Patricia J. Estok

DXA, Health Beliefs, and Osteoporosis Prevention Behaviors

Objective: This experimental longitudinal study was designed to examine the relationship between having a bone density through dual energy X ray absorptiometry (DXA) and osteoporosis preventing behaviors (OPB) among healthy postmenopausal women. Methods: Subjects were 203 healthy community-based women 50-65 years of age. Mediating variables were general knowledge of osteoporosis and revised health belief model variables. Treatment group women (n = 101) had a DXA screen and control group women (n = 102) did not. Study questionnaires were completed at three time points; initially and at 6 months and 12 months. Results: Repeated measures ANOVA revealed treatment group women scored significantly higher on perceived susceptibility and calcium intake. Wilkss Lambda F revealed a significant difference in use of osteoporosis preventing medications. Discussion: Personal knowledge gained from DXAs increased perceived susceptibility to osteoporosis, calcium intake, and use of osteoporosis preventing medications and appears to be an effective intervention in promoting OPB in younger postmenopausal women.

Osteoporosis in Older Men: Knowledge and Health Beliefs

Purpose: The purpose of this theory‐based descriptive study was to describe older mens (≥65 years of age) knowledge of osteoporosis, their health beliefs about osteoporosis (specifically their perceived susceptibility), their confidence to perform osteoporosis‐prevention behaviors, and actual performance of osteoporosis‐prevention behaviors. Design: A descriptive design was used to determine mens knowledge and health beliefs of osteoporosis, confidence to perform osteoporosis prevention behaviors, and performance of osteoporosis prevention behaviors. Sample: A community‐based convenience sample of 138 men 65 years of age and older was obtained in Northeastern Ohio community centers where men were likely to gather. Method: Men completed a questionnaire that included the Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale, Osteoporosis Self‐Efficacy Scale (Kim, Horan & Gendler, 1991), and the Osteoporosis Preventing Behaviors Survey (Doheny & Sedlak, 1995). Main Research Classifications: Osteoporosis, Men, Prevention, Health Beliefs, Orthopaedic Nursing. Findings: Men had poor knowledge of osteoporosis, did not perceive themselves as susceptible to osteoporosis, and engaged in few osteoporosis preventing behaviors such as weight‐bearing exercises and dietary calcium intake. Conclusion: Men need osteoporosis education and modification of lifestyle to include osteoporosis prevention behaviors. Implications for Nursing Research. Future research should include the development of osteoporosis awareness programs for men.

Osteoporosis Knowledge, Health Beliefs, and DXA T-Scores in Men and Women 50 Years of Age and Older.

PURPOSE To compare the knowledge of osteoporosis, revised health belief model variables (RHBM), and DXA (dual energy x-ray absorptiometry) T-scores among men and women 50 years of age and older. DESIGN This was a secondary analysis that used 218 healthy community-based women 50 to 65 years of age and 226 healthy community-based men ≥50 years of age. Data for women were collected for 18 months during 2001–2003, and data for men were collected for 18 months during 2004–2006. The variables were knowledge of osteoporosis, RHBM variables (susceptibility, seriousness, benefits and barriers of calcium intake and of exercise, health motivation, self-efficacy of calcium intake and exercise), and DXA T-scores. METHOD The women and men completed an osteoporosis questionnaire prior to having a DXA screening test. A total of 190 women and 187 men had DXA scans. FINDINGS More than half of the sample had abnormal bone density scans. Knowledge of osteoporosis was low for women and even lower for men. Seven of the nine health belief variables were associated with gender. Women perceived osteoporosis to be serious and that they were susceptible. Men did not perceive osteoporosis to be serious or that they were susceptible. Men were more health motivated and more confident of their ability to engage in exercise.

Structural model for osteoporosis preventing behavior in postmenopausal women.

Background: Osteoporosis prevention behaviors (OPBs) can prevent and delay bone deterioration; dual-energy X-ray absorptiometry (DXA) scan can identify osteoporosis and provide personal osteoporosis risk information that may promote prevention behaviors. Objectives: This study was designed to estimate relationships between receiving personal knowledge of bone mineral density (gained through DXA scan), general knowledge of osteoporosis, health beliefs, and the two OPBs of calcium intake and weight-bearing exercise in healthy postmenopausal women 50 to 65 years. Methods: In this longitudinal, randomized clinical trial (including covariates), receipt of personal DXA information was manipulated by random assignment to the experimental or control group. The remaining antecedent and outcome variable measures were collected by questionnaire at three time points (initial [T1; pre-DXA], 6 months [T2], 12 months [T3]) and by bone density assessment from 203 women over an 18-month period in 2001-2003. Results: The experimental manipulation (DXA results) had a direct positive effect (&bgr; = .23, p < .05) on calcium intake at T2, and indirectly at T3 through T2. Women in the experimental group who were informed they had osteopenia or osteoporosis had a greater T1-T2 change in daily calcium intake than those with normal bone density (&bgr; = .23, p < .05). However, providing DXA results did not relate to change in exercise. Health beliefs and general osteoporosis knowledge predicted initial calcium and exercise levels; there was tentative evidence that susceptibility beliefs partially mediate between DXA results and change in calcium intake. Discussion: Personal knowledge of DXA results was related significantly to increases in calcium intake in postmenopausal women, but not to exercise. Directions for further study are discussed.

Tailored interventions to enhance osteoporosis prevention in women.

PURPOSE The purpose of this pilot study was to determine if tailored nursing interventions based on personal knowledge of bone mineral density from a dual-energy x-ray absorptiometry cause increases in knowledge of osteoporosis, health beliefs, or osteoporosis-prevention behaviors in postmenopausal women 50–65 years of age, 6 months after the intervention. METHOD The design for this pilot study was a two group quasi-experimental design. The treatment group received a tailored intervention; the control group did not. Outcome data were gathered at 6 months after dual-energy x-ray absorptiometry. The tailored intervention was designed and given to each woman via telephone using her dual-energy x-ray absorptiometry results and osteoporosis questionnaire data that addressed her knowledge of osteoporosis and osteoporosis-prevention behaviors of calcium intake, exercise, smoking, and alcohol use. A written mailed copy of the intervention followed the telephone interview. Six months after the intervention, the women were mailed another osteoporosis questionnaire to determine if the tailored intervention made a difference in the outcome variables. SAMPLE A total 124 women between the ages of 50 and 65 (101 control, 23 treatment) comprised the sample. RESULTS There was no difference in knowledge between groups. On the average, there were significantly more perceived barriers to calcium in the tailored group (mean = 13.48) than in the nontailored group (mean = 11.55) (t = 2.147; df = 122; p = .034). There were significantly more perceived barriers to exercise in the tailored group (mean = 14.39) than in the nontailored group (mean = 12.21) (t = .144; df = 122; p = .034). Daily calcium intake increased in both the tailored and the nontailored groups. The tailored intervention increased womens daily calcium intake from 614.28 to 1039.10 mg (t = −2.896; df = 22; p = .008). The nontailored group daily calcium intake increased from 587.91 to 916.30 mg (t = −3.541; df = 100; p = .001); there was no significant difference between the groups. Weight-bearing exercise behaviors decreased from 96.04 minutes to 59.2 minutes in the tailored group but increased slightly in the nontailored group from 81.47 to 87.26 minutes of exercise. CONCLUSION Tailored interventions increased womens perceived barriers to calcium and exercise. Both groups increased calcium intake. The mixed findings of increased perception of barriers to calcium and exercise and decreased exercise behaviors indicate the need for further study. This important intervention has implications for orthopaedic nurses and healthcare professionals involved in health promotion and prevention of osteoporosis.

Structural Model for Osteoporosis Preventing Behavior in Men

This longitudinal study evaluates the effect of bone mineral density screening on calcium intake and daily exercise of 196 healthy men older than 50 years over a period of 1 year. In this randomized clinical trial, the experimental group received personal bone density information via dual-energy X-ray absorptiometry (DXA). The men completed measures addressing knowledge, health beliefs, calcium intake, and exercise behaviors. Outcome measures were collected by a questionnaire at three time points: initial (Time 1 [T1]; pre-DXA), 6 months (Time 2 [T2]), and 12 months (Time 3 [T3]). Using structural equation modeling for data analysis, results indicated that men in the experimental group had a significantly higher T2 calcium intake than the control group, with no additional direct effect at T3. T1 daily calcium intake was significantly predicted by T1 health beliefs. Men with higher levels of health motivation tended to have higher initial levels of daily calcium intake. Personal knowledge of DXA results relate significantly to increased calcium intake.

The meanings of menopause

Multiple meanings have been assigned to menopause and to women experiencing menopause. Meanings are not inherent in reality but are assigned by humans in response to interaction. Once meanings are assigned to entities, they become coercive and influence interactions. Freidsons (1988) theoretical framework includes the imputation of responsibility, legitimacy, and seriousness to a deviance or illness and provides the basis for an analysis of the various meanings of menopause that are found in the literature. This analysis is concerned with the social, political, economic, and health care consequences of the assigned meanings of menopause for women.

Codependency in male and female helping professionals

The purpose of this study is to determine and compare the prevalence of codependency in a group of 77 female and a group of 72 male helping professionals. Relatively low rates of codependency were observed in this sample, and the five-factor structure of the Codependency Assessment Tool (CODAT) was replicated. Males showed slightly higher codependency than females on the total CODAT and on the Hiding Self and Family of Origin Issues subscales. The CODAT was shown to be relevant to both males and females. Further research is needed to determine if a general population of male and female subjects would yield similar results.

Physical, psychosocial, menstrual changes/risks, and addiction in the female marathon and nonmarathon runner

From a sample of marathon (N = 57) and nonmarathon (N = 38) female runners physical, psychosocial, menstrual changes/risks and addictive behaviors were identified. There was a high incidence of knee injury in both groups of runners. Marathon runners had a significantly higher incidence of both heel pain and stress fractures. Psychosocial variables of anxiety, self‐esteem, family/spouse relationships and addictive behaviors did not differ significantly in the two groups. In addition, those reporting more addicitive behaviors did not report a significantly higher incidence of physical injury; however, there was an association between higher addiction scores and lower self‐esteem.

The relationship between eating disorders and running in women.

The purpose of this study was to determine the extent to which eating disorders in women are related to a general tendency toward addiction, addiction to running, and level of running intensity. A stratified sample of 265 women runners/nonrunners (ages 20-35) included 66 nonrunners, 69 low-level runners, 67 medium-level runners, and 63 high-intensity runners. The women were weighed, measured, and had body fat and 4-day nutritional intake assessed. A questionnaire included scales to assess psychological and behavior traits common in women with anorexia (AN) and/or bulimia, general addiction, and running addiction. ANCOVA with age and income as covariates and multiple regression analyses were used. There were significant differences among the groups on the eating disorder scores and percent body fat with higher level runners scoring higher on eating disorder measures and running addiction and lower on body fat. A major finding for those providing health care for women was that 25% of the women who ran >30 miles/week had Eating Attitude Test scores indicating a high risk for anorexia.