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Recent Research Publications and Funding
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April 4, 2014 4:00AM
Many underserved school-age children do not meet the recommended guidelines for physical activity. While children ultimately depend on parents, they also look to schools for their access to developmentally appropriate physical activity. The present randomized controlled trial study utilized a community-academic partnered participatory research approach to evaluate the impact of a culturally sensitive, comprehensive, school-based, program, Kids N Fitness(©), on body mass index (BMI), and child physical activity behavior, including: daily physical activity, team sports participation, attending PE class, and TV viewing/computer game playing, among underserved children ages 8-12 (N = 251) in Los Angeles County. All measures were collected at baseline, 4 and 12 months post-intervention. Students who participated in the KNF program had significant decreases in BMI Z-score, TV viewing, and an increase in PE class attendance from baseline to the 12 month follow-up. Our study shows the value of utilizing community-academic partnerships and a culturally sensitive, multi-component, collaborative intervention.
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April 1, 2014 4:00AM
Purpose: This study examined population-specific risk factors that increase emerging adults’ risk of acquiring sexually transmitted infections (STIs), including the human papillomavirus (HPV).
Design and Method: A cross-sectional sample of 335 diverse, emerging adults ages 18 to 24 years was recruited from a health center at a large university in the Southeastern United States. The mean age was 20.6 ± 1.9 years, majority were females (74.0%), and 61.0% were Hispanic.
Results: Findings revealed inconsistent condom use, reasons for not using condoms, and a need for more culturally-specific intervention strategies.
Discussion and Conclusions: Healthcare providers should identify culturally-specific reasons for inconsistent condom use, examine cultural and geographic differences in sexual risk behaviors among groups and communities, and modify communication, educational programs, and interventions accordingly.
Implications for Practice: By adopting a multi-cultural approach to the control of STIs, nurses can address specific cultural attitudes and behaviors that may influence exposure to STIs, including HPV.
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April 1, 2014 4:00AM
Radon as a human carcinogen has been clearly documented and children are an especially vulnerable population due to biophysical characteristics and duration of exposure. An investigation was necessary to determine if health policies exist to protect school children from radon exposure. This study inventoried the states with regulations regarding school radon testing. Nine states, eight with high geographic risk, have school testing policies. The implication of the policy inventory is that 28 high-radon states do not have policies in place to protect school children from radon. The need for well written policy is evident and as states consider public health initiatives, radon testing in schools should be included in that discussion. The authors drafted a public health policy governing testing of radon in Montana schools based on the best practices included in the nine states. The study authors recommend working with the state attorneys general and nursing organizations to adopt the policy.
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April 1, 2014 4:00AM
Background: The treatment of Multiple Chronic Conditions (MCC) is complex for both patients and providers. Used as integrated tools, technology may decrease complexity, remove the barrier of distance to obtain care, and improve outcomes of care. A new platform that integrates multiple technologies for primary health care called mI SMART (Mobile Improvement of Self-Management Ability through Rural Technology) has been developed. The purpose of this paper is to present to development of mI SMART, a nurse-led technology intervention for treating for MCC in primary care. Methods: The creation of mI SMART was guided by the model for developing complex nursing interventions. The model suggests a process for building and informing interventions with the intention of effectiveness, sustainability, and scalability. Each step in the model builds from and informs the previous step. Results: The process resulted in the integrated technologies of mI SMART. The system combines a HIPAA compliant, web-based, structure of mHealth sensors and mobile devices to treat and monitor multiple chronic conditions within an existing free primary care clinic. The mI SMART system allows patients to track diagnoses, medications, lab results, receive reminders for self-management, perform self-monitoring, obtain feedback in real time, engage in education, and attend visits through video conferencing. The system displays a record database to patients and providers that will be integrated into existing Electronic Health Records. Conclusion: By using the model for developing complex nursing interventions, a multifaceted solution to clinical problems was identified. Through modeling and seeking expert review, we have established a sustainable and scalable integrated nurse-led intervention that may increase access and improve outcomes for patients living in rural and underserved areas. The first trial of mI SMART has been completed and evaluated for feasibility, acceptability, and effectiveness in persons in rural areas living with multiple chronic conditions.
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March 28, 2014 4:00AM
As the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents the rationale and design for a randomized clinical trial of a novel interdisciplinary program to reduce disability among low income older adults based on a previous pilot trial of the same design showing strong effect.
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March 28, 2014 4:00AM
BACKGROUND: As the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents the rationale and design for a randomized clinical trial of a novel interdisciplinary program to reduce disability among low income older adults based on a previous pilot trial of the same design showing strong effect.
METHODS: The CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial is a randomized controlled trial in which low income older adults with self-care disability are assigned to one of two groups: an interdisciplinary team of a nurse, occupational therapist, and handyman to address both personal and environmental risk factors for disability based on participants' functional goals, or an attention control of sedentary activities of choice. Both groups receive up to 10 home visits over 4 months.
OUTCOMES: The primary outcome is decreased disability in self-care (ADL). Secondary outcomes are sustained decrease in self care disability as well as improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization. Careful cost tracking and analysis using intervention data and claims data will enable direct measurement of the cost impact of the CAPABLE approach. CAPABLE has the potential to leverage current health care spending in Medicaid waivers, Accountable Care Organizations and other capitated systems to save the health care system costs as well as improving low income older adults' ability to age at home with improved life quality.
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March 25, 2014 4:00AM
Background: Poor physical function and quality of life are ubiquitous post-stroke. Effective interventions to improve physical function and quality of life for stroke survivors are critically needed.
Objective: Examine the effect of a Tai Chi (TC) intervention on physical function and quality of life.
Methods: In a single-blind randomized clinical trial community-dwelling stroke survivors, aged ≥ 50 years and ≥ 3 months post-stroke, were assigned to: Yang style 24-posture TC (n=53), SilverSneakers® (SS, n=44) strength and range of movement exercise, or Usual Care (UC, n=48) for 12 weeks. TC and SS attended a 1-hour class 3 times/week, while UC had weekly phone calls. Standardized measures for Physical Function were the Short Physical Performance Battery (SPPB), Fall Rates and 2-Minute StepTest; and for Quality of Life were the Medical Outcomes Study SF-36, Center for Epidemiological Studies Depression and Pittsburgh Sleep Quality Index.
Results: A total of 145 stroke survivors (47% women, mean age=70 years, time post-stroke=3 years, ischemic stroke=66%, hemiparesis=73%) enrolled. During the intervention, TC participants had 2/3 fewer falls (n=5 falls), than the SS (n=14 falls) and UC (n=15 falls) groups (χ2=5.60, p=0.06). All groups had improvements in the SPPB score (F1,142=85.29, p<0.01), after the 12-week intervention. Post-hoc tests following a significant interaction for the 2-Minute StepTest (F2,142=4.69, p<0.01) indicated TC (t53=2.45, p=0.02) and SS (t44=4.63, p<0.01) groups had significantly better aerobic endurance over time, though the UC group did not (t48=1.58, p=0.12). All groups reported better perceived physical (SF-36 PCS, F1,142=4.15, p=0.04) and mental health (SF-36 MCS, F1,142=15.60, p<0.01), after the intervention. There were no significant within group changes in perceived physical health (p>0.05), while significant improvements in perceived mental health (p < 0.05) were observed within all groups. No significant changes in depressive symptoms or sleep quality were observed (p>0.05). Attrition was 10% (n=14), and intervention adherence rates were 85%.
Conclusions: Goals of stroke rehabilitation are to prevent disability, improve physical function and quality of life. TC and SS led to improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration. Our data suggest that a 12-week TC intervention may be more effective in reducing fall rates than SS or UC. Future studies examining the effectiveness of TC to reduce fall rates; and improve physical function and quality of life for community-dwelling stroke survivors are recommended.
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March 19, 2014 4:00AM
Sexual violence is a significant problem on many college campuses. Bystander education programs have been found to train individuals to act to prevent sexual and partner violence and improve the responses of peers to survivors. Limited evidence suggests that gender differences exist between males and females regarding both attitudes toward, and use of, bystander behavior, with females reporting more supportive attitudes and greater use of bystander behavior. The purpose of this study is to compare male and female college students on attitudes toward date rape, bystander efficacy, intention to act as a bystander, and actual use of bystander behaviors. A secondary aim explored gender differences in theoretically driven bystander behaviors and barriers to acting as a bystander. A convenience sample of 157 full-time undergraduate students aged 18–24 years completed survey measures of attitudes related to sexual and partner violence and willingness to help. Analysis of variance and chi-square were used to compare gender differences in scores. Significant gender differences were found for date rape attitudes, efficacy, and intention to act as a positive bystander. Men reported more rape-supportive attitudes and greater intention to act as a bystander than women, whereas women reported greater levels of bystander efficacy than men. The findings can be used in tailoring genderspecific components of bystander education programs for sexual assault prevention and intervention.
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March 13, 2014 4:00AM
The purpose of this study is to describe the relationships among acculturation, risk behaviors, and reported physical dating violence among Cuban-American ninth grade adolescents. Participants (N=82) completed a questionnaire that assessed their level of acculturation to the U.S. (Americanism), their maintenance of the Hispanic culture (Hispanicism), binge drinking, drug use, sexual intercourse, condom use and physical dating violence victimization. Multiple logistic regression was conducted. Hispanicism was associated with a decrease in odds of reporting physical dating violence victimization. Drug use and not using a condom were associated with an increase in odds of reporting physical dating violence victimization.
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March 12, 2014 4:00AM
The purpose of this study is to describe the relationships among acculturation, risk behaviors, and reported physical dating violence among Cuban-American ninth grade adolescents.