Experiences of midlife and older African American men living with type 2 diabetes

OBJECTIVE

Type 2 Diabetes Mellitus (T2DM) is a complicated disease that disproportionately affects African American men. Understanding the experiences of African American men living with T2DM is important for developing effective, culturally sensitive interventions. The purpose of this study was to describe how African American men view their T2DM and describe their perspectives on living with and self-managing T2DM.

DESIGN

In-depth semi-structured qualitative interviews were conducted with 22 African American men aged 40-85 years diagnosed with T2DM. Interviews were transcribed and analyzed using NVivo 10 with thematic analysis.

RESULTS

Disbelief, shock, and denial were commonly experienced reactions at initial diagnosis. Many participants defined diabetes using words such as 'sugar' or 'glucose' and reported an awareness of health complications caused by diabetes, such as amputations and diabetic comas. Participants expressed various perspectives and attitudes towards having diabetes, including avoidance/apathy, fatalism, guilt and shame, fear and concern, and self-mastery. The majority of men described efforts to self-manage diabetes via glucose monitoring, changing dietary habits, and exercise. Many participants expressed concern over the financial burden associated with managing diabetes and reported that high costs can hinder a patient's ability to maintain active self-monitoring and deter patients from attending needed doctor's visits. Many participants expressed confidence in their healthcare providers, although a few expressed feelings of distrust and being uninformed. Participants tended to most appreciate physicians who spent time discussing their condition and who made an effort to engage in open patient-provider communication.

CONCLUSION

Living with diabetes can be emotionally, physically, and mentally challenging. Efforts to improve adoption and maintenance of self-management behaviors may benefit from sensitivity to the patient's attitude and perspectives towards diabetes self-management, assistance overcoming the financial burden of managing diabetes, and open patient-provider communication.

The Perception of Depression in Long-Term-Care Residents: A Qualitative Study Using Residential Journaling

Twenty-four residents in six assisted living facilities and one retirement community across three counties in South Carolina participated in a study to gain an understanding of older adults’ perception of depression in long-term-care (LTC) settings. Participants completed the Geriatric Depression Scale, Meaning Survey (MS), a journal, and a follow-up interview. Spiritual meaning regarding physical and mental health was self-reported from the MS. Five questions were included in the journals regarding emotional, physical, and social health. Results indicate that journaling may be an appropriate investigative tool for researchers, and LTC facilities’ efforts should be channeled to increase the availability and quality of mental health services to residents. Regular residential depression screenings, as well as the standardization of mental health care services within LTC facilities, should be an integral part of LTC.

Factors associated with physical activity literacy among foster parents

OBJECTIVES

To explore associations between physical activity (PA) literacy and psychosocial constructs for providing instrumental social support for youth PA.

METHODS

Ninety-one foster parents completed surveys assessing PA literacy (overall and specific), perceptions of child PA, coordination, PA enjoyment, psychosocial variables: positive/negative beliefs, normative beliefs, perceived behavioral control (PBC), and self-efficacy.

RESULTS

Race, negative beliefs, PBC, and foster parent sport involvement were associated with specific PA literacy. Race and education were associated with overall PA literacy.

CONCLUSIONS

Lower PA literacy is associated with greater negative beliefs and lower perceived control suggesting greater perceived barriers and lower perceived support for/among African Americans and those with less education.

Correlates of availability and accessibility of fruits and vegetables in homes of low-income Hispanic families

Availability and accessibility (AA) has been consistently shown across studies as the most important correlate of fruits and vegetables (FV) intake. However, there is little data on factors that influence AA of FV, especially in Hispanic families. The objective of this cross-sectional study was to examine the association between parental factors, child's preferences for FV and AA of FV in homes of low-income Hispanic families with children 5-12 years old. A convenience sample of 184 parents of low socioeconomic status recruited through public elementary schools completed a self-administered questionnaire about demographics, language spoken at home and food insecurity (FI). Parental factors and child's preferences were measured using a 16-item questionnaire, which was developed specifically for the study. AA of FV was measured using a validated nine-item index. Hierarchical multiple regression analysis indicated that language spoken at home, parental practices that promote consumption of FV, parental role modeling and perceived benefits of fast food had significant and independent associations with AA of FV at home. Intervention programs should take into consideration the language spoken at home and target at improving parental factors in order to improve AA of FV.

Associations among food insecurity, acculturation, demographic factors, and fruit and vegetable intake at home in Hispanic children

The purpose of this cross-sectional pilot study was to examine associations between food insecurity, acculturation, demographic factors, and children's fruit and vegetable intake among a sample of Hispanic children ages 5 to 12 years. A convenience sample of 184 parents of low socioeconomic status completed one-time, self-administered questionnaires assessing demographic information, acculturation, and food insecurity in the spring of 2006. In addition, children's fruit and vegetable intake at home was measured using a validated seven-item index. Parents were recruited through local elementary schools in San Antonio, TX. Pearson and Spearman correlations were used to examine the associations between the variables. t tests were used to explore the differences in means of children's fruit and vegetable intake at home for acculturation and food insecurity levels. Statistical significance was set at P<0.05. Significant correlations were found between demographic variables, acculturation, food insecurity, and children's fruit and vegetable intake at home. The overall mean fruit and vegetable intake at home was 1.04+/-0.63 (mean+/-standard deviation) servings per day. Higher rates of acculturation and higher rates of food insecurity were associated with lower fruit and vegetable intake at home. The findings reported in this study suggest a need for culturally tailored interventions targeting Hispanic children because fruit and vegetable intake at home among Hispanic children was low, regardless of the level of acculturation or food insecurity.

Associations between depressed mood and clusters of health risk behaviors

OBJECTIVES

To examine the association between depressed mood and clusters of health risk behaviors.

METHODS

A nationally representative sample of adolescents (N=15,214) was utilized to construct 10 pseudocontinuous health risk behaviors. Cluster analysis was performed to group adolescents, and subsequent multivariable logistic models were created.

RESULTS

Compared to non-risk takers, belonging to risk clusters significantly increased the odds of reporting depressed mood. African Americans in high-risk clusters appeared to be more vulnerable to depressed mood, when compared to remaining racial groups.

CONCLUSIONS

Results suggest that adolescents engaging in multiple health-risk behaviors do so in the context of depressed mood.

Sociodemographic differences in depressed mood: results from a nationally representative sample of high school adolescents

BACKGROUND

Research on adolescent mental health suggests that prevalence rates for depressed mood are not uniformly distributed across all populations. This study examined demographic difference in depressed mood among a nationally representative sample of high school adolescents.

METHODS

The 2003 National Youth Risk Behavior Survey was utilized to examine the association between depressed mood and demographic variables. To examine demographic associations, chi-square and follow-up logistic regression models were created for the sample of high school adolescents (N = 15,214).

RESULTS

Caucasians and African Americans were significantly less likely to report depressed mood when compared to Hispanics and Others. Women were also more likely than men to report depressed mood. No significant differences were observed among levels of urbanicity and age.

CONCLUSIONS

An understanding of the difference in the prevalence and correlates of depressed mood among adolescents of various ethnic/racial and gender groups deserves increased attention. Given the fact that challenges with depressed mood in adolescents can be substantial and relatively unrecognized, there is an increased need to identify these adolescents early and intervene with culturally appropriate interventions.

Ergonomic decision-making: a conceptual framework for experienced practitioners from backgrounds in industrial engineering and physical therapy

Ergonomists play an important role in preventing and controlling work-related injuries and illnesses, yet little is known about the decision-making processes that lead to their recommendations. This study (1) generated a data-grounded conceptual framework, based on schema theory, for ergonomic decision-making by experienced practitioners in the USA and (2) assessed the adequacy of that framework for describing the decision-making of ergonomics practitioners from backgrounds in industrial engineering (IE) and physical therapy (PT). A combination of qualitative and quantitative analyses, within and across 54 decision-making situations derived from in-depth interviews with 21 practitioners, indicated that a single framework adequately describes the decision-making of experienced practitioners from these backgrounds. Results indicate that demands of the practitioner environment and practitioner factors such as personality more strongly influence the decision-making of experienced ergonomics practitioners than does practitioner background in IE or PT.

Factors of fruit and vegetable intake by race, gender, and age among young adolescents

OBJECTIVE

To explore demographic differences in individual, social, and environmental factors potentially related to fruit and vegetable intake.

DESIGN

Self-report questionnaires administered to a convenience sample of middle school students during regular classes.

PARTICIPANTS

Black and white adolescents, 11 to 15 years of age (N = 736).

VARIABLES MEASURED

Measures included self-efficacy, family dinner frequency, normative beliefs, outcome expectations, modeling, availability, preferences, snack choice, and demographics.

ANALYSIS

Chi-square, general linear models, and Poisson and linear regressions as appropriate.

RESULTS

Black participants reported greater social influences than did white participants, whereas white adolescents reported greater family environmental influences on fruit and vegetable intake. The oldest adolescents reported lower self-efficacy, peer modeling, family dinner frequency, and fruit and vegetable preferences compared with younger adolescents. White participants and females reported a higher preference for vegetables than did black participants and males. Regression models for self-efficacy and snack choice explained 41% and 34% of the variance, respectively. Preferences for vegetables and parental modeling were the strongest correlates of self-efficacy. Self-efficacy was the strongest correlate of snack choice.

CONCLUSIONS AND IMPLICATIONS

Decreases in several factors with age highlight the importance of intervention for this age group. Future research is needed for a better understanding of the formation and modification of self-efficacy and snack choice.

Social support reduces the impact of partner violence on health: application of structural equation models

BACKGROUND

Intimate partner violence (IPV) is associated with poorer health, yet pathways through which IPV affects either mental or physical health are not well characterized.

METHODS

Structural equation modeling was used to test a model in which physical-IPV and battering were considered as separate independent variables. The sample included 191 women currently experiencing either physical IPV or battering. Emotional support provided to women experiencing IPV was hypothesized to mediate the impact of IPV on current mental and physical health (dependent variables).

RESULTS

Higher scores on emotional support were associated with better physical (beta = -0.23, P < 0.01) and mental health (beta = -0.27, P < 0.001). Physical IPV was directly associated with poorer mental health (beta = 0.023, P < 0.01) and indirectly associated with poorer physical health (beta = 0.18, P < 0.001) and mental health (beta = -0.04, P < 0.05), primarily through battering. Higher battering scores were directly associated with less emotional support (beta = -0.33, P < 0.001) and indirectly associated with poorer physical (beta = 0.12, P < 0.01) and mental health (beta = 0.09, P < 0.01), primarily through emotional support. Model diagnostics indicated a good fit (chi(2) = 20.44, P = 0.37, GFI = 0.98, CFI = 0.99, RMSEA = 0.02).

CONCLUSIONS

Higher levels of emotional support may modify the effect of IPV on health. Interventions to increase social and emotional support to abused women may reduce mental and physical health consequences.

The interaction of age and cognitive representations in predicting blood pressure

The purpose of this study was to investigate the interaction of age and cognitive representations of hypertension in predicting blood pressure. A model of illness self-regulation was used as the theoretical framework for the study. Secondary analysis of data collected from 224 hypertensive adult outpatients was conducted to assess five constructs of illness. ANOVA results indicated that older adults reported fewer hypertension-related symptoms than younger- and middle-aged adults, and that younger adults reported fewer health behaviors to control hypertension than did middle-aged and older adults. Results of hierarchical multiple regression models indicated that after adjusting for effects of demographic factors, no single cognitive representation construct was a significant predictor of blood pressure. The interactions of age and three cognitive representation constructs were, however, significant predictors of blood pressure. For younger adults, increases in the perceived Consequences, Control, and Timeline for hypertension were predictive of decreases in hypertension, although for older adults increased perceptions of control were associated with increased blood pressure.

Effect of adults' self-regulation of diabetes on quality-of-life outcomes

OBJECTIVE

To examine the relationships among cognitive representations of diabetes, diabetes-specific health behaviors, and quality of life using Leventhal and Diefenbach's self-regulation model of illness (Leventhal H, Diefenbach M: The active side of illness cognition. In Mental Representation in Health and Illness. SkeltonJA, Croyle RT, Eds. New York, Springer-Verlag, 1991, p. 247-272).

RESEARCH DESIGN AND METHODS

This research involved secondary analysis of a mailed survey completed by 296 adults (ages 20-90 years). Structural equation modeling was conducted to investigate relationships among cognitive representations, diabetes-specific health behaviors, and quality of life. Model differences by diabetes type were also investigated.

RESULTS

Findings indicated that certain cognitive representation constructs were related to increased diabetes-specific health behaviors, decreased sense of burden, and positive quality-of-life outcomes. Individuals levels of understanding of diabetes and their perceptions of control over diabetes were the most significant predictors of outcomes. However, diabetes-specific health behaviors were related to an increased sense of burden that was negatively associated with quality of life. Multigroup analyses indicated that this self-regulatory model provided a good fit for individuals with type 1 diabetes, those with type 2 diabetes who take insulin, and those with type 2 diabetes who do not take insulin.

CONCLUSIONS

These findings advance what is known about cognitive representations of illness and the self-regulation of diabetes as well as the relationships between cognitive representations of illness, quality of life, and behavioral factors. In particular, results from this study suggest the need for further study to address ways of reducing the burden of diabetes associated with health behaviors and decreased quality of life.

Age, pain, and coping with rheumatoid arthritis

The purpose of this study was to examine the relationship of age and pain severity (i.e. mild versus severe pain) in predicting coping strategies of individuals with rheumatoid arthritis (RA). An age-stratified sample (N = 121) of individuals diagnosed with rheumatoid arthritis completed a modified version of the Coping Strategies Questionnaire (CSQ). Individuals were asked to report the coping strategies used for mild versus severe pain. Findings included: (1) older adults were more likely than younger adults to report use of maladaptive coping strategies in the context of mild, but not severe, RA pain, (2) older adults' reported patterns of coping reflected less-than-anticipated expertise in dealing with RA pain, and (3) individuals, regardless of age, reported use of more active coping strategies in the context of mild pain and use of more maladaptive coping strategies in the context of severe pain. The present study suggests that research regarding illness and coping is most informative when it captures the individual-situational interaction of dealing with stressors such as chronic pain.