Donna L. Richter

Environmental, policy, and cultural factors related to physical activity in African American women.

SUMMARY Six focus groups were conducted in South Carolina with African American women (n = 42) aged 19–51 years to identify factors that influence physical activity. Transcripts were analyzed using NUD*IST. Cultural influences were seen as more important in determining the type of physical activity than its level. Barriers to and enablers of physical activity were identified in the social and physical environments, as were policy issues affecting physical activity in the community and at the work site. Potential community and work site interventions were suggested. Child care and monetary costs were frequently cited as barriers to physical activity.

Personal, social, and physical environmental correlates of physical activity in African-American women in South Carolina.

BACKGROUND Little is known about the correlates of physical activity among African-American women living in the southeastern United States. The purpose of this study was to assess the relationship of personal, social, cultural, environmental, and policy variables with physical activity among women in ethnic minority groups. METHODS The Women and Physical Activity Survey was used in a telephone interview of 917 African-American women living in two counties in South Carolina. The sample of women was selected by random-digit dialing. RESULTS Approximately one third (34.1%) of the women met current recommendations for moderate or vigorous physical activity, 49.4% were insufficiently active, and 16.5% were inactive. Meeting the recommendations or engaging in insufficient activity (versus inactive) was related to attaining higher educational levels, being married or with a partner; being in excellent or very good health, having greater self-efficacy, seeing people exercise in the neighborhood, having more favorable ratings of women who exercise (social issues score), having lower social role strain, and reporting the presence of sidewalks or lighter traffic in the neighborhood. CONCLUSION Multiple factors influence physical activity. Interventions to increase physical activity should use multilevel approaches that incorporate the personal, social environmental, and physical environmental factors related to participation in physical activity.

A Study of Body Weight Concerns and Weight Control Practices of 4th and 7th Grade Adolescents

Objective. The purpose of this study was to assess grade, race, socioeconomic status and gender differences in perceptions of body size, weight concerns, and weight control practices between 4th and 7th grade students in South Carolina. Design. Two random samples, consisting of a total of 1,597 children (53.1% white, 51.97% female, 44.9% 4th graders) participated in two questionnaire surveys. Both surveys included a series of seven female and seven male body size drawings, body image and weight concern questions, and questions pertaining to weight control practices. Responses to the questionnaire were analyzed using chi-square analysis and the General Linear Model. Results. Using socioeconomic status (SES), race, gender, and grade as independent variables, differences in ideal adult body size, opposite gender ideal adult body size, weight concerns, perceptions of family/peer weight concerns, perceptions of own body size and weight control practices were studied. Analyses revealed that 4th grade males select a larger ideal adult body size and opposite gender ideal adult body size when compared to 7th grade males ( p < 0.0001 and p = 0.0078, respectively). Fourth grade females indicated less personal concern about their weight than 7th grade females ( p = 0.0009). Fourth graders also perceived less family/peer concern about weight than 7th graders ( p = 0.0027) and 7th graders described themselves as being more overweight than 4th graders ( p = 0.0039). Blacks selected a significantly larger body size than white children for ideal adult ( p = 0.0287) and ideal opposite gender adult body size ( p < 0.0001 for males, p = 0.0030 for females). Blacks also perceived less personal and family/peer concern about weight when compared to whites ( p = 0.0083). More whites reported that they were trying to lose weight, as compared to blacks ( p = 0.0010). Males also selected significantly larger body size silhouettes than females for ideal adult body size ( p = 0.0012). Males expressed less personal concern about weight ( p < 0.0001), perceived less family/peer concern about weight ( p < 0.0001), and were less likely than females to be engaged in weight loss ( p < 0.0001). Females in the high SES category selected a significantly smaller ideal male adult body size than females in the low SES group ( p = 0.0124) and more females in the high SES category were trying to lose weight when compared to females in the low SES group ( p = 0.0055).) Conclusion. This study indicates that early in a childs sociocultural development, grade level, gender, race, and SES are influential in the perception of ideal adult body size and opposite gender ideal adult body size. These factors are also influential in determining concerns about weight and weight control practices. The findings of this study support the need to begin health and wellness education efforts early in childhood while taking into account racial, gender, age, and SES disparities. This knowledge can also be useful in targeting interventions for both obesity and eating disorders.

Factors Influencing Help-Seeking From Informal Networks Among African American Victims of Intimate Partner Violence:

The purpose of this study was to gain an understanding of the challenges African-American women in abusive relationships face when they consider seeking-help from their informal networks. Data are reported from interviews with 15 African-American women who were self-identified as having survived physical intimate partner violence. A 13-item, semi-structured interview guide was developed in order to elicit information from participants. All of the interviews were audio-recorded, transcribed, and coded for analysis. This analysis revealed emergent themes from these interviews concerning the social factors and perceptions that influence help-seeking behavior. Participants perceived their informal networks as willing to offer instrumental support. However, informal networks were not emotionally supportive. Participants also noted that the African-American community at-large believes victims of violence to be “stupid” for remaining in violent relationships. Additional results are also discussed. Results may be used to help enhance efforts to reduce the rates of intimate partner violence among African-Americans.

Identification of the factors associated with compliance to therapeutic diets in older adults with end stage renal disease

OBJECTIVE To identify theory based factors pertinent to compliance with therapeutic diets. DESIGN A paper and pencil survey was read to volunteer hemodialysis patients in outpatient dialysis clinics. SUBJECTS A convenience sample of 276 hemodialysis patients aged 50 years and older who agreed to be interviewed during treatment. STATISTICAL ANALYSIS Descriptive statistics were used to report responses to all survey questions. The Fisher exact test was used to test associations between the dependent variable, dietary compliance, and independent variables, which included knowledge, perceived severity of illness, attitudes toward compliance, environmental factors, perceived barriers, self-efficacy, and perceived health benefits. Principal Components Analysis determined final scale items. Logistic regression was used to develop a model of independent variables profiling the compliant patient. RESULTS Subjects were more likely to be compliant if they indicated favorable attitudes toward compliance (P =.0076), a supportive environment (P =.0107), and knowledge about their diet (P =.0014). A logistic regression model of compliance indicated that subjects who followed their special diets were more likely to have higher knowledge (odds ratio [OR] = 1.092, 95% CI = 1.006, 1.186), perceived fewer barriers (OR = 1.094, 95% CI = 0.841, 1.226), being white race (OR = 0.710, 95% CI = 0.399, 1.263), and having gout (OR = 9.349, 95% CI = 1.139, 76.714). APPLICATION Health professionals should apply these findings in providing dietary education focused on improving not just knowledge, but attitudes and family support. Nutrition education and health promotion applications geared to non-white populations could be particularly important as tools to improve dietary compliance.

Assessing the HIV Prevention Capacity Building Needs of Community-Based Organizations

Community-based organizations (CBOs) have been providing HIV prevention services to priority populations for many years. Recent research suggests that CBOs could benefit from capacity building to strengthen their public health prevention knowledge and skills, including ability to access and use behavioral science to guide prevention efforts. A cross-sectional survey of 316 CBOs was conducted to assess desire and preferences for training, support for training at the organizational level, motivation for training at the individual level, barriers to training, and factors associated with the perceived need for training. Results suggest the need for a national training initiative to increase CBO capacity.

Childhood Forced Sex and Cervical Dysplasia Among Women Prison Inmates

This cross-sectional study is one of the first to investigate an association between childhood forced sex and cervical dysplasia. Cervical dysplasia can be identified through Pap smear screening and indicates precancerous cervical lesions, which if not treated, could become cervical cancer. Of 123 women confined under medium security in a womens correctional facility and surveyed for this study, 31.7% (n = 39) reported forced sex when less than 17 years old. Almost 6% (7 of 123) had an abnormal Pap smear indicating cervical dysplasia on entering prison. Those reporting forced sex before age 17 were six times more likely to have cervical dysplasia on entry into prison. Earlier age at first being forced to have sex was significantly associated with cervical dysplasia prevalence. This study provides data to suggest that early sexual trauma may be associated with precancerous cervical dysplasia. Further research is needed to clarify this association.

Assessing Levels of Adaptation During Implementation of Evidence-Based Interventions: Introducing the Rogers—Rütten Framework

Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Rogers’s diffusion theory and Rütten’s framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention.

Curricular innovation and the science of public health education: a call to action.

Why is the study of public health education and instruction so important at this time? The 2003 Institute of Medicine (IOM) Report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, made it clear that schools of public health should embrace as “a primary mission the preparation of individuals for positions of senior responsibility in public health practice, research, and teaching.” The report further made it clear that “schools of public health should emphasize the importance and centrality of the ecological approach.”1 This report implies that schools of public health are not just about educating individuals for content alone; they are about educating leaders who are expected to take responsible roles in the professional practice of public health.

Transient Populations: Linking HIV, Migrant Workers, and South African Male Inmates

Risk factors associated with the spread of HIV are common among South Africa’s transient populations—migrant workers and prisoners. Social ills in South Africa have yielded a growing transient population. Importantly, the migrant workers and prisoners in this population are likely to subscribe to masculine beliefs. Migrants have proven to be an effective bridge in the spread of HIV from high-risk to low-risk populations. Although a relationship between the populations has yet to be established, the circumstances of migrant camps are similar to those of prison camps. Given the high levels of HIV in South Africa and the parallels between migrants (a population whose great HIV threat to the general community has already been established) and prisoners, the integration of former male inmates into the community may pose serious public health concerns.