Helen Hopp Marshak

IDENTIFYING INTIMATE PARTNER VIOLENCE AT ENTRY TO PRENATAL CARE: CLUSTERING ROUTINE CLINICAL INFORMATION

Intimate partner violence (IPV) is the greatest trauma-related risk to American women. Pregnant women are no exception, and escalation of IPV frequently occurs during pregnancy. Many studies have linked IPV during pregnancy to adverse maternal and fetal outcomes. This study examined IPV at the beginning of prenatal care to identify correlates of routine entry-to-care information with responses on a validated IPV screening tool, the Abuse Assessment Screen. The purpose of the study was to identify specific data from routine, standard intake information, which could alert clinicians to the potential of violence even in the presence of a negative IPV score or no formally administered screening tool. The point prevalence of abuse, as measured by the Abuse Assessment Screen at entry to care, was slightly in excess of the national mean, reinforcing the need for continual assessment throughout pregnancy. Abused women in this study were more likely to be young, single, and without family or partner support. These women relied on friends for support, admitted to depression, and desired their pregnancies. The findings are consistent with previous studies. Further research needs to be conducted to determine if this cluster of findings at entry to care, with or without a positive score on an IPV screening tool, are consistent markers for an increased risk of IPV.

The Effect of Hormone Replacement Therapy and Exercise on Cardiovascular Disease Risk Factors in Postmenopausal Women

AbstractFollowing menopause, women show an increased risk of heart disease to a level equal that of men. This elevated risk is thought to be due, at least partly, to changes in blood lipid and fibrinogen levels. The purpose of this article is to review the published research on the relationship between both exercise and hormone replacement with regards to common cardiovascular disease (CVD) risk factors and the relative importance of each.Menopause is associated with increased total serum cholesterol, triglycerides and fibrinogen, and a decrease in high density lipoprotein (HDL) cholesterol levels. The major reason for these changes following menopause is believed to be a result of fluctuations in hormonal status, primarily a deficiency in estrogen. Intervention may be justified since estrogen replacement therapy has been shown to decrease the risk of developing CVD and to have a significant impact on many of the CVD risk factors. The results vary from study to study, but generally estrogen replacement has been found to decrease total cholesterol and fibrinogen, while increasing HDL cholesterol and triglycerides. All of these changes, other than the increase in triglycerides, are seen as positive. The addition of progestogen to estrogen may negate some of the beneficial changes of estrogen, most notably the increase in HDL cholesterol levels. However, progestogen has also been reported to offset the increase in triglycerides seen with unopposed estrogen replacement. Thus, there are contradictory effects (both positive and negative) of hormone replacement on CVD risk factors in women.Regular aerobic exercise and resulting improvements in cardiorespiratory fitness have consistently been shown as preventive of CVD. This decreased CVD risk is in part because of the impact of exercise on blood lipids and fibrinogen. Increased aerobic exercise is thought to improve the risk profile, mainly through an increase in HDL cholesterol levels and decreases in triglycerides and fibrinogen. Unfortunately, the majority of research supporting the effects of exercise on CVD risk factors has been done on men. Even when research has included women, very few studies have focused on postmenopausal women. However, the research done on postmenopausal women points to a significantly improved CVD risk factor profile with regular cardiorespiratory exercise.

Quality of parent–child relationship and adolescent HIV risk behaviour in St. Maarten

Abstract The highest incidence rates of HIV/AIDS in the Caribbean are recorded in heterosexual and youth populations. With sparse prevention and intervention programmes in place, there is a pressing need to address the HIV/AIDS risk of youth. The objective of this analysis was to describe the extent of youth risk behaviour in St. Maarten and explore the relationship between quality of parental-child relationship and adolescent HIV risk behaviours. The sample consisted of 1,078 students (age range 14–18, mean 15.6 (s.d. 1.7). The data were collected by self-report survey in the Spring of 2001 in the classrooms of all seven secondary schools in St. Maarten. The survey instrument included demographic information, and used questions derived from the Center for Disease Controls (CDC) Youth Risk Behavior Survey (YRBS) to assess health risk behaviour prevalence, including tobacco, alcohol, and drug use, and sexual activity. The survey also asked youth to rate their relationship with their parents. Analysis showed a relatively high rate of risk behaviour in this school population. Multi-variate analysis showed that a ‘great’ relationship with both parents, as perceived by the student, was significantly associated with lower rates of tobacco and alcohol use as well as lower rates of sexual activity.

Acculturation and Gender: Influence on Healthy Dietary Outcomes for Latino Adolescents in California

OBJECTIVE Examine acculturation and gender on intention to eat a healthful diet among Latino adolescents using the Theory of Planned Behavior. DESIGN Secondary analysis of data set and condensed version of the Short Acculturation Scale for Hispanics (SASH). SETTING Data collected from 34 randomly selected high schools in San Bernardino, CA. PARTICIPANTS 265 Latino high school adolescents. MAIN OUTCOME MEASURES Effects of acculturation and gender on variables of the Theory of Planned Behavior on intention to eat a healthful diet. ANALYSIS Multiple regression analysis examined acculturation/gender differences, and modifications on the prediction of intention. General linear modeling determined differences across gender and acculturation groups. RESULTS Females had stronger intention, more positive attitude, and greater subjective normative influence. Females indicated feeling healthy and looking good and males indicated good athletic performance as contributors to eating healthfully. Mother was influential for both genders, and stronger for females. Siblings were influential for less acculturated males, and friends were influential for highly acculturated females. Less acculturated adolescents had stronger intention to eat healthfully, more tolerance to give up liked food items, and more support and encouragement. CONCLUSIONS AND IMPLICATIONS Professionals need to take into account gender and acculturation differences when making dietary recommendations for Latino adolescents.

Closing the Gap in Mammogram Screening An Experimental Intervention Among Low-Income Hispanic Women in Community Health Clinics

A low rate of mammogram screening exists among low-income Hispanic women. To address this disparity, an experimental intervention containing audiovisual and written media was conducted using the health belief model as a framework. The purpose of this study was to determine if low-income Hispanic women, more than 40 years of age, who received targeted cancer prevention education (n = 105) had a significantly greater perceived threat of breast cancer, greater benefits and lower barriers to screening, and stronger intentions to obtain mammograms compared to a control group (n = 105). Intervention participants reported significantly greater perceived benefits, self-efficacy, and mammogram screening intentions than the control group. Predictors of mammogram screening intentions, when controlling for covariates, included receiving the intervention, and having greater perceived benefits, self-efficacy, and lower barriers. Results demonstrate the effectiveness of a low-cost, theory-based intervention aimed at increasing mammogram screening to assist in the monitoring of Healthy People 2020 objectives.

Social Determinants of Physical Activity Among Adult Asian-Americans: Results from a Population-Based Survey in California

The objective of this study was to evaluate the key social determinants of physical activity among six Asian-American subgroups using public access 2007 California Health Interview Survey data. Physical activity was defined as meeting the American College of Sports Medicine recommendation of 450 metabolic equivalent-minutes per week. Factors positively associated with meeting physical activity recommendations included being bilingual among Chinese and Vietnamese, and increasing age for Chinese only. On the other hand, being middle aged, currently married, and low neighborhood safety were significantly associated with lower odds of meeting physical activity recommendations, as were being female for Japanese and Koreans, and living above the poverty level for Vietnamese. Such results highlight the heterogeneity among Asian-Americans and need for health messages targeted at specific subgroups. Additionally, the role of built environment, particularly in areas with high Filipino residents, should be a public health priority for increasing physical activity outcomes.

Using the theory of planned behavior to explore attitudes and beliefs about dietary supplements among HIV-positive Black women

BACKGROUND This cross-sectional study investigated whether the theory of planned behavior (TPB) constructs: attitudes, subjective norms, and perceived behavioral control were related to intention of dietary supplements use among African-American women living with Human Immunodeficiency Virus and/or Acquired Immune Deficiency Syndrome (HIV/AIDS). METHODS A closed-ended questionnaire based on the TPB was utilized to explore the use of dietary supplements among a cohort of 153 HIV-positive African-American women. RESULTS Overall, 45% of the respondents used dietary supplements to manage/control their HIV. Combined, attitudes, subjective norms and perceived behavioral control were significant predictors of intention toward dietary supplement use (69% of the variance explained, p<0.0001). Attitudes (β=0.23, p<0.001) and perceived behavioral control (β=0.45, p<0.0001) were found to be significant independent predictors of intention. Behavioral intention and proximal TPB constructs (attitudes, subjective norms, and perceived behavioral control), as well as their underlying beliefs about dietary supplements use, were all found to be significantly more positive in users of dietary supplements compared to non-users (p<0.001). CONCLUSIONS Results showed that attitudes, subjective norms and perceived behavioral control are important predictors in the intention to use dietary supplements for control of HIV among African-American women. Implications from this study suggest that the TPB can be used to better identify and understand salient beliefs that surround intentions to use alternative therapies for management of disease. These beliefs can be used to develop interventions surrounding HIV treatment and care.

Effects of a Classroom-based Asthma Education Curriculum on Asthma Knowledge, Attitudes, Self-efficacy, Quality of Life, and Self-management Behaviors among Adolescents

Abstract Asthma education interventions primarily target young children and adults, and a few target adolescents. Several constructs of the social cognitive theory were used to design a classroom-based high school asthma education curriculum and to determine if the curriculum would improve asthma knowledge and attitudes among 10th grade students, as well as improve the quality of life, self-efficacy, and self-management behaviors among asthmatic students. Using a nonequivalent control group design with delayed intervention (three-week delay) in one group, we surveyed a sample of 122 10th grade health academy students. Twenty-four students (20%) reported having doctor-diagnosed asthma. Statistical data analysis determined that asthma knowledge mean scores and self-efficacy mean scores significantly improved for students who received the curriculum. Most students held favorable attitudes towards asthmatics before the intervention, with a slight decrease in positive attitudes after the intervention. There were also slight, insignificant improvements in quality of life among asthmatic students. This study demonstrated that the asthma curriculum improved knowledge among asthmatic and nonasthmatic students and self-efficacy among the asthmatic students. Asthma education, based on a theoretical framework, can be effectively incorporated into a traditional high school curriculum.

Partner communication and HIV testing among US Chinese college students.

OBJECTIVES To explore the role of partner communication and relationship status on HIV testing among Chinese/Chinese American college students in northern California. METHODS We used a cross-sectional study design to conduct focus groups and an online or paper-pencil questionnaire (N = 230). RESULTS The majority (60%) of respondents were in committed partnerships, with 21% in casual partnerships. Less than one third (30%) of respondents had ever obtained an HIV test. History of HIV tested was associated with relationship status and partner communication. CONCLUSIONS Interventions to increase partner communication skills while taking into account sociocultural factors among this population and their partners are needed.

Smoke-free parks: a 12-year-old made it happen.

This case study examines how a 12-year-old in the City of Grand Terrace, California was able to get the city council to adopt a resolution making city parks smoke-free/tobacco-free zones in his community. Over a three-month period of time, this 12-year-old (with tremendous support from his parents and sister) applied for and received a mini-grant from the Tri-County SOUTH Regional Tobacco-Free Project and implemented “The Terrace is GRAND with Smoke-Free Parks” activities. This young man recruited 11 youth and 9 adults, trained them in the basics of tobacco prevention called Tobacco 101, and collected 100 surveys and 809 petition signatures supporting smoke-free parks from residents in Grand Terrace. They also collected trash in their parks and separated it into two groups: tobacco-related trash and all other trash. This 12-year-old met with the mayor of Grand Terrace to ask for support for this issue and scheduled a time to present his groups findings to the city council. On June 22, 2000, the youths presented council members with the tobacco-trash collected, the petition signatures, taped end-to-end, that stretched across the council chambers, and asked the city council to make their parks smoke/tobacco-free. Council members acknowledged the excellent work implemented by these youths, adopted a resolution making all parks (except one senior park) tobacco-free, and agreed to place signage in the parks. On August 24, 2000, the city council presented him with his own “Tobacco-Free Zone” sign as an acknowledgment for his hard work in making parks safe places for youths in Grand Terrace.