A Rural Mental Health Research Agenda: Defining Context and Setting Priorities

This article provides a brief overview of research perspectives on rural mental health services and suggests the importance of building an agenda to bring coherence to studies in this area. The need for sound theory and methodology to guide research is emphasized. The importance of better conceptualization of the rural context as a focus of research is addressed, and 14 propositions concerning issues the authors think will advance rural research are presented. This article is intended to stimulate discussion about a research agenda that will lead to better understanding of rural needs for mental health services as well as more responsive service models.     

Cancer Coverage in General-Audience and Black Newspapers

This article presents findings from the first study of cancer news coverage in a national sample of Black and general-audience newspapers. We compared 2,439 health news stories from 23 weekly Black newspapers to 2,767 health news stories from a constructed week sample of 12 daily general-audience newspapers, both collected between April 1, 2004, and March 31, 2005. Analyses examined differences in the amount and nature of cancer coverage, specifically cancer sites, disparities, localization, and personally mobilizing health information for readers. Cancer was the main topic in a higher proportion of health stories in Black newspapers than in general-audience newspapers (13.6% vs. 9.6%; p = .001). Among cancer stories, those in Black newspapers had more localization (p = .004), disparity information (p = .001), and personal mobilization information (p = .001) than those in general-audience newspapers. In neither type of newspaper did the distribution of stories by cancer site accurately reflect the impact of different cancers on population mortality.     

Behavioral Health: Setting the Rural Health Research Agenda

This article seeks to identify current research priorities in the area of rural behavioral health. The method for accomplishing this task begins by identifying several domains where policy has a potential to effect improvements in access or quality but has been hampered by lack of empirical knowledge. In each domain a synthesis of current research summarizes what is known and draws attention to knowledge gaps. Research questions in each domain are proposed. The policy domains are theoretically based, using a conceptual model of access to health care, with a focus on illness level (prevalence), enabling factors (the delivery system, organization and financing, the promise of telemedicine), and predisposing factors (special populations, beliefs, values, stigma).     

Physical Activity Resource Attributes and Obesity in Low-Income African Americans

More than two thirds of Americans are overweight or obese, and African Americans are particularly vulnerable to obesity when compared to Caucasians. Ecological models of health suggest that lower individual and environmental socioeconomic status and the built environment may be related to health attitudes and behaviors that contribute to obesity. This cross-sectional study measured the direct associations of neighborhood physical activity resource attributes with body mass index (BMI) and body fat among low-income 216 African Americans (Mean (M) age = 43.5 years, 63.9% female) residing in 12 public housing developments. The Physical Activity Resource Assessment instrument measured accessibility, incivilities, and the quality of features and amenities of each physical activity resource within an 800-m radius around each housing development. Sidewalk connectivity was measured using the Pedestrian Environment Data Scan instrument. Ecological multivariate regression models analyzed the associations between the built environment attributes and resident BMI and body fat at the neighborhood level. Sidewalk connectivity was associated with BMI (M = 31.3 kg/m²; p < 0.05). Sidewalk connectivity and resource accessibility were associated with body fat percentage (M = 34.8%, p < 0.05). Physical activity resource attributes and neighborhood sidewalk connectivity were related to BMI and body fat among low-income African Americans living in housing developments. This research was funded by the Robert Wood Johnson Foundation’s Active Living Research program.     

Setting the Agenda: An Analysis of Negotiation Strategies in Clinical Talk

This article analyzes the process whereby physicians and patients set the agenda for medical interviews. Applying a conversation analytic perspective to the analysis of 22 videotapes of primary care interviews at a large, urban, teaching and research hospital, a 3-stage model is developed, consisting of (a) an opening sequence, (b) an initial statement of concerns by the patient, and (c) the negotiation process. The analysis illustrates the critical function of the opening verbal exchanges, showing how patient responses to the physician's first question and subsequent queries and summaries by the physician are intricately interwoven. The interaction at the very beginning of the interview is shown to significantly alter the ensuing interaction. The analysis provides a discursive framework for analyzing problematic communication during the primary care interview.     

The Interplay of Environmental Exposures and Mental Health: Setting an Agenda

Background: To date, health-effects research on environmental stressors has rarely focused on behavioral and mental health outcomes. That lack of research is beginning to change. Science and policy experts in the environmental and behavioral health sciences are coming together to explore converging evidence on the relationship—harmful or beneficial—between environmental factors and mental health.Objectives: To organize evidence and catalyze new findings, the National Academy of Sciences, Engineering, and Medicine (NASEM) hosted a workshop 2–3 February 2021 on the interplay of environmental exposures and mental health outcomes.Methods: This commentary provides a nonsystematic, expert-guided conceptual review and interdisciplinary perspective on the convergence of environmental and mental health, drawing from hypotheses, findings, and research gaps presented and discussed at the workshop. Featured is an overview of what is known about the intersection of the environment and mental health, focusing on the effects of neurotoxic pollutants, threats related to climate change, and the importance of health promoting environments, such as urban green spaces.Discussion: We describe what can be gained by bridging environmental and psychological research disciplines and present a synthesis of what is needed to advance interdisciplinary investigations. We also consider the implications of the current evidence for a) foundational knowledge of the etiology of mental health and illness, b) toxicant policy and regulation, c) definitions of climate adaptation and community resilience, d) interventions targeting marginalized communities, and e) the future of research training and funding. We include a call to action for environmental and mental health researchers, focusing on the environmental contributions to mental health to unlock primary prevention strategies at the population level and open equitable paths for preventing mental disorders and achieving optimal mental health for all. https://doi.org/10.1289/EHP9889     

Treating Childhood Obesity in a Public School Setting

Experience at an elementary school in Petaluma, CA, demonstrates that daily group exercise as part of a nutrition education program can help obese children attain normal weight-for-height. Such an exercise program requires minimal equipment and may be led by a classroom aide or volunteer parent at minimal cost. Dramatic improvement in participants' weight-for-height status may occur provided that student interest and attendance is maintained over a period of several months.     

Aging in Correctional Custody: Setting a Policy Agenda for Older Prisoner Health Care

An exponential rise in the number of older prisoners is creating new and costly challenges for the criminal justice system, state economies, and communities to which older former prisoners return. We convened a meeting of 29 national experts in correctional health care, academic medicine, nursing, and civil rights to identify knowledge gaps and to propose a policy agenda to improve the care of older prisoners. The group identified 9 priority areas to be addressed: definition of the older prisoner, correctional staff training, definition of functional impairment in prison, recognition and assessment of dementia, recognition of the special needs of older women prisoners, geriatric housing units, issues for older adults upon release, medical early release, and prison-based palliative medicine programs.Among Western nations, mass incarceration is a uniquely American experience.1 At the US prison population''s zenith in 2008, 1 in every 100 American adults was incarcerated, with an incarceration rate of 756 per 100 000 persons.2,3 This rate surpasses that of Russia, which has the next-highest rate at 629 per 100 000 persons.3 Perhaps more surprising than the sheer number of Americans who are incarcerated are the changing demographics of the prison population; the most rapidly growing prisoner age groups are middle aged (45–54 years) and older (≥ 55 years).4 Between 2000 and 2009, the overall US prison population increased 16.3%, and the number of older prisoners increased 79.0%.5,6Through the Eighth Amendment to the US Constitution (which protects against cruel and unusual punishment), prisoners have a right to timely access to an appropriate level of care for serious medical needs.7 Yet many health care and service providers in the criminal justice system are underprepared to provide cost-effective quality care for older adults. Older prisoners disproportionately account for escalating correctional health care costs and create new and costly challenges for the criminal justice system. Prison-based health care systems increasingly must provide care to older persons with multiple, costly chronic medical conditions, such as diabetes, heart failure, cognitive impairment, and end-stage liver disease.8–10 Older prisoners also have higher rates of disability than do younger prisoners, and their overall costs are approximately 3 times as high.9,11 In addition, older prisoners may generate high hidden costs. For example, prisons built to house younger persons may need to be renovated or rebuilt to accommodate an increasing number of older prisoners with disabilities.Beyond legal and moral arguments for attention to the health care needs of older prisoners, we should consider other benefits to society. More than 95% of prisoners are eventually released to the community.12 Many have chronic medical conditions and rely on expensive emergency services or are hospitalized after release.13 Earlier identification of and attention to age-related disabilities and chronic disease could foster independent function in the community through the use of community health care resources. Furthermore, prison programs that improve health and cognitive skills or that target substance abuse have been associated with decreased recidivism (and rearrest).14 Jails and prisons are also important sites for delivery of needed medical care to vulnerable populations with infectious diseases such as HIV, tuberculosis, and hepatitis C. In light of the increasing number and associated costs of older prisoners, our constitutional obligation to provide medical care to prisoners, and the potential benefits to society, it is critical that a policy agenda be set to improve older prisoner health care. This policy agenda can be advanced through the efforts of policymakers, correctional administrators, health professions organizations, and correctional health care organizations.We convened a roundtable meeting in 2011 at John Jay College of Criminal Justice in New York City to identify special considerations for the care of older prisoners and to propose a set of priority areas that need to be addressed in a new policy agenda. We also, when appropriate, identified important gaps in knowledge that should be addressed to better inform a policy agenda. This meeting was the third in a series of roundtable discussions that brought US private- and public-sector correctional health care leaders together with leaders in academic medicine, nursing, and civil rights to discuss topical issues in prison health care, where there are no existing standards. Discussion focused on the development of action items and standards through group consensus. The Jacob and Valeria Langeloth Foundation funded the public–private roundtables, with additional funding from private correctional health care vendors and in-kind contributions from John Jay College of Criminal Justice. The first15 and second16 roundtables addressed patient safety and challenges in contracting for correctional health care services, respectively.     

Pregnancy-Associated Obesity in Black Women in New York City

Objective: To determine weight gain during pregnancy and weight changes postpartum in first-time mothers delivering at or near term. Methods: At about 2 weeks after delivery, 47 adult, Black and Hispanic women provided information on their prepregnancy weight and height and maximum pregnancy weight. Women reinterviewed at 2 and 6 months after delivery reported their most recent weight measurement and the date of that measurement. This information was used to compute each woman's prepregnancy body mass index, pregnancy weight gain, and weight loss postpartum. Information on infant feeding was also collected at each postpartum visit. Results: About 2/3 of the women and 100% of the overweight and obese women gained excessive weight during pregnancy. Weight gain was most marked in women who started pregnancy overweight or obese. At 2 months postpartum, women were on average almost 18 lb above their prepregnancy weight. No additional maternal weight was lost by 6 months postpartum. Most infants were started on formula by 2 weeks of age. At 2 months of age, 85% were fed formula only and 91% of the infants were on WIC. Conclusions: Our results demonstrate a need for interventions to help women avoid obesity by regulating their pregnancy weight gain, losing weight for a longer period postpartum, and initiating and maintaining exclusive breast-feeding.     

A New Audience Segmentation Tool for African Americans: The Black Identity Classification Scale

Many health communications target African Americans in an attempt to remediate race-based health disparities. Such materials often assume that African Americans are culturally homogeneous; however, research indicates that African Americans are heterogeneous in their attitudes, behaviors, and beliefs. The Black Identity Classification Scale (BICS) was designed as a telephone-administered tool to segment African American audiences into 16 ethnic identity types. The BICS was pretested using focus groups, telephone pretests, and a pilot study (n = 306). The final scale then was administered to 625 Black adults participating in a dietary intervention study, where it generally demonstrated good internal consistency reliability. The construct validity of the BICS also was explored by comparing participants' responses to culturally associated survey items. The distribution of the 16 BICS identity types in the intervention study is presented, as well as select characteristics for participants with core identity components. Although additional research is warranted, these findings suggest that the BICS has good psychometric properties and may be an effective tool for identifying African American audience segments.     

Dietary Pattern Classifications and the Association with General Obesity and Abdominal Obesity in Korean Women

ObjectivesThis study was done to identify dietary patterns and determine relationships between obesity and dietary patterns in Korean women.Subjects/methodsUsing 3,742 cases of baseline data from the Korean Health and Genome Study, dietary patterns were identified using factor analysis of data from a validated food frequency questionnaire. Relationships between dietary patterns and obesity were analyzed.ResultsFour dietary patterns were identified: (a) “animal food” (greater intake of meats and fish), (b) “rice-vegetable” (greater intake of steamed rice, tofu, Kimchi, vegetables, dried anchovy, and seaweeds), (c) “bread-dairy” (greater intake of bread, eggs, milk, and dairy products), and (d) “noodle” (greater intake of ramyun, noodles, and Chajangmyeon). The “animal food,” “bread-dairy,” and “noodle” dietary patterns were preferred by younger people with higher education levels (P<0.01), but the “rice-vegetable” dietary pattern was preferred by older people with lower incomes and education levels (P<0.01). In Korean women, dietary patterns were related to abdominal obesity but not obesity. The “rice-vegetable” and “noodle” dietary patterns were associated with an increased risk of abdominal obesity. However, the “bread-dairy” dietary pattern had an inverse relationship with abdominal obesity.ConclusionIn this study we identified four unique dietary patterns in Korean women that were independently associated with abdominal obesity. Abdominal obesity was positively related to the “rice-vegetable” and “noodle” dietary patterns. These finding may be useful in the development of dietary guidelines and the prevention of abdominal obesity in Korean women.     

Agenda Setting During Follow-Up Encounters in a University Primary Care Outpatient Clinic

At the beginning of the medical encounter, clinicians should elicit patients’ agendas several times using open-ended questions. Little is known, however, about how many times physicians really solicit a patient’s agenda during follow-up encounters. The objective was to analyze the number of agenda solicitations by physicians, of agendas initiated by physicians, and of patients’ spontaneous agendas during the beginning and the entire encounter. We analyzed 68 videotaped follow-up encounters at a university primary care outpatient clinic. The number of different types of agenda setting was searched for and analyzed using negative binomial regression or logistic regression models. Physicians solicited agendas a mean ± SD of 0.8 ± 0.7 times/patient during the first 5 minutes and 1.7 ± 1.2 times/patient during the entire encounter. Physicians in 32.4% of encounters did not solicit the patient agenda, and there were never more than two physician’s solicitations during the first 5 minutes. The mean number of physician’s solicitations of the patients’ agenda was 42% lower among female physicians during the first 5 minutes and 34% lower during the entire encounter. The number of agendas initiated by physicians was 1.2 ± 1.2/patient during the beginning and 3.2 ± 2.3/patient during the entire encounter. In 58.8% of the encounters, patients communicated their agendas spontaneously. There were twice as many patient spontaneous agendas (IRR = 2.12, p = .002) with female physicians than with males. This study showed that agenda solicitation with open-ended questions in follow-up encounters does not occur as often as recommended. There is thus a risk of missing new agendas or agendas that are important to the patient.     

三份报纸在上海崇明地区的健康信息传播能力分析及受众认知比较

目的研究不同类型报纸的健康信息传播能力,分析受众认知情况,同时为三份报纸建设健康信息传播能力提出相关对策和建议。方法本次研究分别选取上海崇明地区发行量较大的三份报纸,并抽取样本人群展开调查。采用内容分析法研究样本报纸,使用调查表调查受众认知情况。结果三份报纸在健康栏目的量上:解放日报每月2～3期,新民晚报每周1～2期,新闻晨报每周1期;专业词汇解释频率比上,解放日报为1.23,新民晚报为0.87,新闻晨报为1.14。结论三份报纸在上海崇明地区的健康信息传播能力存在差距,受众对其健康版面的认知存在差异。     

Scientific Quality of Health-Related Articles in Specialty Cannabis and General Newspapers in San Francisco

Recreational cannabis is being legalized in states across the USA. The public relies on popular media for health information about cannabis. We assessed the accuracy of reporting on health effects of cannabis use in GreenState, a specialty publication on cannabis published by the San Francisco Chronicle and the main newspaper using the Index of Scientific Quality for Health Related News Reports. Results were compared using t-tests. Seventeen GreenState articles and four San Francisco Chronicle articles were identified for analysis. Health articles in GreenState scored 2.9 (±1.1 [SD]) Global, with the highest scoring category Applicability (4.5 ± 0.4) and the lowest Precision (2.4 ± 1.0) on a scale of 1–5. In contrast, the San Francisco Chronicle articles received a Global rating of 4.6 (±0.2), ranging from Applicability (5.0 ± 0) to Benefits (3.8 ± 0.9). Articles in the San Francisco Chronicle scored significantly higher in all categories but Benefits which was not significantly different for the San Francisco Chronicle compared with GreenState (3.8 vs. 3.6, p = 0.77). The public, clinicians, and policymakers need to be aware of this pattern and treat information in publications like GreenState with an appropriate level of skepticism until the quality of reporting improves to general journalistic standards.     

Agenda Setting for Health Promotion: Exploring an Adapted Model for the Social Media Era

Background

The foundation of best practice in health promotion is a robust theoretical base that informs design, implementation, and evaluation of interventions that promote the public’s health. This study provides a novel contribution to health promotion through the adaptation of the agenda-setting approach in response to the contribution of social media. This exploration and proposed adaptation is derived from a study that examined the effectiveness of Twitter in influencing agenda setting among users in relation to road traffic accidents in Saudi Arabia.

Objective

The proposed adaptations to the agenda-setting model to be explored reflect two levels of engagement: agenda setting within the social media sphere and the position of social media within classic agenda setting. This exploratory research aims to assess the veracity of the proposed adaptations on the basis of the hypotheses developed to test these two levels of engagement.

Methods

To validate the hypotheses, we collected and analyzed data from two primary sources: Twitter activities and Saudi national newspapers. Keyword mentions served as indicators of agenda promotion; for Twitter, interactions were used to measure the process of agenda setting within the platform. The Twitter final dataset comprised 59,046 tweets and 38,066 users who contributed by tweeting, replying, or retweeting. Variables were collected for each tweet and user. In addition, 518 keyword mentions were recorded from six popular Saudi national newspapers.

Results

The results showed significant ratification of the study hypotheses at both levels of engagement that framed the proposed adaptions. The results indicate that social media facilitates the contribution of individuals in influencing agendas (individual users accounted for 76.29%, 67.79%, and 96.16% of retweet impressions, total impressions, and amplification multipliers, respectively), a component missing from traditional constructions of agenda-setting models. The influence of organizations on agenda setting is also highlighted (in the data of user interactions, organizational accounts registered 17% and 14.74% as source and target of interactions, respectively). In addition, 13 striking similarities showed the relationship between newspapers and Twitter on the mentions trends line.

Conclusions

The effective use of social media platforms in health promotion intervention programs requires new strategies that consider the limitations of traditional communication channels. Conducting research is vital to establishing a strong basis for modifying, designing, and developing new health promotion strategies and approaches.     

HIV/AIDS Coverage in Black Newspapers, 1991-1996: Implications for Health Communication and Health Education

HIV/AIDS coverage in five African American newspapers ( Amsterdam [New York] News , Oakland [California] Post , Washington [District of Columbia] Afro American , Atlanta Inquirer , and Chicago Citizen ) was analyzed from 1991 to 1996. During this period, HIV / AIDS became the leading cause of death of young adult African Americans. This study found that coverage of the disease was most prominent in the New York, Oakland, and Washington, D.C., African American newspapers. Although most of the 201 articles analyzed framed the story primarily as a health issue, a large proportion also exhibited a critical attitude toward the government and the "AIDS establishment" about their commitment to saving the lives of minorities. Articles often conveyed the message that fighting HIV/AIDS first requires substantial action regarding the larger contextual issues--economic, political, and social--that cause health inequities. Alternative theories of cause and treatment, such as the possibility that AIDS was created as an extermination plot against African Americans, or that the drug Kemron, endorsed by the Nation of Islam, was the most promising treatment for HIV, generally were discussed as legitimate even though much evidence exists to refute these theories. These frames reflect distrust and rational concerns rooted in the historicaI context of American race relations, including the legacy of the Tuskegee study.