Ken W. Watkins

Social support reduces the impact of partner violence on health: application of structural equation models.

BACKGROUND Intimate partner violence (IPV) is associated with poorer health, yet pathways through which IPV affects either mental or physical health are not well characterized. METHODS Structural equation modeling was used to test a model in which physical-IPV and battering were considered as separate independent variables. The sample included 191 women currently experiencing either physical IPV or battering. Emotional support provided to women experiencing IPV was hypothesized to mediate the impact of IPV on current mental and physical health (dependent variables). RESULTS Higher scores on emotional support were associated with better physical (beta = -0.23, P < 0.01) and mental health (beta = -0.27, P < 0.001). Physical IPV was directly associated with poorer mental health (beta = 0.023, P < 0.01) and indirectly associated with poorer physical health (beta = 0.18, P < 0.001) and mental health (beta = -0.04, P < 0.05), primarily through battering. Higher battering scores were directly associated with less emotional support (beta = -0.33, P < 0.001) and indirectly associated with poorer physical (beta = 0.12, P < 0.01) and mental health (beta = 0.09, P < 0.01), primarily through emotional support. Model diagnostics indicated a good fit (chi(2) = 20.44, P = 0.37, GFI = 0.98, CFI = 0.99, RMSEA = 0.02). CONCLUSIONS Higher levels of emotional support may modify the effect of IPV on health. Interventions to increase social and emotional support to abused women may reduce mental and physical health consequences.

Factors of Fruit and Vegetable Intake by Race, Gender, and Age among Young Adolescents

OBJECTIVE To explore demographic differences in individual, social, and environmental factors potentially related to fruit and vegetable intake. DESIGN Self-report questionnaires administered to a convenience sample of middle school students during regular classes. PARTICIPANTS Black and white adolescents, 11 to 15 years of age (N = 736). VARIABLES MEASURED Measures included self-efficacy, family dinner frequency, normative beliefs, outcome expectations, modeling, availability, preferences, snack choice, and demographics. ANALYSIS Chi-square, general linear models, and Poisson and linear regressions as appropriate. RESULTS Black participants reported greater social influences than did white participants, whereas white adolescents reported greater family environmental influences on fruit and vegetable intake. The oldest adolescents reported lower self-efficacy, peer modeling, family dinner frequency, and fruit and vegetable preferences compared with younger adolescents. White participants and females reported a higher preference for vegetables than did black participants and males. Regression models for self-efficacy and snack choice explained 41% and 34% of the variance, respectively. Preferences for vegetables and parental modeling were the strongest correlates of self-efficacy. Self-efficacy was the strongest correlate of snack choice. CONCLUSIONS AND IMPLICATIONS Decreases in several factors with age highlight the importance of intervention for this age group. Future research is needed for a better understanding of the formation and modification of self-efficacy and snack choice.

Measurement of health-related QOL in diabetes mellitus

A number of health-related QOL (HR-QOL) measures specifically designed for people with diabetes mellitus have appeared in the literature. This article provides a selective review of 12 measures that address this important construct. For each included study, a description of the measure and its development phase is provided, followed by discussion of sampling, reliability, validity and appropriateness for selected populations. Measures designed to investigate broad and specific conceptualisations of diabetes-specific QOL are included.For research in which a broad conceptualisation of diabetes-specific QOL is appropriate, the following measures are recommended: Diabetes-39, Diabetes Care Profile (DCP), Diabetes Impact Management Scales (DIMS), Diabetes Quality of Life (DQOL) and the Diabetes-Specific Quality of Life Scale (DSQOLS). For investigation of one or more specific aspects of diabetes-specific QOL, other measures may also be appropriate: single-scale questionnaires such as the Appraisal of Diabetes Scale (ADS) [stressful impact], Audit of Diabetes-Dependent Quality of Life (ADDQoL) [life without diabetes] and the Problem Areas in Diabetes scale (PAID) [diabetes-related distress]; the Diabetes Health Profile (DHP) which focuses on diabetes-related distress, activity and eating behaviour; the Questionnaire on Stress in Patients with Diabetes-Revised (QSDR) which has a primary focus on diabetes-related distress; and the Well-Being Enquiry for Diabetics (WED) which is primarily concerned with the perceptions of patients with diabetes in relation to mental health. Researchers selecting a diabetes-specific QOL measure should also carefully consider the conceptual underpinnings of the available instruments, as there is little uniformity in the definition and conceptualisation of HR-QOL.Based upon participants involved in questionnaire development and validation studies, those questionnaires that appear to be most appropriate for use with a variety of patient populations include the Diabetes-39, DIMS, Diabetes Quality of Life Clinical Trial Questionnaire — Revised (DQLCTQ-R), PAID and the QSD-R. The DCP and DHP appear to be especially relevant measures of HR-QOL for patients with type 2 diabetes, while the DQOL, DSQOLS and WED have clear emphases on concerns of individuals with type 1 diabetes. The length of the DQLCTQ-R may raise concerns about its use among some populations (e.g. older adults).Recommendations for future research include: (i) increasing the diversity of samples used to develop and evaluate existing and new measures in terms of race/ethnicity, age and gender; (ii) examination of the causal relationship between diabetes self-management and QOL using longitudinal designs; (iii) increasing emphasis on the positive aspects of successful chronic illness self-management; and (iv) use of HR-QOL measures to inform empowering relationships between physicians and patients.

Associations among Food Insecurity, Acculturation, Demographic Factors, and Fruit and Vegetable Intake at Home in Hispanic Children

The purpose of this cross-sectional pilot study was to examine associations between food insecurity, acculturation, demographic factors, and childrens fruit and vegetable intake among a sample of Hispanic children ages 5 to 12 years. A convenience sample of 184 parents of low socioeconomic status completed one-time, self-administered questionnaires assessing demographic information, acculturation, and food insecurity in the spring of 2006. In addition, childrens fruit and vegetable intake at home was measured using a validated seven-item index. Parents were recruited through local elementary schools in San Antonio, TX. Pearson and Spearman correlations were used to examine the associations between the variables. t tests were used to explore the differences in means of childrens fruit and vegetable intake at home for acculturation and food insecurity levels. Statistical significance was set at P<0.05. Significant correlations were found between demographic variables, acculturation, food insecurity, and childrens fruit and vegetable intake at home. The overall mean fruit and vegetable intake at home was 1.04+/-0.63 (mean+/-standard deviation) servings per day. Higher rates of acculturation and higher rates of food insecurity were associated with lower fruit and vegetable intake at home. The findings reported in this study suggest a need for culturally tailored interventions targeting Hispanic children because fruit and vegetable intake at home among Hispanic children was low, regardless of the level of acculturation or food insecurity.

Correlates of availability and accessibility of fruits and vegetables in homes of low-income Hispanic families

Availability and accessibility (AA) has been consistently shown across studies as the most important correlate of fruits and vegetables (FV) intake. However, there is little data on factors that influence AA of FV, especially in Hispanic families. The objective of this cross-sectional study was to examine the association between parental factors, childs preferences for FV and AA of FV in homes of low-income Hispanic families with children 5-12 years old. A convenience sample of 184 parents of low socioeconomic status recruited through public elementary schools completed a self-administered questionnaire about demographics, language spoken at home and food insecurity (FI). Parental factors and childs preferences were measured using a 16-item questionnaire, which was developed specifically for the study. AA of FV was measured using a validated nine-item index. Hierarchical multiple regression analysis indicated that language spoken at home, parental practices that promote consumption of FV, parental role modeling and perceived benefits of fast food had significant and independent associations with AA of FV at home. Intervention programs should take into consideration the language spoken at home and target at improving parental factors in order to improve AA of FV.

The Interaction of Age and Cognitive Representations in Predicting Blood Pressure

The purpose of this study was to investigate the interaction of age and cognitive representations of hypertension in predicting blood pressure. A model of illness self-regulation was used as the theoretical framework for the study. Secondary analysis of data collected from 224 hypertensive adult outpatients was conducted to assess five constructs of illness. ANOVA results indicated that older adults reported fewer hypertension-related symptoms than younger-and middle-aged adults, and that younger adults reported fewer health behaviors to control hypertension than did middle-aged and older adults. Results of hierarchical multiple regression models indicated that after adjusting for effects of demographic factors, no single cognitive representation construct was a significant predictor of blood pressure. The interactions of age and three cognitive representation constructs were, however, significant predictors of blood pressure. For younger adults, increases in the perceived Consequences, Control, and Timeline for hypertension were predictive of decreases in hypertension, although for older adults increased perceptions of control were associated with increased blood pressure.

The Perception of Depression in Long-Term-Care Residents: A Qualitative Study Using Residential Journaling

Twenty-four residents in six assisted living facilities and one retirement community across three counties in South Carolina participated in a study to gain an understanding of older adults’ perception of depression in long-term-care (LTC) settings. Participants completed the Geriatric Depression Scale, Meaning Survey (MS), a journal, and a follow-up interview. Spiritual meaning regarding physical and mental health was self-reported from the MS. Five questions were included in the journals regarding emotional, physical, and social health. Results indicate that journaling may be an appropriate investigative tool for researchers, and LTC facilities’ efforts should be channeled to increase the availability and quality of mental health services to residents. Regular residential depression screenings, as well as the standardization of mental health care services within LTC facilities, should be an integral part of LTC.

A multidisciplinary management program in primary care to improve hypertension control and healthy behaviors in elderly patients.

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Factors associated with physical activity literacy among foster parents.

OBJECTIVES To explore associations between physical activity (PA) literacy and psychosocial constructs for providing instrumental social support for youth PA. METHODS Ninety-one foster parents completed surveys assessing PA literacy (overall and specific), perceptions of child PA, coordination, PA enjoyment, psychosocial variables: positive/negative beliefs, normative beliefs, perceived behavioral control (PBC), and self-efficacy. RESULTS Race, negative beliefs, PBC, and foster parent sport involvement were associated with specific PA literacy. Race and education were associated with overall PA literacy. CONCLUSIONS Lower PA literacy is associated with greater negative beliefs and lower perceived control suggesting greater perceived barriers and lower perceived support for/among African Americans and those with less education.