Charlene A. Winters

Social support in cyberspace: the next generation.

The goal of the Women to Women Project (WTW) is to help chronically ill rural women to adapt to their long-term illnesses by providing support and health information via computers. The specific aims are to (1) assess the impact of the computer-based intervention on psychosocial health (self-efficacy, self-esteem, empowerment, social support, stress, depression, loneliness), computer literacy skills, and health knowledge; and (2) analyze the computer exchanges for insights to explicate the complex process of adapting to chronic illness within the rural context. Participants are 240 rural women with a chronic illness who reside in rural areas of Montana, Idaho, Wyoming, North Dakota, and South Dakota. Preliminary data analysis suggests that the intervention is helping to improve the womens ability to adapt to their chronic illnesses. The WTW intervention model has the potential to effectively connect these women in a program of support and education.

Social Support in Cyberspace: Lessons Learned

&NA; The lessons learned from the implementation of phase one of Women to Women (WTW1), a research‐based computer outreach program for rural women with chronic illness, and their influence on the development of phase two of Women to Women (WTW2) are discussed in this article. The changes implemented in WTW2 included moving from the FirstClass delivery platform to WebCT; increasing the intra‐and interdisciplinary nature of the team by adding nurse experts in Web skills and womens health and non‐nurse colleagues in family finance and nutrition; expanding the geographical area to be served from Montana to adjoining states; developing health teaching units that harness the internet as the major source of ever‐current health information; including a control group in the study design; and selecting more pertinent, repeated measurement instruments to assess psychosocial variables.

Descriptive analysis of the respiratory health status of persons exposed to Libby amphibole asbestos

Objective Describe respiratory health and quality of life in persons exposed to Libby amphibole asbestos (LAA) contaminated vermiculite. Design Cross-sectional descriptive. Setting Asbestos-related disease clinic in Libby, Montana USA. Participants 329 individuals exposed to LAA; mostly men, married, between 50 and 69 years; two-thirds lived in the surrounding county; one-third lived elsewhere in the state and USA. Primary outcome measures Chest radiograph (CXR), pulmonary function data and the St George Respiratory Questionnaire (SGRQ). Results Exposure categories included vermiculite workers=7.6%; family/household contact of vermiculite worker=32%; and environmental exposure only=60%. Of the participants, 55% had only pleural abnormalities; 5.4% had only interstitial abnormalities; nearly 21% had both abnormalities and 18% had no lung abnormality on chest x-ray. Mean forced vital capacity (FVC) 95.3% (SD=18.7); forced expiratory volume (FEV1) mean 87% (SD=20.2); ratio of FEV11/FVC 95.5% (SD=12.0); and diffusing capacity (DLCO) of 83% (SD=21.7) of the percent predicted. The mean total SGRQ (38.5; SD=22.1) indicated a lower quality of life than healthy persons and persons with other chronic conditions. SGRQ subscale means were Symptoms 52.1 (SD=24.9), activity 49.4 (SD=26.9) and impacts 27.5 (SD=21.9). Participants with normal CXR differed significantly from those with both interstitial and pleural abnormalities on total, activity and impacts scores. For activity alone, subjects with normal CXR differed significantly from those with pleural disease; no differences were found for those with interstitial disease. Significant findings were found for smoking history across all pulmonary measures, and for exposure status, radiographic findings, age and gender for select pulmonary parameters. Subjects with any smoking history had significantly worse average total and subscale scores on the SGRQ. Conclusions Of 329 persons exposed to LAA, the majority (182) had pleural abnormalities identified on CXR. SGRQ scores for persons with abnormalities (pleural, interstitial or both) (269) differed significantly from those with a normal CXR.

Rural Public Health Policy Models to Address an Evolving Environmental Asbestos Disaster

The health-related dangers of asbestos exposure were recognized early in the 20th century when occupational exposure was found to be associated with excess pneumoconiosis among asbestos industry workers. Today, the epicenter for examining the public health effects and the human toll that this toxin has had on a population is located in the rural community of Libby, MT. Rurality and multideterminants of health frame both the history of asbestos-related disease and the service/policy challenges within a community dealing with chronic illness and designation as a Superfund clean-up site. Despite efforts by public health advocates to address the lingering aftermath of an environmental disaster in this community, policy gaps exist that continue to impact the populations health. The purpose of this paper is to describe the history and outcomes of asbestos exposure in a rural community and discuss 3 models that provide public health policy insights related to rural health and health care for a community affected by both a sentinel and ongoing environmental event.

Psychosocial Health Status of Persons Seeking Treatment for Exposure to Libby Amphibole Asbestos

A cross-sectional exploratory study was conducted to describe the psychosocial health status of persons seeking health care for exposure to Libby amphibole asbestos (LAA). Health indicators including depression, stress, acceptance of illness, and satisfaction with access and financial aspects of care were obtained via electronic and paper-pencil survey. The exposure pathway and demographic data were gleaned from the health record. Of the 386 participants, more than one-third (34.5%) demonstrated significant levels of psychological distress. The oldest group of women had the lowest levels of depression and stress and the highest acceptance of illness. Gender, age, and satisfaction with financial resources were significantly related to depression, stress, and acceptance of illness. Satisfaction with access to care was significant only for stress. No differences in depression, stress, and acceptance of illness were found based on residence, exposure pathway, or insurance status.

Determining Satisfaction with Access and Financial Aspects of Care for Persons Exposed to Libby Amphibole Asbestos: Rural and National Environmental Policy Implications

Libby, Montana is a Superfund site and epicenter of one of the worst environmental disasters in the USA history in terms of asbestos-related mortality and morbidity. Perceptions of access and financial aspects of care were explored among a national cohort of persons postasbestos exposure and prior to a 2009 Public Health Emergency Declaration. Our findings indicated the Libby cohort was significantly less satisfied with access and financial aspects of care as measured by two PSQ-III scales when compared to an adult, chronically ill patient sample. Participants with higher levels of respiratory morbidity and depression had significantly lower satisfaction scores.

A Case Study Exploring Research Communication and Engagement in a Rural Community Experiencing an Environmental Disaster

As a means to involve the public in research, the National Institutes of Health (NIH) established the Partners in Research Program and solicited research grant applications from academic/scientific institutions and community organizations that proposed to forge partnerships: (a) to study methods and strategies to engage and inform the public regarding health science, and (b) to increase scientists’ understanding of and outreach to the public in their research efforts (NIH Public Trust, 2007). In this article, we report on a study funded by the NIH Partners in Research Program, to understand the research milieu (knowledge, acceptance, and research participation) and communication preferences of rural people experiencing an environmental disaster from amphibole asbestos exposure.

Spousal support experiences of rural women living with chronic illness.

From an examination of the spousal support experiences of rural women with chronic conditions who participated in a research-based, online support intervention, indications were that health care providers must recognize the need for and provide appropriate support/information related to the emotional, psychosocial, sexual, and relational impacts of chronic illness.