Tyrone F. Borders

Development and validation of the State Hope Scale

Defining hope as a cognitive set comprising agency (belief in ones capacity to initiate and sustain actions) and pathways (belief in ones capacity to generate routes) to reach goals, the Hope Scale was developed and validated previously as a dispositional self-report measure of hope (Snyder et al., 1991). The present 4 studies were designed to develop and validate a measure of state hope. The 6-item State Hope Scale is internally consistent and reflects the theorized agency and pathways components. The relationships of the State Hope Scale to other measures demonstrate concurrent and discriminant validity; moreover, the scale is responsive to events in the lives of people as evidenced by data gathered through both correlational and causal designs. The State Hope Scale offers a brief, internally consistent, and valid self-report measure of ongoing goal-directed thinking that may be useful to researchers and applied professionals.

Understanding why medication administration errors may not be reported.

Because the identification and reporting of medication administration errors (MAE) is a nonautomated and voluntary process, it is important to understand potential barriers to MAE reporting. This paper describes and analyzes a survey instrument designed to assist in evaluating the relative importance of 15 different potential MAE-reporting barriers. Based on the responses of over 1300 nurses and a confirmatory LISREL analysis, the 15 potential barriers are combined into 4 subscales: Disagreement Over Error, Reporting Effort, Fear, and Administrative Response. The psychometric properties of this instrument and descriptive profiles are presented. Specific suggestions for enhancing MAE reporting are discussed.

Gender-specific disparities in obesity.

Little prior research has investigated whether the correlates of obesity differ between men and women. The objective of this study was to examine gender-specific disparities in obesity by rurality of residence, race/ethnicity, and socioeconomic status. Particular emphasis was devoted to examining potential differences between residents of urban, suburban, and rural areas. Data from the adult version of the 2003 Behavioral Risk Factor Surveillance System (BRFSS) for the state of Texas were used to model the crude and adjusted odds of being obese as compared to normal weight. The findings showed that males of other race/ethnicity had lower adjusted odds of obesity than non-Hispanic whites, but other race/ethnicity was insignificant for females. Females who were Hispanic or black/African American had higher adjusted odds of obesity than non-Hispanic whites, but Hispanic ethnicity and black/African American race were insignificant for males. Men and women residing in non-metropolitan areas had higher adjusted odds of obesity than their counterparts in metropolitan areas. No economic disparities were revealed among men, but females with high household income had lower odds of obesity than those with low income. Educational status was insignificant for men and women. The findings suggest that programs and policies aimed at curbing obesity should target males and females residing in non-metropolitan localities. Other initiatives should focus on particular groups of women, including those who are Hispanic or black/African American and have low household income.

Ethnic Differences in Parents' Perception of Participatory Decision-Making Style of Their Children's Physicians

Objectives:The objectives of this study were to test whether there are ethnic differences in parents’ perceptions of the participatory styles of their childrens physicians, and to determine how Hispanic ethnicity influences the factors that are correlated with the perceptions of participatory styles. Study Design:We conducted a population-based cross-sectional telephone survey in 111 counties of West Texas. Parents of children and adolescents 3 to 18 years of age (n = 3876) were included in analyses. Methods:The participatory decision-making (PDM) style of physicians was measured by a 3-item instrument used in the Medical Outcomes Study. Multivariate analyses were performed to identify ethnic differences and whether the effect of independent variables on participatory style varied by ethnicity. Results:The t test showed that the mean participatory decision-making score for Hispanics was significantly lower than that for non-Hispanic whites (P <0.01). However, the variance of the PDM score among Hispanics was greater than that among non-Hispanic whites using an F test (P = 0.03). After controlling for other independent variables, the effect of ethnicity was still significant. The association between PDM scores and a childs insurance and the parents age varied by ethnicity. Parents’ age, education, self-employment status, and income were associated with non-Hispanic white parents’ perceptions of physicians’ PDM, whereas childrens insurance, parents’ education and income were associated with Hispanic parents’ perceptions of physicians’ PDM (P <0.05). Conclusions:Because patient participation is closely related to health outcomes and patient satisfaction, improving Hispanic patients’ participation can be 1 avenue for diminishing ethnic disparities in health. Further research is needed to establish whether ethnic differences in childrens physicians’ participation style exist from physicians’ perspective and whether the differences are associated with physicians’ characteristics.

Longitudinal Changes in Methamphetamine and Cocaine Use in Untreated Rural Stimulant Users: Racial Differences and the Impact of Methamphetamine Legislation

AIMS To examine how race and methamphetamine legislation are associated with changes in cocaine and methamphetamine use among untreated rural stimulant users. DESIGN A longitudinal study of stimulant users identified through respondent-driven sampling. SETTING Rural areas of three US states. PARTICIPANTS Participants at baseline were current users of methamphetamine and/or cocaine. MEASURES Self-reports of methamphetamine, crack cocaine and powder cocaine use were assessed at 6-month intervals over a 2-year period. Generalized estimating equations were performed to account for correlations between the repeated measurements. FINDINGS Compared to whites, African Americans were much more likely to use crack cocaine, equally likely to use powder cocaine and much less likely to use methamphetamine. Both whites and African Americans reduced their consumption of methamphetamine and both forms of cocaine over 2 years. Exposure to laws restricting the purchase of over-the-counter cold medications containing methamphetamine precursors was not associated with methamphetamine use, but associated with a slight rise in powder and crack cocaine use. CONCLUSIONS The study yielded disconcerting as well as promising findings regarding the natural history of stimulant use in rural areas. Of some concern is that methamphetamine precursor laws were correlated with increased cocaine consumption, diminishing their net public health benefits. However, despite its insurgence in rural areas of the United States, very few African Americans have initiated methamphetamine use. Regardless of race, many stimulant users stopped using cocaine and methamphetamine without formal substance abuse treatment over 24 months.

Does Being an Immigrant Make a Difference in Seeking Physician Services

The current study investigated the effects of immigration status, acculturation, and health beliefs on the use of preventive and non-preventive visits, through use of a nationally representative sample of U.S.-born and foreign-born adults. U.S.-born adults were found to have significantly more preventive and non-preventive visits than immigrants. The effects on predicting preventive visits of education, having a usual source of care, and having other public insurance were stronger among immigrants than among the U.S.-born. Health confidence and believing in the need for health insurance significantly predicted the numbers of both preventive and non-preventive visits among the U.S.-born but correlated little with either type of visit among immigrants. Among immigrant adults, acculturation affected only the number of preventive visits. The lower utilization of both preventive and non-preventive care among immigrants may be associated with a combination of better health and more limited enabling resources.

Patient satisfaction, self-rated health status, and health confidence: an assessment of the utility of single-item questions.

This study examined if known predictors of patient satisfaction would still be significant when single items are used. Approximately 5000 elderly persons were randomly sampled from 65 000 households in West Texas. Single-item questions about patient satisfaction, self-rated overall health status, self-rated mental health, and health confidence were analyzed by chi-square tests and logistic regressions. Slightly more than 12% of the participants were not satisfied or barely satisfied with health care received. Those who reported higher health confidence, lower self-rated overall health, having emotional problems, or who were men were less likely to be satisfied with health care. A simple survey tool based on single-item questions identified by the current study might be useful for monitoring patient satisfaction, self-rated health, and health confidence in primary care settings and hence might assist management in capturing the basic picture for improving health care quality.

Rural residence is not a risk factor for frequent mental distress: a behavioral risk factor surveillance survey

BackgroundResidents of rural areas may be at increased risk of mental health problems. If so, public health programs aimed at preventing poor mental health may have to be customized for delivery to rural areas. The purpose of this study was to examine the relationship between residing in a rural area and frequent mental distress, which is one indicator of poor mental health.MethodsThe Behavioral Risk Factor Surveillance System (BRFSS) survey for the state of Texas was the source of information about obesity, demographic characteristics, and frequent mental distress (FMD). FMD was defined as poor self-rated mental health during at least half of the days in the last month. Adjusted odds for FMD were computed for rural and suburban respondents relative to urban respondents.ResultsFMD was found to be independently associated with lower education, being younger, being non-Hispanic, being unmarried, and being female. FMD also was associated with being obese or underweight and suburban residence (relative to metro-central city). FMD was not more common among rural respondents than in the metro-central city.ConclusionRural respondents were not at greater risk of frequent mental distress than urban respondents in this sample. Programs seeking to improve community mental health should target persons with less education and extremes in body weight, along with women and single persons, regardless of whether they live in rural or urban areas.

Longitudinal Changes in Drug Use Severity and Physical Health-Related Quality of Life among Untreated Stimulant Users

The primary objective of this study was to investigate whether drug use severity is associated with physical health-related quality of life (HRQL) over time. Data are from a longitudinal, multi-state, natural history community study of users of cocaine and/or methamphetamine who were interviewed at 6-month intervals over 2 years with a 79% follow-up participation rate. Physical HRQL was assessed with the physical component summary (PCS) of the SF-8 Health Survey and drug, alcohol, and psychiatric severity were all assessed with the Addiction Severity Index (ASI). Random coefficient regression analyses were conducted to test for longitudinal associations between the independent variables and SF-8 PCS scores. Reductions in drug use severity over time were accompanied by only minor improvements in SF-8 PCS scores, underscoring the potential long-term harm of illicit drug use on physical health. Greater psychiatric severity was strongly associated with lower SF-8 PCS scores, suggesting that clinical attention to mental health issues could potentially lead to improvements in perceived physical health as well as among stimulant users.

Parents' reports of children's medical care access: are there Mexican-American versus non-Hispanic white disparities?

Objectives:We investigated whether there were Mexican-American versus non-Hispanic white disparities in parents’ reports of problems with 4 dimensions of childrens medical care access after controlling for a range of demographic, social, economic, and health status factors. Methods:Data were collected through a telephone survey of 5941 parents residing in Texas. The survey questionnaire included measures of the parents demographic and socioeconomic status and the childs health-related quality of life. The behavioral model was used to guide the inclusion of factors in multivariate logistic regression analyses of parents’ reports of their childrens ability to obtain an appointment for routine/regular care, obtain care for illness/injury, obtain help/advice over the phone when calling the doctors office, and having to wait more than 15 minutes in the doctors office. Results:Mexican-American parents had worse reports of all 4 dimensions of their childrens access even after controlling for predisposing, enabling, and need factors. Among Mexican-Americans, there were no differences between those who primarily spoke English versus Spanish. Other factors that were significantly associated with at least 2 reports of access were household income, the childs insurance status, and the childs health-related quality of life. Conclusions:Mexican-American children face problems accessing medical care in a timely manner that are not fully explained by parents’ demographic, social, and economic status or childrens health-related quality of life. Health policy makers, managers, and clinicians should further consider how they could reduce the inequity of access to medical services among Mexican-American children.