWI. Implications for interventions are discussed.

Effects of heat exposure and 3% dehydration achieved via hot water immersion on repeated cycle sprint performance.

This study examined effects of heat exposure with and without dehydration on repeated anaerobic cycling. Males (n = 10) completed 3 trials: control (CT), water-bath heat exposure (∼39°C) to 3% dehydration (with fluid replacement) (HE), and similar heat exposure to 3% dehydration (DEHY). Hematocrit increased significantly from pre to postheat immersion in both HE and DEHY. Participants performed 6 × 15s cycle sprints (30s active recovery). Mean Power (MP) was significantly lower vs. CT (596 ± 66 W) for DEHY (569 ± 72 W), and the difference approached significance for HE (582 ± 76 W, p = 0.07). Peak Power (PP) was significantly lower vs. CT (900 ± 117 W) for HE (870 ± 128 W) and approached significance for DEHY (857 ± 145 W, p = 0.07). Postsprint ratings of perceived exertion was higher during DEHY (6.4 ± 2.0) and HE (6.3 ± 1.6) than CT (5.7 ± 2.1). Combined heat and dehydration impaired MP and PP (decrements greatest in later bouts) with HE performance intermediate to CT and DEHY.

Attitude and knowledge changes in collegiate dancers following a short-term, team-centered prevention program on eating disorders.

Eating knowledge, nutritional knowledge, and psychological changes among female collegiate dancers were examined before and after a 4-wk. team-centered program on sport nutrition, exercise, and disordered eating consequences. Collegiate female dancers from two NCAA Division I institutions participated in a control (n = 19; M age = 19.1 yr., SD = 1.0) or intervention (n = 21; M age = 19.2 yr., SD = 1.2) group. Measures were administered to both groups before and after intervention to assess eating disorders, depression, and nutritional and disordered eating knowledge. There was a statistically significant increase in scores on nutritional and overall eating disorder knowledge in the intervention group compared to the control group. Mean scores on depression, drive for thinness, body dissatisfaction, and maturity fears decreased in the intervention group.

Knowledge of eating disorders among collegiate administrators, coaches, and auxiliary dancers.

Knowledge of eating disorders, confidence in knowledge, and attendance of eating disorder educational programs were assessed among NCAA Division I and II university administrators (n = 61), coaches (n = 44), and dancers (n = 53). A questionnaire assessed knowledge in 5 domains: etiology, signs and symptoms, management and treatment, risk factors, and prevention and education. Overall, dancers' knowledge and previous attendance were significantly lower than administrators' and coaches'. There was inconsistency between participants' confidence in answers and the correctness of their answers. Education is necessary for improving knowledge and reducing risky behaviors in auxiliary dancers.

Pipeline Programs Can Support Reforms in Medical Education: A Cohort Study of Alabama's Rural Health Leaders Pipeline to Engage Community Leaders.

PURPOSE: To demonstrate for county leaders the utility of rural pipelines to gain physicians and produce health professionals. METHODS: This cohort study, 1993-2018, aggregated 1,051 students in the Rural Health Leaders Pipeline to their home counties (N = 67) to study the relationship between county participation in pipeline programs and outcomes of family physicians gained and health professionals produced. Additional county demographics were included. We conducted descriptive, bivariate, and multivariable linear regression analyses controlling for poverty, race, and rurality. FINDINGS: All 67 Alabama counties participated with means of 9.6 Rural Health Scholars, 2.7 Rural Minority Health Scholars, 3.4 Rural Medical Scholars, 67% rural population, 29.7% Black population, and 21.5% under poverty. Best regression model for gaining family physicians included Rural Medical Scholars involved (b = 0.24, P < .001) with R2 0.30, indicating a county gained 1 family physician for 4 students. Best model for health professionals included Rural Health Scholars involved (b = 0.20, P < .001) with R2 0.31, indicating production of 1 health professional for 5 students. Best model for any professional included Rural Health Scholars involved (b = 0.23, P < .001) with R2 0.35, indicating 1 professional produced for 4 students. CONCLUSIONS: Rural pipeline programs can be useful tools in medical education reform to benefit counties with the gain of family physicians and production of health professionals. Local public officials could use these findings, eg, 1 family physician gained for every 4 students a county involved in the pipeline, to advocate that health professional education employ such pipelines.

Impact of dehydration on a full body resistance exercise protocol.

This study examined effects of dehydration on a full body resistance exercise workout. Ten males completed two trials: heat exposed (with 100% fluid replacement) (HE) and dehydration (approximately 3% body mass loss with no fluid replacement) (DEHY) achieved via hot water bath (approximately 39 degrees C). Following HE and DEHY, participants performed three sets to failure (using predetermined 12 repetition maximum) of bench press, lat pull down, overhead press, barbell curl, triceps press, and leg press with a 2-min recovery between each set and 2 min between exercises. A paired t test showed total repetitions (all sets combined) were significantly lower for DEHY: (144.1 +/- 26.6 repetitions) versus HE: (169.4 +/- 29.1 repetitions). ANOVAs showed significantly lower repetitions (approximately 1-2 repetitions on average) per exercise for DEHY versus HE (all exercises). Pre-set rate of perceived exertion (RPE) and pre-set heart rate (HR) were significantly higher [approximately 0.6-1.1 units on average in triceps press, leg press, and approached significance in lat pull down (P = 0.14) and approximately 6-13 b min(-1) on average in bench press, lat pull down, triceps press, and approached significance for overhead press (P = 0.10)] in DEHY versus HE. Session RPE difference approached significance (DEHY: 8.6 +/- 1.9, HE: 7.4 +/- 2.3) (P = 0.12). Recovery HR was significantly higher for DEHY (116 +/- 15 b min(-1)) versus HE (105 +/- 13 b min(-1)). Dehydration (approximately 3%) impaired resistance exercise performance, decreased repetitions, increased perceived exertion, and hindered HR recovery. Results highlight the importance of adequate hydration during full body resistance exercise sessions.

Coping strategies and caregiving outcomes among rural dementia caregivers.

We studied the coping styles by which family caregivers living in rural areas of Alabama deal with the demands of caring for an older relative with dementia. Data were obtained from a sample of 141 caregivers through the random-digit dialing telephone survey. Two coping styles were identified: deliberate coping and avoidance coping. Deliberate coping was related to higher life satisfaction scores and, avoidance coping was related to lower life satisfaction scores and higher caregiver burden scores. Avoidance coping appeared to moderate the effects of caregiver health on caregiver burden. Social workers should pay greater attention to caregivers with dysfunctional coping styles.

Social support, caregiver burden, and life satisfaction in a sample of rural African American and White caregivers of older persons with dementia.

This article reports the findings of a study of African American and White dementia caregivers (n = 141) living in rural areas of Alabama that examined the relations between the participants' receipt of informal social support, and their levels of caregiver burden and life satisfaction. The sample, as a whole, reported high levels of social support with no reported differences in social support by race. Female caregivers reported higher mean scores on 3 of the 4 dimensions of social support than their male counterparts. Two of the 4 dimensions of social support accounted for 32% of the variance of the caregivers' reported level of life satisfaction.

Racial Disparities in Substance Use Treatment Completion Among Older Adults.

BACKGROUND AND OBJECTIVES: Racial disparities in substance use among young adults have been well documented in the substance use literature, but little attention has been paid to older adults. While being an older adult is positively associated with substance use treatment completion, racial disparities in treatment completion have yet to be examined. The purpose of this study was to determine to what extent racial disparities exist in substance use treatment completion among older adults (65 and older). RESEARCH DESIGN AND METHODS: This cross-sectional study utilized data from the most recent Treatment Episode Data from the Substance Abuse and Mental Health Services Administration, which documents discharges from a publicly funded substance use treatment program in the United States. A total of 17,942 older adults reported to a substance use treatment program in 2017 and 6,653 met the criteria for the study. Chi-squared tests were used to analyze group differences and a binary logistic regression was used to predict substance use treatment completion. RESULTS: Results show that Black older adults were 37% less likely to complete a substance use treatment program than Whites (OR = 0.630) while Hispanic older adults were 26% more likely to complete a substance use treatment program than Whites (OR = 1.26). DISCUSSION AND IMPLICATIONS: These results support the findings from similar studies with younger adults and support the theory that racial disparities are prevalent across the life span. Although Hispanics had a higher treatment completion rate than Whites, this is likely a reflection of familismo, where decisions about health treatments is a group process and a steady network of family members are available to provide advice and encouragement. The significant disparity observed between Black and White older adults suggest a need to consider cultural, historical, and systemic factors that affect voluntary termination of substance use treatment among Black older adults.

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.

Overweight and obesity are associated with emotion- and stress-related eating as measured by the eating and appraisal due to emotions and stress questionnaire.

OBJECTIVE: Identify if constructs from the Eating and Appraisal Due to Emotions and Stress Model, including Emotion and Stress Related Eating, Appraisal of Ability and Resources to Cope, and Appraisal of Outside Influences and Stressors, were related to overweight and obesity. DESIGN: Data were collected from a cross-sectional study using the Eating and Appraisal Due to Emotions and Stress Questionnaire. SUBJECTS/SETTING: Convenience sample from a southeastern public university, including staff and faculty (n=822) with ages ranging from 18 to 83 years and 55.8% of the sample being overweight or obese. STATISTICAL ANALYSIS PERFORMED: Total sum scores were given to each construct and converted to quartiles. Lower quartiles represented higher stress- or emotion-related eating and more compromised appraisal skills or resources to cope. chi(2) Analyses were used to identify variables associated with overweight and obesity. Forward stepwise logistic regression (n=783) was used to identify the independent association of each significant variable with overweight and obesity. RESULTS: A model including race, sex, life stage, and job category as covariates, with a cumulative R(2) of 0.075 was produced. Emotion- and Stress-Related Eating remained in the model during stepwise regression producing a cumulative R(2)=0.265. Individuals scoring in the lowest quartiles for Emotion- and Stress-Related Eating were 13.38 times more likely to be overweight or obese, compared with individuals scoring in the highest quartiles. CONCLUSIONS: The Eating and Appraisal Due to Emotions and Stress Model construct of Emotion- and Stress-Related Eating as measured by the Eating and Appraisal Due to Emotions and Stress Questionnaire can be used to assess nontraditional factors that contribute to overweight and obesity.

Drinking likelihood, alcohol problems, and peer influence among first-year college students.

Excessive alcohol consumption is a predominant health concern on college campuses in the United States. A stepwise multiple regression analysis was used to examine the predictive values of demographic factors in relation to alcohol subscales (Drinking Context Scale, College Alcohol Problems Scale-revised, and Social Modeling Scale) with the outcome of number of drinking days in the past 30 days among a sample (n = 224) of first-year college students. The final model predicted 37.5% of the variability in drinking days in the past month. All variables, except for race, were significantly associated with the outcome (p < .05).

Educating Physicians for Rural America: Validating Successes and Identifying Remaining Challenges With the Rural Medical Scholars Program.

PURPOSE: To evaluate the Rural Medical Scholars (RMS) Program's effectiveness to produce rural physicians for Alabama. METHODS: A nonrandomized intervention study compared RMS (1997-2002) with control groups in usual medical education (1991-2002) at the University of Alabama School of Medicine's main and regional campuses. Participants were RMS and others admitted to regular medical education, and the intervention was the RMS Program. Measures assessed the percentage of graduates practicing in rural areas. Odds ratios compared effectiveness of producing rural Alabama physicians. FINDINGS: The RMS Program (N = 54), regional campuses (N = 182), and main campus (N = 649) produced 48.1% (odds ratio 6.4, P < .001), 23.8% (odds ratio 2.5, P < .001), and 11.2% (odds ratio 1.0) rural physicians, respectively. CONCLUSIONS: The RMS Program, contrasted to other local programs of medical education, was effective in producing rural physicians. These results were comparable to benchmark programs in the Northeast and Midwest USA on which the RMS Program was modeled, justifying the assumption that model programs can be replicated in different regions. However, this positive effect was not shared by a disparate rural minority population, suggesting that models for rural medical education must be adjusted to meet the challenge of such communities for physicians.

A Predictive Model for a Reputation-Based General Surgery Residency Match and a Novel Online Calculator.

OBJECTIVE: This study aimed to identify medical student characteristics that predict a successful categorical match into a general surgery residency and a match based upon Doximity program rankings. DESIGN: This was a retrospective study that analyzed academic and personal predictors of a successful general surgery residency match. SETTING: This study was set at the University of Alabama at Birmingham School of Medicine, a public medical school. PARTICIPANTS: This study included 173 fourth-year medical students at a public medical school who matched into general surgery residency programs. METHODS: Our cohort comprised students graduating from our institution between 2004 and 2015 that matched into preliminary or categorical general surgery positions. We collected academic variables and performed univariate analyses and logistic regression to examine the likelihood of specific match outcomes. RESULTS: Of 173 students, 132 (76%) matched into a categorical position and 41 (24%) matched into a preliminary position. Of all variables, clinical ranking quartile was most effective in predicting a categorical match (R2 = 0.35). Models for a match based upon Doximity ranking lacked the same predictive power. CONCLUSIONS: This research identifies students that are at risk for not matching into a categorical position and predicts competitiveness for certain programs. It provides a novel calculator to give applicants easily interpretable match probabilities.

The Eating and Appraisal Due to Emotions and Stress (EADES) Questionnaire: development and validation.

OBJECTIVE: To develop and validate the Eating and Appraisal Due to Emotions and Stress (EADES) Questionnaire that was created to measure how one uses food to cope with stress and emotions. DESIGN: Data were collected from a cross-sectional study using the EADES Questionnaire. SUBJECTS/SETTING: Convenience sample (response rate 22%) from a southeastern public university, including staff and faculty (n=854) with ages ranging from 18 to 83 years and a mean body mass index of 27.3+/-6.4. STATISTICAL ANALYSIS PERFORMED: Exploratory factor analysis was completed on 54 items that were originally meant to describe constructs from the Transactional Model of Stress and Coping. Reliability of scales was estimated using Cronbach's alpha. Total sum scores were given to each factor. Pearson correlation coefficients assessed linear associations between factors. RESULTS: Three factors accounting for 43.5% of the variance were retained with a total Cronbach's alpha=.949. The factors did not represent the theoretical constructs from the Transactional Model of Stress and Coping as anticipated. A new model was created, including Emotion- and Stress-Related Eating, Appraisal of Resources and Ability to Cope, Appraisal of Outside Stressors and Influences with Cronbach's alpha being .949, .869, and .652, respectively. These factors were significantly correlated with one another. CONCLUSIONS: The EADES model provides a viable conceptual model to help explain variables that may contribute to overeating, whereas the EADES Questionnaire provides a measurement tool for evaluating these variables that have not traditionally been explored in weight management efforts.

Family caregiving to those with dementia in rural Alabama: racial similarities and differences.

This study explored differences and similarities in the experiences of African American and White family caregivers of dementia patients living in rural Alabama. This cross-sectional survey used a caregiving stress model to investigate the interrelationships between caregiving burden, mediators, and outcomes. Random-digit-dialing telephone interviews were used to obtain data on a probability sample of 74 non-Hispanic White and 67 African American caregivers. White caregivers were more likely to be married and older, used acceptance and humor as coping styles, and had fewer financial problems. African American caregivers gave more hours of care, used religion and denial as coping styles, and were less burdened. The authors have developed a methodology for obtaining a representative sample of African American and White rural caregivers. Further investigations are needed of the interactions between urban/rural location and ethnic/racial backgrounds of dementia caregivers for heuristic and applied reasons.

Using the Theory of Planned Behavior to predict HPV vaccination intentions of college men.

OBJECTIVE: The purpose of this study was to test Theory of Planned Behavior (TPB) constructs in predicting human papillomavirus (HPV) vaccination behavioral intentions of vaccine-eligible college men. PARTICIPANTS: Participants were unvaccinated college men aged 18-26 years attending a large public university in the southeastern United States during Spring 2015. METHODS: A nonexperimental, cross-sectional study design was employed. Instrumentation comprised a qualitative elicitation study, expert panel review, pilot test, test-retest, and internal consistency, construct validity, and predictive validity assessments using data collected from an online self-report questionnaire. RESULTS: The sample consisted of 256 college men, and the final structural model exhibited acceptable fit of the data. Attitude toward the behavior (ß = .169) and subjective norm (ß = 0.667) were significant predictors of behavioral intention, accounting for 58% of its variance. CONCLUSIONS: Practitioners may utilize this instrument for the development and evaluation of TPB-based interventions to increase HPV vaccination intentions of undergraduate college men.

Physicians for rural America: the role of institutional commitment within academic medical centers.

CONTEXT: Prior study suggests that contextual characteristics of medical schools (e.g., state demographics, public vs private, NIH research effort) predict output of rural physicians without also considering the effects of the medical schools' own policies and programs. PURPOSE: This study examines medical school commitment to rural policies and programs and its relationship to contextual characteristics and rural physician output. METHODS: A survey of 122 U.S. allopathic medical schools provided data to construct a 32-item Rural Commitment Index for each medical school. Data for other characteristics were linked from published sources. Correlations, t tests, and multiple regression analysis were used to study the association between variables and percentage of medical school graduates (1988-1996) who were in rural primary care practice in 2000. FINDINGS: Among 90 medical schools (response rate, 73.8%), the Rural Commitment Index correlated with the percentage of the state population that is rural and whether the school is public or private, and it joined percentage state population rural, public vs private, and National Institutes of Health support in correlating with percentage of graduates in rural primary care. In a regression model that explained 48.4% of variation in the percentage of graduates in rural primary care, the Rural Commitment Index explained most variation, followed by percentage state population rural, public vs private, National Institutes of Health support, and the interaction between the Rural Commitment Index and public vs private. CONCLUSIONS: The findings support the proposition that observable institutional commitment affects rural physician output and provide justification for a definitive study to verify that a change in medical school commitment to rural medicine produces a change in rural physician output.