Shannon L. Smith

Osteoporosis prevention in premenopausal women: using a stage model approach to examine the predictors of behavior.

The precaution adoption process model was used to examine the predictors of 2 behaviors recommended to reduce the risk of developing osteoporosis: calcium consumption and weight-bearing exercise. A total of 452 premenopausal women completed a mailed questionnaire assessing stage in the precaution adoption process and 12 knowledge and attitudinal variables. Participants were also given an opportunity to request information about osteoporosis. In all, 11 of the 12 knowledge and attitudinal variables were associated with calcium stage; 8 were associated with exercise stage. Information requests were associated with both calcium and exercise stage. Findings provide substantial support for the precaution adoption process model and suggest that the model can be usefully applied in this area to increase understanding of why many women do not practice behaviors that could reduce their risk of developing osteoporosis.

Interindividual-Intergroup Discontinuity in the Prisoner's Dilemma Game

The present research involved an examination of interindividual-intergroup discontinuity in the context of three different generalizations of the prisoners dilemma game (PDG). (Interindividual-intergroup discontinuity is the tendency of intergroup relations to be more competitive and less cooperative than interindividual relations.) Experiment 1 used a multi-prisoners dilemma (MPD) game to compare interaction between three individuals with interaction between three groups. Results revealed just as much discontinuity between three players (MPD) as between two players (PDG). Experiment 2 used the approach of n-person games to examine two further generalizations from the PDG. One generalization involved the intergroup public goods (IPG) game, and the other the intergroup prisoners dilemma (IPD) game. With both games, it was found that groups were more competitive than individuals. It was also found that discussion between groups is characterized by a higher frequency of fear and greed statements than is discussion between individuals.

Diabetes Foot Self-care Practices in a Rural, Triethnic Population

Purpose The purposes of this study were to assess the level of foot self-care performed in a rural, multiethnic population of older adults and to identify factors associated with foot self-care. Methods The Evaluating Long-term Diabetes Self-management Among Elder Rural Adults study included a random sample of 701 African American, Native American, and white adults from 2 rural North Carolina counties. Participants completed in-home interviews, 5 foot selfcare practices from the Summary of Diabetes Self-Care Activities (SDSCA), functional status measures, and measures of education and support for foot care. Results Foot care practices/behaviors reported at least 6 days/week ranged from 35.6% for inspecting shoes to 79.2% for not soaking feet. Four independent predictors of the SDSCA summary foot care index score were observed: having been shown how to care for feet (P< .0001), female gender (P= .03), having had a doctor check nerves in feet in past year (P= .02), and not receiving support caring for feet (P = .0425). Conclusions These findings indicate that educating patients about foot self-care may encourage routine foot care but that those dependent on either formal or informal support to perform foot care do so less frequently than those who perform it independently.

Self-monitoring of blood glucose in a multiethnic population of rural older adults with diabetes.

Purpose The purpose of the study was to describe self-monitoring of blood glucose (SMBG) practices of 698 older adults with type 2 diabetes in the rural Southeast, to identify characteristics differentiating testers from nontesters, and to identify personal and support-related predictors of monitoring frequency. Methods The ELDER (Evaluating Long-term Diabetes Selfmanagement Among Elderly Rural Adults) study was a population-based, cross-sectional survey of African American, Native American, and white Medicare recipients = 65 years with diagnosed diabetes. Data were obtained through in-home interviews. Multiple logistic regression models were used to identify factors associated with SMBG and frequency of monitoring. Results Seventy-seven percent of respondents practiced SMBG in the previous week; 40% tested every day in that week. No ethnic differences were seen. Significant independent predictors of any SMBG were medication regimen (taking oral agents or insulin with or without oral agents) and health care provider (HCP) recommendation to test. Among those monitoring, significant independent predictors of SMBG frequency were medication regimen, HCP recommendation to test, duration of diabetes, and receiving help with testing, which was negatively associated with monitoring frequency. Conclusions Among rural older persons with diabetes, HCP recommendation significantly affected practicing SMBG and SMBG frequency. These findings suggest points of intervention by diabetes educators with this vulnerable population. Further research is needed to determine how older adults use SMBG data in their self-care regimen.

Comparative validation of standard, picture-sort and meal-based food-frequency questionnaires adapted for an elderly population of low socio-economic status

OBJECTIVE To compare the validity of a modified Block food-frequency questionnaire (FFQ), a picture-sort administration of the FFQ (PSFFQ) and a meal pattern-based questionnaire (MPQ) in a multi-ethnic population of low socio-economic status (SES). DESIGN Participants completed six 24-hour dietary recalls (24HR) over six months; the FFQ, PSFFQ and MPQ were completed in random order in the subsequent month. Instruments were interviewer-administered. The PSFFQ and MPQ were developed in formative research concerning difficulties for older adults in responding to standard food-frequency instruments. SETTING Rural North Carolina, USA. Subjects One hundred and twenty-two African American, Native American and white adults aged > or = 65 years, with approximately one-third in each ethnic group. Inclusion criteria included education < or = 12 years and income < or = 150% of national poverty level or Medicaid recipient. RESULTS Comparing median intakes from the average of the 24HR with the three diet assessment instruments, the MPQ tended to overestimate intakes compared with the FFQ and PSFFQ. Correlations among nutrients obtained by the 24HR and the other three instruments were generally statistically significant and positive. Across nutrients, the PSFFQ was most highly correlated with the 24HR for women, while the FFQ was most highly correlated with the 24HR for men. CONCLUSIONS Dietary assessments using 24HR and FFQ were similar to results reported elsewhere, although correlations between 24HR and FFQ were somewhat lower. Interviewer-administered dietary assessments should be used with caution to evaluate dietary intake among older adults with low SES. Gender differences and the lower correlations should be investigated more thoroughly to assist in choosing dietary assessment instruments for this population.

Consumption of sugar- and fat-modified foods among rural older adults: the Rural Nutrition and Health (RUN) Study.

Abstract The objective of the paper is to assess the diet and nutritional status of the tribal elderly (> 60 years) using data from a cross-sectional study carried out by National Nutrition Monitoring Bureau (NNMB) exclusively in Integrated Tribal Development Project (ITDP) villages of 9 provincial States in India during 1998-1999. A total of 1,239 elderly completed the diet survey (24-hour recall) and 3,932 elderly completed anthropometric measurements. In general, the mean consumption of all the foods and the median intakes of all the nutrients were below the Recommended Dietary Intakes (RDI) in both men and women. The mean heights and weights significantly decreased with increase in age in both males and females (p < 0.001). The prevalence of Chronic Energy Deficiency (CED = BMI < 18.5) was relatively higher (65.4%) in females compared with their male counterparts (61.8%). The prevalence of CED was significantly higher (p < 0.001) among the elderly living in kutcha and landless households. The tribal elderly are subsisting on inadequate diets, which are reflected in the poor intakes of all the nutrients and higher prevalence of undernutrition. Significantly higher proportion of tribal elderly are undernourished compared with their rural counterparts (p < 0.001).

Complementary and Alternative Medicine Use and Diabetes Self-Management Among Rural Older Adults

Complementary and alternative medicine (CAM) is a growing form of self-care and is related to other healthy behaviors. This study examines the relationship between CAM use and diabetes self-management. A survey of rural older African American, Native American, and White adults with diabetes was conducted. Data were collected on diabetes self-management domains and general and diabetes-specific CAM use. Some associations were observed, particularly for CAM use and following a healthy eating plan. CAM is part of the health maintenance strategy of rural older adults with diabetes. Further research should examine the health trajectory associated with CAM use in this population.

The survival of a cooperative tradition in the intergroup discontinuity context.

Interindividual-intergroup discontinuity is the tendency, in mixed-motive situations, for groups to interact more competitively, or less cooperatively, than individuals, even though mutual competition yields worse results that mutual cooperation. The present laboratory experiment attempted to assess whether the discontinuity effect could be reduced by the establishment of an intergroup cooperative tradition. Cooperation between intact pairs of groups was induced by placing in each group confederates who successfully convinced their fellow group members of the long-term advantage of trust and cooperation. On subsequent blocks of trails, the confederate was replaced by an actual subject, and then each of the original subjects was replaced so as to simulate generational turnover. By the time all initial members were replaced, their level of cooperation had eroded to the level of groups never experiencing mutual cooperation. The results are discussed in the context of other means of reducing discontinuity.

A Multi-season Investigation of Microbial Extracellular Enzyme Activities in Two Temperate Coastal North Carolina Rivers: Evidence of Spatial but Not Seasonal Patterns

Riverine systems are important sites for the production, transport, and transformation of organic matter. Much of the organic matter processing is carried out by heterotrophic microbial communities, whose activities may be spatially and temporally variable. In an effort to capture and evaluate some of this variability, we sampled four sites—two upstream and two downstream—at each of two North Carolina rivers (the Neuse River and the Tar-Pamlico River) ca. twelve times over a time period of 20 months from 2010 to 2012. At all of the sites and dates, we measured the activities of extracellular enzymes used to hydrolyze polysaccharides and peptides, and thus to initiate heterotrophic carbon processing. We additionally measured bacterial abundance, bacterial production, phosphatase activities, and dissolved organic carbon (DOC) concentrations. Concurrent collection of physical data (stream flow, temperature, salinity, dissolved oxygen) enabled us to explore possible connections between physiochemical parameters and microbial activities throughout this time period. The two rivers, both of which drain into Pamlico Sound, differed somewhat in microbial activities and characteristics: the Tar-Pamlico River showed higher β-glucosidase and phosphatase activities, and frequently had higher peptidase activities at the lower reaches, than the Neuse River. The lower reaches of the Neuse River, however, had much higher DOC concentrations than any site in the Tar River. Both rivers showed activities of a broad range of polysaccharide hydrolases through all stations and seasons, suggesting that the microbial communities are well-equipped to access enzymatically a broad range of substrates. Considerable temporal and spatial variability in microbial activities was evident, variability that was not closely related to factors such as temperature and season. However, Hurricane Irenes passage through North Carolina coincided with higher concentrations of DOC at the downstream sampling sites of both rivers. This DOC maximum persisted into the month following the hurricane, when it continued to stimulate bacterial protein production and phosphatase activity in the Neuse River, but not in the Tar-Pamlico River. Microbial community activities are related to a complex array of factors, whose interactions vary considerably with time and space.