Patrick O. Monahan

Breakage, slippage and acceptability outcomes of a condom fitted to penile dimensions

Objective: This study compared failure rates of a standard-sized condom and a condom fitted to a man’s penile length and circumference and assessed users’ perceptions of condom acceptability and confidence in the efficacy of both condoms. Method: Using an experimental crossover design with Internet-based daily diaries, 820 men who wore at least one of each condom type reported outcomes and perceptions of condoms used during vaginal and anal intercourse events for which they were the insertive partner. Results: Breakage for fitted condoms (0.7%) was significantly less than for standard-sized condoms (1.4%). When assessed by penile dimensions, significantly less breakage of fitted condoms than standard-sized condoms was observed among men in the middle circumference category (12–13 cm) during anal intercourse (1.2% versus 5.6%), men in the larger circumference category (⩾14 cm) during vaginal intercourse (0.6% versus 2.6%), and men in the longer length category (⩾16 cm) for both vaginal (0.5% versus 2.5%) and anal (3.0% versus 9.8%) intercourse. More slippage upon withdrawal after vaginal intercourse occurred with fitted condoms among men in the middle penile length (1.9% versus 0.9%) and circumference (2.2% versus 0.7%) categories. Conclusions: Fitted condoms may be valuable to sexually transmitted infection prevention efforts, particularly for men with larger penile dimensions. That fitted condoms slipped more for some men provides insights into the need for unique educational materials to accompany such products. Findings also highlight the need for participatory approaches between public health, condom manufacturers, and the retail industry to integrate fitted products into our work successfully.

Differences in health and cultural beliefs by stage of mammography screening adoption in African American women

Behavioral studies show that womens stage of readiness to adopt mammography screening affects their screening rates and that beliefs about breast cancer and screening affect stages of screening. The purposes of this study were to determine, first, the relationship between particular health and cultural beliefs and stage of mammography screening adoption in urban African American women, and second, whether demographic and experiential characteristics differed by stage. Data were analyzed from 344 low‐income African American women nonadherent to mammography screening who participated in a 21‐month trial to increase screening. At baseline, these women were randomized into 1 of 3 groups: tailored interactive computer instruction, targeted video, or usual care. Participants were categorized by stage of mammography screening adoption at 6 months as precontemplators (not planning to have a mammogram), contemplators (planning to have a mammogram), or actors (had received a mammogram). Although demographic and experiential variables did not differentiate stages of screening adoption at 6 months postintervention, some health and cultural beliefs were significantly different among groups. Actors were more preventive‐health–oriented than precontemplators and had fewer barriers to screening than did contemplators. Precontemplators had more barriers, less self‐efficacy, and greater discomfort with the mammography screening environment than did contemplators or actors. These results will be useful, not to change cultural beliefs, but to guide the design of health education messages appropriate to an individuals culture and health belief system. Cancer 2007.

Health-related quality of life of African American breast cancer survivors compared with healthy African American women

Background: The diagnosis and treatment of breast cancer can result in an array of late cancer-specific side effects and changes in general well-being. Research has focused on white samples, limiting our understanding of the unique health-related quality of life outcomes of African American breast cancer survivors (BCSs). Even when African American BCSs have been targeted, research is limited by small samples and failure to include comparisons of peers without a history of breast cancer. Objective: The purpose of this study was to compare health-related quality of life of African American female BCSs with that of African American women with no history of breast cancer (control group). Methods: A total of 140 women (62 BCSs and 78 controls), 18 years or older and 2 to 10 years postdiagnosis, were recruited from a breast cancer clinic and cancer support groups. Participants provided informed consent and completed a 1-time survey based on the proximal-distal health-related quality of life model of Brenner et al (1995). Results: After adjusting for age, education, income, and body mass index, results show that African American BCSs experienced more fatigue (P = .001), worse hot flashes (P < .001), and worse sleep quality (P < .001) but more social support from their partner (P = .028) and more positive change (P = .001) compared with African American female controls. Conclusions: Our results suggest that African American female BCSs may experience unique health-related outcomes that transcend age, education, socioeconomic status, and body mass index. Implications for Practice: Findings suggest the importance of understanding the survivorship experience for particular racial and ethnic subgroups to proactively assess difficulties and plan interventions.

Childhood Characteristics and Personal Dispositions to Sexually Compulsive Behavior Among Young Adults

This study explored possible associations between two personal tendencies “sexual compulsivity” and “sexual sensation seeking,” and self-esteem, family environmental conditions and sexual abuse experiences during childhood in a sample of 539 young adults in a mid-western university. A cross-sectional survey design was employed and data were collected using self-report, anonymous questionnaires. Men scored higher on the measures of sexual compulsivity and sexual sensation seeking than women. Mean scores on the measure of sexual compulsivity and sexual sensation seeking in this young adult college sample were lower when compared with high risk groups such as men living with HIV. Sex abuse experiences and poor family environment during childhood were associated with sexual sensation seeking and sexual compulsive tendencies. Neither sexual compulsivity nor sexual sensation seeking was associated with childhood self-esteem. Further, the results of this study suggest that sexual compulsive behavior compared to sexual sensation seeking, has much stronger connection with childhood etiological factors investigated in this study. Thus, as suggested by other sex researchers, those who are challenged by compulsive behaviors may need long-term treatment, but sensation seekers could possibly be effectively treated with short-term behavioral interventions. Causal relationships between childhood etiological factors and out-of-control behaviors, and subsequent risky sexual behaviors, as well as their implications for health promotion programs targeted at young adults, need to be investigated using longitudinal and qualitative research methods.

Practical clinical tool to monitor dementia symptoms: the HABC-Monitor.

Background Dementia care providers need a clinical assessment tool similar to the blood pressure cuff (sphygmomanometer) used by clinicians and patients for managing hypertension. A “blood pressure cuff ” for dementia would be an inexpensive, simple, user-friendly, easily standardized, sensitive to change, and widely available multidomain instrument for providers and informal caregivers to measure severity of dementia symptoms. The purpose of this study was to assess the reliability and validity of the Healthy Aging Brain Care Monitor (HABC-Monitor) for measuring and monitoring the severity of dementia symptoms through caregiver reports. Methods The first prototype of the HABC-Monitor was developed in collaboration with the Indianapolis Discovery Network for Dementia, which includes 200 members representing 20 disciplines from 20 local organizations, and an expert panel of 22 experts in dementia care and research. The HABC-Monitor has three patient symptom domains (cognitive, functional, behavioral/psychological) and a caregiver quality of life domain. Patients (n = 171) and their informal caregivers (n = 171) were consecutively approached and consented during, or by phone shortly following, a patient’s routine visit to their memory care provider. Results The HABC-Monitor demonstrated good internal consistency (0.73–0.92); construct validity indicated by correlations with the caregiver-reported Neuropsychiatric Inventory (NPI) total score and NPI caregiver distress score; sensitivity to three-month change compared with NPI “reliable change” groups; and known-groups validity, indicated by significant separation of Mini-Mental Status Examination severity groups and clinical diagnostic groups. Although not designed as a screening study, there was evidence for good operating characteristics, according to area under the receiver-operator curve with respect to gold standard clinical diagnoses, relative to Mini-Mental Status Examination or NPI. Conclusion The HABC-Monitor demonstrates good reliability and validity as a clinically practical multidimensional tool for monitoring symptoms of dementia through the informal caregiver.

Operating Characteristics of PROMIS Four-Item Depression and Anxiety Scales in Primary Care Patients with Chronic Pain

OBJECTIVEnDepression and anxiety are prevalent in patients with chronic pain and adversely affect pain, quality of life, and treatment response. The purpose of this psychometric study was to determine the reliability and validity of the four-item Patient Reported Outcomes Measurement Information System (PROMIS) depression and anxiety scales in patients with chronic pain.nnnDESIGNnSecondary analysis of data from the Stepped Care to Optimize Pain care Effectiveness study, a randomized clinical trial of optimized analgesic therapy.nnnSETTINGnFive primary care clinics at the Roudebush VA Medical Center (RVAMC) in Indianapolis, Indiana.nnnSUBJECTSnTwo hundred forty-four primary care patients with chronic musculoskeletal pain.nnnMETHODSnAll patients completed the four-item depression and anxiety scales from the PROMIS 29-item profile, as well as several other validated psychological measures. The minimally important difference (MID) using the standard error of measurement (SEM) was calculated for each scale, and convergent validity was assessed by interscale correlations at baseline and 3 months. Operating characteristics of the PROMIS measures for detecting patients who had probable major depression or were anxiety-disorder screen-positive were calculated.nnnRESULTSnThe PROMIS scales had good internal reliability, and the MID (as represented by two SEMs) was 2 points for the depression scale and 2.5 points for the anxiety scale. Convergent validity was supported by strong interscale correlations. The optimal screening cutpoint on the 4- to 20-point PROMIS scales appeared to be 8 for both the depression and anxiety scales.nnnCONCLUSIONSnThe PROMIS four-item depression and anxiety scales are reasonable options as ultra-brief measures for screening in patients with chronic pain.

Psychological distress symptoms of individuals seeking HIV-related psychosocial support in western Kenya

Abstract While researchers in many western countries have documented the nature of psychological distress that is commonly present among individuals living with HIV, there has been virtually no research on the same topic among other high prevalence areas of the world, particularly in countries like Kenya. This study sought to document the nature of psychological distress among 397 individuals living with HIV in western Kenya and who were participating in psychosocial support groups in conjunction with their enrolment in HIV-related treatment. Psychological distress was assessed using the Brief Symptom Inventory (BSI), a 53-item self-report psychological inventory that asks individuals to recall symptoms experienced in the prior seven days. The levels of psychological distress in this sample were moderate with a substantial proportion of participants meeting the criteria that suggested a need for further psychiatric evaluation. Findings support the need for further assessments of the range and nature of psychological distress among the diverse communities of countries like Kenya and the need for greater attention to the inclusion of mental health services in the rapidly developing treatment and prevention programs in this region of the world.

Measuring psychological distress symptoms in individuals living with HIV in western Kenya

Background: As the HIV-related infrastructure continues to develop in sub-Saharan African countries, it will be important to consider appropriate mechanisms that will support attention to psychological distress among those seeking care and treatment. Aim: The purpose of this study was to assess the reliability and validity of the Brief Symptom Inventory (BSI) in order to consider its potential for use in measuring psychological distress symptoms among individuals living with HIV in Kenya. Method: Data were collected from a convenience sample of 397 individuals living with HIV who were participating in psychosocial support groups as part of their care in a large HIV-related treatment and prevention program in western Kenya. Internal consistency, factorial validity, and convergent validity analyses were conducted to measure the reliability and validity of the BSI. Test-retest reliability measures were conducted with a sample size of 187. Content validity was assessed during four single-gendered focus groups, in which a total of 24 individuals participated. Results: Multiple analyses revealed test-retest reliability levels ranging from .51 to .95 on the BSI subscales and overall global severity index. Conclusions: The findings suggest that the BSI may serve as a reliable instrument for assessing psychological distress in Kenya. However, further research is needed to continue understanding issues associated with the measurement of psychological distress in this particular country and across its cultural groups. Declaration of interest:u2003None.

Alternative Matching Scores to Control Type I Error of the Mantel–Haenszel Procedure for DIF in Dichotomously Scored Items Conforming to 3PL IRT and Nonparametric 4PBCB Models:

When the matching score is either less than perfectly reliable or not a sufficient statistic for determining latent proficiency in data conforming to item response theory (IRT) models, Type I error (TIE) inflation may occur for the Mantel—Haenszel (MH) procedure or any differential item functioning (DIF) procedure that matches on summed-item score, but primarily on short tests. Alternative matching scores were developed based on sufficient statistics, reliability, and explicit corrections for measurement error. Manipulated factors were tests (20, 24, 26 items), reference/focal sample sizes (1,000/1,000, 800/200), proficiency distributions (identical, means differed, variances differed, means and variances differed), and simulation technique (three-parameter logistic IRT model and four-parameter beta compound-binomial model with nonparametric nonmonotonic item-true score step functions). Outcomes were as follows: TIE of MH chi-square test at the .05 nominal level; and the bias, standard error, and root mean square error of the MH delta-DIF statistic under null-DIF conditions. Of eight categorized alternative matching scores, four scores controlled TIE as well as or better than traditional summed-item score in almost all items for all conditions: (a) estimated latent proficiency from a 3PL IRT model, (b) the sum of weighted item scores where the weight was the item— total score biserial correlation coefficient excluding the item from total score, (c) the sum of weighted item scores where the weight was the item loading on the single common factor from factor analysis of tetrachoric correlation coefficients, and (d) Kelley’s linear regressed true score estimate.

Tailored telephone counseling increases colorectal cancer screening

To compare the efficacy of two interventions to promote colorectal cancer screening participation and forward stage movement of colorectal cancer screening adoption among first-degree relatives of individuals diagnosed with adenomatous polyps. One hundred fifty-eight first-degree relatives of individuals diagnosed with adenomatous polyps were randomly assigned to receive one of two interventions to promote colorectal cancer screening. Participants received either a tailored telephone counseling plus brochures intervention or a non-tailored print brochures intervention. Data were collected at baseline and 3 months post-baseline. Group differences and the effect of the interventions on adherence and stage movement for colorectal cancer screening were examined using t-tests, chi-square tests, and logistic regression. Individuals in the tailored telephone counseling plus brochures group were significantly more likely to complete colorectal cancer screening and to move forward on stage of change for fecal occult blood test, any colorectal cancer test stage and stage of the risk-appropriate test compared with individuals in the non-tailored brochure group at 3 months post-baseline. A tailored telephone counseling plus brochures intervention successfully promoted forward stage movement and colorectal cancer screening adherence among first-degree relatives of individuals diagnosed with adenomatous polyps.