Stephanie L. Ayers

Chronic illness and health-seeking information on the Internet

ABSRACT By using the theories of help-seeking behavior and health-information seeking, this article demonstrates the relationship between chronic illness, retrieving health information from the Internet and changing health behavior. Research on the impact of health information on the Internet and changing health behavior is fairly new, given the growth of the Internet in recent years. Using US data on Internet use within the US population, multiple regression analysis was performed to explore the relationships between chronic medical conditions and frequency of Internet use, as well as changes in health behavior due to frequency of Internet use. The findings suggest that it is not merely the presence of a particular chronic illness, but rather the total number of chronic conditions that determine Internet use. Also, the more frequently a person uses the Internet as a source of health information, the more likely they are to change their health behavior.

Spirituality and religion: intertwined protective factors for substance use among urban American Indian youth.

Background and objective: This article explores the aspects of spirituality and religious involvement that may be the protective factors against substance use among urban American Indian (AI) youth. Methods: Data come from AI youth (N = 123) in five urban middle schools in a southwestern metropolis. Results: Ordinary least squares regression analyses indicated that following Christian beliefs and belonging to the Native American Church were associated with lower levels of substance use. Conclusions and Scientific Significance: Following AI traditional spiritual beliefs was associated with antidrug attitudes, norms, and expectancies. Having a sense of belonging to traditions from both AI cultures and Christianity may foster integration of the two worlds in which urban AI youth live.

Religiosity and Adolescent Substance Use in Central Mexico: Exploring the Influence of Internal and External Religiosity on Cigarette and Alcohol Use

This study explores the multidimensional nature of religiosity on substance use among adolescents living in central Mexico. From a social capital perspective, this article investigates how external church attendance and internal religious importance interact to create differential pathways for adolescents, and how these pathways exert both risk and protective influences on Mexican youth. The data come from 506 self-identified Roman Catholic youth (ages 14–17) living in a semi-rural area in the central state of Guanajuato, Mexico, and attending alternative secondary schools. Findings indicate that adolescents who have higher church attendance coupled with higher religious importance have lower odds of using alcohol, while cigarette use is lower among adolescents who have lower church attendance and lower religious importance. Adolescents are most at risk using alcohol and cigarettes when church attendance is higher but religious importance is lower. In conclusion, incongruence between internal religious beliefs and external church attendance places Mexican youth at greater risk of alcohol and cigarette use. This study not only contributes to understandings of the impact of religiosity on substance use in Mexico, but highlights the importance of understanding religiosity as a multidimensional phenomenon which can lead to differential substance use patterns.

Beyond Primary Prevention of Alcohol Use: A Culturally Specific Secondary Prevention Program for Mexican Heritage Adolescents

Classroom-based primary prevention programs with adolescents are effective in inhibiting the onset of drug use, but these programs are not designed to directly address the unique needs of adolescents at higher risk of use or already using alcohol and other drugs. This article describes the initial efficacy evaluation of a companion psychosocial small group program which aims at addressing the needs of Mexican heritage students identified by their teachers as being at higher risk for substance use or already experimenting with alcohol and other drugs. The adolescent (7th grade) small group curricula, REAL Groups, is a secondary prevention program which supplements the primary classroom-based substance use prevention program, keepin’ it REAL. Following a mutual aid approach, a total of 109 7th grade students were referred by their teachers and participated in the REAL Groups. The remaining 252 7th grade students who did not participate served as the control group. To account for biased selection into REAL Groups, propensity score matching (PSM) was employed. The estimated average treatment effect for participants’ use of alcohol was calculated at the end of the 8th grade. Results indicate that alcohol use decreased among students who participated in the REAL Groups relative to matched students who did not participate. These findings suggest that REAL Groups may be an effective secondary prevention program for higher-risk Mexican heritage adolescents.

Examining School-Based Bullying Interventions Using Multilevel Discrete Time Hazard Modeling

Although schools have been trying to address bulling by utilizing different approaches that stop or reduce the incidence of bullying, little remains known about what specific intervention strategies are most successful in reducing bullying in the school setting. Using the social-ecological framework, this paper examines school-based disciplinary interventions often used to deliver consequences to deter the reoccurrence of bullying and aggressive behaviors among school-aged children. Data for this study are drawn from the School-Wide Information System (SWIS) with the final analytic sample consisting of 1,221 students in grades K – 12 who received an office disciplinary referral for bullying during the first semester. Using Kaplan-Meier Failure Functions and Multi-level discrete time hazard models, determinants of the probability of a student receiving a second referral over time were examined. Of the seven interventions tested, only Parent-Teacher Conference (AOR = 0.65, p < .01) and Loss of Privileges (AOR = 0.71, p < .10) were significant in reducing the rate of the reoccurrence of bullying and aggressive behaviors. By using a social-ecological framework, schools can develop strategies that deter the reoccurrence of bullying by identifying key factors that enhance a sense of connection between the students’ mesosystems as well as utilizing disciplinary strategies that take into consideration student’s microsystem roles.

Using factor analysis to create complementary and alternative medicine domains: An examination of patterns of use

Previous research on complementary and alternative medicine (CAM) in the United States has relied heavily on the National Center for Complementary and Alternative Medicine’s (NCCAM) domains of CAM but with noted limitations. We conducted a multifaceted examination of previous CAM domains and tested if they represent actual patterns of CAM use. The data come from the 2002 United States’ National Health Interview Survey and include 30,923 adults. Outcome measures included 20 types of CAM used in the last 12 months. Both exploratory and confirmatory factor analysis were used to test how CAM modalities should be categorized. Results indicate that prayer should be created as a new domain apart from Mind—Body Medicine. Herbs and vitamins fit best with Alternative Medical Systems while acupuncture best fits with chiropractic and massage. These findings suggest that how types of CAM have been previously categorized in earlier research is inconsistent with actual patterns of CAM utilization.These findings provided a framework for conducting and analyzing future CAM research, both in the USA and in other countries, and should be used in future research to try to explain and understand the variation and predictors of CAM utilization.

The power of a paired t-test with a covariate

Many researchers employ the paired t-test to evaluate the mean difference between matched data points. Unfortunately, in many cases this test in inefficient. This paper reviews how to increase the precision of this test through using the mean centered independent variable x, which is familiar to researchers that use analysis of covariance (ANCOVA). We add to the literature by demonstrating how to employ these gains in efficiency as a factor for use in finding the statistical power of the test. The key parameters for this factor are the correlation between the two measures and the variance ratio of the dependent measure on the predictor. The paper then demonstrates how to compute the gains in efficiency a priori to amend the power computations for the traditional paired t-test. We include an example analysis from a recent intervention, Families Preparing the New Generation (Familias Preparando la Nueva Generación). Finally, we conclude with an analysis of extant data to derive reasonable parameter values.

Familias: Preparando la Nueva Generación: A Randomized Control Trial Testing the Effects on Positive Parenting Practices.

Objectives: This article reports the effects of a culturally grounded parenting intervention to strengthen positive parenting practices. Method: The intervention was designed and tested with primarily Mexican origin parents in a large urban setting of the southwestern United States using an ecodevelopmental approach. Parents (N = 393) were randomly assigned three treatment conditions: (1) a parenting and youth intervention, (2) a youth only intervention, or (3) a control group. A measurement model for positive parenting was first evaluated using confirmatory factor analysis, followed by structural equation modeling to estimate the effects of the intervention on positive parenting (i.e., baseline to follow-up). Results: As hypothesized, parents in the intervention group reported higher rates of positive parenting compared to parents in youth-only condition. Conclusion: The results are promising and add to growing evidence that interventions tailored to the cultural characteristics and environments of parents and their children can strengthen positive parenting.

Short-Term Effects on Substance Use of the Keepin' It REAL Pilot Prevention Program: Linguistically Adapted for Youth in Jalisco, Mexico

This article presents the short-term effects of a pilot study of keepin’it REAL (Manténte REAL) conducted in central Mexico by a binational team of investigators. This middle school-based model program for preventing substance use was adapted for Mexico linguistically but not culturally. Two Guadalajara public middle schools were recruited and randomly assigned to either implement the prevention program or serve as a control site. The program was implemented in the treatment site by the students’ regular teachers, who were trained by the research team. Seventh graders in ten classrooms in the treatment and control schools (N = 432) completed a pretest and posttest survey in Spanish similar to the survey utilized in the original efficacy trial of keepin’it REAL in the US. T-tests and OLS regressions were conducted to determine the effects of the intervention on substance use outcomes. Differences between treatment and control groups in frequency of use of alcohol and tobacco, the two substances of choice in this sample, were significant and in the desired direction. Differences in amount of use were also in the preferred direction but were not significant for alcohol and only marginally significant for tobacco. When the sample was split by gender, statistically significant treatment effects remained for females but were not observed among males. Effects of the linguistically adapted version of keepin’it REAL appears to be driven by the change in female use; however, the difference in male and female outcomes was not statistically significant. Implications for cultural adaptation and prevention in Mexico are discussed from a communication competency perspective. The promising results of the pilot study suggest that the linguistic adaptation was effective, but that a comprehensive cultural adaptation of keepin’it REAL in partnership with Mexican investigators and communities may be warranted.

Delays in seeking conventional medical care and complementary and alternative medicine utilization.

OBJECTIVE To test the association between delays in utilization of conventional medical care and complementary and alternative medicine (CAM) utilization. DATA SOURCE The 2007 National Health Interview Survey, a cross-sectional nationally representative study of adults aged 18 years and older. STUDY DESIGN Using zero-inflated regression models, delays in utilizing conventional care due to organizational inaccessibility are examined to determine whether delays are associated with both the decision to try CAM and the number of CAM types used. PRINCIPAL FINDINGS Individuals have significantly higher odds using provider-based CAM types if they delayed seeking conventional care due to organizational inaccessibility (OR = 1.63). Individuals use significantly more types of both provider-based (IRR = 1.35) and non-provider-based (IRR = 1.49) CAM if they delayed seeking conventional care due to organizational inaccessibility. CONCLUSION Individuals who delay seeking conventional medical care are more likely to use CAM and use more types of CAM. The current structure of the conventional health care system may have created barriers that can make conventional health care inaccessible. Individuals who face these barriers appear to be pushed not only into trying CAM but using a greater number of CAM types, a finding not in previous research.