Parent health literacy and adherence-related outcomes in children with epilepsy.

BACKGROUND: The relationship between parent health literacy and adherence to treatment in children with epilepsy has not been fully explored. The purpose of this study was to determine whether parent health literacy and other variables predicted factors associated with adherence, such as missed medication doses, missed medical appointments, and seizure frequency, in children with epilepsy between 1 and 12 years old. METHODS: It was hypothesized that parents with adequate parent health literacy would report fewer missed doses, missed appointments, and seizure occurrences. Using a nonexperimental, cross-sectional study design, interviews were conducted with 146 parents and guardians of children with epilepsy who resided in rural communities. Univariate analyses, including ANOVA, and multiple linear regressions were conducted. RESULTS: Results indicated that parent health literacy was the strongest predictor of two of the adherence-related factors. Higher health literacy scores were associated with fewer missed medication doses and seizure occurrences. However, health literacy was not associated with missed medical appointments. Among other study variables, higher household income was also predictive of fewer missed doses. CONCLUSION: The study findings suggest that inadequate health literacy among parents may serve as an independent risk factor for adherence-related outcomes among children with epilepsy. Further research, as well as effective, targeted parent health literacy strategies used to improve epilepsy management and care in children, is recommended.

Prevalence of pediatric epilepsy in low-income rural Midwestern counties.

Epilepsy is one of the most common disabling neurological disorders, but significant gaps exist in our knowledge about childhood epilepsy in rural populations. The present study assessed the prevalence of pediatric epilepsy in nine low-income rural counties in the Midwestern United States overall and by gender, age, etiology, seizure type, and syndrome. Multiple sources of case identification were used, including medical records, schools, community agencies, and family interviews. The prevalence of active epilepsy was 5.0/1000. Prevalence was 5.1/1000 in males and 5.0/1000 in females. Differences by age group and gender were not statistically significant. Future research should focus on methods of increasing study participation in rural communities, particularly those in which research studies are rare.

Factors associated with medication adherence in patients with epilepsy and recommendations for improvement.

Although it is one of the most common neurological disorders, epilepsy continues to be a highly stigmatized and disabling chronic condition. Healthy People 2020 aims for improvement in the health-related quality of life and well-being of Americans, including these medically vulnerable patients. Efforts to research and improve medication adherence in this population and others with chronic conditions are an important step towards this end. The purpose of this study was to investigate factors associated with adherence and to provide recommendations for improvement. A cross-sectional survey research design was used in a convenience sample of patients receiving treatment at a tertiary epilepsy center. Adherence was measured by self-reported missed/skipped medication doses and seizure frequencies and by the presence of intractable seizures as indicated in patients' medical charts. Analysis was conducted with SPSS 21.0 on the data collected from the returned mailed surveys. Among the sample of 180 patients, most had some education beyond high school, household incomes of varying amounts, and health insurance coverage. Most of the participants were unemployed. Clinical records showed that 46% had intractable seizures. About 66% missed taking their medication on a monthly basis, with "forgetfulness" being the primary reason. Adherence (seizure frequency) was associated with being employed (P=.028). Adherence (complying with medication treatment plan) was also associated with "medication reminders" (P=.002) and educational attainment (P=.008). The findings indicate a continued need to explore the complex issue of adherence. The findings also highlight the need for health education and other public health and medical professionals to design effective strategies to connect patients with employment opportunities and other resources. Efforts are also needed to help provide information and build skills among patients with epilepsy that would lead to improved medication adherence and management.

Parent opinions about use of text messaging for immunization reminders.

BACKGROUND: Adherence to childhood immunization schedules is a function of various factors. Given the increased use of technology as a strategy to increase immunization coverage, it is important to investigate how parents perceive different forms of communication, including traditional means and text-message reminders. OBJECTIVE: To examine current forms of communication about immunization information, parents' satisfaction levels with these communication modes, perceived barriers and benefits to using text messaging, and the ideal content of text messages for immunization reminders. METHODS: Structured interviews were developed and approved by two Institutional Review Boards. A convenience sample of 50 parents was recruited from two local pediatric clinics. The study included a demographics questionnaire, the shortened form of the Test of Functional Health Literacy for Adults (S-TOFHLA), questions regarding benefits and barriers of text communication from immunization providers, and preferred content for immunization reminders. Content analyses were performed on responses to barriers, benefits, and preferred content (all Cohen's kappas > 0.70). RESULTS: Respondents were mostly female (45/50, 90%), white non-Hispanic (31/50, 62%), between 20-41 years (mean = 29, SD 5), with one or two children (range 1-9). Nearly all (48/50, 96%) had an S-TOFHLA score in the "adequate" range. All parents (50/50, 100%) engaged in face-to-face contact with their child's physician at appointments, 74% (37/50) had contact via telephone, and none of the parents (0/50, 0%) used email or text messages. Most parents were satisfied with the face-to-face (48/50, 96%) and telephone (28/50, 75%) communication. Forty-nine of the 50 participants (98%) were interested in receiving immunization reminders by text message, and all parents (50/50, 100%) were willing to receive general appointment reminders by text message. Parents made 200 comments regarding text-message reminders. Benefits accounted for 63.5% of comments (127/200). The remaining 37.5% (73/200) regarded barriers; however, no barriers could be identified by 26% of participants (13/50). Parents made 172 comments regarding preferred content of text-message immunization reminders. The most frequently discussed topics were date due (50/172, 29%), general reminder (26/172, 26%), and child's name (21/172, 12%). CONCLUSIONS: Most parents were satisfied with traditional communication; however, few had experienced any alternative forms of communication regarding immunizations. Benefits of receiving text messages for immunization reminders far outweighed the barriers identified by parents. Few barriers identified were text specific. Those that were, centered on cost if parents did not have unlimited texting plans.

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.

Distracted mobile device use among street-crossing college student pedestrians: an observational approach.

ObjectiveTo estimate the incidence of mobile device use among street-crossing pedestrians and explore differences by sex and intersection type at a large public South-eastern university in the United States.ParticipantsAll instances of campus pedestrians crossing the street during the observation period (N = 4,878).MethodsVideo recordings of crosswalk activity at four locations were analyzed for pedestrian use of a mobile device while crossing.ResultsDevice use while crossing was observed 1,201 (24.6%) times. Of male crossing instances, 277 (16.8%) were coded as using a device. Of female instances, 924 (28.6%) were coded as using a device. Differences in device use while crossing were found between sexes and some intersection types.ConclusionsThis study estimates mobile device use while crossing the street and suggests differences by sex and intersection type. Future research should focus on improving understanding of the problem and evaluation of interventions to address the issue.

Standards for epidemiologic studies and surveillance of epilepsy.

Worldwide, about 65 million people are estimated to have epilepsy. Epidemiologic studies are necessary to define the full public health burden of epilepsy; to set public health and health care priorities; to provide information needed for prevention, early detection, and treatment; to identify education and service needs; and to promote effective health care and support programs for people with epilepsy. However, different definitions and epidemiologic methods complicate the tasks of these studies and their interpretations and comparisons. The purpose of this document is to promote consistency in definitions and methods in an effort to enhance future population-based epidemiologic studies, facilitate comparison between populations, and encourage the collection of data useful for the promotion of public health. We discuss: (1) conceptual and operational definitions of epilepsy, (2) data resources and recommended data elements, and (3) methods and analyses appropriate for epidemiologic studies or the surveillance of epilepsy. Variations in these are considered, taking into account differing resource availability and needs among countries and differing purposes among studies.

The role of local health departments in providing sexually transmitted disease services and surveillance in rural communities.

Local health departments (LHDs) are an important source for screening and treating sexually transmitted diseases (STDs) in rural communities. Yet, they oftentimes lack the resources needed to adequately assess and monitor these conditions. The purpose of this study was to (1) explore how rural LHDs assess and monitor STDs; (2) identify barriers to effective surveillance; (3) examine STD patterns in their communities; and (4) provide recommendations for improving surveillance. Data were collected from questionnaires, LHD site visits, client management system records, and state reports. One of the greatest challenges to adequately monitoring STDs was the lack of standardized data collection methods among LHDs. In addition, race/ethnicity information, which is critical to monitoring disparities, was lacking in most records. Among records where recorded, racial/ethnic minorities were most affected. STD patterns indicated adolescents lead all age groups in STDs. LHDs should consider regionalized or statewide approaches to assessing and monitoring STDs and develop standardized STD interview/intake forms, paying particular attention to race, ethnicity, and income data. Demographic and coding variables should be included and standardized across all forms for consistency. STD interventions and campaigns targeting adolescents and racial/ethnic minorities in rural counties should also be considered. Due to limited time and resources, little can be done by rural LHDs in regards to prevention and education, yet, state and federal agencies should consider how additional resources and enhanced support could be provided to assist them in fulfilling their public health role in STD surveillance.

Addressing health disparities among African Americans: using the stages of change model to document attitudes and decisions about nutrition and physical activity.

Physical activity (PA) and poor fruit/vegetable intake are contributors of health disparities among African Americans (AA). In order to design effective interventions to address these behaviors, it is essential to assess where individuals are in terms of their attitudes and decisions. The aim of this study was to use the Stages of Change Model to assess AA's attitudes and decisions regarding pertinent health behaviors and provide suggestions about how to address them. A survey was administered to 242 low-income, medically underserved adults (47% AA, 27% White, and 26% "Others"). The majority was in the SOC's: "contemplation" stage for PA (they were considering PA); "maintenance" stage for vegetable intake (they had consumed > or =3 vegetable servings daily for > or =6 months); and in the "contemplation" stage for fruit intake (those grouped as "Others" were significantly more likely to be in the "maintenance" stage). Although education and awareness are important, this study has implications for interventions with greater emphasis on creating environments or providing resources to promote or support behavioral change.

Comparison of focus groups on cancer and employment conducted face to face or by telephone.

Findings from telephone focus groups have not been compared previously to findings from face-to-face focus groups. We conducted four telephone focus groups and five face-to-face focus groups in which a single moderator used the same open-ended questions and discussion facilitation techniques. This comparison was part of a larger study to gain a better understanding of employment experiences after diagnosis of gynecologic cancer. Offering the telephone option made it easier to recruit women from rural areas and geographically distant cities. Interaction between participants occurred in both types of focus group. Content analysis revealed that similar elements of the employment experience after cancer diagnosis were described by telephone and face-to-face participants. Participants disclosed certain emotionally sensitive experiences only in the telephone focus groups. Telephone focus groups provide useful data and can reduce logistical barriers to research participation. Visual anonymity might help some participants feel more comfortable discussing certain personal issues.

The influence of experience and credential status on perceptions of agency competency in delivery of the 10 essential environmental public health services.

Contributions made by the environmental health (EH) workforce in reducing human disease are some of the most significant to public health. A shrinking workforce and increased work complexity have called for workforce training in the 10 essential public health services. The preliminary study discussed here assesses perceived competency of the Kansas EH workforce in the 10 essential public health services and evaluates credentialing influence on perceptions. State and local food service inspectors were anonymously surveyed using the Northwest Center for Public Health Practice Environmental Health Workforce Questionnaire. Credentialed respondents reported more years of experience and supervisory responsibilities, Noncredentialed respondents were more likely than credentialed respondents to answer that their work unit was capable of providing the 10 essential public health services. Kansas should establish an accredited EH program and national credentialing requirements established for EH practitioners would encourage and institutionalize ongoing workforce training programs.

Immigrants vs. non-immigrants: attitudes toward and practices of non-therapeutic male circumcision in the United States of America.

OBJECTIVES: To explore and compare attitudes toward and practices of non-therapeutic male circumcision (NTMC) between immigrants and non-immigrants. STUDY DESIGN: We conducted 8 focus groups involving 44 participants of the lay public (21 immigrants and 23 non-immigrants) and 14 extended interviews with physicians (9 family physicians and 5 pediatricians). RESULTS: Four themes regarding NTMC were identified: knowledge and awareness, benefits and drawbacks, Medicaid and American Academy of Pediatrics practices and recommendations, and medical and cultural competence issues. CONCLUSIONS: The influx of immigrants may decrease the incidence of NTMC in the United States. Health professionals need to be culturally competent in interacting with both immigrants and non-immigrants regarding NTMC-related issues.

Mobile device use while crossing the street: Utilizing the theory of planned behavior.

Every year, thousands of pedestrians are killed and tens-of-thousands are nonfatally injured as a result of traffic crashes. The year 2016 holds the record for the most pedestrians killed in one year since 1990. Mobile device use while crossing the street has been associated with unsafe crossing behaviors and gait abnormalities, potentially increasing the risk of pedestrian injury or death. Expanding upon the small body of literature, the present study utilized the theory of planned behavior to guide the development of a questionnaire used to collect data from 480 adults on predictors of intentions to use a mobile device while crossing the street. Questionnaire development involved one round of expert panel review (N = 4), subsequent pilot testing of a revised questionnaire, and a test-retest reliability assessment. Results demonstrate that attitude toward the behavior, subjective norm, and perceived behavioral control significantly predicted the intention to use a mobile device while crossing the street in this population. Such a questionnaire can be used in the design and evaluation of TPB-based interventions to decrease distracted mobile device use while crossing the street.

Measures of adherence to epilepsy treatment: review of present practices and recommendations for future directions.

Epilepsy is one of the most common neurological disorders worldwide, and the majority of people with epilepsy who live in developed countries manage their condition with antiseizure medication. Surprisingly, therefore, the literature on epilepsy does not document a comprehensive investigation of patient adherence to medication treatment. This paper reviews existing literature on direct and indirect measures of adherence. Based on this review, areas in need for further research have been identified, including improvement of self-report instruments, consideration of cultural factors, attention to patient literacy or numeracy levels, and inclusion of patient-guided measures. While no single method of determining adherence has proved effective, combining direct and indirect measures in a patient-guided, culturally competent atmosphere may increase adherence to treatment, improving health outcomes for this population.

Addressing physical inactivity among developmentally disabled students through visual schedules and social stories.

INTRODUCTION: This project tested visual schedules and social stories in a physical education setting in order to increase the physical activity of developmentally disabled students. METHOD: This cohort study design involved 17 physical education teachers in a training course with an initial survey and 7-month post-survey. The initial survey assessed participant experience with developmentally disabled students, visual schedules and social stories. The post-survey assessed usage of, effectiveness of, and satisfaction with visual schedules and social stories in a physical education setting. RESULTS: On the initial survey, 100% of the participants reported that they work with developmentally disabled students and 24% reported little to no training in working with this population. On the post-survey, 75% of the participants reported using visual schedules in their teaching and 64% found them to be "effective" or "very effective". Six percent used social stories in their teaching, reporting them as 100% "very effective". CONCLUSION: There is an indication that visual schedules and social stories are effective learning tools in the physical education setting, increasing opportunities for developmentally disabled students to be physically active. However, additional resources and training are needed in order for physical education teachers to implement these tools widely in their classes.

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.

Evaluating the impact of a hypertension program for African Americans.

Although hypertension affects all racial and ethnic groups, its prevalence is highest in the African-American community. The goal of Healthy People 2010 is to reduce hypertension among African Americans from 40% to 16%. Although current levels remain high, culturally sensitive, community-based clinical projects might be helpful in addressing this problem. The goal of this study was to assess whether a community-based clinic's program was effective in improving blood pressure control among a sample of 134 African-American adults. The program design involved health education and physical fitness classes offered over a nine-month period, with blood pressure checks being conducted pre- and postphases to determine whether the program was effective in controlling high blood pressure. Health questionnaires were also administered pre- and posttest to assess whether health behaviors and perceived health status were influenced by the project. Two-thirds (70%) of the sample had high blood pressure at baseline and 43% at program conclusion. This was a statistically significant difference (p=0.003). Overall self-reported health survey results indicated improved health behaviors and health status changes. Findings suggest that culturally sensitive, community-based clinic programs that incorporate both health education and physical fitness might be effective in reducing hypertension among African Americans.

Unmet needs for dental care in children with special health care needs.

OBJECTIVE: The unmet need for dental care is one of the greatest public health problems facing U.S. children. This issue is particularly concerning for children with special health care needs (CSHCN), who experience higher prevalence of unmet dental care needs. The primary purpose of this study was to investigate regional differences in unmet dental care needs for CSHCN. Using the Social Ecological Model as a framework, additional variables were analyzed for regional differences. It was hypothesized that (H1) unmet dental care needs would be high in the CSHCN population, (H2) there would be regional differences in unmet dental care needs in CSHCN, and (H3) there would be differences in specific individual, interpersonal (family), community (state), and policy level factors by region. METHODS: Data were obtained from the 2009-2010 National Survey of CSHCN. SPSS was used for data management and analysis. RESULTS: Each of the study hypotheses was supported for the sample of 40,242 CSHCN. The West region was more likely to have more unmet needs for preventive and specialized dental care in CSHCN than the reference region (Northeast). The South region followed the West region in unmet dental care needs. Statistically significant differences in individual, interpersonal (family), community (state) and policy factors were found by region. CONCLUSION: Further research is recommended. Effective strategies that include policy to address unmet dental care needs at multiple levels of intervention are suggested.

A definition and operational framework for health numeracy.

Health numeracy has often been overshadowed by health literacy, either ignored completely or identified simply as a subset of health literacy. Only now are researchers beginning to realize the importance of health numeracy as a separate entity. One of the first steps in this evolution is to establish a distinct definition for health numeracy, something that has not been addressed in the literature to date. This paper proposes such a definition, as well as a set of clarifying categories in hopes of helping researchers both to advance the field of health numeracy and to focus their topics within the realm of health numeracy.