Perinatal Illicit Drug and Marijuana Use

PURPOSE

To assess use, screening, and disclosure of perinatal marijuana and other illicit drugs during first obstetric visits.

DESIGN

Observational study that qualitatively assesses provider screening and patient disclosure of substance use.

SETTING

Study sites were five urban outpatient prenatal clinics and practices located in Pittsburgh, Pennsylvania.

PARTICIPANTS

Pregnant patients and obstetric providers were recruited as participants.

METHODS

We audio recorded patient-provider conversations during first obstetric visits and obtained patient urine samples for drug analyses. Audio recordings were reviewed for provider screening and patient disclosure of illicit drug use. Urine analyses were compared with audio recordings to determine disclosure.

RESULTS

Four hundred and twenty-two pregnant patients provided complete audio recordings and urine samples for analyses. Providers asked about illicit drug use in 81% of the visits. One hundred twenty-three patients (29%) disclosed any current or past illicit drug use; 48 patients (11%) disclosed current use of marijuana while pregnant. One hundred and forty-five samples (34%) tested positive for one or more substances; marijuana was most commonly detected (N = 114, 27%). Of patients who tested positive for any substance, 66 (46%) did not disclose any use; only 36% of patients who tested positive for marijuana disclosed current use.

CONCLUSION

Although marijuana is illegal in Pennsylvania, a high proportion of pregnant patients used marijuana, with many not disclosing use to their obstetric care providers.

A Reach, Effectiveness, Adoption, Implementation, Maintenance Evaluation of Weekend Backpack Food Assistance Programs

PURPOSE

The purpose of this study was to evaluate an ongoing statewide weekend backpack program through the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

DESIGN

Mixed-methods inquiry was used to explore the reach, effectiveness, adoption, implementation, and maintenance of backpack programs within Montana.

SETTING

Study participants completed audio-recorded one-on-one phone interviews.

PARTICIPANTS

Key informants (e.g., managers at food banks, staff at participating schools, policy makers) were purposively sampled (N = 20).

METHOD

Semistructured interviews were conducted to gather data to describe each RE-AIM dimension. Interviews were transcribed verbatim and deductively (i.e., using RE-AIM as themes) coded for meaning units, placed into higher-order categories, and summarized in narrative. Supporting quantitative data (e.g., the proportion of eligible students that joined the program, rate of school-level adoption) were calculated using descriptive statistics.

RESULTS

Backpack programs with a broad reach and evidenced effect may be appealing to adopt. Weekend food bags cost an average $3.87 (SD ± .94) and there were some positive (i.e., ease, protecting participants' privacy) and very few negative (logistical) components of implementation. Collaborators and community partners are necessary for long-term sustainability.

CONCLUSION

Backpack programs are widespread and have potential to relieve weekend hunger; however, more efforts need to be made to end childhood hunger.

Exploring Perceptions of Barriers, Facilitators, and Motivators to Physical Activity Among Female Bariatric Patients: Implications for Physical Activity Programming

PURPOSE

To explore barriers, facilitators, and motivators to adopting and maintaining regular physical activity among women with obesity who have undergone bariatric surgery.

APPROACH

Individual interviews with women 3 to 24 months post-bariatric surgery.

SETTING

Participants were recruited from a bariatric clinic in Montreal, Canada.

PARTICIPANTS

Twelve women were recruited (mean age = 47 ± 9 years) using poster advertisements and word of mouth. Participants were on average 15 months postsurgery.

METHOD

Each woman was interviewed once using a semistructured interview protocol. Recruitment was conducted until data saturation (i.e., no new information emerged). The interviews were transcribed, coded, and analyzed using inductive thematic analysis.

RESULTS

Three interrelated themes emerged: the physical body, appraisal of the physical and social self, and the exercise environment. Barriers included weight-restricted mobility, side effects of surgery, body dissatisfaction, compromised psychological health, competing responsibilities, a lack of exercise self-efficacy and social support, reduced access to accommodating facilities, lack of exercise knowledge, and northern climate. Participants reported postsurgical weight loss, weight and health maintenance, enjoyment, body image, and supportive active relationships, as well as access to accommodating facilities and exercise knowledge, as facilitators and motivators.

CONCLUSION

Suggested physical activity programming strategies for health care professionals working with this unique population are discussed. Physical activity and health promotion initiatives can also benefit from a cultural paradigm shift away from weight-based representations of health.

Toward Effective Water Pipe Tobacco Control Policy in the United States: Synthesis of Federal, State, and Local Policy Texts

PURPOSE

Water pipe tobacco smoking (WTS) is growing in popularity among U.S. young adults and is associated with health risks similar to those of cigarette smoking. The purpose of this study is to examine existing tobacco control policies (TCPs) in order to investigate how they engage WTS.

APPROACH

A systematic synthesis of content and legal interactions among federal, state, and local TCP documents.

SETTING

Pennsylvania, which represents a politically and demographically diverse microcosm of the United States.

PARTICIPANTS

No human subjects.

METHOD

Federal and state TCPs were retrieved via public legal repositories. Local policy searches were conducted via county/municipal Web sites, inclusive of 13 localities that had autonomous health departments or existing TCPs based on a National Cancer Institute report. Full-text TCPs were double coded within a grounded theory framework for health policy analysis. Emergent codes were used to compare and contrast policy texts and to examine legal interactions among TCPs.

RESULTS

Examination of policy categories including youth access, use restrictions, and taxation revealed WTS as largely omitted from current TCPs. WTS was sometimes addressed as an "other" tobacco product under older TCPs, though ambiguities in language led to questionable enforceability. State preemptions have rolled back or prevented well-tailored reforms at the local level. Federal preemptions have likewise constrained state TCPs.

CONCLUSION

Outdated, preempted, and unclear policies limit the extent to which TCPs engage WTS. Health advocates might target these aspects of TCP reform.

Community Lenses Revealing the Role of Sociocultural Environment on Physical Activity

PURPOSE

To identify perceptions of how sociocultural environment enabled and hindered physical activity (PA) participation.

DESIGN

Community-based participatory research.

SETTING

Two semirural and two urban communities located in Alberta, Canada.

PARTICIPANTS

Thirty-five people (74.3% females, 71.4% aged 25-64 years) across the four communities.

METHOD

PhotoVoice activities occurred over 3 months during the spring of 2009. Participants were asked to document perceived environmental attributes that might foster or inhibit PA in their community. Photographs and narratives were shared in one-on-one interviews. Line-by-line coding of the transcripts was independently conducted by two researchers using an inductive approach. Codes were arranged into themes and subthemes, which were then organized into the Analysis Grid for Environments Linked to Obesity (ANGELO) framework.

RESULTS

Six main themes (accompanied by subthemes) emerged: sociocultural aesthetics, safety, social involvement, PA motivation, cultural ideas of recreation, and car culture. Representative quotes and photographs illustrate enablers and obstacles identified by participants.

CONCLUSION

This PhotoVoice study revealed how aspects of participants' sociocultural environments shaped their decisions to be physically active. Providing more PA resources is only one step in the promotion of supportive environments. Strategies should also account for the beautification and maintenance of communities, increasing feelings of safety, enhancement of social support among community members, popularization of PA, and mitigating car culture, among others.

A Qualitative Examination of Smoke-Free Policies and Electronic Cigarettes Among Sheltered Homeless Adults

PURPOSE

To examine attitudes toward smoke-free policies and perceptions of e-cigarette use among homeless adults.

APPROACH

A cross-sectional qualitative study was conducted.

SETTING

Study setting comprised seven transitional homeless shelters with indoor smoke-free policies in San Diego County; facilities differed in outdoor restrictions on smoking.

PARTICIPANTS

Sixty-six current or former smokers were the study participants.

METHOD

Participants completed a questionnaire on smoking behaviors, perceived antitobacco norms, and attitudes toward smoke-free policies, and attended a focus group interview that explored these topics. We used a directed content analysis approach to analyze the focus group transcripts.

RESULTS

Clients in facilities with outdoor restrictions on smoking had stronger perceived antitobacco norms than those in facilities without such restrictions. We identified the following major themes: attitudes toward smoke-free policies, the use of e-cigarettes, the addictive potential of cigarettes, vulnerability to tobacco industry marketing, and interest in smoking cessation. The consensus was that smoke-free policies were important because they limited secondhand smoke exposure to nonsmokers and children. All were curious about e-cigarettes, particularly if they could be smoked in areas where smoking was prohibited and/or used as a cessation aid.

CONCLUSION

In this study of homeless adults, there was strong support for indoor and outdoor smoke-free policies. However, misperceptions that e-cigarettes could be used indoors could threaten antitobacco norms, highlighting opportunities to educate about the potential risks of e-cigarette use among homeless individuals.

Improvements in Health Behaviors, Eating Self-Efficacy, and Goal-Setting Skills Following Participation in Wellness Coaching

Purpose . This project examined potential changes in health behaviors following wellness coaching. Design . In a single cohort study design, wellness coaching participants were recruited in 2011, data were collected through July 2012, and were analyzed through December 2013. Items in the study questionnaire used requested information about 11 health behaviors, self-efficacy for eating, and goal-setting skills. Setting . Worksite wellness center. Participants . One-hundred employee wellness center members with an average age of 42 years; 90% were female and most were overweight or obese. Intervention . Twelve weeks of in-person, one-on-one wellness coaching. Method . Participants completed study questionnaires when they started wellness coaching (baseline), after 12 weeks of wellness coaching, and at a 3-month follow-up. Results . From baseline to week 12, these 100 wellness coaching participants improved their self-reported health behaviors (11 domains, 0- to 10-point scale) from an average of 6.4 to 7.7 (p < .001), eating self-efficacy from an average of 112 to 142 (on a 0- to 180-point scale; p < .001), and goal-setting skills from an average of 49 to 55 (on a 16- to 80-point scale; p < .001). Conclusion . These results suggest that participants improved their current health behaviors and learned skills for continued healthy living. Future studies that use randomized controlled trials are needed to establish causality for wellness coaching.

Perspectives on Workplace Health Promotion Among Employees in Low-Wage Industries

PURPOSE

Study goals were to (1) understand the attitudes of employees in low-wage industries toward workplace health promotion, including views on appropriateness of employer involvement in employee health and level of interest in workplace health promotion overall and in specific programs, and (2) determine the potential for extending workplace health promotion to spouses and partners of these employees.

APPROACH

The study used 42 interviews of 60 to 90 minutes.

SETTING

Interviews were conducted with couples (married or living together) in the Seattle/King County metropolitan area of Washington State.

PARTICIPANTS

Study participants were forty-two couples with one or more members working in one of five low-wage industries: accommodation/food services, education, health care/social assistance, manufacturing, and retail trade.

METHOD

The study employed qualitative analysis of interview transcripts using grounded theory to identify themes.

RESULTS

Employees consider workplace health promotion both appropriate and desirable and believe it benefits employers through increased productivity and morale. Most have little personal experience with it and doubt their employers would prioritize employee health. Employees are most interested in efforts focused on nutrition and physical activity. Both employees and their partners support extending workplace health promotion to include partners.

CONCLUSION

Employees and their partners are interested in workplace health promotion if it addresses behaviors they care about. Concern over employer involvement in their personal health decisions is minimal; instead, employees view employer interest in their health as a sign that they are valued.

Understanding small business engagement in workplace violence prevention programs

PURPOSE

Worksite wellness, safety, and violence prevention programs have low penetration among small, independent businesses. This study examined barriers and strategies influencing small business participation in workplace violence prevention programs (WVPPs).

APPROACH

A semistructured interview guide was used in 32 telephone interviews.

SETTING

The study took place at the University of North Carolina Injury Prevention Research Center.

PARTICIPANTS

Participating were a purposive sample of 32 representatives of small business-serving organizations (e.g., business membership organizations, regulatory agencies, and economic development organizations) selected for their experience with small businesses.

INTERVENTION

This study was designed to inform improved dissemination of Crime Free Business (CFB), a WVPP for small, independent retail businesses.

METHODS

Thematic qualitative data analysis was used to identify key barriers and strategies for promoting programs and services to small businesses.

RESULTS

Three key factors that influence small business engagement emerged from the analysis: (1) small businesses' limited time and resources, (2) low salience of workplace violence, (3) influence of informal networks and source credibility. Identified strategies include designing low-cost and convenient programs, crafting effective messages, partnering with influential organizations and individuals, and conducting outreach through informal networks.

CONCLUSION

Workplace violence prevention and public health practitioners may increase small business participation in programs by reducing time and resource demands, addressing small business concerns, enlisting support from influential individuals and groups, and emphasizing business benefits of participating in the program.

Moving the Barricades to Physical Activity: A Qualitative Analysis of Open Streets Initiatives Across the United States

PURPOSE

Ciclovía, or Open Streets initiatives, are events where streets are opened for physical activity and closed to motorized traffic. Although the initiatives are gaining popularity in the United States, little is known about planning and implementing them. The goals of this paper are to explore the development and implementation of Open Streets initiatives and make recommendations for increasing the capacity of organizers to enhance initiative success.

APPROACH

Phenomenology with qualitative analysis of structured interviews was used.

SETTING

Study setting was urban and suburban communities in the United States.

PARTICIPANTS

Study participants were organizers of Open Streets initiatives in U.S. cities.

METHOD

Using a list of 47 events held in 2011, 27 lead organizers were interviewed by telephone about planning, implementation, and lessons learned. The interviews were digitally recorded and transcribed. A phenomenologic approach was used, an initial coding tool was developed after reviewing a sample of transcripts, and constant comparative coding methodology was applied. Themes and subthemes were generated from codes.

RESULTS

The most common reasons for initiation were to highlight or improve health and transportation. Most initiatives aimed to reach the general population, but some targeted families, children, or specific neighborhoods. Getting people to understand the concept of Open Streets was an important challenge. Other challenges included lack of funding and personnel, and complex logistics.

CONCLUSION

These initiatives democratize public space for citizens while promoting physical activity, social connectedness, and other broad agendas. There are opportunities for the research community to contribute to the expanse and sustainability of Open Streets, particularly in evaluation and dissemination.

Perceptions of Prostate Cancer Screening Controversy and Informed Decision Making: Implications for Development of a Targeted Decision Aid for Unaffected Male First-Degree Relatives

PURPOSE

First-degree relatives (FDRs) of prostate cancer (PC) patients should consider multiple concurrent personal risk factors when engaging in informed decision making (IDM) about PC screening. This study assessed perceptions of IDM recommendations and risk-appropriate strategies for IDM among FDRs of varied race/ethnicity.

DESIGN

A cross-sectional, qualitative study design was used.

SETTING

Study setting was a cancer center in southwest Florida.

PARTICIPANTS

The study comprised 44 participants (24 PC patients and 20 unaffected FDRs).

METHOD

Focus groups and individual interviews were conducted and analyzed using content analysis and constant comparison methods.

RESULTS

Patients and FDRs found the PC screening debate and IDM recommendations to be complex and counterintuitive. They overwhelmingly believed screening saves lives and does not have associated harms. There was a strongly expressed need to improve communication between patients and FDRs. A single decision aid that addresses the needs of all FDRs, rather than one separating by race/ethnicity, was recommended as sufficient by study participants. These perspectives guided the development of an innovative decision aid that deconstructs the screening controversy and IDM processes into simpler concepts and provides step-by-step strategies for FDRs to engage in IDM.

CONCLUSION

Implementing IDM among FDRs is challenging because the IDM paradigm departs from historical messages promoting routine screening. These contradictions should be recognized and addressed for men to participate effectively in IDM. A randomized pilot study evaluating outcomes of the resulting decision aid is underway.

Factors Facilitating the Implementation of Church-Based Heart Health Promotion Programs for Older Adults: A Qualitative Study Guided by the Precede-Proceed Model

PURPOSE

To describe the factors facilitating the implementation of heart health promotion programs for older adults in Anglican, United, and Catholic churches.

DESIGN

The study used qualitative methods comprising semistructured interviews and focus groups.

SETTING

The interviews and focus groups were conducted in Anglican, Catholic, and United churches located in the Canadian cities of Toronto and Hamilton, Ontario.

PARTICIPANTS

Twelve ordained pastors and 21 older parishioners who attended church regularly and who had no health conditions were recruited to best explain how churches could be suitable locations for health promotion activities targeting older adults.

METHODS

Twelve semistructured interviews with the pastors and three focus groups with the 21 parishioners were undertaken. A component of the Precede-Proceed model (a model for planning health education and health promotion programs and policies) was applied to the findings after direct content analysis of the data.

RESULTS

Participants identified pastor leadership, funding for a parish nurse, community-focused interventions, secured infrastructure, and social support from congregation members as pertinent factors required for implementing health promotion programs in Anglican, United, and Catholic churches.

CONCLUSION

The findings have particular relevance for health promotion and public health because they suggest factors that would be necessary to design church-based heart health promotion programs for older adults at risk of chronic diseases.

A qualitative study of recruitment barriers, motivators, and community-based strategies for increasing clinical trials participation among rural and urban populations

PURPOSE

Participation in clinical trials (CTs) is low among rural communities. Investigators report difficulty recruiting rural individuals for CTs. The study purpose was to identify recruitment barriers, motivators, and strategies to help increase access to and participation in CTs in rural and urban communities.

APPROACH

Qualitative focus groups/interviews.

SETTING

Rural and urban counties in one southeastern state.

PARTICIPANTS

Two hundred twelve African-American and white men and women ages 21+.

METHOD

Nineteen focus groups and nine interviews were conducted. Audio files were transcribed and organized into NVivo10. Recurring themes were examined by geographic location.

RESULTS

Although similar barriers, motivators, and strategies were reported by urban and rural groups, perceptions regarding their importance varied. Recruitment barriers mentioned in both rural and urban groups included fear, side effects, limited understanding, limited time, and mistrust. Rural groups were more mindful of time commitment involved. Both rural and urban participants reported financial incentives as the top motivator to CT participation, followed by personal illness (urban groups) and benefits to family (rural groups). Recruitment strategies suggested by rural participants involved working with schools/churches and using word of mouth, whereas partnering with schools, word of mouth, and media were recommended most by urban groups.

CONCLUSION

Perceived recruitment barriers, motivators, and strategies did not differ considerably between rural and urban groups. Major barriers identified by participants should be addressed in future CT recruitment and education efforts. Findings can inform recruitment and communication strategies for reaching both urban and rural communities.

Lessons learned from community-based approaches to sodium reduction

PURPOSE

This article describes lessons from a Centers for Disease Control and Prevention initiative encompassing sodium reduction interventions in six communities.

DESIGN

A multiple case study design was used.

SETTING

This evaluation examined data from programs implemented in six communities located in New York (Broome County, Schenectady County, and New York City); California (Los Angeles County and Shasta County); and Kansas (Shawnee County).

SUBJECTS

Participants (n = 80) included program staff, program directors, state-level staff, and partners.

MEASURES

Measures for this evaluation included challenges, facilitators, and lessons learned from implementing sodium reduction strategies.

ANALYSIS

The project team conducted a document review of program materials and semistructured interviews 12 to 14 months after implementation. The team coded and analyzed data deductively and inductively.

RESULTS

Five lessons for implementing community-based sodium reduction approaches emerged: (1) build relationships with partners to understand their concerns, (2) involve individuals knowledgeable about specific venues early, (3) incorporate sodium reduction efforts and messaging into broader nutrition efforts, (4) design the program to reduce sodium gradually to take into account consumer preferences and taste transitions, and (5) identify ways to address the cost of lower-sodium products.

CONCLUSION

The experiences of the six communities may assist practitioners in planning community-based sodium reduction interventions. Addressing sodium reduction using a community-based approach can foster meaningful change in dietary sodium consumption.

Mediatory myths in the U.S. military: tobacco use as "stress relief"

PURPOSE

To examine perceptions of military personnel about tobacco use.

DESIGN

Secondary analysis of (1) focus group and (2) interview data.

SETTING

U.S. military.

SUBJECTS

Total participants (n = 241): Enlisted personnel, supervisors (n = 189 individuals participating in 23 focus groups), tobacco control managers, and policy leaders (n = 52 interview participants).

INTERVENTION

Not applicable.

MEASURES

Not applicable.

ANALYSIS

Inductive, iterative coding for salient themes using an interpretive approach. Application of the concept of mediatory myths, used by institutions to cover over internal contradictions.

RESULTS

All types of participants endorsed the idea that tobacco was needed in the military for stress relief. Types of stress identified included fitting in, (relationships with coworkers and superiors) and control of workflow (taking breaks). Participants also discussed beliefs about the impact of tobacco on the military mission, and institutional sanction of tobacco use.

CONCLUSION

Despite tobacco's well-documented negative effects on fitness, the myth that tobacco relieves stress serves several institutional functions in the military. It serves to minimize perceptions of stress on the fitness of personnel, suggests that stress can be managed solely by individuals, and institutionalizes tobacco use. Growing recognition among military leadership that countering stress is essential to fitness offers an opportunity to challenge this myth.