LeaVonne Pulley

Personal, social, and physical environmental correlates of physical activity in rural African-American women in Alabama.

BACKGROUND Physical inactivity is prevalent among African-American women in rural Alabama. The purpose of this study was to explore personal, social, and physical environmental factors associated with activity to help plan interventions. METHODS As part of the Womens Cardiovascular Health Network Project, telephone surveys were collected from African-American women residing in three rural counties. The women reported the number of minutes engaged in moderate or vigorous activities and were categorized into the following groups: (1) inactive (no moderate or vigorous activities), (2) insufficient (not meeting recommendations), and (3) meets recommendations (engaged in moderate activity five times per week for at least 30 minutes or vigorous activity three times per week for at least 20 minutes). Logistic regression modeling was used to identify personal, social, and physical environmental factors associated with the more active groups. RESULTS Among the 567 women who were classified in physical activity groups, 221 (39%) met the recommendations, 260 (46%) were insufficiently active, and 86 (15%) were inactive. In the adjusted model, the social environmental factors associated with women meeting the recommendations (versus inactive) were attending religious services and seeing people exercise in the neighborhood. Attending religious services, knowing people who exercise, and a higher social issue score were associated with women who reported any activity (versus inactive). No physical environmental factors were associated with the more active groups. CONCLUSIONS Social environmental factors were associated with higher levels of activity and need to be considered when planning interventions. More research is needed to identify associations between specific aspects of the social environment and physical activity behaviors.

Women at risk of HIV / STD: the importance of male partners as barriers to condom use.

Womens perceptions of power in their relationship with their main partner, control over condom use, concerns about potential partner retribution, condom requests, and condom use were assessed by interviewing a group of women attending two urban public clinics for sexually transmitted diseases in Alabama. Only 5% reported that they had no control over condom use by their partner. Fears of catastrophic partner reactions to condom use requests (sexual coercion, abuse, or abandonment) and experiences of partner objections were also uncommon. Women did not perceive themselves to be powerless. Inconsistent condom use was associated with wanting condom use but not asking and with perceived consequences of relationship loss, however, most power-related measures, including physical abuse, were not related to condom use in the 30 days prior to the interview.

Changes in School Environments With Implementation of Arkansas Act 1220 of 2003

Changes in school nutrition and physical activity policies and environments are important to combat childhood obesity. Arkansas Act 1220 of 2003 was among the first and most comprehensive statewide legislative initiatives to combat childhood obesity through school‐based change. Annual surveys of principals and superintendents have been analyzed to document substantial and important changes in school environments, policies, and practices. For example, results indicate that schools are more likely to require that healthy options be provided for student parties (4.5% in 2004, 36.9% in 2008; P ≤ 0.0001) and concession stands (1.6% in 2004, 19.6% in 2008; P ≤ 0.0001), ban commercial advertising by food or beverage companies (31.7% in 2005, 42.6% in 2008; P ≤ 0.0001), and offer skim milk options for students in cafeterias (white milk: 26.1% in 2004, 41.0% in 2008, P ≤ 0.0001; chocolate milk: 9.0% in 2004, 24.0% in 2008, P ≤ 0.0001). They are less likely to have vending machines available during the lunch period (72.3% in 2004, 37.2% in 2008; P ≤ 0.0001) and to include sodas in vending machines (83.8% in 2004, 73.5% in 2008; P ≤ 0.0001). Other changes were noted in foods and beverages offered in the cafeteria, in classrooms, and at school events, as well as in fund‐raising and physical activity practices. A significant number of school districts have modified physical education requirements for elementary schools and developed policies prohibiting the use of physical activity as a punishment. We conclude that Arkansas Act 1220 of 2003 is associated with a number of changes in school environments and policies, resulting from both statewide and local initiatives spawned by the Act.

Breast and Cervical Cancer Screening Among Latinas Attending Culturally Specific Educational Programs

Background. Latinas in the United States have higher morbidity and mortality rates for breast and cervical cancers (compared with non-Latina Whites), often due to lower screening rates. A community-based participatory research (CBPR) approach could help to improve screening rates by creating a culturally customized educational program for Latino men and women addressing low knowledge, gender roles, and spirituality. Objectives. This study was designed to assess the effectiveness of a culturally customized program (Esperanza y Vida [Hope and Life]) in increasing breast and cervical cancer screening among Latinas, and to examine how screening rates related to changes in cancer knowledge, differences in ethnic origins, and geographic location. Methods. Participants were recruited to attend either a breast and cervical (intervention) or diabetes (control) education program, within a randomized plan. Sixty-nine programs (44 intervention; 25 control) were conducted in Arkansas (AR; n = 39) and New York City (NYC; n = 30) with a total of 847 Latino men and women. Telephone follow-up data were collected on 49% of the women who consented to being contacted 2 months postintervention. Results. At the 2-month follow-up call, screening rates were significantly higher for the intervention versus the control group for clinical breast examination (CBE; 48% vs. 31%; adjusted odds ratio [aOR], 2.2; 95% confidence interval [CI], 1.1–4.2), breast self-examination (45% vs. 27%; aOR, 2.3; 95% CI, 1.1–5.0), and Pap testing (51% vs. 30%; aOR, 3.9; 95% CI, 1.1–14.1), but not for mammography (67% vs. 58%; aOR, 0.7; 95% CI, 0.1–3.6). The aORs accounted for the significant effects of study site (AR vs. NYC) and marital status. Conclusions.Esperanza y Vida has the potential to reduce health disparities in breast and cervical cancer morbidity and mortality rates through increasing cancer screening and thereby increasing early detection.

Stepped-Care, Community Clinic Interventions to Promote Mammography Use among Low-Income Rural African American Women:

Few studies have investigated community clinic-based interventions to promote mammography screening among rural African American women. This study randomized older low-income rural African American women who had not participated in screening in the previous 2 years to a theory-based, personalized letter or usual care; no group differences in mammography rate were evident at 6-month follow-up. Women who had not obtained a mammogram were then randomized to a tailored call delivered by community health care workers or a tailored letter. There were no group differences in mammography rates after the second 6-month follow-up. However, among women who had never had a mammogram, the tailored call was more effective in promoting mammography use. Tailored counseling may be an effective screening promotion strategy for hard-to-reach rural African American women with no history of screening. Further research into this strategy may facilitate efforts to reduce health disparities in underserved low-income rural African American populations.

Care seeking after stroke symptoms

To assess risk factors associated with care for stroke symptoms.

The Scientific Misconduct Questionnaire—Revised (SMQ-R): Validation and Psychometric Testing

Purpose: The overall purposes of this article are to report the development of a survey instrument, Scientific Misconduct Questionnaire-Revised (SMQ-R) that elicits the perceptions of research coordinators managing clinical trials about the various aspects of scientific misconduct and to present the psychometric analyses for the SMQ-R. Methods: A panel of five researchers and research coordinators reviewed the original SMQ (Rankin and Esteeves, 1997) and suggested an additional 42 items based on the review of the literature and their own experiences in research. The SMQ-Revised (SMQ-R) consists of 68 closed-choice items in six sections and one section with 12 open-ended questions. The SMQ-R was sent to 5302 persons who were members of the Association for Clinical Research Professionals (ACRP) or subscribers to Research Practitioner, published by the Center for Clinical Research Practice (CCRP). Findings: Internal consistency of subscales was assessed with Cronbachs alpha and ranged from .83 to .84. Confirmatory factor analysis was used to test construct validity of the instrument subscales. The factor structure was assessed with the principal factors method, using the squared multiple correlations as initial communality estimates followed by varimax (orthogonal) or biquartimax (oblique) rotations. Analyses revealed five distinct factors among three subscales. Construct validity for the SMQ-R was also assessed by testing hypothesized relationships using the known groups approach. Conclusion: The current effort demonstrated the usefulness of the SMQ-R in obtaining information from a national sample of experienced research coordinators about their perceptions of the prevalence of different types of scientific misconduct and of factors that influence the occurrence of misconduct. The psychometric evaluation of the SMQ-R suggests good internal consistency for most subscales and suggests adequate construct validity of the instrument as a whole. The analyses also suggest that further refinement of the instrument for future studies is warranted.

Impact of a smoke-free hospital campus policy on employee and consumer behavior.

Objective. Although smoke-free hospital campuses can provide a strong health message and protect patients, they are few in number due to employee retention and public relations concerns. We evaluated the effects of implementing a clean air policy on employee attitudes, recruitment, and retention; hospital utilization; and consumer satisfaction in 2003 through 2005. Methods. We conducted research at a university hospital campus with supplemental data from an affiliated hospital campus. Our evaluation included (1) measurement of employee attitudes during the year before and year after policy implementation using a cross-sectional, anonymous survey; (2) focus group discussions held with supervisors and security personnel; and (3) key informant interviews conducted with administrators. Secondary analysis included review of employment records and exit interviews, and monitoring of hospital utilization and patient satisfaction data. Results. Employee attitudes toward the policy were supportive (83.3%) at both institutions and increased significantly (89.8%) at post-test at the university hospital campus. Qualitatively, administrator and supervisor attitudes were similarly favorable. There was no evidence on either campus of an increase in employee separations or a decrease in new hiring after the policy was implemented. On neither campus was there a change in bed occupancy or mean daily census. Standard measures of consumer satisfaction were also unchanged at both sites. Conclusion. A campus-wide smoke-free policy had no detrimental effect on measures of employee or consumer attitudes or behaviors.

The impact of a family history of breast cancer on screening practices and attitudes in low-income, rural, African American women

BACKGROUND Women with a family history of breast cancer are at increased risk for developing cancer and, therefore, might be expected to engage in early detection practices more actively than women without a family history. Alternatively, women with a family history may avoid thinking about cancer and have attitudes and practices that do not promote early detection. METHODS This study examined breast cancer attitudes and practices among African American women aged >or=50 who had not had a mammogram in the last 2 years. RESULTS Phone survey data from 320 female clients of low-income, rural primary care clinics (91% African American) indicated that 15% self-reported a family history of breast cancer (FH(+)). Half of the FH(+) women did not know their relative risk of developing breast cancer. Of those providing a risk estimate, 67% perceived themselves at low risk compared with other women their age. Perceived relative risk was comparable between FH(+) and FH(-) women. Further, FH(+) women did not indicate greater worry about breast cancer, nor did they have more accurate knowledge of mammography recommendations than FH(-) women. Two thirds of FH(+) women had never had a mammogram. Monthly breast self-examination did not differ between FH(+) and FH(-) women. CONCLUSIONS Thus, neither knowledge of a positive family history nor perceived relative risk of breast cancer was associated with either increased or decreased early detection practices among these low-income, rural, African American women who have underused mammography. Furthermore, a substantial proportion of FH(+) women had not ever participated in screening mammography. Interventions to increase mammography rates in this population of underusers are indicated.

Developing Community Capacity and Improving Health in African American Communities

Community-based programs have produced mixed results. Community capacity is thought to be a major determinant of program effectiveness. Thus, enhancing community capacity may increase the beneficial effects of existing programs and enhance future program effectiveness. This highlights the need to focus on understanding the components of capacity and the methods of enhancing capacity. Although we are just beginning to examine and understand key concepts, community capacity is probably influenced by both relatively nonmodifiable characteristics (such as demographic factors, institutional resources, and social structures) and relatively modifiable characteristics (such as knowledge, skills, and the ability and willingness of members and agencies to work collaboratively). In their relationships with community members and agencies, academicians and public health practitioners may help acquire categorical funding to enhance opportunities to build community capacity and their own capacity as well. The relationship between academicians/practitioners and community members/agencies probably is influenced by a host of characteristics which determine the degree to which capacity can be built. This paper discusses: the key components of capacity; the factors that influence building capacity through collaborations; a community health advisor (CHA) model which both builds on sociocultural aspects of African American culture and is consistent with methods for building community capacity; and how modifications to this model allow it to be compatible with categorically funded projects.