Recent Research Publications and Funding

  •  | October 1, 2008 4:00AM

    PURPOSE: The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study. METHODS: Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included story-telling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period. RESULTS: Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME. CONCLUSIONS: The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions usinga culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.

  •  | October 1, 2008 4:00AM

    The new human papillomavirus (HPV) vaccine is a research breakthrough for pediatric/adolescent health to prevent cervical cancer and related morbidity. The annual heath care cost for the treatment of cervical cancer and genital warts is estimated to be more than three billion dollars a year. The new HPV vaccine has incredible potential to improve reproductive health promotion, reduce health care costs, and close health care disparity gaps. However, issues both for and against the new HPV vaccine, including mandating vaccination, high cost of the vaccine, the short duration of protection offered, and the perceived promotion of sexual activity, cause confusion. Pediatric nurses, including those in advanced practice, benefit by understanding the pros and cons of these issues in advocating for their patients.

  •  | September 30, 2008 4:00AM

    Introduction: This study examines risks for high blood pressure (BP) among undiagnosed African American mothers and daughters, because African American children are at risk for hypertension due to familial influences. Method: This study was cross-sectional in design and included 70 African American mother and daughter participants from the Detroit metropolitan area. Results: BP readings clinically diagnostic of hypertension were found for mothers (25.7%) and daughters (54.3%), although they were undiagnosed. Many participants with BP readings in pre-hypertension or hypertension categories were overweight or obese (mothers, 90.9%; daughters, 50.2%). Fewer underweight or normal-weight mothers (25.0%) and daughters (64.3%) had BP readings indicative of hypertension. Lower diastolic BP was associated with higher body mass index (BMI) among mothers (r = -.34, P = .045). Higher systolic BP was positively related to potassium consumption among daughters and total African Americans (r = .55, P = .005 and r = .41, P = .003, respectively).  

  •  | September 30, 2008 4:00AM

    The purpose of this study was to examine non-fatal strangulation by an intimate partner as a risk factor for major assault, or attempted or completed homicide of women. A case control design was used to describe non-fatal strangulation among complete homicides and attempted homicides (n = 506) and abused controls (n = 427). Interviews of proxy respondents and survivors of attempted homicides were compared with data from abused controls. Data were derived using the Danger Assessment. Non-fatal strangulation was reported in 10% of abused controls, 45% of attempted homicides, and 43% of homicides. Prior non-fatal strangulation was associated with greater than six-fold odds (odds ratio [OR] 6.70, 95% confidence interval [CI] 3.91–11.49) of becoming an attempted homicide, and over seven-fold odds (OR 7.48, 95% CI 4.53–12.35) of becoming a completed homicide. These results show non-fatal strangulation as an important risk factor for homicide of women, underscoring the need to screen for non-fatal strangulation when assessing abused women in emergency department settings.  

  •  | September 1, 2008 4:00AM

    OBJECTIVE: The objective of this study was to test the feasibility and impact of a 2-tiered motivational intervention, the Restorative Care Intervention for the Cognitively Impaired (Res-Care-CI), on nursing home residents with moderate to severe cognitive impairment. DESIGN: Single-group repeated measures study. PARTICIPANTS AND SETTING: Participants were 46 nursing home residents with moderate to severe cognitive impairment at a single nursing home designed for individuals with dementia. MEASUREMENTS: Descriptive data, the Barthel Index, the Physical Activity Survey in Long-Term Care, actigraphy, the Cornell Scale for Depression in Dementia, and the Cohen-Mansfield Agitation Inventory (short form). RESULTS: There was significant improvement in resident mood (F = 3.26, P = .02) and behavioral symptoms (F = 3.21, P = .04), but no significant change in physical function (F = 0.897, P = .43) or overall reported physical activity (F = 0.931, P = .43). There was a significant decrease in physical activity measured by actigraphy in 35 participants (F = 4.93, P = .005). CONCLUSIONS: Restorative care interventions were feasible to implement, and demonstrated improvements in mood and behavior, when used with nursing home residents with moderate to severe cognitive impairment

  •  | September 1, 2008 4:00AM

    Prostate cancer affects African Americans at a higher rate than any other ethnic group in the United States. Prostate cancer does not only affect the man with the disease but also affects those individuals who are closest to him, such as his family and friends. Open communication is valuable in coping with stressors that are affiliated with chronic illnesses. This article focuses on family and friend social support of men with prostate cancer. Data analysis revealed that support from family members and friends plays an important role in how men cope with their treatment and recovery from prostate cancer.

  •  | September 1, 2008 4:00AM

    Prostate cancer is the most common cause of cancer in men and the second leading cause of cancer deaths. African-American men bear a disproportionate burden of prostate cancer diagnosis and mortality. Current guidelines for prostate cancer screening differ among various medical organizations. Therefore, it is important that African-American men have the appropriate information needed to make informed decisions about prostate cancer screening. Unfortunately, a large percentage of African-American men could potentially be excluded from receiving culturally appropriate prostate cancer education. Therefore, a study was designed to recruit and intervene with African-American men and barbershops for increasing prostate cancer screening decision-making. The purpose of this study was to learn effective strategies for recruiting African-American barbershops for prostate cancer education and to determine barbershop proprietors' willingness to allow their barbershops to be used for research. In this paper, we present the outcomes of our recruitment methods for African-American barbershops, including a comparative description of participating and nonparticipating barbershops using the iMark Data System. One-hundred percent of the surveyed proprietors reported that they would allow their clients to learn about prostate cancer. Ninety-six percent reported they would consider allowing their clients to have access to handheld computers to learn about prostate cancer. We conclude from this study that African-American barbershops in general are welcoming environments in which to implement community-based prostate cancer education and public health research.

  •  | September 1, 2008 4:00AM

    The ability to make sense of events in one's life has held a central role in theories of adaptation to adversity. However, there are few rigorous studies on the role of meaning in adjustment, and those that have been conducted have focused predominantly on direct personal trauma. The authors examined the predictors and long-term consequences of Americans' searching for and finding meaning in a widespread cultural upheaval--the terrorist attacks of September 11, 2001--among a national probability sample of U.S. adults (N=931). Searching for meaning at 2 months post-9/11 was predicted by demographics and high acute stress response. In contrast, finding meaning was predicted primarily by demographics and specific early coping strategies. Whereas searching for meaning predicted greater posttraumatic stress (PTS) symptoms across the following 2 years, finding meaning predicted lower PTS symptoms, even after controlling for pre-9/11 mental health, exposure to 9/11, and acute stress response. Mediation analyses suggest that finding meaning supported adjustment by reducing fears of future terrorism. Results highlight the role of meaning in adjustment following collective traumas that shatter people's fundamental assumptions about security and invulnerability.

  •  | September 1, 2008 4:00AM

     As the body of evidence linking disparities in the health of urban residents to disparate social, economic and environmental contexts grows, efforts to delineate the pathways through which broader social and economic inequalities influence health have burgeoned. One hypothesized pathway connects economic and racial and ethnic inequalities to differentials in stress associated with social and physical environments, with subsequent implications for health. Drawing on data from Detroit, Michigan, we examined contributions of neighborhood-level characteristics (e.g., poverty rate, racial and ethnic composition, residential stability) and individual-level characteristics (e.g., age, gender) to perceived social and physical environmental stress. We found that neighborhood percent African American was positively associated with perceptions of both social and physical environmental stress; neighborhood percent poverty and percent Latino were positively associated with perceived physical environmental stress; and neighborhood residential stability was negatively associated with perceived social environmental stress. At the individual level, whites perceived higher levels of both social and physical environmental stress compared to African American residents of the same block groups, after accounting for other variables included in the models. Our findings suggest the importance of understanding and addressing contributions of neighborhood structural characteristics to perceptions of neighborhood stress. The consistency of the finding that neighborhood racial composition and individual-level race influence perceptions of both social and physical environments suggests the continuing importance of understanding the role played by structural conditions and by personal and collective histories that vary systematically by race and ethnicity within the United States.

  •  | August 31, 2008 4:00AM

    AIM: This paper is a report of a study to explore women's perceptions of and experiences with breast cancer treatment decision-making in managed care organizations (MCOs). BACKGROUND: Managed care organizations are the predominant form of employer-sponsored healthcare insurance in the United States of America. These healthcare financing entities minimize cost by streamlining healthcare delivery and may impose choice restrictions. The extent of these restrictions has not previously been studied from an in-depth patient perspective. METHOD: A qualitative descriptive approach was adopted using interviews with a purposive sample of 14 managed care enrollees diagnosed with breast cancer at all stages. The data were collected between 2003 and 2005. Data analysis involved a reflexive process of transcript reading, categorization, data reduction and interpretation. FINDINGS: The findings are presented as a single theme: 'decisional conflict in managed care', with two distinct categories: decisions regarding (1) the MCOs and (2) treatment. MCO selection was perceived to be limited by employer constraints, cost issues or healthcare plan providers. For study participants, selecting a MCO was less difficult than issues surrounding treatment decision-making. Women reported that their most important treatment-related decisions surrounded diagnosis and involved selecting a treatment facility and provider. Once a satisfactory facility and provider were selected, these women preferred to defer treatment decisions to their healthcare providers. CONCLUSION: Decision interventions should be focused on assisting women with provider and treatment facility selection early in diagnosis. Our findings might also serve as a basis for policy/practice changes to address healthcare financing limitations and to expand cancer treatment-related choices while providing desired treatment decision-making support.