Recent Research Publications and Funding

  •  | April 1, 2013 4:00AM

    Human papillomavirus (HPV) infection is etiologically linked to cancers of the cervix, anus, oropharynx, penis, vagina, and vulva (Parkin & Bray, 2006). The HPV vaccine is a health care breakthrough and an essential element of health promotion in pediatric and adolescent health care for boys and girls (Chaturvedi, 2010). The Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommends vaccinating girls and boys from the age of 9 to 26 years (CDC, 2010). To eliminate HPV-related cancers through HPV vaccination, it is essential to recognize the factors involved in parents’ decision whether to permit their children to get the HPV vaccine (Harper et al., 2006). Indeed, the prevalence of HPV infection and cervical cancer rates continue to increase in African American and Latina women (Kobetz et al., 2010). So, the primary author sought to develop a theory-based survey that was short and simple to use with items that could identify intervention points to address HPV vaccination in populations of children and adolescents with low vaccine rates and those experiencing health disparities.

  •  | March 14, 2013 4:00AM

    Adolescents and young adults have the highest rates of sexually transmitted infections (STIs) in the USA despite national priority goals targeting their reduction. Research on the role of neighborhoods in shaping STI risk among youth has increased in recent years, but few studies have explored the longitudinal effects of neighborhoods on STI acquisition during the adolescent to young adult transition. The aims of this study were to examine: (1) the longitudinal relationships between the neighborhood context (poverty, residential instability, and racial/ethnic concentration) of exposure during adolescence and young adults’ acquisition of chlamydia, and (2) the extent to which sexual risk behaviors and depression over the transition from adolescence to young adulthood mediate the relationship between the neighborhood context of exposure during adolescence and young adults’ acquisition of chlamydia. A longitudinal observational design was employed using data from the National Longitudinal Study of Adolescent Health (Add Health), waves 1–3 (1994–2002). The sample was composed of 11,460 young adults aged 18 to 27 years. Neighborhood measures during adolescence were derived from the 1990 US Census appended to adolescents’ interview data. Chlamydia infection was measured via urine assay at wave 3 and 4.6 % of the young adults in the sample tested positive for chlamydia. Multilevel logistic regression analyses were conducted adjusting for numerous neighborhood and individual risk factors. Multivariate findings indicated exposure to neighborhood poverty during adolescence increased the likelihood of a positive urine test for chlamydia during young adulthood (AOR = 1.23, 95 % CI = 1.06, 1.42), and the association was not mediated by sexual risk behaviors or depression. Further research is needed to better understand the pathways through which exposure to neighborhood poverty contributes to chlamydia over the life course as are comprehensive STI prevention strategies addressing neighborhood poverty.

  •  | March 5, 2013 6:00AM

    OBJECTIVE(S): This study examined the health status of women with a recent history of incarceration and explored if/how women were accessing health care resources at the time immediately following release.

    DESIGN AND SAMPLE: This mixed methods study utilized two phases: (1) a quantitative survey; and (2) qualitative interviewing. Thirty-four women (18 years of age and older, released from incarceration in the last 12 months) participated in the quantitative phase; 11 of those completed the qualitative interviews.

    MEASURES: In phase 1, data were collected on demographics, health history, health status, and health-promoting behaviors. In the second phase, semi-structured interviews were used.

    RESULTS: Women in the study reported below average health status compared with the general population. The major health issues identified by participants included specific health problems affected by incarceration, mental health needs, routine health promotion and maintenance, recovery from substance abuse as a major health concern, and social and environmental barriers to care.

    CONCLUSIONS: Women leaving jail or prison have significant and complex health care needs. This period of transition appears to be an opportune time to offer support, services, and other health-promoting interventions.

  •  | March 5, 2013 6:00AM

    We examined whether the oxytocin receptor gene (OXTR) single nucleotide polymorphism (SNP) rs53576 genotype buffers the combined impact of negative social environments (e.g., interpersonal conflict/constraint) and economic stress on post-traumatic stress (PTS) symptoms and impaired daily functioning following collective stress (September 11th terrorist attacks). Saliva was collected by mail and used to genotype 704 respondents. Participants completed Web-based assessments of pre-9/11 mental health, acute stress 9-23 days after 9/11, the quality of social environments 1 year post-9/11, economic stress 18 months post-9/11, and PTS symptoms and impaired functioning 2 and 3 years post-9/11. Interactions between negative social environments and economic stress were examined separately based on OXTR rs53576 genotype (GG vs. any A allele). For individuals with an A allele, a negative social environment significantly increased PTS symptoms without regard to the level of economic stress experienced. However, for respondents with a GG genotype, negative social environments predicted elevated PTS symptoms only for those also experiencing high economic stress. Gender moderated associations between negative social environments, economic stress, and impaired functioning. The functioning of females was most affected by negative social environments regardless of genotype and economic stress, whereas the functioning of males was differentially susceptible to economic stress depending on OXTR genotype and negative social environments. These findings suggest that it is important to consider the combined impact of gender and ongoing stress in different domains as moderators of genetic vulnerability following collective stress.

  •  | March 1, 2013 6:00AM

    Traditionally, education interventions have been delivered by healthcare personnel. In the Montana Radon Study, digital signage technology (DST) is being evaluated for its effectiveness in delivering health information while clients wait for their appointment. The objective is to make better use of the client’s time in the waiting room and un-burden the client-provider relationship. The purpose of this nested, cross-sectional study was to measure the attitudes and perceptions of waiting room clients to the DST. Survey data was collected over nine-weeks in the winter of 2011-2012 from three health department waiting rooms in Gallatin and Flathead Counties. Participants (n = 110) voluntarily responded to eight questions and were given a pack of sugar-free gum as a token of appreciation. The study was approved by the Montana State University Institutional Review Board. Out of 110 surveys, 92 replied that the system was moderately informative, very informative, or extremely informative. Also, 65 said that they would prefer a mixture of entertainment and health care information. Through this study, the opinion of the public of DST was heard and more can be done to inform clients of health related topics.

  •  | February 26, 2013 6:00AM

    Introduction: Students aged 16–24 years are at greatest risk for interpersonal violence and the resulting short and long-term health consequences. Electronic survey methodology is well suited for research related to interpersonal violence. Yet methodological questions remain about best practices in using electronic surveys. While researchers often indicate that potential participants receive multiple emails as reminders to complete the survey, little mention is made of the sender of the recruitment email. The purpose of this analysis is to describe the response rates from three violence-focused research studies when the recruitment emails are sent from a campus office, researcher or survey sampling firm.

    Methods: Three violence-focused studies were conducted about interpersonal violence among college students in the United States. Seven universities and a survey sampling firm were used to recruit potential participants to complete an electronic survey. The sender of the recruitment emails varied within and across the each of the studies depending on institutional review boards and university protocols.

    Results: An overall response rate of 30% was noted for the 3 studies. Universities in which researcher-initiated recruitment emails were used had higher response rates compared to universities where campus officials sent the recruitment emails. Researchers found lower response rates to electronic surveys at Historically Black Colleges or Universities and that other methods were needed to improve response rates.

    Conclusion: The sender of recruitment emails for electronic surveys may be an important factor in response rates for violence-focused research. For researchers identification of best practices for survey methodology is needed to promote accurate disclosure and increase response rates.

  •  | February 24, 2013 6:00AM

    Objective: To discuss how the effects of culture, economy, and geographical location intersect to form a gestalt triad determining health-related disparities in rural areas.

    Methods: We critically profile each component of the deterministic triad in shaping current health-related disparities in rural areas; evaluate the uniquely composed intersections of these disparities in relation to Human Papillomavirus (HPV)-related cancer prevention in three isolated rural Georgia counties; and develop implications for future leadership in rural healthcare research, policy, and practice.

    Results: The deterministic triad of culture, economy, and geographical location is unique to a rural community, and even if two rural communities experience the same health disparity, each community is likely to have a discretely different composition of cultural, economic, and geographic determinants.

    Conclusion: The deterministic triad presents a challenge for health policymakers, researchers, and practitioners trying to develop health-related interventions that are equitable, efficacious, and practical in low-resource rural communities. The situation is worsened by the limited opportunities for employment, which leads to greater disparities and creates propagating cultural norms that further reduce access to healthcare and opportunities for sustainable health promotion.

  •  | February 18, 2013 6:00AM

    Objective. To describe a comprehensive strategy for implementing an effective diabetes self-management support intervention incorporating goal-setting and followup support in community health clinics (CHCs) serving vulnerable patients. Methods. The Replicating Effective Programs (REP) framework was applied to develop an intervention strategy. In order to create a strategy consistent with the REP framework, four CHCs engaged in an iterative process involving key-informant interviews with clinic staff, ongoing involvement of clinic staff facilitating translational efforts, feedback from national experts, and an instructional designer. Results. Moving through the REP process resulted in an implementation strategy that aims to facilitate commitment, communication, and change at the clinic level, as well as means of providing interactive, time-limited education about patient behavior change and support to health care providers. Conclusion. The REP offered a useful framework for providing guidance toward the development of a strategy to implement a diabetes self-management intervention in CHCs serving medically underserved and underrepresented patient populations.

  •  | February 1, 2013 6:00AM

    The purpose of this cross-sectional cohort study was to evaluate the relationship between the number of OR personnel involved in a surgery and subsequent postoperative outcomes. We collected data from a sample of general surgery patients (N = 911) by using the American College of Surgeons National Surgical Quality Improvement Project processes. Data obtained from electronic medical records about the number of different personnel involved in the surgeries were used to create total OR staffing and nurse staffing variables for each surgery. Two associations approached statistical significance after we controlled for significant risk factors, including OR duration. A higher number of total nursing personnel involved in a surgical procedure was associated with any postoperative complication at the P = .095 level. A higher number of total OR personnel was associated with surgical site infections at the P = .057 level. We recommend further evaluation of these measures in multiple hospital settings.

  •  | February 1, 2013 6:00AM

    Background: Physical activity reduces recurrent stroke risk, yet suitable community-based programs are lacking. Tai Chi (TC) and SilverSneakers® (SS) can be easily adapted for persons with disabilities. TC integrates physical movements with mindfulness, while SS focuses on strength and range of movement.

    Purpose: To examine the effects of TC and SS interventions on physical functioning compared to Usual Care (UC).

    Methods: A randomized trial was conducted among stroke survivors (n=145), aged ≥ 50 years, and at ≥ 3 months post-stroke (TC, n=53; SS, n=44; or UC, n=48). TC and SS groups attended a 1-hour class 3X/week for 12 weeks. The UC group received a weekly phone call along with written materials for participating in community-based physical activity. The Short Physical Performance Battery (SPPB) assessed balance, gait speed, and lower body strength; a two-minute step-in-place test (StepTest) assessed aerobic endurance. The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) assessed amount of self-reported physical activity. Clinically meaningful changes in SPPB (small=0.5 points, substantial=1.0 points), and gait speed (small=0.05 m/sec, substantial=0.10 m/sec) were examined. Data were analyzed using 2 (time) X 3 (group) ANOVAs.

    Results: Subjects (47% women) were on average 70±10 years old, and 37±48 months post-stroke. The majority were married (58%), White (79%), college educated (79%), retired (80%), reporting an ischemic stroke (66%) with hemiparesis (73%). All groups reported a similar amount of physical activity (PASIPD=14.8±11.0 MET hrs/day, F2,142=1.04, p=0.36); and had substantial improvements in SPPB score (F1,142=85.29, p<0.01), with small improvements in gait speed (F1,142=25.97, p<0.01). There was a significant group by time interaction for the StepTest (F2,142=4.69, p<0.01); TC (t53=2.45, p=0.02) and SS (t44=4.63, p<0.01) had significantly better aerobic endurance over time, while this was not observed in the UC group (t48=1.58, p=0.12).

    Conclusions: A goal of stroke rehabilitation is to prevent disability and declines in physical functioning. TC and SS improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration.