Recent Research Publications and Funding

  •  | February 9, 2009 6:00AM

     Background National or state-level estimates on trends in the prevalence of chronic low back pain (LBP) are lacking. The objective of this study was to determine whether the prevalence of chronic LBP and the demographic, health-related, and health care–seeking characteristics of individuals with the condition have changed over the last 14 years.

    Methods A cross-sectional, telephone survey of a representative sample of North Carolina households was conducted in 1992 and repeated in 2006. A total of 4437 households were contacted in 1992 and 5357 households in 2006 to identify noninstitutionalized adults 21 years or older with chronic (>3 months), impairing LBP or neck pain that limits daily activities. These individuals were interviewed in more detail about their health and health care seeking.

    Results The prevalence of chronic, impairing LBP rose significantly over the 14-year interval, from 3.9% (95% confidence interval [CI], 3.4%-4.4%) in 1992 to 10.2% (95% CI, 9.3%-11.0%) in 2006. Increases were seen for all adult age strata, in men and women, and in white and black races. Symptom severity and general health were similar for both years. The proportion of individuals who sought care from a health care provider in the past year increased from 73.1% (95% CI, 65.2%-79.8%) to 84.0% (95% CI, 80.8%-86.8%), while the mean number of visits to all health care providers were similar (19.5 [1992] vs 19.4 [2006]).

    Conclusions The prevalence of chronic, impairing LBP has risen significantly in North Carolina, with continuing high levels of disability and health care use. A substantial portion of the rise in LBP care costs over the past 2 decades may be related to this rising prevalence.

  •  | February 1, 2009 6:00AM

    BACKGROUND: This study investigates the relationships between health insurance coverage and prescription contraceptive use among women 18-24 years of age at risk for unintended pregnancy.

    STUDY DESIGN: Data from the 2002 National Survey of Family Growth were analyzed. The sample comprised 1049 women 18-24 years of age at risk for unintended pregnancy. Multivariate logistic regression analysis was employed to examine the likelihood of prescription contraceptive use (1) between uninsured women versus ones with private insurance, Medicaid or another form of government insurance and (2) between those who had consistent versus inconsistent insurance coverage, after adjusting for a range of sociodemographic and sexual health factors.

    RESULTS: Twenty percent of the participants were uninsured and over 30% had inconsistent coverage. Only 55% were currently using prescription contraceptives. In multivariate analyses, young women with private insurance or Medicaid were more likely than the uninsured to use prescription contraceptives. No significant differences in prescription contraceptive use were found between other forms of government insurance and uninsurance or between consistent and inconsistent coverage.

    CONCLUSIONS: Access to comprehensive health insurance should be considered one strategy to address the high rates of unintended pregnancy among this vulnerable population.

     

  •  | February 1, 2009 6:00AM

     This secondary analysis examined relationships between the environment and adherence to a walking intervention among 252 urban and suburban, midlife African American women. Participants received an enhanced or minimal behavioral intervention. Walking adherence was measured as the percentage of prescribed walks completed. Objective measures of the women's neighborhoods included walkability (land use mix, street intersection density, housing unit density, public transit stop density), aesthetics (physical deterioration, industrial land use), availability of outdoor (recreational open space) and indoor (recreation centers, shopping malls) walking facilities/spaces, and safety (violent crime incidents). Ordinary least squares regression estimated relationships. The presence of one and especially both types of indoor walking facilities were associated with greater adherence. No associations were found between adherence and other environmental variables. The effect of the enhanced intervention on adherence did not differ by environmental characteristics. Aspects of the environment may influence African American women who want to be more active.

  •  | February 1, 2009 1:00AM

    The study's purpose was to describe and compare depression, anxiety, and quality of life, by degree of relationship, between closely related and distantly related survivors (persons close to the suicide victim, or "suicide survivors"; N = 60) during the acute phase of bereavement (within 1 month of the death). The close relationship category included spouses, parents, children, and siblings, whereas the distant relationship category included in-laws, aunts/uncles, and nieces/nephews. Analysis of covariance examined differences between the two groups on the symptom measures. Results indicate that, after controlling for age and gender effects, closely related survivors had significantly higher mean levels of depression and anxiety and had lower levels of mental health quality of life. There were no statistically significant differences on the physical health quality of life subscale.  

  •  | January 31, 2009 6:00AM

    This paper describes the importance of a life management enhancement (LME) group intervention for older minority women in developing personal control and self-confidence in social relationships as they overcome homelessness. Women in the treatment group showed significantly greater personal control and higher levels of self-confidence following the six-week intervention than women in the control group. Increasing personal control and developing self-confidence in social relationships can help individuals achieve desired outcomes as a result of their actions, efforts, and abilities. These attributes can help women increase and sustain appropriate coping methods and overcome homelessness.  

  •  | January 1, 2009 6:00AM

    Heart failure (HF) is a growing public health problem affecting approximately 23 million people worldwide. Treatment options for advanced HF patients have moved beyond pharmacologic therapy to include left-ventricular assist devices (LVADs). Patients with an LVAD must manage a complex regimen of care. This article proposes the use of self-care deficit nursing theory (SCDNT) as a framework to identify and organize the care needs of patients with an LVAD from a nursing perspective. Within SCDNT, self-care refers to actions designed to meet self-care requisites to achieve regulatory goals. When formalized, self-care requisites have two components: the general action to be taken and a "factor" to be controlled. The reformulation of health-deviation self-care requisites common to LVAD patients are presented and may serve as an exemplar for other technology-assisted living situations. The strengths and limitations of using the SCDNT for patients with such complex needs, as well as implications for clinical practice, research, and advancement of nursing science, are examined.

  •  | January 1, 2009 6:00AM

    PURPOSE: We examined the prevalence of recent HIV testing among sexually active adult Black women in the United States and the social, behavioral, and health care factors associated with their receipt of these services.

    METHODS: Data from the 2002 National Survey of Family Growth were obtained. Our analyses focused on 1,122 sexually active non-Hispanic Black women aged 18-44 years. Descriptive and multivariate logistic regression analyses were conducted on the total sample of women and on 3 subsamples of women, stratified by age group.

    MAIN FINDINGS: Only 29% of the total sample of women reported recent HIV testing. Younger age and recent Pap testing were positively associated with recent HIV testing, whereas uninsurance and no recent pregnancy were negatively associated with recent HIV testing. Unique factors of recent HIV testing also were revealed for each age group.

    CONCLUSIONS: A low prevalence of Black women received HIV testing in 2001 and 2002. Efforts to facilitate access to and utilization of health care are needed because these factors were associated with HIV testing. Public health messages to increase HIV testing among this vulnerable population of women also need to consider the factors unique to each age group.

     

    HIV, HIV
  •  | December 31, 2008 6:00AM

    Regulatory process may be altered in response to the intrauterine environment, leading to the development of altered growth trajectory and disease later in life. Previously, our lab reported reduced leptin levels in pregnant hypertensive Sprague-Dawley rat dams with placental insufficiency. The purposes of this study were to investigate the relationship between leptin levels, growth and hypertension in two generations of offspring exposed to placental insufficiency. Leptin levels were significantly different only at 12 weeks in female first generation offspring (p < 0.05). Variations in postnatal body and organ weights were evident in first generation females at 3 and 12 weeks of age. There were no significant correlations with plasma leptin levels and systolic blood pressure in offspring groups at any age point. Our findings indicate that fetal exposure to maternal hypertension and hypoleptinemia is associated with altered leptin and growth patterns in mature female offspring and not perpetuated to a second generation.  

  •  | December 31, 2008 6:00AM

    The cognitive function of breast cancer survivors (BC, n = 52) and individually matched healthy controls (n = 52) was compared on a battery of sensitive neuropsychological tests. The BC group endorsed significantly higher levels of subjective memory loss and scored significantly worse than controls on learning and delayed recall indices from the Rey Auditory Verbal Learning Test (AVLT). Defining clinically significant impairment as scores at or below the 7th percentile of the control group, the rate of cognitive impairment in the BC sample was 17% for total learning on the AVLT, 17% for delayed recall on the AVLT, and 25% for either measure. Findings indicate that a sizeable percentage of breast cancer survivors have clinically significant cognitive impairment.  

  •  | December 18, 2008 6:00AM

    Violence against women is a major public health concern. This paper describes an educational strategy to increase nursing students’ understanding of the experience of violence and to foster recognition and intervention with victims of violence. Students in an elective course were asked to critically reflect on the personal stories of victims/survivors of violence. The assignment provided four learning opportunities that include examination of societal myths on sexual victimization, understanding the lived experience of the victim, exploration of personal beliefs and values, and the relationship of the individual’s experience to theoretical content of the course. Students gave permission for the use of quotes from papers to illustrate the learning opportunities.