Matthew Lee Smith

Social-Cognitive Predictors of Fruit and Vegetable Intake in Children

Social-cognitive theory (SCT) was used to explain the fruit and vegetable intake of 1,398 3rd graders. SCT variables assessed included self-efficacy, outcome expectations, preferences, social norms, asking skills, and knowledge. Fruit and vegetable intake was assessed with 7-day records. Bivariate correlations with fruit and vegetable intake ranged from .17 for asking skills to .29 for fruit and vegetable preferences. In analyses controlling for school-level clustering, only preferences and positive outcome expectations remained significantly associated with fruit and vegetable intake, accounting for approximately 10%-11% of the variance. Limitations in the conceptualization, scope, and measurement of the variables assessed may have contributed to the weak associations observed. Models incorporating factors other than individual-level social-cognitive variables may be required to more fully explain childrens dietary behavior.

Successes of a National Study of the Chronic Disease Self-Management Program Meeting the Triple Aim of Health Care Reform

Background:Emerging health care reform initiatives are of growing importance amidst concerns about providing care to increasing numbers of adults with multiple chronic conditions. Evidence-based self-management strategies are recognized as central to managing a variety of chronic diseases by improving the medical, emotional, and social role management demands of chronic conditions. Objectives:To examine the effectiveness of the Chronic Disease Self-Management Program (CDSMP) among a national sample of participants organized around the Triple Aim goals of better health, better health care, and better value in terms of reduced health care utilization. Research Design:Utilizing data collected from small-group CDSMP workshops, baseline, 6-month, and 12-month assessments were examined using 3 types of mixed-effects models to provide unbiased estimates of intervention effects. Subjects:Data were analyzed from 1170 community-dwelling CDSMP participants. Measures:Triple Aim–related outcome measures: better health (eg, self-reported health, pain, fatigue, depression), better health care (eg, patient-physician communication, medication compliance, confidence completing medical forms), and better value [eg, reductions in emergency room (ER) visits and hospitalizations in the past 6 mo]. Results:Significant improvements for all better health and better health care outcome measures were observed from baseline to 12-month follow-up. The odds of ER visits significantly reduced from baseline to 12-month follow-up, whereas significant reductions in hospitalization were only observed from baseline to 6-month follow-up. Conclusions:This National Study of CDSMP (National Study) demonstrates the successful translation of CDSMP into widespread practice and its potential for helping the nation achieve the triple aims of health care reform.

National study of chronic disease self-management: six-month outcome findings.

Objective: To investigate how the Chronic Disease Self-Management Program (CDSMP) changes health outcomes, lifestyle behaviors, and health care service utilization over a 6 month period. Method: The participants were 1,170 adults enrolled in the National Study of CDSMP in 2010-2012 (M age = 65.4 years). Six-month assessments were available for 903 participants. Linear mixed models and generalized linear mixed models were used to assess the changes between baseline and 6-month assessment for primary and secondary outcomes among CDSMP participants. Results: Social/role activities limitations, depression, and communication with physicians improved significantly from baseline to 6-month follow-up. Study participants reported significant improvements in more physical activity and less emergency room (ER) visits and hospitalization during that period. Discussion: Nationally, CDSMP not only improves health outcomes and lifestyle behaviors but also decreases costly ER visits and hospitalization. Geriatricians and other primary care providers should be encouraged to refer patients with chronic conditions to such self-management programs.

The science of sustaining health behavior change: the health maintenance consortium.

OBJECTIVE To enhance understanding of the long-term maintenance of behavior change, as well as effective strategies for achieving sustainable health promotion and disease prevention through the Health Maintenance Consortium (HMC). METHODS This introductory research synthesis prepared by the resource center gives context to this theme issue by providing an overview of the HMC and the articles in this journal. RESULTS It explores the contributions to our conceptualization of behavior change processes and intervention strategies, the trajectory of effectiveness of behavioral and social interventions, and factors influencing the long-term maintenance of behavioral and social interventions. CONCLUSIONS Future directions for furthering the science of maintaining behavior change and reducing the gaps between research and practice are recommended.

Self-Management at the Tipping Point: Reaching 100,000 Americans with Evidence-Based Programs

Baby boomers are crossing the traditional “aging” threshold. More than 10,000 baby boomers now turn 65 each day. In turn, there is an increasing prevalence of chronic conditions, and more importantly, older adults are ever more likely to be living with multiple chronic conditions. It is important to recognize that, despite advances in medical care, individuals with chronic conditions live the majority of their lives outside of the healthcare system. Thus, it is critical for healthcare providers to be aware of ways in which their patients are managing—or failing to manage—their chronic conditions in their everyday lives. This editorial highlights the benefits of community-based self-management programs, discusses the results of a national rollout for one widely disseminated evidence-based program, and reflects upon the synergistic partnerships that need to be developed between healthcare providers and community service practitioners to create a seamless infrastructure to help expand delivery capacity and sustain such programs. There is accumulating documentation about the success of evidence-based self-management programs in helping people with the medical, role, and emotional management demands associated with chronic conditions. One of the most widely disseminated programs, the Stanford University Chronic Disease Self-Management Program (CDSMP), has been shown in randomized trials to improve symptoms such as pain, shortness of breath, and fatigue; improve ability to engage in everyday activities; reduce depression; enrich communication with healthcare providers; and decrease costly health care such as emergency department visits. Drawing upon evidence-based principles of behavior change, CDSMP workshops consist of six 2.5-hour sessions delivered in small group settings (e.g., 10–16 participants) over a 6-week period. CDSMP is designed to help participants develop skills to manage symptoms and learn specific coping strategies using action planning and feedback, behavior modeling, problemsolving techniques, and decision-making. The program is well scripted, and two leaders who have successfully completed 4 days of training facilitate each workshop. Nevertheless, there is emerging concern about pervasive research-to-practice gaps in which programs developed in research settings fail to be translated into widespread practice in the “aging services network.” This phrase describes a network of state units on aging, area agencies on aging, tribal organizations, and more than 30,000 community-based organizations (e.g., senior centers, social service agencies, faith-based organizations, senior housing) that serve older adults. Working together alongside the U.S. Administration on Aging, state health departments, state Medicaid agencies, and other public agencies, the aging services network is responsible for planning, administering, and providing a wide array of social, long-term care, and health-support services. It is this network of providers that has recognized the importance of being able to bring community-based self-management programs to scale to reach diverse populations of older adults who can benefit from participating in such programs. After 20 years of development and evaluation, CDSMP-type programs have gained traction and are now ready to be introduced nationally. Toward this end, the American Recovery and Reinvestment Act of 2009 (i.e., Recovery Act) Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative, led by the U.S. Administration on Aging in collaboration with the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, allotted

Geographic variations in access and utilization of cancer screening services: examining disparities among American Indian and Alaska Native Elders

32.5 million to support the translation of the Stanford program in 45 states, Puerto Rico, and the District of Columbia. The goal was to have 50,000 Americans complete at least four of six CDSMP sessions between 2010 and 2012 and to embed delivery structures into statewide systems. This editorial describes the first 100,000 participants who enrolled in this national initiative and reflects on what is needed for the continued widespread dissemination of evidence-based self-management programs. Within the first 24 months of this initiative, more than 100,000 middle-aged and older adults were reached through 9,305 workshops in 1,234 U.S. counties. Participants self-reported 2.2 chronic conditions, the most prevalent being hypertension (43.0%), arthritis (40.8%), diabetes mellitus (30.3%), and depression (19.5%). Participants were primarily female (77.7%), older (mean age 67; 31.7% aged 75), and from diverse ethnic and minority backgrounds. Approximately 17% self-identified as Hispanic, 66.4% as white, 21.5% as African American, 4.5% as Asian or Pacific Islander, and 1.6% as American Indian or Native Alaskan. Although the majority of participants attended CDSMP workshops delivered in English (89.3%), the program was also offered in Spanish, Chinese, Vietnamese, French, and Somali. Paralleling findings from the original randomized clinical trials, participation attendance was high, with approximately 75% attending at least four of the six sessions. Workshops were offered in many DOI: 10.1111/jgs.12239

National Study of Chronic Disease Self-Management Age Comparison of Outcome Findings

BackgroundDespite recommendations for cancer screening for breast and colorectal cancer among the Medicare population, preventive screenings rates are often lower among vulnerable populations such as the small but rapidly growing older American Indian and Alaska Native (AIAN) population. This study seeks to identify potential disparities in the availability of screening services, distance to care, and the utilization of cancer screening services for Medicare beneficiaries residing in areas with a higher concentration of AIAN populations.MethodsUsing the county (n =3,225) as the level of analysis, we conducted a cross-sectional analysis of RTI International’s Spatial Impact Factor Data (2012) to determine the level of disparities for AIAN individuals. The outcomes of interest include: the presence of health care facilities in the county, the average distance in miles to the closest provider of mammography and colonoscopy (analyzed separately) and utilization of screening services (percent of adults aged 65 and older screened by county).ResultsCounties with higher concentrations of AIAN individuals had greater disparities in access and utilization of cancer screening services. Even after adjusting for income, education, state of residence, population 65 and older and rurality, areas with higher levels of AIAN individuals were more likely to see disparities with regard to health care services related to mammograms (p ≤ .05; longer distance, lower screening) and colonoscopies (p ≤ .05; longer distance, lower screening).ConclusionsThese findings provide evidence of a gap in service availability, utilization and access facing areas with higher levels of AIAN individuals throughout the US. Without adequate resources in place, these areas will continue to have less access to services and poorer health which will be accelerated as the population of older adults grows.

The relationship between mosquito abundance and rice field density in the Republic of Korea

Introduction. The adult population is increasingly experiencing one or more chronic illnesses and living with such conditions longer. The Chronic Disease Self-Management Program (CDSMP) helps participants cope with chronic disease-related symptomatology and improve their health-related quality of life. Nevertheless, the long-term effectiveness of this evidence-based program on older adults as compared to the middle-aged populations has not been examined in a large-scale, national rollout. Method. We identified baseline characteristics of CDSMP participants aged 65 years or older (n = 687, M = 74.8 years) in the National Study of CDSMP from 2010 to 2012. Comparisons were made to middle-aged participants aged 50 to 64 (n = 325, M = 58.3 years). Assessments were conducted at baseline and 12-month follow-up. Linear and generalized linear mixed models were performed to assess changes in primary and secondary outcomes, controlling the key sociodemographics and number of chronic conditions. Results. All primary outcomes (i.e., social/role activities limitation, depression, communication with doctors) significantly improved in both the older and middle-aged cohorts. Although improvements in illness symptomatology (e.g., fatigue, pain, shortness of breath, and sleep problems) were similar across both cohorts, only the middle-aged cohort benefitted significantly in terms of overall quality of life and unhealthy mental health days. Effect sizes were larger among the middle-aged population who were also more likely to enter the program in poorer health and be from minority backgrounds. Conclusions. The current study documented improved health outcomes but more so among the middle-aged population. Findings suggest the importance of examining how age and interacting life circumstances may affect chronic disease self-management.

Successful Falls Prevention Programming for Older Adults in Texas Rural–Urban Variations

BackgroundJapanese encephalitis virus (JEV), the causative agent of Japanese encephalitis (JE), is endemic to the Republic of Korea (ROK) where unvaccinated United States (U.S.) military Service members, civilians and family members are stationed. The primary vector of the JEV in the ROK is Culex tritaeniorhynchus. The ecological relationship between Culex spp. and rice fields has been studied extensively; rice fields have been shown to increase the prevalence of Cx. tritaeniorhynchus. This research was conducted to determine if the quantification of rice field land cover surrounding U.S. military installations in the ROK should be used as a parameter in a larger risk model that predicts the abundance of Cx. tritaeniorhynchus populations.Mosquito data from the U.S. Forces Korea (USFK) mosquito surveillance program were used in this project. The average number of female Cx. tritaeniorhynchus collected per trap night for the months of August and September, 2002-2008, was calculated. Rice fields were manually digitized inside 1.5 km buffer zones surrounding U.S. military installations on high-resolution satellite images, and the proportion of rice fields was calculated for each buffer zone.ResultsMosquito data collected from seventeen sample sites were analyzed for an association with the proportion of rice field land cover. Results demonstrated that the linear relationship between the proportion of rice fields and mosquito abundance was statistically significant (R2 = 0.62, r = .79, F = 22.72, p < 0.001).ConclusionsThe analysis presented shows a statistically significant linear relationship between the two parameters, proportion of rice field land cover and log10 of the average number of Cx. tritaeniorhynchus collected per trap night. The findings confirm that agricultural land cover should be included in future studies to develop JE risk prediction models for non-indigenous personnel living at military installations in the ROK.

Complexities of Fall Prevention in Clinical Settings: A Commentary

This study assessed health-related changes of participants attending A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) model falls-prevention program for older adults based on their residential location. Data were examined from 1,482 older Texans enrolled in AMOB/VLL over a 2-year period and assessed at baseline and postintervention. Results indicate participants significantly increased falls efficacy by an average of 14.4% (p < .01), reduced activity interference due to their health by an average of 6.5% (p < .01), and decreased the number of days limited from usual activity by an average of 28.2% (p < .05). Regression models show that rural participants, despite entering and exiting the program with lower health status, report greater rates of positive change for falls efficacy and health interference compared with their urban counterparts. Findings contribute to the understanding of geographic variation with falls-prevention program outcomes.