Lauren S. Aaronson

Perceived and received support: effects on health behavior during pregnancy.

The effects of several measures of social support on three health behavior practices during pregnancy—abstinence from alcohol, cigarettes, and caffeine—were explored. Both specificity of support and the distinction between perceived and received support were examined. The sample consisted of 529 pregnant women who completed written questionnaires and telephone interviews. Analyses showed that specific perceived and received support were significant and largely independent predictors of all three behaviors. General social support, however, was not a significant predictor of any of the behaviors. Although others have found perceived support rather than received support to be the critical component of social support in its stress-buffering effects on health, this study offers evidence that received support is also important for facilitating positive health behaviors.

A Randomized Controlled Trial of Breastfeeding Support and Education for Adolescent Mothers

Despite substantial evidence of maternal and infant benefits of breastfeeding, adolescent mothers initiate breastfeeding less often and maintain breastfeeding for shorter durations when compared to their adult counterparts. A randomized controlled trial drawing on the theory of planned behavior and developmental theory was conducted to determine if an education and counseling intervention provided by a lactation consultant—peer counselor team increased breastfeeding initiation and duration up to 6 months postpartum among adolescent mothers. Study participants ( N = 289) enrolled from multiple prenatal clinic and school settings, were 15 to 18 years old, and predominately African American, single, and primiparous. The intervention, which started in the second trimester of pregnancy and extended through 4 weeks postpartum, positively influenced breastfeeding duration (p < .001) within the experimental group, but not breastfeeding initiation or exclusive breastfeeding rates. This education/support intervention was partially effective in enhancing breastfeeding outcomes. Implications for research and practice are described.

Measuring Adherence to a Women’s Walking Program

The purpose of this study is to demonstrate the use of a self-report exercise log and a heart-rate monitor in the measurement of adherence to the dimensions of an exercise prescription and to propose an alternative way to define adherence to a 24-week home-based women’s walking program, which reflects the dynamic process of behavior change. Adherence was measured with exercise logs, Polar Vantage XL Heart-Rate Monitors, and pre-to postintervention change in VO2 max. Of the dimensions of the exercise prescription, frequency of walks documented by both the heart-rate monitor and the exercise log had a higher correlation than duration and intensity of walking, with change in VO2 max suggesting that frequency was potentially the most predictive adherence measure. Examination of the total number of walks and the number and sequence of weeks without walks over the 24-week intervention revealed dynamic patterns of adherence suggesting variation in the degree of behavioral change.

Intensive Nutrition Counseling Enhances Outcomes of National Cholesterol Education Program Dietary Therapy

OBJECTIVE To compare the effect of the addition of medical nutrition therapy administered by a registered dietitian with the usual physician counseling on nutrition knowledge, attitudes regarding dietary change, body mass index, dietary intake, and lipid and lipoprotein concentrations during initial management of persons at risk for cardiovascular disease. DESIGN A 3-month prospective, randomized trial of subjects stratified by sex and assigned to one of four nested treatment groups, which were subsequently collapsed into two groups. SUBJECTS Fifty-two men and 52 women classified at risk for cardiovascular disease. INTERVENTION Two groups of subjects received dietary counseling from a physician or nurse; in one group the Grocery Shopping Guide was used. Two other groups received medical nutrition therapy from a registered dietitian (one or three visits) in addition to the instruction from a physician or nurse and the information provided by the Grocery Shopping Guide. STATISTICAL ANALYSES Analyses of covariance were performed to determine differences between the groups. Paired t tests were performed to study changes within the groups. RESULTS The group receiving medical nutrition therapy from a registered dietitian gained statistically significantly more nutrition knowledge; had significantly greater perceptions of the benefits and efficacy of following a cholesterol-lowering diet; consumed a significantly lower percentage of fat, higher percentage of carbohydrate, and less dietary cholesterol than subjects counseled only by a physician or nurse. They also had significantly greater improvement in body mass index. Both groups of subjects achieved statistically significant reductions in serum lipid levels. APPLICATIONS Increased knowledge, benefits, and efficacy and lower-fat eating behaviors associated with additional nutrition therapy may have significant implications on the ability of persons to follow low-fat eating plans long term, which could reduce the need for costly medication intervention.

Seeking Information: Where Do Pregnant Women Go?

As part of a larger investigation of health behaviors and beliefs during pregnancy, a sample of 529 women were asked to identify their major sources of information about what they should and should not do during their pregnancies. Health care providers and books were cited as first or second most important by the largest number of respondents. When associations between respondent characteristics and preferred in formation sources were explored, it was found that women of higher socioeconomic status (SES) relied more on books and less on family than did women of lower SES. In addition, having had a previous pregnancy was associated with greater use of ones self as an information source. Although provider characteristics were not associated with choice of information source, women who perceived more support from their pro viders viewed them as more important sources of information. A similar effect for family was found. Health locus of control beliefs also were related to the relative importance of selected sources of information, while general social support was not.

Quality of Life in Hospice Patients with Terminal Illness

To better understand quality of life (QOL) and its important correlates among patients with terminal illness, a cross-sectional correlational design was used in a study based on Stewart, Teno, Patrick, and Lynn’s conceptual model of factors affecting QOL of dying patients and their families. Sixty participants were recruited from two local hospice programs in the midwestern region of the United States. Data were collected at the participants’ homes. The participants had an above average QOL. Living with the caregiver, spirituality, pain intensity, physical performance status, and social support as a set explained 38% of the variance in their QOL. Among these five predictors, living with the caregiver, spirituality, and social support statistically were significant predictors of the QOL of these participants. Participants who did not live with their caregivers experienced less pain intensity, perceived higher spirituality, had more social support, and had a significantly better QOL. Important contributions of these findings are discussed.

A Qualitative Investigation of Fatigue among Healthy Working Adults

Despite considerable attention to fatigue in acute and chronic illnesses, little is known about fatigue in a healthy population. A detailed exploration of fatigue, therefore, was conducted to answer the broad question of what fatigue is to a basically healthy population and to lay the groundwork for establishing an empirically based definition of fatigue. Qualitative and quantitative methods were used. Results of the qualitative phase of the study, in which 40 persons were interviewed, are presented here. Categories and themes of the experience of fatigue were identified. Based on the qualitative findings, we propose that fatigue in generally healthy adults is an acute, subjective, sometimes overwhelming, but temporary state (with physical, emotional, and behavioral manifestations) caused by stress and overwork in ones life roles, which disrupts activity and alerts the person to take restorative measures.

Exercise for Everyone: A randomized controlled trial of Project Workout On Wheels in promoting exercise among wheelchair users

OBJECTIVE To compare the effectiveness of 2 home-based behavioral interventions for wheelchair users to promote exercise adoption and maintenance over 12 months. DESIGN Randomized controlled trial, with participants stratified into groups based on disability type (stable, episodic, progressive) and support partner availability. SETTING Exercise occurred in participant-preferred locations (eg, home, recreation center), with physiological data collected at a university-based exercise laboratory. PARTICIPANTS Inactive wheelchair users (N=128; 64 women) with sufficient upper arm mobility for arm-based exercise were enrolled. Participants on average were 45 years of age and lived with their impairment for 22 years, with spinal cord injury (46.1%) most commonly reported as causing mobility impairment. INTERVENTIONS Both groups received home-based exercise interventions. The staff-supported group (n=69) received intensive exercise support, while the self-guided group (n=59) received minimal support. Both received exercise information, resistance bands, instructions to self-monitor exercise, regularly scheduled phone calls, and handwritten cards. MAIN OUTCOME MEASURES The primary outcome derived from weekly self-reported exercise. Secondary outcomes included physical fitness (aerobic/muscular) and predictors of exercise participation. RESULTS The staff-supported group reported significantly greater exercise (∼17min/wk) than the self-guided group over the year (t=10.6, P=.00), with no significant between-group difference in aerobic capacity (t=.76, P=.45) and strength (t=1.5, P=.14). CONCLUSIONS Although the staff-supported group reported only moderately more exercise, the difference is potentially clinically significant because they also exercised more frequently. The staff-supported approach holds promise for encouraging exercise among wheelchair users, yet additional support may be necessary to achieve more exercise to meet national recommendations.

The Greater Plains Collaborative: a PCORnet Clinical Research Data Network

The Greater Plains Collaborative (GPC) is composed of 10 leading medical centers repurposing the research programs and informatics infrastructures developed through Clinical and Translational Science Award initiatives. Partners are the University of Kansas Medical Center, Childrens Mercy Hospital, University of Iowa Healthcare, the University of Wisconsin-Madison, the Medical College of Wisconsin and Marshfield Clinic, the University of Minnesota Academic Health Center, the University of Nebraska Medical Center, the University of Texas Health Sciences Center at San Antonio, and the University of Texas Southwestern Medical Center. The GPC network brings together a diverse population of 10 million people across 1300 miles covering seven states with a combined area of 679 159 square miles. Using input from community members, breast cancer was selected as a focus for cohort building activities. In addition to a high-prevalence disorder, we also selected a rare disease, amyotrophic lateral sclerosis.

An exercise trial for wheelchair users: Project workout on wheels

There is growing interest in promoting health for people with disabilities, yet evidence regarding community-based interventions is sparse. This paper describes the design details of a randomized controlled trial (RCT) that will test the effectiveness of a multi-component behaviorally based, intervention to promote exercise adoption (over 6 months) and maintenance (up to one year) among wheelchair users and includes descriptive data on participant characteristics at baseline. Participants were randomly assigned to either a staff-supported intervention group or a self-guided comparison group. The primary study aim is to assess the effectiveness of the multi-component behaviorally based intervention for promoting physical activity adoption and maintenance. The RCT will also assess the physical and psychosocial effects of the intervention and the complex interplay of factors that influence the effectiveness of the intervention. Therefore, the primary outcome derives from participant reports of weekly exercise (type, frequency, duration) over 52 weeks. Secondary outcomes collected on four occasions (baseline, 3 months, 6 months, 12 months) included physiological outcomes (VO(2) peak, strength), disability-related outcomes (pain, fatigue, participation), and psychosocial outcomes (exercise self-efficacy, exercise barriers, quality of life, depression, mood). This study will provide evidence regarding the effectiveness of a multi-component behaviorally based intervention for promoting exercise adoption among people with mobility impairments that necessitate wheelchair use.