Kimberlee A. Gretebeck

Factors influencing cancer screening practices of underserved women

Purpose: This integrated review was conducted to evaluate the factors that inhibit or promote decisions by African American and Hispanic women to obtain cervical cancer screening. Data sources: Research articles were identified using MEDLINE, PubMed, and Cumulative Index to Nursing and Allied Health literature, published between 1999 and 2005. Conclusions: Cervical cancer screening practices of African American and Hispanic women were influenced by extrinsic motivators including lack of insurance, no usual source of health care, acculturation, and socioeconomic factors. Intrinsic motivators were related to beliefs and perceptions of vulnerability, such as ignoring cervical cancer screening when no symptoms were present; believing that not knowing if one had cervical cancer was better; and thinking that only women who engage in sexual risk–taking behaviors need to obtain Papanicolaou (Pap) smear testing. Implications for practice: Nurse practitioners (NPs) have an opportunity to impact the incidence and mortality of cervical cancer by improving screening practices of minority women. They can emphasize the importance of obtaining Pap smears regularly, teach patients the risks for and signs and symptoms of cervical cancer, and provide recommendations for obtaining screening at low cost or no cost to the patient. To improve cancer screening practices, NPs need to address minority women’s beliefs about cervical cancer and provide information and services in a culturally sensitive manner at an appropriate level of learning.

A Systematic Review of Mammography Educational Interventions for Low-income Women

Objective. We conducted a systematic review to examine the effectiveness of educational interventions in increasing mammography screening among low-income women. Data Sources. Bibliographic databases, including MEDLINE, The Cochrane Central Register of Controlled Trials, The Cochrane Database of Systematic Reviews, and the ISI Web of Science, were searched for relevant articles. Study Inclusion and Exclusion Criteria. Randomized, community-based trials targeting low-income women and published between January 1980 and March 2003 were included. Data Extraction. The search yielded 242 studies; 24 met all inclusion criteria. Data Synthesis. Three studies used mammography vans, three used low-cost vouchers or provided free mammograms, three used home visits, one used community education alone, one provided referrals, five incorporated multiple intervention strategies, two used phone calls, one used videos and print material, and five used primarily print material. Results. Of nine studies that reduced barriers to care via mammography vans, cost vouchers, or home visits, eight showed statistically significant increases in mammography screening. Seven of the eight studies that used peer educators had significant increases in screening, as did four of the five studies that used multiple (intervention) components. Conclusions. Interventions that used peer educators, incorporated multiple intervention strategies, or provided easy access via vans, cost vouchers, or home visits were effective in increasing screenings. Mailed letter or telephone reminders were not effective in trials involving low-income women, which is contrary to findings from middle/upper-income studies.

Longitudinal Change in Physical Activity and Disability in Adults

OBJECTIVES To prospectively examine whether physical activity or change in physical activity increases or decreases the risk of disability later in life. METHODS Tobit regression models were used to examine the effect of physical activity at baseline and change from baseline on disability 10 and 20 years later in 6913 adults. RESULTS Increasing recreational physical activity was associated with reduced risk of disability whereas reducing recreational physical activity increased the risk of disability after 10 years. CONCLUSIONS The analyses reveal a protective effect of sustained physical activity on disability among adults.

Effect of Caffeine on LT, VT and HRVT

UNLABELLED Caffeine has many diverse physiological effects including central nervous system stimulation. Ventilatory threshold and a recently described heart rate variability threshold both have a relationship with autonomic control that could be altered by caffeine consumption. The purpose of this investigation was to determine the influence of caffeine on lactate, ventilatory, and heart rate variability thresholds during progressive exercise. Using a randomized placebo controlled, double-blind study design, 10 adults performed 2 graded maximal cycle ergometry tests with and without caffeine (5 mg·kg⁻¹). Respiratory gas exchange, blood lactate concentrations, and heart rate variability data were obtained at baseline and throughout exercise. RESULTS At rest, caffeine (p<0.05) increased blood lactate, oxygen consumption, carbon dioxide production, and minute ventilation. For indices of heart rate variability at rest, caffeine increased (p<0.05) the coefficient of variation, while standard deviation, and mean successive difference displayed non-significant increases. During progressive exercise, minute ventilation volumes were higher in caffeine trials but no other parameters were significantly different compared to placebo tests. CONCLUSION These data demonstrate the robustness of the lactate, ventilatory and heart rate variability thresholds when challenged by a physiological dose of caffeine.

Influences on neighborhood walking in older adults.

The purpose of this cross-sectional survey study was to examine the influence of self-efficacy, outcome expectations, and environment on neighborhood walking in older adults with (n = 163, mean age = 78.7, SD = 7.96 years) and without (n = 163, mean age = 73.6, SD = 7.93 years) mobility limitations, controlling for demographic characteristics. Multiple regression revealed that in mobility-limited older adults, demographic characteristics, self-efficacy, and outcome expectations explained 17.4% of variance in neighborhood walking, while environment (neighborhood destinations and design) explained 9.4%. Destinations, self-efficacy, sex, and outcome expectations influenced walking. In those without mobility limitations, demographic characteristics, self-efficacy, and outcome expectations explained 15.6% of the variance, while environment explained 5.6%. Self-efficacy, sex, and design influenced walking. Neighborhood walking interventions for older adults should include self-efficacy strategies tailored to mobility status and neighborhood characteristics.

The bath environment, the bathing task, and the older adult: A review and future directions for bathing disability research

Purpose. To review existing research studies to identify optimal intervention strategies for remediation and prevention of bathing disability and future directions for bathing disability research. Method. Bathing disability, defined as problems in the interaction between the person and the environment during bathing performance, is examined through a comprehensive, narrative literature review. Results. Most studies focus on the relationship between the person and the environment (such as assistive device use and environmental hazards) while fewer studies focus on analysis of the bathing task or the interaction of the person, environment, and bathing task. Of intervention studies, most do not focus solely on remediation of bathing disability and outcomes vary widely. Conclusions. In order to help remediate and prevent bathing disability, it will be necessary to better understand and measure the person-environment-occupation interaction involved in bathing as it relates to specific groups of older adults.

Beliefs of blue-collar workers: stage of readiness for exercise.

OBJECTIVE To address a theoretical debate regarding contributions of self-efficacy and the theory of planned behavior (TPB) in explaining the amount of variance in stage of readiness to exercise among blue-collar workers. METHOD A validated questionnaire was used for assessment. RESULTS LISREL indicated that self-efficacy had the most influence on stage and TPB constructs were subjugated to self-efficacy. Univariate analyses indicated that self-efficacy and TPB variables are important for intervention. CONCLUSIONS Self-efficacy plays a major role in explaining exercise stage among high-risk blue-collar workers, and self-efficacy and TPB constructs are important to consider in designing interventions.

Gender Differences in Neighborhood Walking in Older Adults

Objective: This study examined mobility, self-efficacy, outcome expectations, neighborhood (density, destinations, and design), and neighborhood walking in older men (n = 106, 60-99 years, M = 76.78, SD = 8.12) and women (n = 216, 60-99 years, M = 75.81, SD = 8.46). Method/Results: In hierarchical regression, the variables explained 32% of the variance in neighborhood walking in men (p < .001) and 27% of the variance in women (p < .01). Self-efficacy (β = .49, p < .01), density (β= .22, p < .05), and design (β= .21, p = .05) were associated with walking in men. Significant design characteristics included sidewalks (β= .25, p < .05) and crime (β= .36, p < .01). In women, self-efficacy (β= .48, p < .001) and destinations (β= .15, p < .05) were associated with walking. Walking was associated with self-efficacy for walking despite individual barriers in women (β= .38, p < .001) and neighborhood barriers in men (β= .30, p < .05). Conclusion: Walking interventions targeting older women should incorporate local destinations. In older men, interventions should consider neighborhood sidewalk design and crime. Walking interventions for all older adults should include enhancement of self-efficacy, but gender differences may exist in the types of self-efficacy on which to focus.

Self-Efficacy, Neighborhood Walking, and Fall History in Older Adults

This cross-sectional study examined the association of self-efficacy with neighborhood walking in older adult (mean age = 76.1, SD = 8.34) fallers (n = 108) and nonfallers (n = 217) while controlling for demographic characteristics and mobility. Hierarchical multiple regression indicated that the full model explained 39% of the variance in neighborhood walking in fallers (P < .001) and 24% in nonfallers (P < .001). Self-efficacy explained 23% of the variance in fallers (P < .001) and 11% in nonfallers (P < .001). Neighborhood walking was significantly associated with self-efficacy for individual barriers in both groups. Self-efficacy for neighborhood barriers trended toward significance in fallers (β = .18, P = .06). Fall history did not moderate the relationship between self-efficacy and neighborhood walking. Walking interventions for older adults should address self-efficacy in overcoming individual walking barriers. Those targeting fallers should consider addressing self-efficacy for overcoming neighborhood barriers.

Physical Activity, Functional Ability, and Obesity in Older Adults: A Gender Difference

Disability, institutionalization, and loss of independence may be directly caused or exacerbated by physical inactivity and obesity. The purpose of the current cross-sectional survey was to explore the impact of gender and obesity on functional ability tasks, physical activity, and psychosocial factors in older adults. Participants comprised 964 University retirees (55% female, mean age = 75.3 years, SD = 6.7 years) with a mean body mass index (BMI) of 26.1 kg/m2 (SD = 4.7 kg/m2). Results revealed significant gender and BMI interaction effects. Women were less active than men and obese women were most functionally impaired, particularly in activities that target lower extremity function, regardless of weight status. These findings suggest that physical activity interventions for older adults should focus on exercises that improve functional ability and are tailored to meet individual needs while considering weight and gender. Type, intensity, frequency, and duration of exercises should be individualized to limit injuries and improve functional ability and physical activity adherence. [Journal of Gerontological Nursing, 43(9), 38-46.].