Anamaria S. Kazanis

Effectiveness of a tailored intervention to increase factory workers' use of hearing protection.

BackgroundIn the United States it is estimated that more than 30 million workers are exposed to harmful levels of noise on the job. When engineering or administrative controls cannot be used to reduce noise, workers should always use hearing protection devices (HPDs) when exposed to loud noise to prevent noise-induced hearing loss (NIHL). Previous research has shown that workers do not always use HPDs when required; therefore, it is essential that workers assume personal responsibility for preventing NIHL by increasing their use of HPDs. ObjectivesThis study tested the effectiveness of an individually tailored multimedia intervention to increase use of HPDs by factory workers. MethodsA randomized controlled design was used to compare the effects of a tailored intervention (n = 446) with two other interventions (a nontailored predictor-based intervention (n = 447) and a control intervention (n = 432)) on workers’ self-reported use of HPDs 6 to 18 months following the intervention. ResultsOnly those workers receiving the tailored intervention significantly increased their use of HPDs from pretest to posttest. However, this increase significantly differed from the nontailored group but not from the control group. ConclusionsIndividually-tailored interventions offer promise for changing behavior. In light of the similarity between the results for the tailored intervention and the control intervention groups, further research is needed to understand barriers to HPD use and how to maximize the benefits of individually tailored interventions in this setting.

Statins in the Last Six Months of Life: A Recognizable, Life-Limiting Condition Does Not Decrease their Use

BACKGROUND Some have advocated discontinuing statins in patients with life-limiting conditions. However, the extent of statin use at the end of life has yet to be described and whether statin prescribing may already be influenced by the presence of a recognizable, life-limiting condition is unknown. OBJECTIVE To measure the prevalence of statin use during the last 6 months of life and determine if statin prescribing varies according to the presence of a recognizable, life-limiting condition. DESIGN Matched, case-control trial nested within a retrospective, cohort study. SETTING/SUBJECTS From 3031 VISN 11 patients who died in FY2004, we identified 1584 (52%) receiving statins at least 6 months before death. Of those, we identified 337 cases with a recognizable, life-limiting condition and 1247 controls matched on number of comorbidities, age, and socioeconomic status. ANALYSES We used survival analysis to test the relationship between days without statins and the presence of a life limiting condition, while controlling for pills supplied and comorbidity score. RESULTS There was no significant difference in the time off statins between cases and controls even though the study was sufficiently powered to detect one. CONCLUSIONS These findings underscore a missed opportunity to reduce the therapeutic burden upon dying patients and limit health care spending.

Exercise Self-Efficacy, Enjoyment, and Feeling States Among Adolescents

Knowledge of cognitions and feelings related to physical activity (PA) can assist in counseling adolescents to prevent the decrease in PA that occurs during this developmental period. This study, which involves a 2 (gender) 2 (race) 3 (developmental stage) design, examines relationships among PA self-efficacy (SE), enjoyment, and feeling states (FS) during PA and compares responses among 168 African American and European American boys and girls during early, middle, and late adolescence. More positive FS during a standardized PA episode on a treadmill predicts higher postactivity SE and greater enjoyment of the task. FS worsens as the session progresses, particularly for adolescents who in early puberty, report feeling significantly worse than those in both middle and late puberty at 16 minutes and 20 minutes. Findings suggest that nurses should assist adolescents to reduce negative feelings during activity to augment PA enjoyment, as well as SE following PA.

Effects of booster interventions on factory workers' use of hearing protection.

BackgroundThe provision of reinforcements or boosters to interventions is seen as a logical approach to enhancing or maintaining desired behavior. Empirical studies, however, have not confirmed the effectiveness of boosters nor assessed the optimum number of boosters or the timing for their delivery. ObjectivesThis randomized controlled trial contrasted the effect of four booster conditions (a) 30 days; (b) 90 days; (c) 30 and at 90 days; and (d) no boosters of the intervention to increase the use of hearing protection devices (HPDs). MethodsA total of 1,325 factory workers completed a computerized questionnaire and were randomly assigned to one of three computer-based (tailored, nontailored predictor-based, or control) multimedia interventions designed to increase the use of hearing protection devices. After the intervention, colorful boosters specific to the type of training received were mailed to workers’ homes. Posttest measures of use were administered at the time of their next annual audiogram 6 to 18 months after the intervention. ResultsRepeated measures of analysis of variance (ANOVA) showed a significant main effect for the booster (after 30 days) in the group that received tailored training (F [3,442] = 2.722; p = .04). However, in the assessment of the interaction between time (pretest and posttest) and boosters (four groups), the ANOVA did not find significant differences in hearing protection device use for any of the training groups. To assess for significant differences between groups, post hoc comparisons were conducted at the pretest and posttest for the total sample and for the subsample of workers who reported using hearing protection devices less than 100% of the time needed. Sheffé contrasts by intervention group, gender, ethnicity, and hearing ability found no significant changes in the mean use of hearing protection devices for the booster groups. ConclusionsAlthough the provision of boosters represented a considerable commitment of resources, their use was not effective in this study. However, it would be premature to eliminate boosters of interventions. Further study is needed to explore the effects of different booster types for increasing the use of hearing protection devices, and to assess carefully the effects of boosters on other health behaviors in studies with controlled designs.

Physical activity self-definition among adolescents.

Since research involving adults indicates that physical activity (PA) self-definition influences PA participation, understanding PA self-definition and related factors, such as PA frequency and enjoyment, in youth is essential for designing interventions to reverse the decline in PA that occurs from childhood through adolescence. The objective of this study was to explore correlates of PA self-definition and assess differences in PA self-definition among African American and European American boys and girls in early, middle, and late puberty. A 3 (developmental stage) ¥ 2 (gender) design was used. African American and European American boys and girls, ages 9 to 17, participated. A total of 168 adolescents completed demographic data, developmental stage, and current and future PA self-definition questionnaires. Peak VO2 was obtained as a measure of physical fitness. Current PA self-definition was positively correlated with peak VO2 (p < .01) and future PA self-definition (p < .01). Males had higher current (p = .032) and future (p = .021) PA self-definition than females. The finding that boys have stronger current and future PA self-definitions than girls highlights the challenge for health professionals to enact immediate and effective measures to alter girls’ perceptions of themselves in terms of PA participation. Since current PA self-definition is also significantly correlated with future PA participation, strategies to assist girls in developing a strong PA self-definition may contribute to increased PA in their adult years.

Demographic, Cognitive, Affective, and Behavioral Variables Associated With Overweight and Obesity in Low-Active Girls

This study examined personal, cognitive, affective, and behavioral variables related to body mass index (BMI) among 73 6th and 7th grade girls, and differences between categories of healthy weight, overweight, and obese in the variables. BMI was correlated with barriers to physical activity, enjoyment of physical activity, light physical activity, moderate to vigorous physical activity, vigorous physical activity, and sedentary time. As compared to obese girls, those who were non-obese perceived greater enjoyment of physical activity, engaged in more light and vigorous physical activity, and had fewer minutes/hour of sedentary time. Findings can inform interventions.

Cardiorespiratory fitness in urban adolescent girls: associations with race and pubertal status

ABSTRACT Cardiorespiratory fitness affords health benefits to youth. Among females, weight-relative fitness declines during puberty and is lower among African American (AA) than Caucasian girls. Data indicate racial differences in pubertal timing and tempo, yet the interactive influence of puberty and race on fitness, and the role of physical activity (PA) in these associations have not been examined. Thus, independent and interactive associations of race and pubertal development with fitness in adolescent girls, controlling for PA were examined. Girls in grades 5–8 (n = 1011; Caucasian = 25.2%, AA = 52.3%, Other Race group = 22.5%) completed the Pubertal Development Scale (pubertal stage assessment) and Fitnessgram® Progressive Aerobic Cardiovascular Endurance Run (PACER) test (cardiorespiratory fitness assessment). PA was assessed by accelerometry. Bivariate and multivariate analyses were used to examine associations among race, pubertal stage and fitness, controlling for vigorous PA, AA, and pubertally advanced girls demonstrated lower fitness than Caucasian and less mature counterparts. Puberty and race remained significantly associated with fitness after controlling for vigorous PA. The interaction effect of race and puberty on fitness was non-significant. The pubertal influence on fitness is observed among AA adolescents. Associations between fitness and race/puberty appear to be independent of each other and vigorous PA. Pubertally advanced AA girls represent a priority group for fitness interventions.

Reliability and Validity of the Commitment to Physical Activity Scale for Adolescents.

Purpose. To examine psychometric properties of a Commitment to Physical Activity Scale for Adolescents (CPASA). Design. Two test-retest studies and a prospective study, approved by a university institutional review board, were conducted in midwestern U.S. urban areas. Setting. The first test-retest study occurred in four community centers, the second test-retest study took place in a community school, and the prospective study occurred in eight middle schools. Subjects. To measure commitment at baseline and 1 week later, 51 girls in the first test-retest study completed an original 26-item scale, and 91 in the second test-retest study completed a revised 11-item scale. In the prospective study, 503 girls completed the 11-item scale. Measures. Commitment was measured via the CPASA. After completing the CPASA, girls in the prospective study wore ActiGraph GT3X-plus accelerometers that measured light, moderate, and vigorous physical activity (LMVPA) and moderate to vigorous physical activity (MVPA). Analysis. Internal consistency and test-retest reliability were estimated. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to cross-validate the factor structure. Results. For the 11-item CPASA, Cronbach α ranged from .81 to .82, and test-retest reliability was .88. Both EFA and CFA indicated a single factor. The scale was significantly correlated with LMVPA (r = .10) and MVPA (r = .11). Conclusion. The 11-item CPASA demonstrated acceptable reliability and validity with girls.

Research process in the health sciences: a focus on methods.

Research in the health sciences is becoming increasingly challenging as data and methods advance in complexity. This article was written to provide an overview of the research process for complex and intricate projects, with a focus on methods. The insights regarding structuring and managing research projects are intended to guide researchers through all phases of the research process. Our key suggestions include the following: (1) conceptual and methodological complexity must be balanced, (2) skilled project managers and statisticians are needed, and can be rewarded for their contributions to projects in part through authorship, and (3) grants involving multiple investigators present problems related in part to the abstruseness of integrated methods and so require special solutions for effective management. Overall, we conclude that researchers are rewarded in a variety of ways when they remain focused on the original study aims, keep methods simple, utilize skilled staff, and engage in strategic planning.