Deaf Persons' English Reading Levels and Associations with Epidemiological,Educational, and Cultural Factors

One hundred six Michigan d/Deaf persons, part of a study evaluating how to improve d/Deaf persons' understanding of cancer prevention recommendations, had reading levels determined using the Test of Reading Comprehension, Syntactic Sentences. Respondents averaged 52 years old, 59% female, 84% Caucasian, 58% married, and 75% Deaf community members. The mean Test of Reading Comprehension, Syntactic Sentences score was 6.1 (women: 6.2, men: 6.0). Higher scores were associated with greater income (p = .02), employment (p = .01), education (high school p = .002, some college p < .001), English use (child at home, teacher in school, at home now: all p < .001), a hearing spouse (p = .003), hard of hearing/d/Deaf father (p = .02), losing hearing after age 20 years, believing smoking is bad (p < .001), speaking with and satisfaction with physicians and nurses (p < .001), good communication with (p = .01), and comfort discussing cancer with doctors (p < .001). Lower scores were associated with using American Sign Language with physicians and nurses (.019) and Deaf community membership (p = .02). In multivariate analysis, higher scores were associated with higher income, college degree, and teacher using English. Reading levels of a predominantly Deaf population were low. Higher income, college degree, and teacher using English were associated with higher reading levels.     

Gender differences in variables associated with sleep quality in chronic tension type headache

We aimed to evaluate gender differences in the relationships between headache features, sleep quality, anxiety, depressive symptoms, and burden of headache in 193 patients (73 percent women) with chronic tension type headache (CTTH). Sleep quality was assessed with the Pittsburgh Sleep Quality Index. Headache features were collected with a four-week diary. The Hospital Anxiety and Depression Scale was used to assess anxiety/depressive symptoms. Headache Disability Inventory was used to evaluate the burden of headache. In men with CTTH, sleep quality was positive correlated with headache frequency (r = 0.310; p = .018), emotional (r = 0.518; p < .001) and physical (r = 0.468; p < .001) burden of headache, and depressive symptoms (r = 0.564; p < .001). In women, positive correlations were observed between sleep quality and headache intensity (r = 0.282; p < .001), headache frequency (r = 0.195; p = .021), emotional burden (r = 0.249; p = .004), and depressive symptoms (r = 0.382; p < .001). The results of stepwise regression analyses revealed that depressive symptoms and emotional burden of headache explained 37.2 percent of the variance in sleep quality in men (p < .001), whereas depressive symptoms and headache intensity explained 17.4 percent of the variance in sleep quality in women (p < .001) with CTTH. Gender differences associated with poor sleep should be considered for proper management of individuals with CTTH.     

Systematic viewing in radiology: seeing more,missing less?

To prevent radiologists from overlooking lesions, radiology textbooks recommend “systematic viewing,” a technique whereby anatomical areas are inspected in a fixed order. This would ensure complete inspection (full coverage) of the image and, in turn, improve diagnostic performance. To test this assumption, two experiments were performed. Both experiments investigated the relationship between systematic viewing, coverage, and diagnostic performance. Additionally, the first investigated whether systematic viewing increases with expertise; the second investigated whether novices benefit from full-coverage or systematic viewing training. In Experiment 1, 11 students, ten residents, and nine radiologists inspected five chest radiographs. Experiment 2 had 75 students undergo a training in either systematic, full-coverage (without being systematic) or non-systematic viewing. Eye movements and diagnostic performance were measured throughout both experiments. In Experiment 1, no significant correlations were found between systematic viewing and coverage, r = ?.10, p = .62, and coverage and performance, r = ?.06, p = .74. Experts were significantly more systematic than students F _2,25 = 4.35, p = .02. In Experiment 2, significant correlations were found between systematic viewing and coverage, r = ?.35, p < .01, but not between coverage and performance, r = .13, p = .31. Participants in the full-coverage training performed worse compared with both other groups, which did not differ between them, F _2,71 = 3.95, p = .02. In conclusion, the data question the assumption that systematic viewing leads to increased coverage, and, consequently, to improved performance. Experts inspected cases more systematically, but students did not benefit from systematic viewing training.     

Family Members' Obstructive Behaviors Appear to Be More Harmful Among Adults With Type 2 Diabetes and Limited Health Literacy

Family members' diabetes-specific obstructive behaviors (e.g., nagging/arguing or getting in the way of patients' self-care) are associated with adults having worse glycemic control (HbA_1C), with diabetes-specific supportive family behaviors protecting against this detrimental effect. Given the role of family members in helping patients with limited health literacy, patients' health literacy status may moderate these relations. The authors tested this hypothesis with 192 adults with type 2 diabetes. Twenty-six percent had limited health literacy, and limited health literacy was associated with more supportive family behaviors (p < .05), but not with obstructive family behaviors or with patients' HbA_1C. Adjusted stratified analyses indicated obstructive family behaviors were more strongly associated with worse HbA_1C among participants with limited health literacy and low supportive family behaviors than for participants with adequate health literacy and low supportive family behaviors (adjusted simple slopes β = 0.70, p = .05 vs. β = 0.36, p = .009). However, there was no association between obstructive family behaviors and HbA_1C in the context of high supportive family behaviors, regardless of health literacy status. Involving family members in adults' self-care without teaching them to avoid obstructive behaviors may be particularly harmful for patients with limited health literacy. Future research should identify intervention content to reduce obstructive family behaviors and identify which supportive family behaviors may be protective.     

Coping and Psychological Distress in Mothers of Adolescents with Type 1 Diabetes

The purpose of this study was to describe coping in mothers of adolescents with type 1 diabetes and to examine the association among mothers’ diabetes-related stress and coping strategies and maternal psychological distress (e.g., symptoms of anxiety and depression), adolescent adjustment (e.g., symptoms of depression, quality of life), diabetes-related family conflict, and glycemic control. One hundred and eighteen mother-adolescent dyads completed measures of diabetes-related stress, coping, symptoms of anxiety and depression, quality of life, and family conflict. Data on glycemic control were collected from adolescents’ medical charts. Single/divorced mothers and mothers of color were significantly more likely to use disengagement coping strategies (e.g., avoidance) than White and married/partnered mothers. Mothers’ use of primary control coping (e.g., problem solving) and secondary control coping (e.g., acceptance) strategies was related to fewer symptoms of anxiety (r = ? .51, ?.39) and depression (r = ? .32, ?.37) and less family conflict (r = ? .22, ?.30, all p < .05). Mothers’ use of disengagement coping strategies was related to greater symptoms of anxiety (r = .30) and depression (r = .27, both p < .01). Further, secondary control coping was found to mediate the relationship between diabetes-related stress and maternal symptoms of anxiety and depression. Maternal coping was not significantly associated with adolescent outcomes. The ways in which mothers of adolescents with type 1 diabetes cope with diabetes-related stress are associated with psychological distress and family conflict. By identifying and improving mothers’ coping through screening and targeted interventions, we may have the potential to improve both maternal and adolescent outcomes.     

Consulting With a Surgeon Before Breast Cancer Surgery: Patient Question Asking and Satisfaction

Research has found a negative association between patient question asking and aspects of their satisfaction. In the context of surgical oncology, the aim of this exploratory study was to test the association between patient question asking and 3 indices of their satisfaction. Participants included 51 women who were newly diagnosed with breast cancer engaged in presurgical consultations with a surgical oncologist from a National Cancer Institute–designated cancer center in the Northeastern United States. Outcomes were patients' postconsultation reports of their satisfaction with the treatment plan, intentions to adhere to the treatment plan, and satisfaction with the surgeon. The main predictor was the frequency of patients' self-initiated questions coded from videotapes of consultations. The frequency of patients' self-initiated questions was negatively associated with their satisfaction with the treatment plan (p = .02), intentions to adhere to the treatment plan (p = .02), and satisfaction with the surgeon (p = .07). Results can be explained in terms of patients' perceptions that the surgeon's information was insufficient or inadequate. Future research needs to identify the specific content of patients' questions and how such content might be associated with satisfaction.     

Diabetes Risk Factor Knowledge Varies Among Multiracial College Students

All racial/ethnic groups are at higher risk for type 2 diabetes compared to whites, but it is unknown if young adults recognize their risk. Risk knowledge and individual risk perception were examined in 1579 multiracial urban college students. Students have little knowledge of diabetes risk factors; identifying less than three of ten. Considerable variation exists in the understanding of risk; only .02 % of Asian, 14.0 % of Hispanic and 22.8 % of black students recognized that their race increased risk. Among those with ≥3 risk factors (n = 541) only 39 % perceived their risk. These under-estimators had lower knowledge scores (p = .03) than those who acknowledged their risk; indicating that the cause of under-estimating risk may be, at least, in part due to a lack of information. There is a pressing need to heighten understanding of type 2 diabetes risk among young adults to decrease the future burden of this disease.     

The association between social network factors and mental health at different life stages

Objectives

Psychosocial factors are important determinants of an individual’s health. This study examines the association between health scores and social network factors on mental health across different life stages.

Methods

Data were drawn from the Household Income and Labour Dynamics in Australia survey for adolescents (n = 1739), adults (n = 10,309) and seniors (n = 2287). Hierarchical regression modelling was applied to examine effects within and across age groups. All the variables were derived from the self-completion questionnaire.

Results

The social network factors were statistically significant predictors of mental health outcomes for all three life stages. For adolescents, the three social network factors were statistically significant with social isolation having the largest impact (β = ?.284, p < .001), followed by social connection (β = .084, p < .001) and social trust having a similar effect (β = .073, p < .001). For adults social isolation had the highest impact (β = ?.203, p < .001), followed by social connection (β = .110, p < .001) and social trust (β = .087, p < .001).The results for seniors were social isolation (β = ?.188, p < .001), social connection (β = .147, p < .001) and social trust (β = .032, p < .05).

Conclusions

After adding the social network factors, the models improved significantly with social isolation playing the most significant role across all life stages, whereas the other social network factors played a differentiated role depending upon the life stage. These findings have practical implications in the design of mental health interventions across different life stages.

     

Intimate partner violence and academic performance: the role of physical,mental, behavioral,and financial health

Undergraduate students of all gender identities are at risk of experiencing intimate partner violence (IPV) victimization. It is known that IPV negatively affects academic performance, yet little is known about the role of health. This study examined if past-year IPV victimization was associated with an increase in students’ self-perception of health interfering with academic performance. Data were drawn from the 2011–2014 National College Health Assessment (N = 84,734). Structural equation modeling was used to examine the relationship between a latent variable of IPV and health impediments to academic performance. The model was a good fit for the data (RMSEA = .012, CFI = .994, TLI = .981). Undergraduate survivors of past-year IPV – and transgender students – were more likely to report impediments to their academic performance: physical assault (0.66, p < .001), sexual assault (0.57, p < .001), sexually transmitted infections (0.42, p < .001), pregnancy (0.38, p < .001), depression (0.38, p < .001), disordered eating (0.36, p < .001), financial problems (0.33, p < .001), anxiety (0.32, p < .001), sleep problems (0.32, p < .001), chronic health problems (0.29, p < .001), drug use (0.29, p < .001), injury (0.25, p < .001), and alcohol use (0.25, p < .001). This demonstrates that IPV has a spiral effect, such that IPV’s impact on health is perceived by students as detrimental to their academics.     

South African abortion attitudes from 2007-2016: the roles of religiosity and attitudes toward sexuality and gender equality

ABSTRACT

Abortion is legal in South Africa, but negative abortion attitudes remain common and are poorly understood. We used nationally representative South African Social Attitudes Survey data to analyze abortion attitudes in the case of fetal anomaly and in the case of poverty from 2007 to 2016 (n = 20,711; ages = 16+). We measured correlations between abortion attitudes and these important predictors: religiosity, attitudes about premarital sex, attitudes about preferential hiring and promotion of women, and attitudes toward family gender roles. Abortion acceptability for poverty increased over time (b = 0.05, p < .001), but not for fetal anomaly (b = ?0.008, p = .284). Highly religious South Africans reported lower abortion acceptability in both cases (Odds Ratio (OR)_anomaly = 0.85, p = .015; OR_poverty = 0.84, p = .02). Premarital sex acceptability strongly and positively predicted abortion acceptability (OR_anomaly = 2.63, p < .001; OR_poverty = 2.46, p < .001). Attitudes about preferential hiring and promotion of women were not associated with abortion attitudes, but favorable attitudes about working mothers were positively associated with abortion acceptability for fetal anomaly ((OR_anomaly = 1.09, p = .01; OR_poverty = 1.02, p = .641)). Results suggest negative abortion attitudes remain common in South Africa and are closely tied to religiosity, traditional ideologies about sexuality, and gender role expectations about motherhood.     

Development and Validation of the Chinese Health Literacy Scale for Chronic Care

This study aims to develop and test the psychometric properties of the Chinese Health Literacy Scale for Chronic Care (CHLCC). This is a methodological study with a sample of 262 patients 65 years of age and older who had chronic illnesses. Pearson's correlation, independent sample t tests, and analyses of variance were used. The CHLCC showed a significant positive correlation with Chinese literacy levels (r = 0.80; p < .001) but was negatively correlated with age (r =?0.31; p <.001). Respondents who were male (t =4.34; p <.001) and who had reached Grade 12 or higher in school (F = 51.80; p <.001) had higher CHLCC scores than did their counterparts. Individuals with high levels of health literacy had fewer hospitalizations than did their counterparts (β =?0.31; incidence rate ratio = 0.73; p <.05). The CHLCC also displayed good internal reliability (Cronbach'sα =0.91) and good test–retest reliability (intraclass correlation coefficient = 0.77; p <.01). The CHLCC is a valid and reliable measure for assessing health literacy among Chinese patients with chronic illness. The scale could be used by practitioners before implementing health promotion and education.     

Identifiable Characteristics and Potentially Malleable Beliefs Predict Stigmatizing Attributions Toward Persons With Alzheimer’s Disease Dementia: Results of a Survey of the U.S. General Public

The general public’s views can influence whether people with Alzheimer’s disease (AD) experience stigma. The purpose of this study was to understand what characteristics in the general public are associated with stigmatizing attributions. A random sample of adults from the general population read a vignette about a man with mild Alzheimer’s disease dementia and completed a modified Family Stigma in Alzheimer’s Disease Scale (FS-ADS). Multivariable ordered logistic regressions were used to examine relationships between personal characteristics and FS-ADS ratings. Older respondents expected that persons with AD would receive less support (OR = 0.82, p = .001), have social interactions limited by others (OR = 1.13, p = .04), and face institutional discrimination (OR = 1.13, p = .04). Females reported stronger feelings of pity (OR = 1.57, p = .03) and weaker reactions to negative aesthetic features (OR = 0.67, p = .05). Those who believed strongly that AD was a mental illness rated symptoms more severely (OR = 1.78, p = .007). Identifiable characteristics and beliefs in the general public are related to stigmatizing attributions toward AD. To reduce AD stigma, public health messaging campaigns can tailor information to subpopulations, recognizable by their age, gender, and beliefs.     

Risky sexual behaviors among sexually active first-year students matriculating at a historically Black college: Is a positive self-image an instigator?

A sample of 498 sexually active first-year students matriculating at a historically Black college in North Carolina was used to determine correlates of risky sexual behaviors. In an Ordinary Least Squares regression, the self-esteem element “I take a positive attitude toward myself” (B = 1.12, p = .05), non-condom use because of partner issues (B = .53, p = .05) and being drunk or high (B = 1.20, p = .001), oral sex (B = 1.74, p = .001), anal sex (B = .61, p = .04), and bisexuality (B = .85, p = .03) all increased the number of these behaviors. Higher scores on the condom usage scale (B = –.38, p = .002) were found to decrease the number of risky sexual behaviors. Illicit drug use was an underpinning of the surprisingly positive relationship between positive self-image and risky sexual behaviors. It was concluded that school-based social workers, mental health care professionals, and community-based prevention providers can play a critical role in the training of peer facilitators, development, and supervision of peer-driven risk-reduction programs to address the complex interplay among self-esteem, sex, and substances.     

A cross-national analysis of the association between years of implementation of opioid substitution treatments and drug-related deaths in Europe from 1995 to 2013

Data at the individual-level provide evidence that opioid substitution treatment (OST) programs protect against mortality for opioid dependent populations. Prior research has not examined the merits of national implementation of opioid substitution programs for reducing mortality at the country-level. This study elucidates longitudinal associations between country-level implementation of opioid substitution treatment programs on mortality rates of drug related deaths (DRD) from 1995 to 2013 in 30 European nations. Cases of DRD were measured using National Definitions for each country from official sources of data. Preliminary analysis of dispersion of cases of DRD using means and variances justified use of the negative binomial regression model with a population offset. Year and country-level fixed effects negative binomial regression models investigated the association between years of implementation of methadone maintenance therapy (MMT), OST in prison, and high dose buprenorphine treatment (HDBT) implementation and mortality rates from drug related deaths after adjusting for unemployment rates, heroin seizures and per capita expenditures on health. Beta coefficients were converted to Incidence Rate Ratios (IRR) and standard errors bootstrapped using non-parametric methods to adjust for bias (SD_bs). The mean mortality rate of DRD was 1.81 from 1995 to 2013. In adjusted models, each additional year of MMT (IRR = .61, SD = .04, p < .001; SD_bs = .08, p < .001), prison OST (IRR = .90, SD = .01, p < .001; SD_bs = .02, p < .001), and HDBT (IRR = .09, SD = .02, p < .001; SD_bs = .02, p < .01) was significantly associated with lower rates of DRDs after adjusting for country and year fixed effects. Implementation of OST programs in the general population and in prison settings may have protected against mortality from drug use at the country-level in Europe from 1995 to 2013.     

Discrimination and Hate Crimes in the Context of Neighborhood Poverty and Stressors Among HIV-Positive African-American Men Who Have Sex with Men

In a sample of HIV-positive African-American men who have sex with men (MSM), we examined neighborhood factors that may contextualize perceived discrimination from three intersecting stigmatized characteristics: race, HIV status, and sexual orientation. HIV-positive African-American MSM (N = 162, mean age = 44, SD = 8) provided information on neighborhood-related stressors and discrimination experiences related to being Black, HIV-positive, or perceived as gay. Residential ZIP codes and US Census data were used to determine neighborhood poverty rates. Regressions, controlling for socio-demographics, indicated that (1) higher neighborhood poverty was significantly related to more frequent experiences with hate crimes (Gay-related: b = 1.15, SE = .43, p < .008); and (2) higher neighborhood-related stressors were significantly related to more frequent discrimination (Black-related: b = .91, SE = .28, p = .001; gay-related: b = .71, SE = .29, p = .01; and HIV-related: b = .65, SE = .28, p = .02) and hate crimes (Gay-related: b = .48, SE = .13, p = .001; and Black-related: b = .28, SE = .14, p = .04). For HIV-positive African-American MSM, higher neighborhood poverty and related stressors are associated with experiencing more discrimination and hate crimes. Interventions for this group should promote individual- and neighborhood-level socioeconomic empowerment and stigma reduction.     

Why Communication Is Crucial: Meta-Analysis of the Relationship Between Safer Sexual Communication and Condom Use

The purpose of this study was to quantitatively synthesize the growing literature on the relationship between safer sexual communication (SSC) among sexual partners and condom use, and to systematically examine a number of conceptual and methodological moderators of this relationship. Data from 53 articles published in 27 journals met criteria for the study. Fifty-five independent effect sizes coded from samples totaling N = 18,529 were meta-analyzed. Results indicate that the mean sample-size weighted effect size of the SSC-condom use relation was r = .22, and a number of conceptual variables were found to moderate this relationship. Specifically, communication about condom use (r = .25) and sexual history (r = .23) had significantly (p < .05) larger effect sizes than communication about safer sex (r = .18). In addition, SSC measures operationalized differently had significantly (p < .05) different effect sizes. From largest to smallest, these were behavioral format (r = .29), intentional format (r = .18), and self-efficacy format (r = .13). Measures that tried to assess persuasion attempts as compared with informational exchanges were not found to have significantly different effect sizes (p > .05). Further, methodological moderators tended to be unrelated to effect size. Implications for the future study of safer sexual communication as well as the importance of emphasizing communication skills in HIV preventive interventions are discussed.     

Measuring the Effectiveness of Mass-Mediated Health Campaigns Through Meta-Analysis

A meta-analytic review was undertaken to examine the effects of mass communication campaigns on changes in behavior, knowledge, and self-efficacy in the general public. A review of the academic literature was undertaken and identified 1,638 articles from 1966 through 2012. Using strict inclusion criteria, we included 63 studies for coding and analyses. Results from these efforts indicated that campaigns produced positive effects in behavior change (r = .05, k = 61) and knowledge (r = .10, k = 26) but failed to produce significant increases in self-efficacy (r = .02, k = 14). Several moderators (e.g., health topic, the theory underlying the campaign) were examined in relation to campaign principles that are prescribed to increase campaign effects. The major findings are reviewed, and the implications for future campaign design are discussed.     

Physical Activity Related Information Sources Predict Physical Activity Behaviors in Adults with Type 2 Diabetes

Physical activity (PA) is a key management strategy for type 2 diabetes. Despite the known benefits, PA levels are low. Whether the low level of PA is related to lack of knowledge or support is not fully understood. This study was conducted to describe where and how often adults with type 2 diabetes receive and seek information related to PA and examine the relationships between the source and quality of PA information with PA behaviors. A series of questions related to the source and quality of PA information were added to a baseline survey distributed to the participants (N = 244) of the Canadian Aerobic and Resistance Training in Diabetes (CARED) study. Physicians and television were found to be the main sources of PA-related information. In our cross-sectional model, sources of PA-related information other than that from health care professionals explained 14% (p = .05) and 16% (p < .05) of the variance for aerobic-based and resistance training behaviors and 22% (p < .01) and 15% (p < .05) for these behaviors in our longitudinal model. Physical activity (PA)-related information is widely available to adults with type 2 diabetes. Neither the quantity nor the quality of the PA information provided by health care professionals predicted PA behavior. These data provide further insight into the modes with which PA can be promoted to adults with type 2 diabetes.     

Spiritual Coping and Anxiety in Palliative Care Patients: A Pilot Study

Patients often rely on spirituality to cope with anxiety, yet it is not known if spiritual coping actually helps patients deal with anxiety. The present study was designed, therefore, to examine this relationship. A series of patients who were referred to the palliative care team at New York University, Langone Medical Center (N = 44) were interviewed about their spiritual coping and anxiety. Anxiety was measured using the first three items of the GAD-7. Fourteen items, which were adapted from existing scales, were used to create the “Beliefs and Activities Spirituality Scale” (BASS), having two subscales: Activities (α = .79) and Beliefs (α = .82). Anxiety had a significant negative correlations with the total BASS (r = ?.56), and the Activities (r = ?.52) and Beliefs (r = ?.42) subscales. The salubrious association of spiritual coping and anxiety remained for the BASS and the Activities subscale, after controlling for demographic variables.