Janice C. Probst

Understanding information technology acceptance by individual professionals: Toward an integrative view

Although information technology is becoming a vital part of the workplace of skilled professionals, it is unclear what factors contribute to its acceptance by them. Building upon and integrating the key findings of three closely related theoretical paradigms (the technology acceptance model, the theory of planned behavior, and innovation diffusion theory), we developed a more complete, coherent, and unified model and tested the resulting model in the context of PDA acceptance by healthcare professionals. Using LISREL, data collected from 222 physicians in the U.S. were tested against the model; it explained 57% of the physicians intention to accept an innovation, with good model fit. Our study produced useful insights into the factors that influence technology acceptance decisions by professionals and provided new ideas in the understanding of user acceptance of technology.

Person and Place: The Compounding Effects of Race/Ethnicity and Rurality on Health

Rural racial/ethnic minorities constitute a forgotten population. The limited research addressing rural Black, Hispanic, and American Indian/Alaska Native populations suggests that disparities in health and in health care access found among rural racial/ethnic minority populations are generally more severe than those among urban racial/ethnic minorities. We suggest that disparities must be understood as both collective and contextual phenomena. Rural racial/ethnic minority disparities in part stem from the aggregation of disadvantaged individuals in rural areas. Disparities also emerge from a context of limited educational and economic opportunity. Linking public health planning to the education and economic development sectors will reduce racial/ethnic minority disparities while increasing overall well-being in rural communities.

Urban-Rural Differences in Overweight Status and Physical Inactivity Among US Children Aged 10-17 Years

CONTEXT Few studies have examined the prevalence of overweight status and physical inactivity among children and adolescents living in rural America. PURPOSE We examined urban and rural differences in the prevalence of overweight status and physical inactivity among US children. METHODS Data were drawn from the 2003 National Survey of Childrens Health, restricted to children aged 10-17 (unweighted N = 47,757). Overweight status was defined as the gender- and age-specific body mass index (BMI) values at or above the 95th percentile. Physical inactivity was defined using parentally reported moderate-to-vigorous intensity leisure-time physical activity lasting for at least 20 minutes/d on less than three days in the past week. The 2003 Urban Influence Codes were used to define rurality. Multiple logistic regression models were used to examine urban/rural differences in overweight status and physical inactivity after adjusting for potential confounders. FINDINGS Overweight status was more prevalent among rural (16.5%) than urban children (14.3%). After adjusting for covariates including physical activity, rural children had higher odds of being overweight than urban children (OR: 1.13; 95% CI: 1.01-1.25). Minorities, children from families with lower socioeconomic status, and children living in the South experienced higher odds of being overweight. More urban children (29.1%) were physically inactive than rural children (25.2%) and this pattern remained after adjusting for covariates (OR: 0.79; 95% CI: 0.73-0.86). CONCLUSIONS The higher prevalence of overweight among rural children, despite modestly higher physical activity levels, calls for further research into effective intervention programs specifically tailored for rural children.

Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey

BackgroundTravel burden is a key element in conceptualizing geographic access to health care. Prior research has shown that both rural and minority populations bear disproportionate travel burdens. However, many studies are limited to specific types of patient or specific locales. The purpose of our study was to quantify geographic and race-based differences in distance traveled and time spent in travel for medical/dental care using representative national data.MethodsData were drawn from 2001 National Household Travel Survey (NHTS), a nationally representative, cross-sectional household survey conducted by the US Department of Transportation. Participants recorded all travel on a designated day; the overall response rate was 41%. Analyses were restricted to households reporting at least one trip for medical and/or dental care; 3,914 trips made by 2,432 households. Dependent variables in the analysis were road miles traveled, minutes spent traveling, and high travel burden, defined as more than 30 miles or 30 minutes per trip. Independent variables of interest were rural residence and race. Characteristics of the individual, the trip, and the community were controlled in multivariate analyses.ResultsThe average trip for care in the US in 2001 entailed 10.2 road miles (16.4 kilometers) and 22.0 minutes of travel. Rural residents traveled further than urban residents in unadjusted analysis (17.5 versus 8.3 miles; 28.2 versus 13.4 km). Rural trips took 31.4% longer than urban trips (27.2 versus 20.7 minutes). Distance traveled did not vary by race. African Americans spent more time in travel than whites (29.1 versus 20.6 minutes); other minorities did not differ. In adjusted analyses, rural residence (odds ratio, OR, 2.67, 95% confidence interval, CI 1.39 5.1.5) was associated with a trip of 30 road miles or more; rural residence (OR, 1.80, CI 1.09 2.99) and African American race/ethnicity (OR 3.04. 95% CI 2.0 4.62) were associated with a trip lasting 30 minutes or longer.ConclusionRural residents and African Americans experience higher travel burdens than urban residents or whites when seeking medical/dental care.

The Effect of Maternity Leave Length and Time of Return to Work on Breastfeeding

OBJECTIVE: We investigated the effect of maternity leave length and time of first return to work on breastfeeding. METHODS: Data were from the Early Childhood Longitudinal Study–Birth Cohort. Restricting our sample to singletons whose biological mothers were the respondents at the 9-month interview and worked in the 12 months before delivery (N = 6150), we classified the length of total maternity leave (weeks) as 1 to 6, 7 to 12, ≥13, and did not take; paid maternity leave (weeks) as 0, 1 to 6, ≥7, and did not take; and time of return to work postpartum (weeks) as 1 to 6, 7 to 12, ≥13, and not yet returned. Analyses included χ2 tests and multiple logistic regressions. RESULTS: In our study population, 69.4% initiated breastfeeding with positive variation by both total and paid maternity leave length, and time of return to work. In adjusted analyses, neither total nor paid maternity leave length had any impact on breastfeeding initiation or duration. Compared with those returning to work within 1 to 6 weeks, women who had not yet returned to work had a greater odds of initiating breastfeeding (odds ratio [OR]: 1.46 [1.08–1.97]; risk ratios [RR]: 1.13 [1.03–1.22]), continuing any breastfeeding beyond 6 months (OR: 1.41 [0.87–2.27]; RR: 1.25 [0.91–1.61]), and predominant breastfeeding beyond 3 months (OR: 2.01 [1.06–3.80]; RR: 1.70 [1.05–2.53]). Women who returned to work at or after 13 weeks postpartum had higher odds of predominantly breastfeeding beyond 3 months (OR: 2.54 [1.51–4.27]; RR: 1.99 [1.38–2.69]). CONCLUSION: If new mothers delay their time of return to work, then duration of breastfeeding among US mothers may lengthen.

Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality.

UNLABELLED We examined whether levels of rurality are associated with hospitalization for ambulatory care-sensitive conditions (ACSH) in eight states of the United States. ACSH is an indicator of access to reasonably effective primary health care. ACSH for children did not vary systematically with rurality. Compared to the most urban counties, the adjusted rate in the most rural was 90% greater for ages 18-64 and 45% greater for ages 65+ (both p<.001). Adjusted adult rates generally increased with the level of rurality. CONCLUSIONS Increasing levels of rurality may be positively associated with ACSH, suggesting rural disparities in access to primary health care.

Disparities in Dental Insurance Coverage and Dental Care Among US Children: The National Survey of Children's Health

OBJECTIVES We sought to understand disparities in dental insurance coverage and dental care among US children by race/ethnicity, urban/rural residence, and socioeconomic status. METHODS Linked data from the National Survey of Childrens Health and Area Resource File were analyzed (N = 89 071). Multiple logistic regression analysis was used to adjust for confounders. RESULTS A total of 22.1% of US children lacked parentally reported dental insurance coverage in the preceding year, 26.9% did not have a routine preventive dental visit, and 5.1% had parentally perceived unmet need for preventive dental care. US born minority children were less likely to lack dental insurance than US-born white children; however, foreign-born Hispanic children were more likely to be uninsured. Rural children were more likely to be uninsured than urban children. Children with health insurance were more likely to have dental coverage. Children who lacked dental insurance were less likely to have received preventive care and more likely to have unmet need for care. Compared with US-born white children, all minority children were less likely to receive preventive care. These disparities were exacerbated among foreign-born children. Fewer race-based disparities were found for unmet need for dental care. Only black children, both US and foreign-born, had higher odds of unmet need for preventive services than US-born white children. Poor dental health was strongly associated with unmet need. Disparities in dental insurance coverage and dental care are also evident by family socioeconomic status. CONCLUSIONS Poor and minority children were less likely to receive preventive dental care, even when insurance status was considered. Rural children were less likely to have dental insurance than urban children. Foreign birth affected insurance status for Hispanic children and use of preventive services for all minority children.

Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states

BackgroundFederally qualified community health centers (CHCs) and rural health clinics (RHCs) are intended to provide access to care for vulnerable populations. While some research has explored the effects of CHCs on population health, little information exists regarding RHC effects. We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by county-level rates of hospitalization for ambulatory care sensitive (ACS) conditions.MethodsWe conducted an ecologic analysis of the relationship between facility presence and county-level hospitalization rates, using 2002 discharge data from eight states within the US (579 counties). Counties were categorized by facility availability: CHC(s) only, RHC(s) only, both (CHC and RHC), and neither. US Agency for Healthcare Research and Quality definitions were used to identify ACS diagnoses. Discharge rates were based on the individuals county of residence and were obtained by dividing ACS hospitalizations by the relevant county population. We calculated ACS rates separately for children, working age adults, and older individuals, and for uninsured children and working age adults. To ensure stable rates, we excluded counties having fewer than 1,000 residents in the child or working age adult categories, or 500 residents among those 65 and older. Multivariate Poisson analysis was used to calculate adjusted rate ratios.ResultsAmong working age adults, rate ratio (RR) comparing ACS hospitalization rates for CHC-only counties to those of counties with neither facility was 0.86 (95% Confidence Interval, CI, 0.78–0.95). Among older adults, the rate ratio for CHC-only counties compared to counties with neither facility was 0.84 (CI 0.81–0.87); for counties with both CHC and RHC present, the RR was 0.88 (CI 0.84–0.92). No CHC/RHC effects were found for children. No effects were found on estimated hospitalization rates among uninsured populations.ConclusionOur results suggest that CHCs and RHCs may play a useful role in providing access to primary health care. Their presence in a county may help to limit the countys rate of hospitalization for ACS diagnoses, particularly among older people.

Acculturation, physical activity, and obesity among Hispanic adolescents

Objective. Little is known about how acculturation may influence participation in leisure-time physical activity and obesity among adolescents. The objective of this study was to examine these associations among Hispanic adolescents. Design. Data were drawn from the 2003 National Survey of Childrens Health, restricted to Hispanic adolescents aged 10–17 (n=4704). Acculturation was assessed by proxy measures (generation status and language spoken at home). Adolescents who were not reported to engage in physical activity lasting at least 20 minutes, that was vigorous enough to cause sweating and hard breathing, for at least three days per week were defined as failing to meet physical activity requirements. Obesity was defined as gender and age-specific body mass index values at or above the 95th percentile of the reference population. Multiple logistic regressions were performed to adjust for confounders. Results. Of the Hispanic adolescents studied, 25.2%, 43.8%, and 31.1% were first, second, and third generation or more, respectively. English was the primary language in the home for 42.8% of these adolescents. Compared with adolescents in the third generation, adolescents from immigrant families had higher odds for not obtaining recommended physical activity (first generation: adjusted odds ratio [AOR] = 1.50, 95% conference intervals [CI]: 1.09, 2.05; second generation: AOR = 1.29, 95% CI: 0.99, 1.69). Living in homes where English was not the primary language, vs. English-speaking homes, was also associated with not obtaining recommended physical activity (AOR = 1.36, 95% CI: 1.06, 1.75). The unadjusted prevalence of obesity was higher in homes where English was not the primary language (22.5% vs. 16.1%; p<0.01), but this difference disappeared after adjusting for family socioeconomic status. Generational status was not a significant correlate of obesity. Conclusions. Findings suggest that future public health interventions that aim to increasing physical activity among Hispanic adolescents should be tailored based on generational status and English-language use.

Clinical Feasibility of a Free-Weight Strength-Training Program for Older Adults

Background: An emerging trend in the field of gerontology is the recognition that older adults, especially the frail elderly population, can increase their levels of strength and thus improve functional capability. Social acceptance of physical frailty and provision of care and assistance to dependent persons has now turned to helping the frail elderly adults maintain or improve functional independence. Methods: The purpose of our study was to show the feasibility and effectiveness of a low-cost strength-training program using free weights for increasing strength and functional fitness among older adult volunteers. Participants aged 73 to 94 years were residents of a multilevel care retirement community in Columbia, SC. The strength-training program, led by an instructor, used dumbbells and ankle weights and was conducted in a multipurpose recreation room at the retirement facility. Results: Functional performance measures (timed chair stand, 6-meter walk, stair climb, balance) handgrip strength, and self-assessment of activity level were outcome measures. All 25 participants completed the strength-training program. The average program adherence rate of all participants was 87 percent. No participant injuries or other adverse effects were observed. Functional performance measures improved significantly among program participants, with the greatest improvement in the timed chair stand (33.5 percent improvement) and the stair climb (17.6 percent improvement). Conclusion: Free-weight strength-training programs are appropriate for older adults, can be implemented in community settings, and are associated with significant improvement in functional performance.