Catherine J. Atkins

Validity of a quality of well-being scale as an outcome measure in chronic obstructive pulmonary disease

This paper evaluates the validity of the Quality of Well-being Scale (QWB) as an outcome measure for research on Chronic Obstructive Pulmonary Disease (COPD). The Quality of Well-being Scale was originally designed for use as a general health outcome measure. One criticism of this approach has been that it may not be valid in studies limited to a specific disease or condition. We report correlations between the QWB and a variety of other outcome measures obtained in an experimental trial evaluating the benefits of behavioral programs for COPD patients. The data from the trial suggest that the QWB is substantially correlated with both performance and physiological variables relevant to the health status of COPD patients. An advantage of the QWB is that it can be transformed into well-year units for cost-effectiveness studies. It is concluded that the QWB has many advantages as an outcome measure for specific disease groups.

Specific Efficacy Expectations Mediate Exercise Compliance in Patients with COPD

Social learning theory has generated two different approaches for the assessment of expectancies. Bandura argues that expectancies are specific and do not generalize. Therefore, he prefers measures of specific efficacy expectations. Others endorse the role of generalized expectancies measured by locus of control scales. The present study examines specific versus generalized expectancies as mediators of changes in exercise behavior among 60 older adult patients with Chronic Obstructive Pulmonary Disease. The patients were given a prescription to increase exercise and randomly assigned to experimental groups or control groups. All groups received attention but only experimental groups received training to increase their exercise. After 3 months, groups given specific training for compliance with walking significantly increased their activity in comparison to the control group receiving only attention. These changes were mediated by changes in perceived efficacy for walking, with efficacy expectations for other behaviors changing as a function of their similarity to walking. A generalized health locus of control expectancy measure was less clearly associated with behavior change. The results are interpreted as supporting Banduras version of social theory.

A Family Approach to Cardiovascular Risk Reduction: Results from The San Diego Family Health Project:

The effectiveness of a family-based cardiovascular disease risk reduction intervention was evaluated in two ethnic groups. Participants were 206 healthy, volunteer low-to-middle-income Mexican-American and non-Hispanic white (Anglo-American) families (623 individuals), each with a fifth or a sixth-grade child. Families were recruited through elementary schools. Half of the families were randomized to a year-long educational intervention designed to decrease the whole familys intake of high salt, high fat foods, and to increase their regular physical activity. Eighty-nine percent of the enrolled families were measured at the 24-month follow-up. Both Mexican- and Anglo-American families in the experimental groups gained significantly more knowledge of the skills required to change dietary and exercise habits than did those in the control groups. Experimental families in both ethnic groups reported improved eating habits on a food frequency index. Anglo families reported lower total fat and sodium intake. There were no significant group differences in reported physical activity or in tested cardiovascular fitness levels. Significant differences for Anglo-American experimental vs. control adult subjects were found for LDL cholesterol. Significant intervention-control differences ranging from 2.2 to 3.4 mmHg systolic and/or diastolic blood pressure were found in all subgroups. Direct observation of diet and physical activity behaviors in a structured environment suggested generalization of behavior changes. There was evidence that behavior change persisted one year beyond the completion of the intervention program. It is concluded that involvement of families utilizing school based resources is feasible and effective. Future studies should focus on the most cost-effective methods of family involvement, and the potential for additive effects when family strategies are combined with other school health education programs.

Aggregation of physical activity habits in Mexican-American and Anglo families

It is believed that families are important influences on the development of health habits, and the purpose of the present study was to examine the familial aggregation of physical activity. Physical activity habits were assessed by standardized interview in adults and children in 95 Anglo families and 111 Mexican-American families. The results indicated a moderate degree of aggregation of physical activity in both samples, and adjustment for body mass index was inconsequential. Intrafamily correlations tended to be higher in Mexican-Americans. Mother-child correlations usually were higher than father-child correlations. These findings support the hypothesis that the family is a significant influence on physical activity.

Cohesion and Adaptability in Mexican-American and Anglo Families

This article reports data from a community sample of Anglos and Mexican Americans concerning two dimensions of family functioning: cohesion and adaptability. The Family Adaptability and Cohesion Evaluation Scales-II (FACES) were used with a sample of 294 parents with school-age children who were taking part in a large community-based health promotion project. In addition, an acculturation measure was used in order to test for differences that might be attributable to intracultural variation among Mexican Americans. No significant differences in mean scores or distributions were detected between ethnic groups for cohesion or adaptability, even when acculturation was controlled. Next, a circumplex model was used to test for differences in distribution within a 16-cell matrix of family types. It was found that the distribution of scores for both ethnic groups fell predominantly within two quadrants of the model that predict well-functioning families during this stage of the life course (childrearing, with children reaching adolescence). Some differences were found in the distribution of scores into the three regions of the model (balanced, midrange, and extreme), with Anglos somewhat more likely to be represented in the balanced region and Mexican Americans more likely to be either midrange or extreme. However, tests for acculturation effects indicated that intracultural variation among Mexican Americans accounts for these differences, with low-acculturation respondents more likely to score outside of the balanced region. Implications of the findings are discussed within the explanatory framework of the circumplex model and related to national findings.

The costs and effects of behavioral programs in chronic obstructive pulmonary disease.

This paper uses a General Health Policy Model to determine the costeffectiveness of an experimental behavioral program for patients with chronic obstructive pulmonary disease (COPD). Patients were randomly assigned to either experimental or control groups, and only those in the experimental groups were given the behavioral strategies. Health status information was collected over 18 months, and the Health Policy Model translated program outcomes into well-year equivalents. At the end of the program, greater improvements in health status were observed in the experimental subjects, and a total of 4.41 well-years were produced. Costs of the program were gathered on a per-year basis using an administrative perspective. Both costs and health effects were discounted to present value using a 5% discount rate. Dividing costs by effects, the COPD program produced well-years at a unit cost of

Selective attrition causes overestimates of treatment effects in studies of weight loss

24,256. Comparing the cost-utility figure to those of other health care programs using the General Health Policy Model, the behavioral program appears reasonably cost-effective as an adjunct therapy for patients suffering from COPD.

Reduction of secondary smoke exposure in asthmatic children : parent counseling

Selective attrition causes serious threats to the validity of experimental trials. Experimental studies in behavior therapy typically include only data from those who complete an experiment. In this paper, we examine the probability of dropping out of a study contingent upon failure to achieve desired benefits. The data are derived from an experimental trial evaluating the effects of weight loss for patients with Diabetes Mellitus. Seventy-six percent of the original participants completed the intervention and the follow-up assessments. However, the probability of failing to appear for follow-ups over an 18 month period was examined. The chances of dropping out of the study were significantly higher for those who did not achieve a goal of weight reduction. This selective loss to follow-up results in an overestimate of treatment effectiveness. By failing to acknowledge drop-outs, treatment failures may be systematically eliminated from the analyses.

Attendance at Health Promotion Programs: Baseline Predictors and Program Outcomes

Epidemiological evidence shows that childrens exposure to secondhand tobacco smoke increases their risk of respiratory illness. This study evaluated five families and their asthmatic children (aged 5-14 years) in an outpatient counseling program for reducing the childrens exposure to passive smoking. Intervention included biweekly counseling/instructions for parents to limit their childrens tobacco exposure. A multiple-baseline, quasiexperimental design was used for self-reported measures of the childrens smoke exposure and the parents smoking frequency. Counseling was associated with smoke exposure reduction of 40-80% from baseline for each of 5 children, with most improvements sustained during follow-up. This study provides support for the development of tobacco exposure prevention programs for children with pulmonary disease.

Relationship between self-monitoring of diet and exercise change and subsequent risk factor changes in children and adults

As part of a family cardiovascular health promotion project, 111 Mexican-American and 95 Anglo-American families with fifth- or sixth-grade children were assigned to either a primary prevention program involving 18 sessions or to a control condition. This article evaluates predictors of attendance at the year long sequence of sessions in the intervention group. In addition it considers the relationship between attendance and program outcomes. Low baseline scores on physical activity and cardiovascular fitness measures were associated with higher attendance for both children and adults. High initial health knowledge and self-motivation were also associated with attendance. Multiple regression analysis showed that adult attendance was significantly predicted by a model including completion of a three-day food record, low exercise, higher socioeconomic status, family adaptability, and self-motivation. Attendance was correlated with greater knowledge gains and larger reductions in blood pressure. The results indicate that motivated families who are in greater need of conditioning attended more sessions in a health promotion program.