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Henning-Smith C, Tuttle M, Tanem J, Jantzi K, Kelly E, Florence LC. Social Isolation and Safety Issues among Rural Older Adults Living Alone: Perspectives of Meals on Wheels Programs. J Aging Soc Policy 2024; 36:282-301. [PMID: 35635290 DOI: 10.1080/08959420.2022.2081025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/13/2021] [Indexed: 10/18/2022]
Abstract
Ensuring the safety and social well-being of rural populations, especially rural older adults living alone with complex medical conditions, is challenging, given large, sparsely populated communities and limited resources. Using qualitative data from surveys with 42 rural Meals on Wheels programs from across the U.S., we highlight particular challenges to meeting the social and safety needs of rural older adults living alone. Respondents described challenges, opportunities, and successes in meeting the needs of their clients. We describe these under four domains: main challenges, what can be done to address social isolation and loneliness, safety issues, improving safety, and current successes. We also identify cross-cutting themes related to programs' rural environment (long distances, inclement weather), infrastructure (housing quality, access to broadband Internet and technological connectivity, road conditions), funding and resource availability, and service provision (availability of health care and partner organizations.) We describe each of these in more detail and also share policy recommendations for improving health and safety of older adults living alone in rural areas, including funding nutrition programs as a health benefit and addressing aging, poor-quality housing stock.
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Affiliation(s)
- Carrie Henning-Smith
- Associate Professor, Division of Health Policy and Management, University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, US
| | - Mariana Tuttle
- Research and Communications Fellow, Division of Health Policy and Management, University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, US
| | - Jill Tanem
- Graduate Research Assistant, Division of Health Policy and Management, University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, US
| | - Katie Jantzi
- Vice President of Government Affairs, Meals on Wheels America, Arlington, Virginia, US
| | - Erika Kelly
- Chief Membership and Advocacy Officer, Meals on Wheels America, Arlington, Virginia, US
| | - L Carter Florence
- Senior Director, Strategy & Impact, Meals on Wheels America, Arlington, Virginia, US
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Jiménez FN, Brazier JF, Davoodi NM, Florence LC, Thomas KS, Gadbois EA. A Technology Training Program to Alleviate Social Isolation and Loneliness Among Homebound Older Adults: A Community Case Study. Front Public Health 2021; 9:750609. [PMID: 34869167 PMCID: PMC8637200 DOI: 10.3389/fpubh.2021.750609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Despite substantial evidence of the negative health consequences of social isolation and loneliness and the outsized impact on older adults, evidence on which interventions are most effective in alleviating social isolation and loneliness is inconclusive. Further complicating the translation of evidence into practice is the lack of studies assessing implementation and scalability considerations for socialization programs delivered by community-based organizations (CBOs). Our primary objective was to describe the implementation barriers, facilitators, and lessons learned from an information and communication technology (ICT) training program aimed at reducing social isolation and loneliness for homebound older adults in a home-delivered meals program. Participants received in-home, one-on-one ICT training lessons delivered by volunteers over a 14-week period with the goal of increasing social technology use. To assess implementation facilitators and barriers, 23 interviews were conducted with program staff (n = 2), volunteers (n = 3), and participants (n = 18). Transcripts were analyzed using thematic analysis. Aspects that facilitated implementation included the organization's existing relationship with clientele, an established infrastructure to deliver community-based interventions, alignment of intervention goals with broader organizational aims, and funding to support dedicated program staff. Challenges to implementation included significant program staff time and resources, coordinating data sharing efforts across multiple project partners, participant and volunteer recruitment, and interruptions due to COVID-19. Implications of these facilitators and barriers for scalability of community-based ICT training interventions for older adults are described. Lessons learned include identifying successful participant and volunteer recruitment strategies based on organizational capacity and existing recruitment avenues; using a targeted approach to identify potential participants; incorporating flexibility into intervention design when working with the homebound older adult population; and monitoring the participant-volunteer relationship through volunteer-completed reports to mitigate issues. Findings from this formative evaluation provide insight on strategies CBOs can employ to overcome challenges associated with implementing technology training programs to reduce social isolation and loneliness for older adults, and thus improve overall well-being for homebound older adults. Recommendations can be integrated into program design to facilitate implementation of ICT programs in the community setting.
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Affiliation(s)
- Frances N Jiménez
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Joan F Brazier
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
| | - Natalie M Davoodi
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States
| | | | - Kali S Thomas
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
| | - Emily A Gadbois
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
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Hillhouse J, Turrisi R, Scaglione NM, Cleveland MJ, Baker K, Florence LC. A Web-Based Intervention to Reduce Indoor Tanning Motivations in Adolescents: a Randomized Controlled Trial. Prev Sci 2017; 18:131-140. [PMID: 27549602 DOI: 10.1007/s11121-016-0698-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Youthful indoor tanning as few as ten sessions can increase the risk of melanoma by two to four times with each additional session adding another 2 % to the risk. Recent research estimates that indoor tanning can be linked to approximately 450,000 cases of skin cancer annually in the USA, Europe, and Australia. Despite these risks, indoor tanning remains popular with adolescents. This study tested the efficacy of a web-based skin cancer prevention intervention designed to reduce indoor tanning motivations in adolescent females. A nationally representative sample of 443 female teens was enrolled from an online panel into a two-arm, parallel group design, randomized controlled trial. Treatment participants received an appearance-focused intervention grounded in established health behavior change models. Controls viewed a teen alcohol prevention website. Outcome variables included willingness and intentions to indoor tan, willingness to sunless tan, and measures of indoor tanning attitudes and beliefs. The intervention decreased willingness and intentions to indoor tan and increased sunless tanning willingness relative to controls. We also examined indirect mechanisms of change through intervening variables (e.g., indoor tanning attitudes, norms, positive and negative expectancies) using the product of coefficient approach. The web-based intervention demonstrated efficacy in changing adolescent indoor tanning motivations and improving their orientation toward healthier alternatives. Results from the intervening variable analyses give guidance to future adolescent skin cancer prevention interventions.
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Affiliation(s)
- Joel Hillhouse
- Department of Community and Behavioral Health, College of Public Health, The Academic Health Sciences Center, East Tennessee State University, Johnson City, TN, 37614, USA.
| | - Rob Turrisi
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, 16802, USA.,Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, PA, 16802, USA
| | - Nichole M Scaglione
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, 16802, USA
| | - Michael J Cleveland
- Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, PA, 16802, USA.,Department of Human Development, Washington State University, Pullman, WA, 99164, USA
| | - Katie Baker
- Department of Community and Behavioral Health, College of Public Health, The Academic Health Sciences Center, East Tennessee State University, Johnson City, TN, 37614, USA
| | - L Carter Florence
- Department of Community and Behavioral Health, College of Public Health, The Academic Health Sciences Center, East Tennessee State University, Johnson City, TN, 37614, USA
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Hillhouse J, Stapleton JL, Florence LC, Pagoto S. Prevalence and Correlates of Indoor Tanning in Nonsalon Locations Among a National Sample of Young Women. JAMA Dermatol 2016; 151:1134-6. [PMID: 26108092 DOI: 10.1001/jamadermatol.2015.1323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joel Hillhouse
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City
| | - Jerod L Stapleton
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick
| | - L Carter Florence
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City
| | - Sherry Pagoto
- Department of Medicine, University of Massachusetts Medical School, Worcester
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Pagoto SL, Lemon SC, Oleski JL, Scully JM, Olendzki GF, Evans MM, Li W, Florence LC, Kirkland B, Hillhouse JJ. Availability of tanning beds on US college campuses. JAMA Dermatol 2015; 151:59-63. [PMID: 25353714 DOI: 10.1001/jamadermatol.2014.3590] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Indoor tanning is widespread among young adults in the United States despite evidence establishing it as a risk factor for skin cancer. The availability of tanning salons on or near college campuses has not been formally evaluated. OBJECTIVE To evaluate the availability of indoor tanning facilities on US college and university campuses (colleges) and in off-campus housing surrounding but not owned by the college. DESIGN, SETTING, AND PARTICIPANTS This observational study sampled the top 125 US colleges and universities listed in US News and World Report. Investigators searched websites of the colleges and nearby housing and contacted them by telephone inquiring about tanning services. MAIN OUTCOMES AND MEASURES Frequency of indoor tanning facilities on college campus and in off-campus housing facilities, as well as payment options for tanning. RESULTS Of the 125 colleges, 48.0% had indoor tanning facilities either on campus or in off-campus housing, and 14.4% of colleges allow campus cash cards to be used to pay for tanning. Indoor tanning was available on campus in 12.0% of colleges and in off-campus housing in 42.4% of colleges. Most off-campus housing facilities with indoor tanning (96%) provide it free to tenants. Midwestern colleges had the highest prevalence of indoor tanning on campus (26.9%), whereas Southern colleges had the highest prevalence of indoor tanning in off-campus housing facilities (67.7%). Presence of on-campus tanning facilities was significantly associated with enrollment (P = .01), region (P = .02), and presence of a school of public health (P = .01) but not private vs public status (P = .18) or presence of a tobacco policy (P = .16). Presence of tanning facilities in off-campus housing was significantly associated with region (P = .002) and private vs public status (P = .01) but not enrollment (P = .38), tobacco policy (P = .80), or presence of a school of public health (P = .69). CONCLUSIONS AND RELEVANCE Reducing the availability of indoor tanning on and around college campuses is an important public health target.
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Affiliation(s)
- Sherry L Pagoto
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jessica L Oleski
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jonathan M Scully
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Gin-Fei Olendzki
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Martinus M Evans
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Wenjun Li
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - L Carter Florence
- College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Brittany Kirkland
- College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Joel J Hillhouse
- College of Public Health, East Tennessee State University, Johnson City, Tennessee
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