William N. Dudley

A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: Results of the Eat for Life trial.

OBJECTIVES This study reports on Eat for Life, a multicomponent intervention to increase fruit and vegetable consumption among African Americans that was delivered through Black churches. METHODS Fourteen churches were randomly assigned to 3 treatment conditions: (1) comparison, (2) self-help intervention with 1 telephone cue call, and (3) self-help with 1 cue call and 3 counseling calls. The telephone counseling in group 3 was based on motivational interviewing. The primary outcome, assessed at baseline and 1-year follow-up, was fruit and vegetable intake as assessed by 3 food frequency questionnaires. RESULTS Change in fruit and vegetable intake was significantly greater in the motivational interviewing group than in the comparison and self-help groups. The net difference between the motivational interviewing and comparison groups was 1.38, 1.03, and 1.21 servings of fruits and vegetables per day for the 2-item, 7-item, and 36-item food frequency questionnaires, respectively. The net difference between the motivational interviewing and self-help groups was 1.14, 1.10, and 0.97 servings for the 2-item, 7-item, and 36-item food frequency questionnaires, respectively. CONCLUSIONS Motivational interviewing appears to be a promising strategy for modifying dietary behavior, and Black churches are an excellent setting to implement and evaluate health promotion programs.

A randomized clinical trial of energy conservation for patients with cancer‐related fatigue

The efficacy of energy conservation and activity management (ECAM) for fatigue reduction and maintenance of functional performance has never been evaluated in adults with cancer who are undergoing treatment.

Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation

Background: Life stresses and negative emotions, such as anxiety and depression, are associated with adverse cardiac events, including arrhythmia. Patients undergoing implantation of an automatic internal cardioverter defibrillator provide a unique opportunity to characterize these relationships since all tachyarrhythmia episodes are recorded by the device.

The Relationship Between Parent-Adolescent Communication and Safer Sex Behaviors in College Students:

An increased incidence of HIV infection in adolescents has led researchers to examine factors that influence young people’s sexual behaviors. One of these factors is parent-adolescent communication about sexuality. In this study, two measurements of this communication were developed and tested through a mailed survey instrument methodology, with a sample of 732 college students. The instruments were found to be psychometrically sound. An exploration of the associations between selected demographic variables, parent-adolescent communication about sexuality, and specific safer sexual behaviors was conducted using a Chi Square Automatic Interaction Detection statistical technique. Overall, the study findings suggest that race, gender, and communication with parents are important factors within the sexual activity of college students.

Keepin' it R.E.A.L.!: results of a mother-adolescent HIV prevention program.

Background: The concern that adolescents may be placing themselves at risk for contracting HIV has led to widespread public and parental support for HIV prevention programs. Several programs on increasing communication between parents and teenagers have been tested, but the study of the impact of these programs on resulting sexual behavior is lacking. Objective: To test the efficacy of two interventions for mothers and their adolescents in delaying initiation of sexual intercourse for youth who are not sexually active and encouraging the use of condoms among sexually active youth. Methods: Employed were a control group and two treatment groups: one based on social cognitive theory (SCT) and the other a life skills program (LSK) based on problem behavior theory. Assessments were conducted before the intervention (baseline) and at 4, 12, and 24 months after the baseline assessment. Results: Adolescents and their mothers (total N = 582) enrolled in the trial. At baseline, the adolescents ranged in age 11-14 years and were mostly male and African American. The mean age of the mothers was 37.9 years, and most were African American and single. The primary analyses showed no difference among groups in abstinence rates for adolescents. However, adolescents in the LSK group demonstrated an increase in the condom use rate, and those in the SCT and control groups scored higher on human immunodeficiency virus (HIV) knowledge than those in the LSK group. Mothers showed substantial increases over time in comfort talking about sex and self-efficacy. For HIV knowledge, mothers in the SCT group scored significantly higher than those in the LSK and control groups. Conclusion: The results of this study are comparable to previous studies that have included mothers in the HIV education of their adolescents. Although the program did not demonstrate a substantial effect on abstinence rates, increases were observed in condom use among adolescents and in mothers sex-based discussions and comfort in talking about sexual issues.

Social cognitive factors associated with mother-adolescent communication about sex.

To better understand why some mothers talk to their children about sex and others do not, we examined the role of two social cognitive variables--self-efficacy and outcome expectancies--in explaining sex-based communication. The present study was part of a larger study to test the efficacy of two HIV prevention programs for mothers and their adolescents. Mothers and their adolescents were recruited from a large community organization that serves youth who live in disadvantaged circumstances. The sample for the present study included 486 mothers who averaged 38.4 years of age (SD = 6.73). The majority were African American (97.7%), not married (66.7%), and had a high school degree (89.5%). Their adolescents ranged in age from 11 through 14 years of age and most were male (61.3%). The results of the analysis revealed that mothers who expressed higher levels of self-efficacy and more favorable outcomes associated with talking to their children about sex were more likely to do so. In a regression analysis, we learned that the mothers degree of efficacy beliefs, along with her expected outcomes associated with talking about sex, the importance of religious beliefs to her, and the age and sex of her adolescents were important factors associated with talking with them about sex.

The Genetic Counseling Video Project (GCVP): Models of practice.

Genetic counseling is conceptualized as having both “teaching” and “counseling” functions; however, little is known about how these functions are articulated in routine practice. This study addresses the question by documenting, on videotape, the practices of a national sample of prenatal and cancer genetic counselors (GCs) providing routine pre‐test counseling to simulated clients (SCs). One hundred and seventy‐seven GCs recruited at two annual conferences of the National Society of Genetic Counselors (NSGC) were randomly assigned to counsel one of six female SCs of varying ethnicity, with or without a spouse, in their specialty. One hundred and fifty‐two videotapes were coded with the Roter Interaction Analysis System (RIAS) and both GCs and SCs completed evaluative questionnaires. Two teaching and two counseling patterns of practice emerged from cluster analysis. The teaching patterns included: (1) clinical teaching (31%) characterized by low psychosocial, emotional and facilitative talk, high levels of clinical exchange, and high verbal dominance; and (2) psycho‐educational teaching (27%) characterized by high levels of both clinical and psychosocial exchange, low levels of emotional and facilitative talk, and higher verbal dominance. The counseling patterns included: (1) supportive counseling (33%) characterized by low psychosocial and clinical exchange, high levels of emotional and facilitative talk, and low verbal dominance; and (2) psychosocial counseling (9%) with high emotional and facilitative talk, low clinical and high psychosocial exchange, and the lowest verbal dominance. SCs ratings of satisfaction with communication, the counselors affective demeanor, and the counselors use of non‐verbal skills were highest for the counseling model sessions. Both the teaching and counseling models seem to be represented in routine practice and predict variation in client satisfaction, affective demeanor, and nonverbal effectiveness.

Cancer-related fatigue, depressive symptoms, and functional status: a mediation model.

BACKGROUND Patients with cancer grapple with a confusing array of disease- and treatment-related symptoms while trying to maintain functioning in usual roles and daily activities. Research is needed to sort out and identify symptom clusters as a basis for a rational approach to symptom management. OBJECTIVE The aim of this study was to test, through secondary analysis, a mediation hypothesis about the direct and indirect relationships between fatigue and depressive symptoms through a pathway involving functional status. METHODS Data from the experimental and control groups of a randomized clinical intervention trial for fatigue management, collected after the second chemotherapy treatment or during the last week of radiotherapy, were analyzed. The mediation pathway from fatigue to depressive symptoms through functional status was tested separately for groups receiving either an energy conservation intervention or a control intervention, equating for time and attention. RESULTS For the control group, the results indicate support for partial mediation. The previously significant relationship between fatigue and depressive symptoms was reduced after functional status was controlled, accounting for 43% of the total mediated effect. The mediation hypothesis was not supported in the energy conservation group, indicating that the intervention may have changed the role of functional status in mediating the effect of fatigue on depressive symptoms. DISCUSSION In the control group, when routine activities became more difficult because of fatigue, individuals had more depressive symptoms. The results suggest that functional status is an important factor to consider in symptom management for fatigue. An appropriate intervention for fatigue would have two targets: the fatigue and strategies to reduce the likelihood of impaired functioning that could result in elevated depressive symptoms.

SPSS and SAS programming for the testing of mediation models.

BackgroundMediation modeling can explain the nature of the relation among three or more variables. In addition, it can be used to show how a variable mediates the relation between levels of intervention and outcome. The Sobel test, developed in 1990, provides a statistical method for determining the influence of a mediator on an intervention or outcome. Although interactive Web-based and stand-alone methods exist for computing the Sobel test, SPSS and SAS programs that automatically run the required regression analyses and computations increase the accessibility of mediation modeling to nursing researchers. ObjectivesTo illustrate the utility of the Sobel test and to make this programming available to the Nursing Research audience in both SAS and SPSS. MethodsThe history, logic, and technical aspects of mediation testing are introduced. The syntax files sobel.sps and sobel.sas, created to automate the computation of the regression analysis and test statistic, are available from the corresponding author. ResultsThe reported programming allows the user to complete mediation testing with the user’s own data in a single-step fashion. A technical manual included with the programming provides instruction on program use and interpretation of the output. ConclusionMediation modeling is a useful tool for describing the relation between three or more variables. Programming and manuals for using this model are made available.

A social cognitive-based model for condom use among college students.

BACKGROUND Social cognitive theory has been used extensively to explain health behaviors. Although the influence of one construct in this model-self-efficacy-has been well established, the role of other social cognitive constructs has not received as much attention in human immunodeficiency virus (HIV) prevention research. More complete understanding of how social cognitive constructs operate together to explain condom use behaviors would be useful in developing HIV and sexually transmitted disease (STD) prevention programs for college students. OBJECTIVE The primary aim of this study was to test a social cognitive-based model of condom use behaviors among college students. METHODS Data were collected from a sample of college students attending six different colleges and universities. Participants were 18 to 25 years of age, single, and sexually active. For the sample of 1,380 participants, the mean age was 20.6 years (SD = 1.76). Most participants reported having had vaginal intercourse (95.8%) and oral sex (86.5%); 16% reported anal sex. FINDINGS Self-efficacy was related directly to condom use behaviors and indirectly through its effect on outcome expectancies. As predicted, self-efficacy was related to anxiety, but anxiety was not related to condom use. Substance use during sexual encounters was related to outcome expectancies but not to condom use as predicted. CONCLUSIONS Overall, the findings lend support to a condom use model based on social cognitive theory and provide implications for HIV interventions. Interventions that focus on self-efficacy are more likely to reduce anxiety related to condom use, increase positive perceptions about condoms, and increase the likelihood of adopting condom use behaviors.