Osteoporosis prevention education: Behavior theories and calcium intake

Predicting factors for breast cancer screening in Middle Eastern women based on health belief model: a systematic review

Background

Breast cancer screening can reduce mortality and improve the quality of life in affected women. The present study aimed to determine the predictive factors of breast cancer screening in Iranian women based on the health belief model (HBM).

Methods

This review was conducted by searching electronic databases of Google Scholar; electronic databases, including Scopus, PubMed/MEDLINE, Cochrane Library, Web of Science, ProQuest, Embase, and Google scholar Magiran; and SID with the English keywords of “breast cancer,” “mammography,” “health belief model,” and “breast self-exam” and the equivalent Persian keywords. The results were evaluated based on the health belief model (HBM) constructs. Articles were evaluated for quality and the findings were extracted and reviewed.

Results

A total of 8 relevant articles were selected for review. Women’s awareness of breast cancer screening methods was moderate in two studies and poor in two other studies. Among the constructs of HBM, knowledge, perceived susceptibility, perceived severity, perceived benefits, and action plan were poor in the majority of the studies, while perceived barriers, cues to action, and self-efficacy were mainly good.

Conclusion

Considering the observed weakness of many HBM constructs, it is recommended that special attention be given to all HBM constructs in implementing HBM-based education programs.

Application of health belief model in the assessment of factors affecting exercise behaviours in preventing osteoporosis

Objectives

Osteoporosis is a skeletal disorder associated with weak and brittle bones, and more susceptible to fracture. Osteo-protective behaviours, such as exercise, may prevent osteoporosis. Therefore, this study aimed to assess the factors influencing the exercise behaviour in Malaysian adults and to assess their health beliefs and self-regulation in preventing osteoporosis.

Methods

A cross-sectional, self-administered questionnaire was conducted throughout Malaysia through a web-based or physical-based survey. The questionnaire consisted of three sections: demographic data, ten questions regarding social and family history related to osteoporosis and 38 questions with seven subdomains (i.e. susceptibility, seriousness, barriers, benefits, health motivation, self-efficacy and self-regulation) which measured the health belief scores and self-regulation using 5-point Likert scale. Descriptive, inferential analysis and linear regression were used to analyse the data.

Key findings

A total of 679 participants completed the questionnaire. The mean health belief score was 63.7%, which was moderate. Most participants (64.4%) perceived low susceptibility to osteoporosis [mean score = 47.0%, standard deviation (SD) = 16.2]. Participants with age 18–27 years (44.8%), single (45.0%) and monthly income <RM 1000 (45.2%), perceived significant lower susceptibility to osteoporosis. Participants’ perception scores were high on the benefits of exercise (75.7%, SD = 16.4), health motivation (74.9%, SD = 17.1) and perceived low barriers to exercise (71.7%, SD = 14.9). Respondents who were at risk of osteoporosis and with family and friends diagnosed with osteoporosis obtained a higher score than those who did not.

Conclusions

The health belief score in the Malaysian population was moderate. However, the majority of participants were unaware of the susceptibility and seriousness of osteoporosis. Efforts need to be taken to break the barriers associated with exercise in preventing osteoporosis.

The effect of educational intervention based on theory of planned behavior on behavioral responses of premenopausal women in prevention of osteoporosis

Background

Osteoporosis is one of the most prevalent bone diseases which is preventable. Implementing educational programs is an important step in prevention of chronic diseases in the community setting. One of the theories used for predicting behavior and performing educational intervention is theory of planned behavior (TPB) which predicts the intention of an individual toward doing a specific behavior. This study was conducted to assess the effect of educational intervention based on TPB on behavioral responses of premenopausal women in prevention from osteoporosis in Fasa city, Iran.

Methods

This study is a quasi-experimental study performed on 200 women aging from 35 and 55 years who referred to health centers in Fasa city; iran in 2019. Simple random sampling was applied to assign participants to control and intervention groups (100 participant for each group). Data were gathered by a "valid" and "reliable" questionnaire arranged based on the constructs of TPB, nutrition performance and physical activity. An educational program on osteoporosis prevention was conducted. educational intervention was performed in six sessions through group discussions and educational films and booklet for experimental group and then the changes in the scores of the two groups were evaluated and compared. Obtained data were analyzed by SPSS-22 software through Chi-square, independent t-test, paired t-test and ANOVA tests.

Results

The mean ages of studied participants in experimental and control groups were respectively 43.39 $$\pm$$ ± 5.20 and 42.94 $$\pm$$ ± 5.52. In experimental group, the average scores of knowledge [2 weeks (31.12 $$\pm$$ ± 4.20) and 2 months (39.04 $$\pm$$ ± 4.10) after educational intervention (p < 0.001)], constructs of theory of planned behavior [attitude construct: 2 weeks (89.32 $$\pm$$ ± 9.22) and 2 months (98.57 $$\pm$$ ± 9.13) after educational intervention (p < 0.001), Subjective norms construct: 2 weeks(88.39 $$\pm$$ ± 8.84) and 2 months (122.57 $$\pm$$ ± 8.58) after educational intervention (p < 0.001), Perceived behavioral control construct: 2 weeks (88.56 $$\pm$$ ± 8.38) and 2 months (120.15 $$\pm$$ ± 8.33) after educational intervention (p < 0.001), Behavioral intention construct: 2 weeks (54.44 ± 4.72) and 2 months (60.26 $$\pm$$ ± 4.12) after educational intervention (p < 0.001)], nutrition performance [2 weeks (19.88 ± 2.56) and 2 months (24.14 $$\pm$$ ± 2.36) after educational intervention (p < 0.001)] and physical activity [2 weeks (16.75 $$\pm$$ ± 1.42) and 2 months (18.94 $$\pm$$ ± 1.68) after educational intervention (p < 0.001)] had more significant enhancement than control group 2 weeks and 2 months after educational intervention.

Discussion

TPB was effected in nutrition performance and physical activity in osteoporosis prevention of subjects. This theory can be used as a framework for designing and performing educational intervention for preventing osteoporosis and promoting women’s health.

A preliminary study on the effects of an osteoporosis prevention program based on an Information-Motivation-Behavioral skill model in older adult women: A cluster randomized controlled trial

We aimed to evaluate the feasibility and effects of an osteoporosis prevention program using the Information-Motivation-Behavioral skill (IMB) model in older adult women in this preliminary study. Korean women ≥65 years were randomly assigned to control (N=21) and intervention (N=23) groups. The intervention group participated in an IMB model-based, 12-week osteoporosis prevention program. The primary outcome was osteoporosis prevention behavior over time in both groups directly before, immediately after (post-test 1), and 4 weeks after (post-test 2) the intervention. Participants had a higher retention and attendance rate for the intervention, and the osteoporosis prevention behavior of the intervention group at post-test 1 and post-test 2 had significantly improved. The program based on the IMB model may be a feasible and effective intervention for osteoporosis prevention behavior in older adult women.

Effect of educational program based on theory of planned behavior on osteoporosis preventive behaviors: a randomized clinical trial

Background

The prevalence of chronic diseases is increasing worldwide. Implementing educational programs is an important step in prevention of chronic diseases in the community setting. This study was conducted to assess the effect of educational program based on the Theory of Planned Behavior (TPB) on the osteoporosis preventive behaviors in middle-aged individuals.

Methods

A randomized clinical trial was conducted on 64 middle-aged individuals presenting to primary care centers. A researcher-made questionnaire developed according to “a guide for compiling and analyzing the questionnaire based on TPB” was used for data collection. Random block sampling was applied to assign participants to control and intervention groups after ensuring the validity and reliability. An educational program on osteoporosis prevention was conducted in six educational sessions based on the TPB constructs for the intervention group in primary care centers. Control group received routine education about lifestyle changes including osteoporosis by primary care centers. Eight weeks after the intervention, the questionnaires were completed again and the data were analyzed using the SPSS V16 software.

Results

Independent t-test found no significant difference in the mean score of knowledge, osteoporosis preventive behavior, attitude, subjective norms, perceived behavioral control and behavioral intention between intervention and control groups before intervention (p > 0.05). After the intervention, however, a significant difference was found in the mean score of knowledge, attitude, subjective norms, perceived behavioral control and behavioral intention between the cases in intervention and control groups (P < 0.05). In addition, based on repeated measurement ANOVA, the intervention had a significant effect on knowledge, preventive behaviors, attitude, subjective norms, perceived behavioral control, and behavioral intention (P < 0.05).

Conclusions

The results of the present study showed that implementation of an educational intervention based on the Theory of Planned Behavior significantly increased the knowledge along with all constructs of TPB in osteoporosis preventive behaviors.

Trial registration

This study was registered in the Iranian Registry of Clinical Trials IRCT2017081735647N2 (11/10/2017).

Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000-2020

Nutrition interventions developed using behaviour theory may be more effective than those without theoretical underpinnings. This study aimed to document the number of theory-based healthy eating interventions, the involvement of dietitians/nutritionists and the behaviour theories employed from 2000 to 2020. We conducted a review of publications related to healthy eating interventions that used behaviour change theories. Interventional studies published in English between 2000 and 2020 were retrieved from searching Medline, Cinahl, Embase, Psycinfo and Cochrane Central. Citation, country of origin, presence or absence of dietitian/nutritionist authors, participants, dietary behaviours, outcomes, theories and any behaviour change techniques (BCTs) stated were extracted. The publication trends on a yearly basis were recorded. A total of 266 articles were included. The number of theory-based interventions increased over the two decades. The number of studies conducted by dietitians/nutritionists increased, but since 2012, increases have been driven by other researchers. Social cognitive theory was the most used behaviour theory. Dietitians/nutritionists contributed to growth in publication of theory-based healthy eating interventions, but the proportion of researchers from other professions engaged in this field increased markedly. The reasons for this growth in publications from other professions is unknown but conjectured to result from greater prominence of dietary behaviours within the context of an obesity epidemic.

Effects of a health-belief-model-based osteoporosis- and fall-prevention program on women at early old age

BACKGROUND

Elderly women are at high risk of osteoporosis and falls. Lifestyle modifications and regular check-ups are strongly recommended to promote their bone health. However, elderly women tend to perform low preventive behaviors due to physiological changes associated with aging. Education facilitating healthy behaviors is essential for older women. Therefore, the purpose of this study was to determine whether a Health Belief Model (HBM)-based osteoporosis- and fall-prevention program could improve osteoporosis- and fall-prevention knowledge, self-efficacy, and health behaviors among women aged 65 to 74 years.

METHODS

This study included an untreated control group with a pretest-posttest design. Women (n = 47) in the intervention group received four sessions of an HBM-based program within a 2-month period. Participants (n = 47) in the control group attended usual education sessions.

RESULTS

Women in the intervention group exhibited greater knowledge in exercise and diet for osteoporosis-prevention (t = 5.473, p < 0.001; t = 6.895, p < 0.001, respectively), fall-prevention knowledge (t = 2.354, p = 0.021), self-efficacy in exercise for osteoporosis-prevention (t = 2.736, p = 0.008), osteoporosis-prevention behavior of exercise, diet, and routine follow-ups (t = 3.019, p = 0.003; t = 2.705, p = 0.008; t = 2.368, p = 0.020, respectively), and fall-prevention behavior (t = 3.879, p < 0.001).

CONCLUSION

HBM-based osteoporosis- and fall-prevention program exhibited outstanding effectiveness in promoting osteoporosis and fall prevention among women at early old age. Further studies with more rigorous designs are needed to provide further evidence that supports this finding.

Knowledge, attitude and practice about osteoporosis among young adults in Riyadh 2019

Objectives:

To study the knowledge, attitude and practice level among young Saudi adults regarding osteoporosis.

Methods:

A cross-sectional study was done in Riyadh among Saudis, within the age group (17–30 years old), with sample size (663). A validated questionnaire was distributed in paper and electronic forms. The questionnaire had five parts: first part was the demographic variables, second part the source of the participant knowledge about the disease, third part assessed the knowledge about osteoporosis, fourth part assessed osteoporosis attitudes, and the fifth part assessed the practice for prevention of osteoporosis. The collected data was analysed by Statistical Package for the Social Sciences program.

Results:

It was found that there was low level of knowledge among overall participants; there was no significant difference between male and female in level of knowledge, while the age group 21–25 had the highest knowledge level among all other age groups. Males have better level of practice of a healthy lifestyle that decreases the risk of osteoporosis than females. In total, 52.5% of males have a sufficient level of practice, while only 34.9% of females have acceptable level of practice

Conclusion:

The study found no significant difference between males and females regarding the knowledge of osteoporosis. Males were found to have better level of practice of a healthy lifestyle that decreases the level of osteoporosis then females. The study recommends similar studies and undertake more efforts in promotion of preventive programs for young adults.

Osteoporosis health beliefs and self-efficacy among orthopedic nurses in Hunan Province, China

Osteoporosis is a growing health problem worldwide. Health beliefs and self-efficacy in regard to osteoporosis may be important targets in preventive behaviours. This study aimed to describe beliefs around osteoporosis held by orthopaedic nurses as well as the nurses' self-efficacy and the associations between knowledge, health beliefs and self-efficacy. A cross-sectional study was conducted with nurses working in orthopaedic departments in 13 tertiary hospitals in Hunan Province, China. Participants completed a questionnaire consisting of the Osteoporosis Health Belief Scale (OHBS), the Osteoporosis Self-Efficacy Scale (OSES) and a survey of their socio-demographic characteristics. A total of 558 nurses completed the survey (response rate 95%). The nurses' scores regarding their perception of the susceptibility to and seriousness of osteoporosis were moderately low (mean OHBS score = 124.72, range 45-171; SD = 14.71), while their corresponding self-efficacy scores were moderately high (mean OSES score = 72.01, range 0-120; SD = 23.15). Knowledge regarding osteoporosis was positively associated with self-efficacy (r = 0.232, p = 0.000) but not with health beliefs (r = 0.030, p = 0.484). The findings of this study revealed moderately high self-efficacy and moderate health beliefs related to osteoporosis among orthopaedic nurses. Osteoporosis knowledge was not associated with health beliefs or self-efficacy. The findings indicate that educational programs should not only focus on knowledge improvement but also changes in health beliefs to improve actual behaviour in practice.

Educational booklet reinforces knowledge of osteoporosis and influences intentions to improve bone health in previously diagnosed and treated patients

We examined individuals' experiences using an educational booklet developed by the Ontario Osteoporosis Strategy. The booklet appeared to motivate individuals to make changes to their existing management of their bone health and served as a reference tool reaffirming current practices and beliefs for others.

INTRODUCTION

The purpose of this study was to examine individuals' experiences of the educational booklet and explore the influence of the booklet on individuals' beliefs and actions regarding their bone health.

METHODS

Eligible individuals were those who had been prescribed medication to treat low bone mass. One-on-one telephone interviews were conducted over an 18-month period. Participants were interviewed for approximately 1 hour and asked to provide their feedback on the booklet, and to discuss what they were doing with respect to the recommendations made in the booklet.

RESULTS

We interviewed 50 participants who ranged in age from 58 to 89. The overall impression of the booklet was positive. Participants described the language in the booklet as clear and easy to understand. Participants stated that they would have appreciated receiving this tool at the onset of their diagnosis. Forty-two participants had already taken action, or expressed an intention to make changes, to their existing routines to improve their bone health. In contrast, eight participants used the booklet to reaffirm current practices and beliefs. For these individuals, the recommendations made in the booklet were consistent with what they had already been doing.

CONCLUSION

The booklet can engage patients in discussions about bone health. The booklet appeared to motivate individuals to make changes to their existing routines in an effort to achieve better health outcomes for their bone health. Providing a tool like this to people recently diagnosed with a bone health issue may prove to be beneficial.

Effect of lifestyle modification education based on health belief model in overweight/obese patients with non-alcoholic fatty liver disease: A parallel randomized controlled clinical trial

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the most common emerging liver disease worldwide. Lifestyle modification is the most emphasized method on management of this disease.

METHODS

In order to conduct this parallel, randomized controlled trial study, eighty-two NAFLD patients recruited and allocated to intervention group or the control.

RESULTS

After two months of intervention, significant improvements in all health belief model (HBM) variables and knowledge were seen within the intervention group (p < 0.001) and also the improvements were significantly superior between two groups (p < 0.001). Furthermore, prominent significant reduction for liver enzyme was observed in the intervention group compared to the controls. Similarly, ultra-sonographic findings revealed a significant improvement in the intervention group versus control.

CONCLUSIONS

This HBM-based lifestyle modification education could be effective not only in the HBM domains but also in the improvement of NAFLD parameters. Therefore, it could be useful to use this educational program for NAFLD patients in order to impact on their beliefs and body together.

REGISTRATION

Iranian Registry of Clinical Trials (IRCT2014101811763N17).

Is a 'healthy diet' and a 'calcium-rich diet' the same thing? Qualitative study examining perceptions of a calcium-rich diet in individuals who have received bone health education

BACKGROUND

In the present study, we aimed to (i) examine perceptions of achieving calcium and vitamin D recommended dietary allowance (RDA) and (ii) determine how participants talked about food in relation to RDA recommendations.

METHODS

Participants aged ≥50 years who were prescribed osteoporosis medication and received two modes of bone health education were eligible. Relying on a qualitative description design, we interviewed participants 1 month after they had attended an education session and received a self-management booklet. Calcium and vitamin D intakes were estimated by in-depth questions about diet and supplements and compared with perceptions of achieved RDA levels. Interview transcripts were analysed based on an analytic hierarchical process.

RESULTS

Forty-five participants (29 reporting previous fragility fractures) were included. Calcium and vitamin D RDA appeared to be potentially achieved by 64% and 93% of participants, respectively, primarily because of reliance on supplements. Few participants talked about vitamin D in relation to food intake and 49% of participants were unclear about the calcium content of food. Most considered that a healthy diet was equivalent to a calcium-rich diet. We noted no differences in our findings in the subset of individuals with fragility fractures.

CONCLUSIONS

Despite reporting a prescription for osteoporosis medication and receiving bone health education, a substantial number of individuals appeared to have sub-optimal calcium levels. This may be attributed to the challenge of achieving RDA with diet alone and the misconception of a healthy diet as a calcium-rich diet.

The Application of PRECEDE Model on Preventing Osteoporosis in Women

The aim of this study is investigating the efficiency of educational intervention based on PRECEDE model on promotion of osteoporosis prevention behaviors in women. This quasi-experimental study was conducted on 200 women registered in two health centers of Fasa city, Fars province, Iran in 2017 to 2018. A questionnaire including items evaluating demographic information and PRECEDE model constructs was used for measuring nutrition and walking performance of studied women in osteoporosis prevention before and 12 months after intervention. Bone mineral density (BMD) was recorded at the lumbar spine and femur before and 12 months after intervention. One year after intervention, the intervention group showed a significant increase in knowledge, attitude, self-efficacy, reinforcing factors, enabling factors, nutrition, and walking performance compared to the control group. Also, the value of lumbar spine and hip BMD T-Score of the intervention group was increased, while this value was reduced in the control group. Our findings showed that educational interventions based on PRECEDE model can positively affect prevention behaviors from osteoporosis by improving subjects' knowledge, attitude, enabling factors (resources such as health care access and services that can provide motivation for prevention behaviors from osteoporosis in women), self-efficacy, and reinforcing factors.

Osteoporosis Knowledge Among Spine Surgery Patients

Background

The purpose of this study is to evaluate the knowledge and attitudes on osteoporosis among first-time spine surgery patients.

Methods

An electronic survey consisting of demographics, prior experience with osteoporosis, and the Facts on Osteoporosis Quiz (FOOQ) was sent via email to first-time spine surgery patients. Patients were then randomized into 2 groups: 1 received a brief osteoporosis information packet prior to beginning the FOOQ, and 1 proceeded directly to the survey.

Results

A total of 63 patients who participated in this study, 29 in the information packet group and 34 in the non-information packet group, completed the survey. The mean FOOQ scores for the information packet patients was 16.37 (± 2.35) and for the non-information packet patients was 15.62 (± 2.87), with a P value of .12. There were no statistically significant differences between the 2 groups in terms of patient demographics or prior experience with osteoporosis. The information packet group trended to higher interest with a P value of .068.

Conclusions

Our study demonstrates high FOOQ scores among all first-time spine patients as compared to historical scores in general at-risk populations. No statistical differences between FOOQ scores were noted between the group that received the information packet and the control group. This study demonstrates that patients new to spine care have a good understanding of osteoporosis and are thus willing to participate in osteoporosis treatment as part of their spine care.

Gender Based Cognitive Determinants Of Medication Adherence In Older Adults With Chronic Conditions

BACKGROUND

Life course gender-role traits and social stereotypes could affect the pattern of medication adherence in old age.

OBJECTIVES

The main purpose of this study was to investigate gender based cognitive determinants of medication adherence in a sample of older adults who suffer from at least a chronic condition.

METHODS

In this cross-sectional design, 455 older adults participated from five health centers in Tabriz city, Iran from June to August 2017 using a random sampling method. Next, required data about medication adherence, knowledge and beliefs about prescribed medications, perceived self-efficacy in medication adherence, illness perception, and reasons for medication non-adherence were gathered using a structured written questionnaire through face-to-face interviews with the attendees.

RESULTS

Low medication adherence was reported by 54.5% of the study participants. Perceived self-efficacy for medication adherence (OR = 1.04; 95% CI: 1.00, 1.08) and medication adherence reason (OR = 0.96; 95% CI: 0.92, 0.99) were two identified strong predictors of medication adherence among the studied older men. Illness perception (OR = 1.02; 95% CI: 1.00, 1.02) and beliefs toward prescribed medication (OR = 0.95; 95% CI: 0.93, 0.98) were both recognized as the significant predictors of medication adherence in the older women subgroup.

CONCLUSION

Gender based variations were noted regarding the medication adherence in the studied sample and attributes of cognitive function were the main pinpointed elucidating parameters for the non-conformity. The explicit cognitive processes must be considered in care provision or interventional programs that target medication adherence in older adults.

The Effect of Health-belief-model-Based Training on Behaviors Preventing Peritonitis in Patients on Peritoneal Dialysis

Background:

Peritonitis is one of the important complications of peritoneal dialysis and one of the reasons for failure of this therapeutic technique. As one of the important reasons for development of peritonitis is disregard for health behaviors, this study aims to investigate the effect of education based on health belief model (HBM) on behaviors preventing peritonitis in peritoneal dialysis patients.

Methods:

This double-blind clinical trial study conducted on 60 patients with peritoneal dialysis in Isfahan, Iran. A researcher-made questionnaire was used to evaluate knowledge, HBM constructs, and peritonitis preventive behaviors in three stages (before, immediately after and 2-month after intervention). The intervention group received four HBM-based educational sessions and the control group received a lecture session. Data were analyzed using Chi-square, Mann–Whitney, Fisher's exact test, independent t-test, and repeated measures ANOVA.

Results:

There was no significant difference between the two groups’ background variables and level of knowledge, perceived, sensitivity, severity, benefits, arriers, self-efficacy, personal and environmental hygiene behaviors and fluid-replacement technique before the intervention. Immediately after the intervention, all of the variables, except perceived barriers, personal, and environmental hygiene, were significantly higher in the intervention group than the control group (P < 0.05); 2 months after the intervention, all of the variables, except personal hygiene and perceived barriers, were significantly higher in the intervention group (P < 0.05); in three stages, personal hygiene was not significantly different between the two groups; and 2 months after the intervention, the variable of perceived barriers decreased significantly in the intervention group (P < 0.05).

Conclusions:

Education based on HBM is effective on promoting behaviors preventing peritonitis. Education based on HBM is suggested in peritoneal dialysis patients to prevent peritonitis.

Osteoporosis knowledge translation for young adults: new directions for prevention programs

INTRODUCTION

Osteoporosis prevention is heavily reliant on education programs, which are most effective when tailored to their intended audience. Most osteoporosis prevention education is designed for older adults, making application of these programs to younger adults difficult. Designing programs for young adults requires understanding the information-seeking practices of young adults, so that knowledge about osteoporosis can be effectively translated.

METHODS

Individual interviews were conducted with 60 men and women-multiethnic, Canadian young adults-to explore both the sources and types of information they search for when seeking information on nutrition or bone health.

RESULTS

The results of this study raised themes related to the sources participants use, to their interests and to ways of engaging young adults. Prevention programs should make use of traditional sources, such as peers, family members and medical professionals, as well as emerging technologies, such as social media. Choice of sources was related to the perceived authority of and trust associated with the source. Messaging should relate to young adult interests, such as fitness and food-topics on which young adults are already seeking information-rather than being embedded within specific osteoporosis awareness materials. Engaging young adults means using relatable messages that are short and encourage small changes. Small gender-based differences were found in the information-seeking interests of participants. Differences related to age were not examined.

CONCLUSION

Creating short, action-oriented messages that are designed to encourage small changes in behaviour and are packaged with information that young adults are actively seeking is more likely to result in active engagement in prevention behaviours.

Comparing measured calcium and vitamin D intakes with perceptions of intake in Canadian young adults: insights for designing osteoporosis prevention education

OBJECTIVE

To identify the relationship between perceptions of Ca and vitamin D consumption and actual intakes to inform the design of osteoporosis prevention education.

DESIGN

An FFQ was used to approximate usual monthly Ca and vitamin D intakes among a group of young Canadians. Qualitative interviews and a food card pile sort activity explored individuals' perceptions of nutrient intakes. The FFQ was used to assess nutrient adequacy for individual participants and the qualitative interviews and pile sort were analysed using thematic content analysis.

SETTING

Hamilton, Canada.

SUBJECTS

Sixty participants aged 17-30 years, representing varying levels of educational attainment.

RESULTS

Seventy-eight per cent of young adults who consumed inadequate vitamin D perceived their intake as adequate, compared with 57 % for Ca. Thematic analysis revealed three major themes that contributed to young adults' understandings of intake: belief their diet was correct, absence of symptoms and confusion over nutrient sources.

CONCLUSIONS

The majority of participants perceived themselves as consuming adequate amounts of Ca and vitamin D, when they were actually consuming inadequate amounts according to FFQ findings. These perceptions were related to low engagement in prevention activities. Prevention education must motivate young adults to question the adequacy of their micronutrient intakes and design tailored programmes that are geared to a young adult audience.

Osteoporosis prevention and osteoporosis exercise in community-based public health programs

Osteoporosis is a serious public health concern worldwide, and community-based public health programs that increase osteoporosis preventive behaviors are ideal to combat this major public health issue. A review of community-based public health programs for osteoporosis prevention show that programs vary in numerous ways and have mixed results in increasing osteoporosis preventive behaviors, although most programs have had success in significantly increasing calcium intake, only a few programs have had success in significantly increasing weight-bearing exercise. Regarding calcium intake, all community-based public health programs that implemented: 1) at least one theoretical behavior change model, such as the health belief model, or 2) bone mineral density (BMD) testing for osteoporosis screening, have shown success in significantly increasing calcium intake. As community-based public health programs for osteoporosis prevention have shown limited success in increasing weight-bearing exercise, an additional review of community-based public health programs incorporating osteoporosis exercise showed that they have high compliance rates to increase weight-bearing exercise, but require high-intensity weight-bearing exercise of 80-85% 1-repetition maximum to significantly increase BMD to prevent osteoporosis. In the prevention of osteoporosis, for community-based public health programs to be most effective, they should implement theoretical behavior change models and/or BMD testing for osteoporosis screening, along with high-intensity resistance training. Recommendations for future research to further study effective community-based public health programs are also provided.

Efficacy of a workplace osteoporosis prevention intervention: a cluster randomized trial

BACKGROUND

Osteoporosis is a debilitating disease. Adequate calcium consumption and physical activity are the two major modifiable risk factors. This paper describes the major outcomes and efficacy of a workplace-based targeted behaviour change intervention to improve the dietary and physical activity behaviours of working women in sedentary occupations in Singapore.

METHODS

A cluster-randomized design was used, comparing the efficacy of a tailored intervention to standard care. Workplaces were the units of randomization and intervention. Sixteen workplaces were recruited from a pool of 97, and randomly assigned to intervention and control arms (eight workplaces in each). Women meeting specified inclusion criteria were then recruited to participate. Workplaces in the intervention arm received three participatory workshops and organization-wide educational activities. Workplaces in the control/standard care arm received print resources. Outcome measures were calcium intake (milligrams/day) and physical activity level (duration: minutes/week), measured at baseline, 4 weeks and 6 months post intervention. Adjusted cluster-level analyses were conducted comparing changes in intervention versus control groups, following intention-to-treat principles and CONSORT guidelines.

RESULTS

Workplaces in the intervention group reported a significantly greater increase in calcium intake and duration of load-bearing moderate to vigorous physical activity (MVPA) compared with the standard care control group. Four weeks after intervention, the difference in adjusted mean calcium intake was 343.2 mg/day (95 % CI = 337.4 to 349.0, p < .0005) and the difference in adjusted mean load-bearing MVPA was 55.6 min/week (95 % CI = 54.5 to 56.6, p < .0005). Six months post intervention, the mean differences attenuated slightly to 290.5 mg/day (95 % CI = 285.3 to 295.7, p < .0005) and 50.9 min/week (95 % CI =49.3 to 52.6, p < .0005) respectively.

CONCLUSION

This workplace-based intervention substantially improved calcium intake and load-bearing moderate to vigorous physical activity 6 months after the intervention began.

TRIAL REGISTRATION

Australia New Zealand Clinical Trial Registry ACTRN12616000079448 . Registered 25 January 2016 (retrospectively registered).

Application of the health belief model and social cognitive theory for osteoporosis preventive nutritional behaviors in a sample of Iranian women

BACKGROUND

Osteoporosis is the most common metabolic bone disease. The purpose of this study is to investigate the health belief model (HBM) and social cognitive theory (SCT) for osteoporosis preventive nutritional behaviors in women.

MATERIALS AND METHODS

In this quasi-experimental study, 120 patients who were women and registered under the health centers in Fasa City, Fars Province, Iran were selected. A questionnaire consisting of HBM constructs and the constructs of self-regulation and social support from SCT was used to measure nutrition performance. Bone mineral density was recorded at the lumbar spine and femur. The intervention for the experimental group included 10 educational sessions of 55-60 min of speech, group discussion, questions and answers, as well as posters and educational pamphlets, film screenings, and PowerPoint displays. Data were analyzed using SPSS 19 via Chi-square test, independent t-test, and repeated measures analysis of variance (ANOVA) at a significance level of 0.05.

RESULTS

After intervention, the experimental group showed a significant increase in the HBM constructs, self-regulation, social support, and nutrition performance, compared to the control group. Six months after the intervention, the value of lumbar spine bone mineral density (BMD) T-score increased to 0.127 in the experimental group, while it reduced to -0.043 in the control group. The value of the hip BMD T-score increased to 0.125 in the intervention group, but it decreased to -0.028 in the control group.

CONCLUSIONS

This study showed the effectiveness of HBM and constructs of self-regulation and social support on adoption of nutrition behaviors and increase in the bone density to prevent osteoporosis.

Perceived threat predictor of calcium-rich foods in the women of premenopausal age Isfahan - Iran in 2013-2014

Background:

During women lives, frequently face the challenge of calcium reduction and absorption. Decreased calcium absorption followed by a decrease in estrogen at perimenopausal ages, low average per capita calcium intake among women, wrong nutritional behavior, household income reductions and make them more susceptible to osteoporosis and related complications. The aim of this study was to evaluate the relationship between the health belief model constructs and consuming calcium-rich foods in menopausal age women.

Materials and Methods:

This study was descriptive-correlation study. The questionnaires were completed by 210 menopausal women who had referred to health centers. The research data were analyzed using: Frequency distribution, mean score, Pearson correlation coefficients and multivariate regression. Significant level of P < 0/05 were considered.

Results:

The mean and standard deviation of the scores for perceived susceptibility and severity of the threats of consumption and complications of inadequate intake were respectively: (62.1 and 38.9, and 60.2 and 39.9) and (59.6 and 37.9 and 56.3 and 36.5). The relationship between the number of units of calcium intake with perceived susceptibility and severity calcium intake and complications caused by the inadequate intake of calcium were (P < 0.001, r = 0.581, r = 0.651) and (P < 0.001, r = 0.634, r = 0.567).

Conclusions:

The obtained results indicate that perceived threat is the prognostic factor for the intake of calcium-rich foods and the increase of perceived threat in the health promotion programs may be associated with the increase in the consumption of calcium-rich foods in the women of premenopausal age.

The Effect of an Educational Program Based on Health Belief Model on Preventing Osteoporosis in Women

BACKGROUND

Osteoporosis is the most common metabolic bone disease. The study's objective is to investigate the effect of an educational program based on Health Belief Model (HBM) on preventing osteoporosis in women.

METHODS

In this quasi-experimental study, 120 patients (60 experimental and 60 control) who were registered under the health centers in Fasa City, Fars Province, Iran, were selected in 2014. A questionnaire consisting of demographic information, HBM constructs was used to measure nutrition and walking performance for the prevention of osteoporosis before, immediately after intervention, and 6 months later. Bone mineral density (BMD) was recorded at the lumbar spine and femur before and 6 months after intervention.

RESULTS

The mean age of women participated in the study was 41.75 ± 5.4 years for the experimental group, and 41.77 ± 5.43 years for the control group. The mean body mass index was 22.44 ± 3.30 for the experimental group and 22.27 ± 3.05 for the control group. The average number of women deliveries for the experimental group was 2.57 ± 1.47 and 2.50 ± 1.19 for the control group. There is no significant difference between the two groups in education level (P = 0.771), marital status (P = 0.880), occupation (P = 0.673), breastfeeding (P = 0.769), smoking (P = 0.315), history of osteoporosis in the family (P = 0.378), history of special diseases (P = 0.769), and records of bone densitometry (P = 0.543). Immediately and 6 months after intervention, the experimental group showed a significant increase in the knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, internal cues to action, nutrition, and walking performance compared to the control group. Six months after intervention, the value of lumbar spine BMD T-score in the experimental group increased to 0.127, while in the control group it reduced to -0.043. The value of the hip BMD T-score in the intervention group increased to 0.125, but it decreased to -0.028 in the control group.

CONCLUSIONS

This study showed the effectiveness of knowledge, walking, and diet on bone mass by HBM. Hence, these models can act as a framework for designing and implementing educational interventions for the osteoporosis prevention.

Effects of an Osteoporosis Prevention Program Based on Health Belief Model Among Females

Background:

Several studies reported the efficacy of osteoporosis prevention interventions in improvement of people’s preventive behaviors. However, there are reports that the interventions were not successful in altering osteoporosis health beliefs and preventive behaviors.

Objectives:

The current study aimed to assess the effect of a program based on health beliefs model (HBM) on females’ health beliefs and performances about osteoporosis preventive behaviors.

Patients and Methods:

This quasi-experimental study was conducted on 120 patients registered in two healthcare centers of Fasa, Fars Province, Iran in 2014. A questionnaire including demographic information and HBM constructs was employed to measure the females’ beliefs regarding nutrition and walking performance in prevention of osteoporosis bone mineral density (BMD) measured at the lumbar spine and femur before, immediately after the intervention, and six months after the intervention. Data were analyzed using Chi-square, independent samples t-, Mann-Whitney U tests and repeated measures ANOVA.

Results:

Immediately and six months after the intervention, a significant increase was found in the intervention group’s health beliefs, nutrition, and walking performances to prevent osteoporosis. Six months after the intervention, lumbar spine BMD T-score increased to 0.127 ± 0.061 in the intervention group but reduced to -0.043 ± 0.059 in the control group. Also, hip BMD T-score increased to 0.125 ± 0.088 in the intervention group, but decreased to -0.028 ± 0.052 in control group.

Conclusions:

The current study showed the effectiveness of HBM in adoption of nutrition and walking behaviors as well as the increase of bone density to prevent osteoporosis.

The Determination of Predictive Construct of Physical Behavior Change on Osteoporosis Prevention Women Aged 30-50: A Trans-Theoretical Method Study

Osteoporosis is a major public health priority in Iran and throughout the world. The prevention of osteoporosis has recently become the ultimate goal of many health professionals. Behavior change is one of the most powerful strategies to prevent osteoporosis. This study aimed to determine the predictive construct of physical preventive behavior of osteoporosis in women aged 30-50 in Khorramabad, west of Iran. This study included 269 women selected from all the health centers of Khorramabad city according to the inclusion criteria of the study and through random cluster and systematic sampling. The data gathering tools were valid and reliable questionnaires of demographic information, stages of change, decisional balance, self-efficacy, and physical activity. Data were analyzed using descriptive and inferential statistics. The mean of the subjects’ age was 38.72±7.003, and the mean of light weekly physical activity was 38.83±56.400. The results showed that the construct of self-efficacy had the highest predictive power of the preventive behavior. The results also showed that self-efficacy among the constructs of the Trans-theoretical Model was the only predictive construct for osteoporosis prevention behavior. Therefore, the findings of this study can serve as a base for educational interventions in behavioral changes to prevent of osteoporosis by health authorities.

Development and validation of a health belief model based instrument for measuring factors influencing exercise behaviors to prevent osteoporosis in pre-menopausal women (HOPE)

BACKGROUND

The health belief model (HBM) is the most commonly used conceptual framework for evaluating osteoporosis health belief and behaviors. The purpose of this study was to develop and evaluate the psychometric properties of a health belief model based questionnaire for exercise behavior for preventing osteoporosis among women aged 30 years and over.

METHODS

This was a cross sectional study of a convenience sample of women aged 30 years and over in Tehran, Iran using a theory-based instrument (HOPE). The instrument contained 39 items covering issues relate to osteoporosis prevention behavior. In this methodological study, exploratory and confirmatory factor analyses were used for psychometric evaluation. The Cronbach's alpha coefficient and Intraclass Correlation Coefficient (ICC) was used to evaluate the reliability of the scale.

RESULTS

In all 240 women participated in the study. The mean age of participant was 39.2 ± 7.8 years. The initial analysis extracted nine factors for the questionnaire that jointly accounted for 66.5% of variance observed. Confirmatory factor analysis showed that the data obtained was fit with Health Belief Model (HBM) and self-regulation construct (X2 = 1132.80, df = 629, P < 0.0001, CFI = 0.94, GFI = 0.91, RMSEA = 0.05 and SRMR = 0.06). The Cronbach's alpha coefficient for the subscales ranged from 0.72 to 0.90 and Intraclass Correlation Coefficient (ICC) ranged from 0.71 to 0.98; well above acceptable thresholds.

CONCLUSIONS

The HOPE was found to be appropriate instrument for measuring health belief and self-regulation for prevention of osteoporosis.

Effectiveness of a theory-driven nutritional education program in improving calcium intake among older Mauritian adults

Background. Low calcium intake, a risk factor of osteoporosis and subsequent fractures, has been previously reported among post-menopausal women in Mauritius. Objective. To assess the effectiveness of a theory-based educational intervention in improving the calcium intake, self-efficacy, and knowledge of older Mauritians. Methodology. The study was conducted as a pre- and post-test design which was evaluated through a baseline, immediate postintervention, and 2-month follow-up assessments. Participants were adults (n = 189) aged ≥40 years old from 2 urban community-based centres. The intervention group (IG) (n = 98) participated in 6 weekly interactive lessons based on the health belief model (HBM). The main outcome measures were calcium intake, HB scale scores, knowledge scores, and physical activity level (PAL). Anthropometric measurements were also assessed. Results. The IG significantly increased its baseline calcium intake, knowledge and self-efficacy (P < 0.001) at post-assessments. A significant decrease in waist circumference in the IG was noted (P < 0.05) after intervention. PAL significantly increased by 12.3% at post-test and by 29.6% at follow-up among intervention adults when compared to the CG (P < 0.001). Conclusion. A theory-driven educational intervention is effective in improving the dietary calcium intake, knowledge, self-efficacy, and PAL of older community-based Mauritian adults.

Older adults attending Georgia senior centers increase preventive behaviors for falls and fractures following a community-based intervention

A community-based intervention to reduce risk factors related to falls and fractures administered to Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 691, mean age = 75, 84% female, 45% Black and 55% White, convenience sample) was evaluated. The intervention consisted of 16 weekly sessions, with 8 focused on prevention of falls and fractures, and all 16 including a physical activity component. Interviewer-administered pre- and posttests evaluated fall preventive home safety behavior, intakes of calcium- and vitamin D-rich foods, use of calcium- and vitamin D-containing supplements, and five modifiable fall- and fracture-related risk factors. Following the intervention, there were significant increases in the intake of calcium- and vitamin D-rich foods (p < 0.001), the use of calcium- or vitamin D-containing supplements (p < 0.05), days of week with physical activity (p < 0.001) and fall preventive home safety behaviors (p < 0.001), and decreases in overall modifiable fall- and fracture-related risk factors (≥4 to 5 risk factors: pre: 32% vs. post: 18%; p < .001). This evaluation provides evidence that a multi-factorial fall prevention intervention offered at senior centers and delivered by trained staff can be beneficial for improving behaviors that may contribute to decreasing the risk of falls and fractures in older adults.

Concern and risk perception of osteoporosis and fracture among post-menopausal Australian women: results from the Global Longitudinal Study of Osteoporosis in Women (GLOW) cohort

PURPOSE

The purpose of this study is to identify factors associated with concern and perception of risks of osteoporosis and osteoporotic fractures and determine whether bone mineral density (BMD) testing influenced concern and risk perception.

METHODS

Study subjects (n = 1,082, age 55-94 years) were female Australian participants of the Global Longitudinal Study of Osteoporosis in Women (GLOW). Self-administered questionnaires were sent annually from 2007 to 2010. Study outcomes included 'concern about osteoporosis', 'perception of getting osteoporosis' and 'perception of fracture risk' compared to similar aged women. The closest post-BMD testing or baseline questionnaires were used for women with and without BMD testing, respectively. Multinomial logistic regression was used for the analysis.

RESULTS

BMD testing, prior fracture after age 45, younger age and lower self-reported general health were significantly associated with being 'very' or 'somewhat concerned' about osteoporosis and having a 'much higher' or 'little higher' risk perception of osteoporosis and fractures. A poorer BMD result was associated with higher concern and higher risk perceptions. The presence of comorbidities, having ≥2 falls in the preceding year and maternal osteoporosis were associated with higher concern. Maternal osteoporosis, presence of comorbidities, weight loss of ≥5 kg in the preceding year and low body mass index were associated with higher perceptions of osteoporosis risk.

CONCLUSION

Women's concern and risk perception of osteoporosis and osteoporotic fractures were reasonably well founded. However, increasing age, height loss, smoking and drinking were not associated with concern and perception despite being known osteoporosis risk factors. These factors should be considered in planning for education and awareness raising programmes.

Postmenopausal osteoporosis: the role of immune system cells

In the last years, new evidences of the relationship between immune system and bone have been accumulated both in animal models and in humans affected by bone disease, such as rheumatoid arthritis, bone metastasis, periodontitis, and osteoporosis. Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone tissue with a subsequent increase in bone fragility and susceptibility to fractures. The combined effects of estrogen deprivation and raising of FSH production occurring in menopause cause a marked stimulation of bone resorption and a rapid bone loss which is central for the onset of postmenopausal osteoporosis. This review focuses on the role of immune system in postmenopausal osteoporosis and on therapeutic strategies targeting osteoimmunology pathways.

Prevalence of postmenopausal osteoporosis in Italy and validation of decision rules for referring women for bone densitometry

We report the prevalence of osteoporosis, osteopenia, and fractures in a cohort of Italian women randomly recruited among the general population and validate the use of clinical guidelines in referring women for bone density testing. We enrolled in the study 995 healthy women (age range 45-92 years). A bone density test at the lumbar spine and femur was performed and a questionnaire on osteoporosis risk factors completed for all patients. The prevalence of osteoporosis was 33.67 %, that of osteopenia was 46.63, and 19.7 % were normal at bone density testing. Osteoporotic women were generally older and thinner, with a shorter period of estrogen exposure. The prevalence of fractures was 21.9 %, and fractured women had a lower bone density, were older, and had a longer postmenopausal period. Clinical guidelines for referring women for bone density testing performed poorly (the best performance was 68 %). This is the first study providing data on the prevalence of osteoporosis/osteopenia and of fractures in a cohort of healthy postmenopausal women. Known risk factors influence bone density and risk of fractures. The role of screening in detecting women with postmenopausal osteoporosis is far from optimal.

Effectiveness of community intervention in improving bone health behaviors in older adults

An 8-week, bone-health community program addressed risks/lifestyle changes within the Health Belief Model and Theory of Reasoned Action frameworks in a randomized format (treatment group n = 35; control group n = 34). Median week 1 values for calcium (control, 963 mg; treatment, 1023 mg) and vitamin D (81 IU both groups) were below recommendations, increasing throughout the program for both control (1023 mg calcium, 128 IU vitamin D) and treatment (1005 mg calcium, 122 IU vitamin D) groups. There was limited response to the exercise outcome variables, with many not participating in that section of the program. Psychosocial variables were positive for both control and treatment groups at week 1, with no significant difference at postintervention. Regression analysis indicated that those with a positive attitude about calcium intake and belief that they could choose calcium-fortified foods were more likely to have higher calcium intake. Intention to exercise was modified by peer and family support. Community-based programs can translate and use clinical trial key topics and outcomes, but participation bias makes impact results difficult to interpret the effectiveness of the program.

Theory-driven intervention improves calcium intake, osteoporosis knowledge, and self-efficacy in community-dwelling older Black adults

OBJECTIVE

To assess the effectiveness of an osteoporosis education program to improve calcium intake, knowledge, and self-efficacy in community-dwelling older Black adults.

DESIGN

Randomized repeated measures experimental design.

SETTING

Churches and community-based organizations.

PARTICIPANTS

Men and women (n = 110) 50 years old and older from 3 south Florida counties.

INTERVENTION

Participants randomly assigned to either of 2 groups: Group 1 (experimental group) or Group 2 (wait-list control group). Group 1 participated in 6 weekly education program sessions immediately following baseline assessment, and Group 2 started the program following Group 1's program completion. A tested curriculum was adapted to meet the needs of the target population.

MAIN OUTCOME MEASURES

Dietary calcium intake, osteoporosis knowledge, health beliefs, and self-efficacy.

ANALYSIS

Descriptive and summary statistics, repeated measures analysis of variance, and regression analysis.

RESULTS

Of the total participants, 84.6% completed the study (mean age = 70.2 years). Overall, an educational program developed with a theoretical background was associated with improvement in calcium intake, knowledge, and self-efficacy, with no effect on most health belief subscales. Assigned group was the major predictor of change in calcium intake.

CONCLUSIONS AND IMPLICATIONS

A theory-driven approach is valuable in improving behavior to promote bone health in this population. Health professionals should consider using more theory-driven approaches in intervention studies.

The effect of the addition of osteoporosis education to a bone health screening program for older adults

Osteoporosis affects approximately 26% of women and 4% of men after the age of 65 years. However, the diffusion of knowledge about osteoporosis risk factors, prevention and treatment remains low. The purpose of this longitudinal study was to investigate the value of adding initial and refresher osteoporosis education classes to a bone health screening program. A convenience sample of 376 men (n = 62) and women (n = 314) over the age of 62 years was assigned randomly to the Screening plus Education (n =193) or Screening only (n = 183) groups. Participants in both study groups demonstrated an increase in knowledge about osteoporosis, regardless of group assignment and other factors, over the two years of the study. Self-reported calcium use increased for all women and for men in the education group from baseline to year one, with a decline thereafter. There was no effect on exercise behaviors. This study points out the critical need for a more comprehensive and personalized bone health program that includes more than classroom-based education.

Bone health nutrition issues in aging

Bone health is an important issue in aging. Calcium and vitamin D currently have the most focus in published research on nutrition and bone health in aging, although evidence from published research is not conclusive. A systematic review was conducted to determine the impact of dietary and supplemental interventions focused on calcium and vitamin D over the past 10 years. Using key words to search, and search limits (aging population, English), 62 papers were found related to diet, nutrition, and bone; and 157 were found related to calcium and bone. Our review found a positive effect on bone health for supplements; food-based interventions; and educational strategies. Although there may be a publishing bias related to non-significant findings not being published, our results suggest the effectiveness of food based and educational interventions with less economic impact to the individual, as well as less risk of physiological side effects occurring.

Determinants of medication adherence in hypertensive patients: an application of self-efficacy and the Theory of Planned Behaviour

Objective

The study aimed to identify the determinants of medication adherence in a population of hypertensive outpatients. The principle objective of the present study was to determine the utility of self-efficacy and the Theory of Planned Behaviour (TPB) in predicting adherence with antihypertensive medication.

Setting

An outpatient hypertension clinic at the Belfast City Hospital, Northern Ireland.

Method

Outpatients who had attended the hypertension clinic on at least one previous occasion were invited to participate in the study. Participants completed a questionnaire incorporating measures of adherence with medication, medical and sociodemographic factors, together with measures of self-efficacy and the TPB. There were no specific study exclusion criteria.

Key findings

A total of 139 participants took part in the study; 20.9% of the participants reported non-adherence with their prescribed antihypertensive medication. A statistically significant difference in self-efficacy scores between the adherent and non-adherent groups was revealed by a Mann-Whitney test, with adherent patients perceiving higher levels of self-efficacy. Regression analysis with the TPB variables revealed that adherence was predicted by intentions and subjective norms, with 41% of the variance explained. Intention was predicted by attitudes and perceived behavioural control, with 61.9% of the variance explained.

Conclusion

The present study provides support for the use of self-efficacy and the TPB in predicting medication adherence; however, further research is required on the application of the TBP in the prediction of health behaviour. These findings have implications for the design of adherence-enhancing interventions.

Greater osteoporosis educational outreach is desirable among Chinese immigrants in Chinatown, Chicago

Osteoporosis beliefs were assessed in immigrant Chinese women in Chinatown, Chicago. Results from a survey utilizing the Osteoporosis Health Belief Scale showed that women expressed concern about osteoporosis but lacked both knowledge of preventive care and health motivation.

INTRODUCTION

The objective of this study was to assess osteoporosis beliefs in immigrant Chinese women in Chinatown, Chicago.

METHODS

In a community-based health fair, osteoporosis knowledge and self-efficacy among postmenopausal Chinese immigrants were assessed using the translated Osteoporosis Health Belief Scale. Bone mineral density (BMD) was assessed with calcaneal ultrasound.

RESULTS

The study population included 94 women with mean age of 51 +/- 9 years, mean length of residence in the United States of 9 +/- 7 years, and 73% (n = 76) of whom were recent immigrants. Women expressed concern about the seriousness of osteoporosis and their relative susceptibility to osteoporosis. In particular, women with a prior fracture reported higher seriousness to osteoporosis. Nonetheless, women exhibited low health motivation and low awareness of the benefits of calcium and exercise. Bone densitometry results corresponded to a T score of -1.2 +/- 1.5. Multiple regression analysis revealed that a younger age and longer length of residence in the USA were associated with higher BMD.

CONCLUSION

Chinese immigrant women in Chicago exhibit concern regarding osteoporosis, but are unaware of the benefits of calcium and exercise, and exhibit low health motivation. Chinese women in Chinatown lack necessary knowledge about osteoporosis to develop adequate self-efficacy. Public health initiatives should be undertaken among recent immigrant Chinese women.

Glucocorticoids and the risk of osteoporosis

BACKGROUND

Glucocorticoid-induced osteoporosis (GIO) refers to a clinical condition in which a class of corticosteroids increases the susceptibility of bones to fracture. Numerous recent studies have improved our understanding of the underlying biology of this condition, whereas data from randomized controlled trials have provided clinicians with more options for prevention of GIO.

OBJECTIVE

To review the pathophysiology and epidemiology of GIO, as well as current pharmacologic treatment and prevention modalities available. To review the state of healthcare provider concordance with GIO prevention guidelines.

METHODS

Representative examples of various cellular and molecular processes underlying GIO were included, with an emphasis towards more recent discoveries. The data used to describe the epidemiology of GIO were derived from both randomized controlled studies and observational studies, framed through a discussion of known osteoporosis risk factors.

RESULTS/CONCLUSION

Progress has been made in clarifying the pathophysiologic mechanisms that result in GIO. Although the options for preventions and treatment of GIO continue to expand, provider compliance with preventive measures remains suboptimal.

Vitamin and mineral supplement use by children and adolescents in the 1999-2004 National Health and Nutrition Examination Survey: relationship with nutrition, food security, physical activity, and health care access

OBJECTIVE

To determine if vitamin and mineral supplement use among children and adolescents in the United States is associated with nutrition, food security, physical activity, and health care access.

DESIGN

Secondary analysis of nationally representative data from the 1999-2004 National Health and Nutrition Examination Survey.

SETTING

Questionnaires, household interviews, and medical examinations.

PARTICIPANTS

Children and adolescents 2 to 17 years of age (N = 10 828).

MAIN EXPOSURE

Vitamin and mineral supplement use in the past month.

MAIN OUTCOME MEASURES

Demographics, nutrition, food security, physical activity, and health care access.

RESULTS

Approximately 34% (SE 1.2) used vitamin and mineral supplements in the past month, with underweight subjects reporting greater intake. Younger age, non-Hispanic white race/ethnicity, being born in the United States, higher milk intake, lower total fat and cholesterol intake, higher dietary fiber intake, higher income, greater food security, lower media/computer use, greater physical activity, lower body mass index, health insurance coverage, better health care access, and better self-reported health were associated with greater use of vitamin and mineral supplements. Such supplements contributed significantly to total daily dietary intakes of vitamins and minerals.

CONCLUSIONS

A large number of US children and adolescents use vitamin and mineral supplements, which for most may not be medically indicated. Such supplements contribute significantly to total dietary intakes of vitamins and minerals, and studies of nutrition should include their assessment. Since vitamin and mineral supplement users report greater health care access, health care providers may be in a position to provide screening and counseling regarding dietary adequacy and indications for supplement use.