Leanne Streja

Results of a Randomized Controlled Trial to Increase Colorectal Cancer Screening in a Managed Care Health Plan

Colorectal cancer (CRC) is the third most common cause of cancer deaths; however, rates of regular screening for this cancer are low. A quality improvement (QI) program to increase CRC screening was developed for use in a managed care health plan.

Increasing Cell Phone Usage Among Hispanics: Implications for Telephone Surveys

OBJECTIVES We examined whether the widespread assumption that Hispanics are subject to greater noncoverage bias in landline telephone surveys because they are more likely than other ethnic groups to use cell phones exclusively was supported by data. METHODS Data came from the 2010 National Health Interview Survey and the 2009 California Health Interview Survey. We considered estimates derived from surveys of adults with landline telephones biased and compared them with findings for all adults. Noncoverage bias was the difference between them, examined separately for Hispanics and non-Hispanic Whites. RESULTS Differences in demographic and health characteristics between cell-only and landline users were larger for non-Hispanic Whites than Hispanics; cell usage was much higher for Hispanics than non-Hispanic Whites. The existence, pattern, and magnitude of noncoverage bias were comparable between the groups. CONCLUSIONS We found no evidence to support a larger noncoverage bias for Hispanics than non-Hispanic Whites in landline telephone surveys. This finding should be considered in the design and interpretation of telephone surveys.

Knowledge of modifiable risk factors of Coronary Atherosclerotic Heart Disease (CASHD) among a sample in India

BackgroundThe prevalence of Coronary Atherosclerotic Heart Disease (CASHD) is increasing in India. Several modifiable risk factors contribute directly to this disease burden. Public knowledge of such risk factors among the urban Indian population is largely unknown. This investigation attempts to quantify knowledge of modifiable risk factors of CASHD as sampled among an Indian population at a large metropolitan hospital.MethodsA hospital-based, cross sectional study was conducted at All India Institute of Medical Sciences (AIIMS), a major tertiary care hospital in New Delhi, India. Participants (n = 217) recruited from patient waiting areas in the emergency room were provided with standardized questionnaires to assess their knowledge of modifiable risk factors of CASHD. The risk factors specifically included smoking, hypertension, elevated cholesterol levels, diabetes mellitus and obesity. Identifying 3 or less risk factors was regarded as a poor knowledge level, whereas identifying 4 or more risk factors was regarded as a good knowledge level. A multiple logistic regression model was used to isolate independent demographic markers predictive of a participants level of knowledge.Results41% of the sample surveyed had a good level of knowledge. 68%, 72%, 73% and 57% of the population identified smoking, obesity, hypertension, and high cholesterol correctly, respectively. 30% identified diabetes mellitus as a modifiable risk factor of CASHD. In multiple logistic regression analysis independent demographic predictors of a good knowledge level with a statistically significant (p < 0.05) adjusted odds ratio (aOR) were: routine exercise of moderate intensity, aOR 8.41 (compared to infrequent or no exercise), no history of smoking, aOR 8.25, and former smokers, aOR 48.28 (compared to current smokers). Although statistically insignificant, a trend towards a good knowledge level was associated with higher levels of education.ConclusionAn Indian population in a hospital setting shows a lack of knowledge pertaining to modifiable risk factors of CASHD. By isolating demographic predictors of poor knowledge, such as current smokers and persons who do not exercise regularly, educational interventions can be effectively targeted and implemented as primary and secondary prevention strategies to reduce the burden of CASHD in India.

Can a Minimal Intervention Reduce Secondhand Smoke Exposure Among Children with Asthma from Low Income Minority Families? Results of a Randomized Trial

We report on the results of a low-intensity behavioral intervention to reduce second hand smoke (SHS) exposure of children with asthma from low income minority households in Los Angeles, California. In this study, 242 child/adult dyads were randomized to a behavioral intervention (video, workbook, minimal counseling) or control condition (brochure). Main outcome measures included child’s urine cotinine and parental reports of child’s hours of SHS exposure and number of household cigarettes smoked. Implementation of household bans was also considered. No differences in outcomes were detected between intervention and control groups at follow-up. Limitations included high attrition and low rates of collection of objective measures (few children with urine cotinine samples). There continues to be a need for effective culturally and linguistically appropriate strategies that support reduction of household SHS exposure among children with asthma in low income, minority households.

Alcohol and other Substance Use among Deaf and Hard of Hearing Youth

Little research has focused on alcohol and illicit drug use among deaf and hard of hearing youth. Findings are reported from survey data collected among high school students at two phases of a program of research primarily focusing on tobacco use [Phase 1: (1999/2000) n = 226, Phase 2: (2004) n = 618). Evidence of considerable ever (lifetime) drinking (59.1%, 42.6%) and other substance use (21.1%, 18.9%) was found. Gender, age, race/ethnic, grade, school type (mainstream vs. school for the deaf), age when deafened, and aspects of self-perception were examined for their possible association with substance use. Current use rates are reported, and study findings are discussed in relation to national data. Understanding these use patterns is critical to developing interventions for this culturally and linguistically unique population.

Do Deaf and Hard of Hearing Youth Need Antitobacco Education

Little research has focused on tobacco use among deaf and hard of hearing youth. Findings are reported from a first-ever tobacco-related survey, completed by 226 California middle and high school students using either a written questionnaire or the Interactive Video Questionnaire, an interactive multimedia computer video technology. Rates for current smoking (3.1%), ever smoking (45.1%), and multiple types of tobacco use (10.6%) were found to be lower than among high school students generally; mainstreamed students were likelier to have ever tried smoking than their deaf school peers (57.8% vs. 31.8%). No statistically significant associations were found between ever smoking and race/ethnicity, gender, school performance, or prelingual vs. postlingual deafening; a quarter of the sample experienced occasional peer pressure to use tobacco products. Tobacco use covariates, exposure to cigarette marketing and antismoking programming, and tobacco education needs of deaf and hard of hearing youth are discussed.

Tobacco Prevention Education in Schools for the Deaf: The Faculty Perspective.

We report results of a survey of tobacco education practices and perspectives among faculty at four Schools for the Deaf participating in the trial of a tailored tobacco prevention curriculum. Few faculty (20.4%) included tobacco use among the three most important health problems facing their students, although 88.8% considered tobacco education to be worthwhile. Despite perceived unmet needs among their students, classroom or school-wide attention to tobacco prevention was limited. Only 13.9% reported delivering tobacco programming in the prior year, most often reporting lack of deaf-friendly curriculum and materials (60.9%), time (47.8%), and training (43.5%) as barriers to program delivery. Perceptions, attitudes, and institutional issues, including lack of tailored curriculum, were seen as contributing to the limited focus on this important health problem.

Teaching Group Drumming to Mental Health Professionals

The author John Updike is quoted as saying “What art offers is space—a certain breathing room for the spirit.” Over the past 10 years, there has been a growing recognition of the healing and restorative power of the arts. Music, art, poetry, and movement therapy are commonly being introduced into healthcare settings. An organization, the Society for the Arts in Healthcare (www.sah.org), has been formed to demonstrate the valuable role that the arts can play in enhancing the healing process. The Society also provides resources and education to healthcare and arts professionals and encourages and supports research on the beneficial effects of the arts in healthcare. In the column this month, Ping Ho and her colleagues describe an innovative program at UCLA where drumming was taught to mental health professionals who, in turn, were encouraged to bring drumming to public school classrooms in underserved areas. The evidence described below suggests that the mental health professionals were receptive to education and roughly a third of those who went through the training, in turn, offered a program to clients in the school. — MJK There is strong evidence from the field of psychoneuroimmunology that stress reduction and social support improve health and resistance to disease. 1,2 Ping Ho and colleagues recently completed a study that focused on the use of drumming in a Los Angeles public school with low-income children. They reported that group drumming, integrated with activities from group counseling, led to significant improvements in a wide spectrum of social-emotional behaviors. 3 Significant reductions in the intervention group compared to controls were found in overall problem behavior and in behaviors reflective of specific problems, such as withdrawn/depression, anxiety, posttraumatic stress, attention deficit/hyperactivity, oppositionaldefiance,andsluggishcognitive tempo. In this study, a school counselor with no music experience was used to deliver the intervention that was designed to accommodate an entire classroom of children, including children with special needs and abilities. Curious as to whether it was possible to educate a group of health professionals on the use of the drumming program, the research team sought support from integrative health advocate Remo Belli (founder and CEO of Remo, Inc) that enabled them to offer free professional development training to an entire division of mental health professionals largely serving elementary youth in underperforming schools in the Los Angeles Unified School District—the second largest school district in the nation. The training took place over a period of two