Susan E. Middlestadt

Sexual Behaviors, Condom Use, and Sexual Health of Americans Over 50: Implications for Sexual Health Promotion for Older Adults

INTRODUCTIONnIn the contemporary U.S., men and women are living longer and healthier lives. As such, many people spend greater portions of their lives as sexually active individuals. Yet, little is known about the myriad of ways that older adults experience their sexual lives.nnnAIMnThis study sought to assess the context and frequency of sexual behaviors, condom use, sexual pleasure, and sexual experience of men and women over age 50.nnnMETHODSnInformation regarding the sexual experiences of a nationally representative sample of men and women over age 50 within the past year was examined.nnnMAIN OUTCOME MEASURESnSexual behavior over the past year was assessed in relation to several situational and contextual characteristics (e.g., event location, type of partner, health status, condom use). Participants were also asked about their experience (i.e., pleasure, arousal, pain, lubrication/erectile difficulties, and orgasm) during their most recent partnered sexual event. Bivariate or ordinal logistic regression models were used to investigate the relationship of age, health and partner status to sexual frequency and experience.nnnRESULTSnAlthough sizable proportions (20-30%) of both men and women remained sexually active well into their 80s age was related to a lower likelihood of solo and most partnered sexual behaviors. When controlling for age, relationship status, and health remained significant predictors of select sexual behaviors. The participants evaluation of their most recent sexual experience in terms of arousal, erectile difficulty, and orgasm all declined with age. Health status was related to mens evaluation of the experience. Relationship status was the most consistent predictor of womens evaluation of the experience. Condom use rates remained low for participants across age groups.nnnCONCLUSIONnMany older adults continue be sexually active well into advanced age (80+). Thus, providers need to be attentive to the diverse sexual health needs of older adults.

Social marketing : theoretical and practical perspectives

Contents: Preface. Part I: Paradigms/Perspectives. A. Andreasen, Challenges for the Science and Practice of Social Marketing. W.A. Smith, Social Marketing: Beyond the Nostalgia. M. Stead, G. Hastings, Advertising in the Social Marketing Mix: Getting the Balance Right. R. Hornik, Public Health Education and Communication as Policy Instruments for Bringing About Changes in Behavior. Part II: Methodological Issues/Psychographic Segmentation. G.I. Balch, S.M. Sutton, Keep Me Posted: A Plea for Practical Evaluation. J.P. Baggaley, From Madison Avenue to the Field: Cross-Cultural Uses of Media Research Technology. M.R. Swenson, W.D. Wells, Useful Correlates of Pro-Environmental Behavior. C. Currence, Demographic and Lifestyle Data: A Practical Application to Stimulating Compliance With Mammography Guidelines Among Poor Women. Part III: Fighting Aids/Promoting Family Planning. M. Fishbein, C. Guenther-Grey, W. Johnson, R.J. Wolitski, A. McAlister, C.A. Rietmeijer, K. OReilly, The AIDS Community Demonstration Projects, Using a Theory-Based Community Intervention to Reduce AIDS Risk Behaviors: The CDCs AIDS Community Demonstration Projects. P.D. Harvey, Advertising Affordable Contraceptives: The Social Marketing Experience. D.W. Dahl, G.J. Gorn, C.B Weinberg, Marketing, Safer Sex, and Condom Acquisition. Part IV: Antismoking Efforts. C. Pechmann, Does Antismoking Advertising Combat Underage Smoking? A Review of Past Practices and Research. J.H. Mintz, N. Layne, R. Ladouceur, J. Hazel, M. Desrosiers, Social Advertising and Tobacco Demand Reduction in Canada. L.T. Kozlowski, C.T. Sweeney, Low Yield, Light, and Ultra Light Cigarettes: Lets Understand the Product Before We Promote. J.B. Cohen, The Dangers of Advertising Low Tar Cigarettes: Lets Understand What Consumers Understand. Part V: Three Differing Institutional Approaches: Government, Nongovernment Organizations, Private Corporations. F. Kroger, J.W. McKenna, M. Shepherd, E.H. Howze, D.S. Knight, Marketing Public Health: The CDC Experience. S.E. Middlestadt, C. Schechter, J. Peyton, B. Tjugum, Community Involvement in Health Planning: Lessons Learned From Practicing Social Marketing in a Context of Community Control, Participation and Ownership. P.N. Bloom, P.Y. Hussein, L.R. Szykman, The Benefits of Corporate Social Marketing Initiatives. Part VI: The Broad Potential of Social Marketing. M.E. Goldberg, O. Sandikci, D. Litvack, Reducing the Level of Violence in Hockey. J.A. Flora, C. Schooler, R.M. Pierson, Effective Health Promotion Among Communities of Color: The Potential of Social Marketing. J. Prottas, Advertising and Its Role in Organ Donation. J.B. Kernan, T.J. Domzal, Hippocrates to Hermes: The Postmodern Turn in Public Health Advertising.

Predictors of continuation of exclusive breastfeeding for the first six months of life.

This study aimed to investigate the relative importance of the psychosocial factors underlying mother’s decision to continue exclusive breastfeeding (EBF) for 6 months using the theory of planned behavior. A cohort of EBF-mothers (N = 78) completed a questionnaire assessing theoretical constructs at baseline and phone-interviewed at follow-up. Multiple regression analyses were performed to find important predictors of intention, overall and married vs unmarried. Attitude, subjective norm, and perceived behavioral control together explained 50.2% (P < .01) of the variance in mothers’ intention to continue EBF for 6 months. Attitude and subjective norm were better predictors of the intention than perceived behavioral control. The role of subjective norm was greater in married than in unmarried women. A strong, positive correlation (γ = 0.67, P < .01) was found between intended and actual EBF duration. Intervention programs designed to positively influence mother’s attitude and social support may be effective in improving intention, thereby increasing EBF maintenance for 6 months. J Hum Lact. 26(1):26-34.

The effect of a smoke-free campus policy on college students' smoking behaviors and attitudes.

OBJECTIVEnTo evaluate the impact of a smoke-free campus policy on college students smoking behaviors and attitudes.nnnMETHODSnThe current study utilized repeated cross-sectional surveys with a nested 4-wave longitudinal cohort design. Data were collected from undergraduate students at two large matched public universities in Indiana before and after one of the campuses went smoke-free in January 2008. Baseline data were collected in fall 2007 (n=3266) and follow-up data were collected in fall 2009 (n=3207). In addition, volunteers provided longitudinal follow-up data at four different time points.nnnRESULTSnIn the cross-sectional analyses, students exposed to the smoke-free campus policy demonstrated significant favorable changes in smoking behavior (16.5% to 12.8%, p<0.001), perceptions of peer tobacco use (73.6% to 66.8%, p<0.001), and smoking norms (45.5% to 40.4%, p<0.001) compared to students on the control campus. In the longitudinal analyses, students exposed to the smoke-free campus policy demonstrated these changes plus significant favorable changes in attitudes toward regulation of tobacco (83.2% to 89.9%, p<0.01).nnnCONCLUSIONSnThe implementation of a smoke-free campus policy may be an effective intervention for reducing tobacco use among college students.

An evidence review of gender-integrated interventions in reproductive and maternal-child health.

Evidence-based behavior change interventions addressing gender dynamics must be identified and disseminated to improve child health outcomes. Interventions were identified from systematic searches of the published literature and a web-based search (Google and implementers websites). Studies were eligible if an intervention addressed gender dynamics (i.e., norms, unequal access to resources), measured relevant behavioral outcomes (e.g., family planning, antenatal care, nutrition), used at least a moderate evaluation design, and were implemented in low- or middle-income countries. Of the 23 interventions identified, 22 addressed reproductive and maternal-child health behaviors (e.g., birth spacing, antenatal care, breastfeeding) that improve child health. Eight interventions were accommodating (i.e., acknowledged, but did not seek to change gender dynamics), and 15 were transformative (i.e., sought to change gender dynamics). The majority of evaluations (n = 12), including interventions that engaged men and women to modify gender norms, had mixed effects. Evidence was most compelling for empowerment approaches (i.e., participatory action for maternal-child health; increase educational and economic resources, and modify norms to reduce child marriage). Two empowerment approaches had sufficient evidence to warrant scaling-up. Research is needed to assess promising approaches, particularly those that engage men and women to modify gender norms around communication and decision making between spouses.

Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and -exposed children

Objective: With the aim of reducing pediatric loss to follow-up (LTFU) from HIV clinical care programs in sub-Saharan Africa, we sought to understand the personal and socio-cultural factors associated with the behavior of caregivers taking HIV-infected and -exposed children for care in western Kenya. Methods: Between May and August, 2010, in-depth interviews were conducted with 26 purposively sampled caregivers caring for HIV-infected (7), HIV-exposed (17) and HIV-unknown status (2) children, documented as LTFU from an urban and rural HIV care clinic. All were women with a majority (77%) being biological parents. Interviews were audio-recorded, transcribed and content analyzed. Results: Thematic content analysis of the womens perceptions revealed that their decision about routinely taking their children to HIV care involved multiple levels of factors including: (1) intrapersonal: transport costs, food availability, time constraints due to work commitment, disclosure of HIV status for both mother and child, perception that child is healthy and religious beliefs; (2) interpersonal: unsupportive male partner, stigma by the family and family conflicts; (3) community: cultural norms, changing community dynamics and perceived stigma; (4) health care system: clinic location, lack of patient-centered care, delays at the clinic and different appointment schedules (mother and child). Furthermore, the factors across these different levels interacted with each other in a complex way, illustrating the challenges women face in taking their children to HIV care. Conclusion: The complexity and interconnectedness of the factors underlying retention of children in HIV care perceived by these women caregivers suggests that interventions to reduce pediatric LTFU need to be holistic and address multiple socio-ecological levels. Patient-centered care that integrates a family-centered approach to HIV pediatric care is recommended.

Factors Associated With Participation in Work-Site Wellness Programs Implications for Increasing Willingness Among Rural Service Employees

The purpose of this study was to identify factors underlying decisions to participate in work-site wellness programs. A sample of 279 full-time workers from a service division of a rural Midwestern university completed a survey assessing demographic and job characteristics, health status and health behaviors, and Reasoned Action Approach (RAA) variables for participating in work-site wellness activities. Regression analyses identified factors associated with intention; multivariate analyses of variance compared low to high intenders on salient beliefs. In sequential regression analyses, constructs of RAA predicted intention over and above the three significant background variables of age, exercise in past month, and fruit and vegetable consumption (R2 = .469, R2 change = .409, p < .001). Attitude had the highest relative weight (β = .445, p < .001); perceived norm had a significant weight (β = .273, p < .001). Significant differences in beliefs were found. To increase participation, planners should design programs that provide benefits employees perceive as advantageous and ensure coworker and supervisor support.

Associated Trends in Sedentary Behavior and BMI Among Chinese School Children and Adolescents in Seven Diverse Chinese Provinces

BackgroundOverweight and obesity is becoming a public health concern in China.ObjectiveWe examined associated trends in sedentary behavior and body mass index (BMI) among school children and adolescents from seven diverse Chinese provinces from 1997 to 2004.MethodSequential multiple regressions were conducted with combined cross-sectional data derived from the China Health and Nutrition Survey (Nu2009=u20095,497) to assess relationships between sedentary behavior and BMI.ResultsBetween 1997 and 2004, the amount of time children (6- to 11-year-olds) spent engaging in sedentary behavior increased from 1.71 to 3.14xa0h/day (pu2009<u20090.05), while the amount of time adolescents (12- to 18-year-olds) spent engaging in sedentary behavior increased from 1.71 to 3.50xa0h/day (pu2009<u20090.05). Studying before and after school and watching TV/videos each accounted for about half the increase in sedentary behavior. Both watching TV/videos and studying before and after school were significantly and positively associated with BMI in males, but not in females.ConclusionWith the growing amount of time Chinese school children and adolescents study outside of school and watch TV/videos, Chinese youth are increasingly likely to become more overweight unless population-based prevention actions are taken.

Comparison of Overweight, Weight Perception, and Weight-Related Practices Among High School Students in Three Large Chinese Cities and Two Large U.S. Cities

PURPOSEnThe study compared differences in overweight prevalence, weight perception, and weight-related practices among high school students in five large Chinese and U.S. cities, and informed interventions for childhood obesity in China and the U.S.nnnMETHODSnThe data used was collected in 2003 from a representative sample of high school students in Hong Kong, Macau, Taipei, New York and Los Angeles.nnnRESULTSnThe prevalence of overweight high school students in New York City and Los Angeles was about twice as high as in Hong Kong, Macau, and Taipei; however, the proportion of Chinese students perceiving themselves to be overweight was 15% higher than their U.S. counterparts. Independent of actual weight status, perceived overweight was significantly associated with weight control practices (p < .05). U.S. students showed higher levels of moderate and vigorous physical activity, but more hours of watching television than their Chinese counterparts.nnnCONCLUSIONnThe continuing pandemic of overweight among youth fosters weight dissatisfaction, which may increase unhealthy weight control practices. Interventions should be designed to prevent overweight without precipitating unhealthy weight control practices by emphasizing an increase in physical activity and a reduction in time watching television.

Trends in overweight among school children and adolescents in seven Chinese Provinces, from 1991–2004

OBJECTIVEnTo examine trends in body mass index (BMI) in relation to energy intake and expenditure among Chinese school children and adolescents from seven Provinces during 1991-2004, a time of rapid economic development in China.nnnMETHODSnCombined cross-sectional data derived from the China Health and Nutrition Survey (N = 1,977 in 1991, 2, 048 in 1993, 2,350 in 1997, 1,872 in 2000, and 1,275 in 2004) was utilized to assess BMI and prevalence of overweight. Sequential multiple regressions were conducted to assess the extent to which changes in energy intake and expenditure accounted for variation in BMI.nnnRESULTSnOverall, the prevalence of overweight among school children and adolescents doubled from 1991 to 2004. It increased from 6.5% to 16.1% for children aged 6-11 years and from 3.3% to 6.2% for adolescents aged 12-18 years. Changes in energy intake, physical activity, and sedentary activity explained 12% and 28% of variance in BMI, respectively, for children and adolescents.nnnCONCLUSIONSnChinese youths, especially children aged 6-11 years, became overweight rapidly during 1991-2004, which coincided with rapid economic growth in China. Effective policies and interventions are needed to curb the overweight epidemic among Chinese youths.