Publications by authors named "Daniela B Friedman"

165 Publications

An Evaluation of Dementia Dialogues: A Program for Informal and Formal Caregivers in North and South Carolina.

J Appl Gerontol 2021 Jan 20:733464820986671. Epub 2021 Jan 20.

University of South Carolina, Columbia, SC, USA.

In 2019, the University of South Carolina's Office for the Study of Aging (OSA) remodeled the curriculum for the nationally registered Dementia Dialogues program that delivers high-quality education to formal and informal caregivers of persons who exhibit signs and symptoms of Alzheimer's disease and related dementias (ADRD). This study evaluated new knowledge acquired and program satisfaction by North and South Carolina program participants ( = 235) after completing updated modules. Pre/post module survey data were analyzed using means and percentiles, McNemar's test, and paired tests. Results demonstrated significant positive increases in caregiver knowledge attainment, with differences in overall knowledge change in specific modules among caregivers and noncaregivers ( < .0001-<.05). Dementia Dialogues may serve as a useful tool in providing important information that increases caregiver knowledge of persons living with ADRD. Further research is recommended to examine how knowledge improvement translates into caregiving practices.
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http://dx.doi.org/10.1177/0733464820986671DOI Listing
January 2021

A systematic review of psychosocial interventions for older adults living with HIV.

AIDS Care 2020 Dec 10:1-12. Epub 2020 Dec 10.

Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA.

The rapidly growing segment of older adults living with HIV faces unique set of psychosocial challenges that may differ from their younger counterparts. The objective of this review is to systematically examine current published literature on interventions designed to improve the psychosocial wellbeing of older adults living with HIV. A pre-specified search strategy was applied to four databases: PubMed, CINAHL Plus with Text, PsycINFO, and Health Source. Authors reviewed published studies on psychosocial interventions for older adults with HIV and reported psychosocial variables as primary outcomes of the interventions. The final review included nine intervention studies. Psychosocial outcomes measured across multiple studies included depression, quality of life, social support, cognitive functioning, and coping skills. Some studies also measured physical activity, HIV-related discrimination, lack of affordable housing, and access to substance abuse treatment. Our study suggests a paucity of psychosocial intervention research on adults aging with HIV. This review suggests that most psychosocial interventions had small to moderate effects in improving the psychosocial wellbeing of older people living with HIV. Findings highlight the need for clinical, community, and home-based interventions to ensure that individuals can achieve a higher quality of life while aging with HIV.
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http://dx.doi.org/10.1080/09540121.2020.1856319DOI Listing
December 2020

Vaccine acceptance among college students in South Carolina: Do information sources and trust in information make a difference?

medRxiv 2020 Dec 4. Epub 2020 Dec 4.

Background: To control the COVID-19 pandemic, governments need to ensure a successful large-scale administration of COVID-19 vaccines when safe and efficacious vaccines become available. Vaccine acceptance could be a critical factor influencing vaccine uptake. Health information has been associated with vaccine acceptance. For college students who are embracing a digital era and being exposed to multimedia, the sources of COVID-19 vaccine information and their trust in these sources may play an important role in shaping their acceptance of vaccine uptake.

Methods: In September 2020, we conducted an online survey among 1062 college students in South Carolina to understand their perceptions and attitudes toward COVID-19 vaccination. Descriptive analysis and linear regression analysis were used to investigate vaccine information sources among college students and examine how COVID-19 vaccine acceptance was associated with information source and trust level in each source.

Results: The top three sources of COVID-19 vaccine information were health agencies (57.7%), mass media (49.5%), and personal social networks (40.5%). About 83.1% of the participants largely or always trusted scientists, 73.9% trusted healthcare providers, and 70.2% trusted health agencies. After controlling for key demographics, vaccine acceptance was positively associated with scientists as information sources but negatively associated with pharmaceutical companies as sources. Higher trust levels in mass media, health agencies, scientists, and pharmaceutical companies was significantly associated with higher COVID-19 vaccine acceptance. However, trust in social media was negatively associated with vaccine acceptance.

Discussion: College students use multiple sources to learn about upcoming COVID-19 vaccines including health agencies, personal networks, and social media. The level of trust in these information sources play a critical role in predicting vaccine acceptance. Trust in health authorities and scientists rather than social media is related to higher level vaccine acceptance. Our findings echo the call for restoring trust in government, healthcare system, scientists, and pharmaceutical industries in the COVID-19 era and highlight the urgency to dispel misinformation in social media. Effective strategies are needed to disseminate accurate information about COVID-19 vaccine from health authorities and scientific research to improve vaccine communication to the public and promote COVID-19 vaccine uptake.
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http://dx.doi.org/10.1101/2020.12.02.20242982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724671PMC
December 2020

Information uncertainty: a correlate for acute stress disorder during the COVID-19 outbreak in China.

BMC Public Health 2020 Dec 7;20(1):1867. Epub 2020 Dec 7.

Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA.

Background: Individuals' stress in responding to the current COVID-19 pandemic may be exacerbated by information uncertainty driven by inconsistent, unverified, and conflicting news from various sources. The current study aims to test if information uncertainty during the COVID-19 outbreak was related to acute stress disorder (ASD) over and above other psychosocial stressors.

Methods: An anonymous online survey was conducted with 7800 college students throughout China from January 31 through February 11, 2020. Existing scales were modified to measure ASD and six potential stressors including information uncertainty during the COVID-19 outbreak. Hierarchical regression analysis was conducted to assess the unique association of information uncertainty with ASD. To minimize the effect of large sample size and also to get a sense of whether the effects of information uncertainty were similar to people at the center of the epidemic, we repeated the hierarchical regression among 10% of the students who were randomly selected from the entire sample ("10% random sample"; n = 780) and 226 students from Hubei Province where the outbreak started.

Results: Information uncertainty was highly prevalent among the respondents (64%). It was significantly associated with ASD beyond other key variables and potential stressors across three samples. In the hierarchical regression among the entire sample, demographic variables accounted for 9.4% of the variance in ASD. The other five stressors added 5.1% of the variance. The information uncertainty (β = .159; p < .001) explained an additional 2.1% of the variance. Likewise, the information uncertainty explained an additional 2.1 and 3.4% of the variance in ASD beyond all other variables among the 10% random sample (β = .165; p < .001) and the Hubei sample (β = .196; p < .01), respectively.

Conclusion: Information uncertainty is a unique correlate of psychological stress during the COVID-19 outbreak. Reducing information uncertainty is essential not only for halting virus transmission but also for mitigating negative impacts of the pandemic on people's psychosocial wellbeing. Transparent, timely, and accurate communication can reduce public confusion, fear, and stress. Capacity building in governments, communities, and media outlets to prevent, reduce and manage information uncertainty should be a critical part of the response to an emerging global health crisis such as the COVID-19 pandemic.
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http://dx.doi.org/10.1186/s12889-020-09952-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719728PMC
December 2020

Training the next generation of aging and cognitive health researchers.

Gerontol Geriatr Educ 2020 Sep 25:1-17. Epub 2020 Sep 25.

Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL, USA.

Dementia is a growing public health concern, and African Americans and Latinos are disproportionately affected compared to White Americans. Improving cognitive health outcomes and reducing disparities requires a diverse, interdisciplinary workforce. The US Centers for Disease Control and Prevention's Healthy Brain Research Network (HBRN) Scholars Program trained racially/ethnically and gender-diverse scholars through mentored, collaborative research. Entry, exit, and alumni surveys and a Scholar Spotlight Series queried motivation, goals, acquired skills, accomplishments, program impact, and scholar perspectives. Scholars (n = 41) were majority female (n = 31, 75.6%), graduate students (n = 23, 56.1%), and racially/ethnically diverse (n = 20, 48.7%). Scholars primarily represented Medicine (n = 19, 46.3%) and Public Health (n = 12, 29.3%). Exiting scholars (n = 25) secured faculty/professional positions (n = 9, 36.0%), awards/funding (n = 12, 48.0%), and publications (n = 8, 32.0%). Alumni (n = 10) secured cognitive health-related positions/fellowships (n = 7, 70.0%). The HBRN Scholars Program is an adaptable model for other thematic networks to prepare scholars in collaborative skills critical for effective research and practice.
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http://dx.doi.org/10.1080/02701960.2020.1824912DOI Listing
September 2020

Development of a Clinical-Academic-Community Collaboration to Improve Health Literacy.

J Prim Care Community Health 2020 Jan-Dec;11:2150132720957440

University of South Carolina, Columbia, SC, USA.

Limited health literacy is associated with poor patient health outcomes and increased hospitalization rates. Patient-provider communication plays an important role in patient health literacy and the understanding of medical terminology. This study demonstrates how a collaboration between clinical, academic, and community partners was instrumental in the design and implementation of a clinic readiness assessment and a clinic-based pilot intervention to encourage patient-provider communication and improve patient health literacy. A state hospital association, academic research team, and community adult literacy center director collaborated to develop a 60-item clinic readiness assessment and an evidence-informed pilot intervention. The clinic readiness assessment captured clinics' motivation and capacity for pilot implementation and providers' current communication strategies. The intervention centered around AskMe3™ educational materials and involved 2 patient visits (initial and follow-up visits). Data collection instruments for the intervention were administered verbally and included questions about patient demographics and communication needs, and a single-item health literacy measure. Descriptive statistics (frequencies/percentages) were used to analyze results from the clinic readiness assessment and pilot intervention. Establishment of the partnership, and collaborative, iterative development of the clinic readiness assessment and pilot intervention are described. This pilot project resulted in important lessons learned which led to critical modifications that will inform future expansion of the intervention. Collaboration between healthcare leaders, researchers, and community partners is recommended for developing clinic-based health literacy initiatives.
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http://dx.doi.org/10.1177/2150132720957440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495516PMC
September 2020

Improving Adherence to Adjuvant Hormonal Therapy Among Disadvantaged Women Diagnosed with Breast Cancer in South Carolina: Proposal for a Multimethod Study.

JMIR Res Protoc 2020 Sep 3;9(9):e17742. Epub 2020 Sep 3.

Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.

Background: Current clinical guidelines recommend that hormone receptor-positive breast cancer survivors take adjuvant hormonal therapy (AHT) for 5 to 10 years, following the end of definitive treatment. However, fewer than half of patients adhere to the guidelines, and suboptimal adherence to AHT is associated with an increased risk of breast cancer mortality. Research has extensively documented sociodemographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors (eg, knowledge, patient-provider communication) that can be modified and targeted by interventions.

Objective: The goal of this study is to develop and test a theory-based, multilevel intervention to improve adherence to AHT among breast cancer survivors from racially and socioeconomically disadvantaged backgrounds (eg, Medicaid-insured). The specific aims are to (1) explore multilevel (eg, patient, health care system) factors that influence adherence to AHT; (2) develop a theory-based, multilevel intervention to improve adherence to AHT; and (3) pilot test and evaluate the intervention developed in Aim 2.

Methods: For Aim 1, we will recruit breast cancer survivors and health care professionals to participate in semistructured interviews to gain their perspectives about barriers and facilitators to AHT use. We will conduct a directed content analysis of the Aim 1 qualitative interview data. For Aim 2, we will integrate Aim 1 findings and current literature into the design of a multilevel intervention using an Intervention Mapping approach. For Aim 3, we will recruit Medicaid-insured breast cancer survivors to assess the feasibility of the pilot intervention.

Results: From May 2016 to July 2018, we completed interviews with 19 breast cancer survivors and 23 health care professionals in South Carolina. We will conduct a directed content analysis of the qualitative interview data. Results from this analysis will be used, in combination with current literature, to design (Aim 2) and pilot test a theory-based multilevel intervention (Aim 3) in Summer 2021. Results of the pilot are expected for Fall 2021.

Conclusions: This study will provide a deeper understanding of how to improve adherence to AHT, using a novel and multilevel approach, among socioeconomically disadvantaged breast cancer survivors who often experience disproportionate breast cancer mortality.

International Registered Report Identifier (irrid): DERR1-10.2196/17742.
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http://dx.doi.org/10.2196/17742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499167PMC
September 2020

Mentorship and Training to Increase Diversity of Researchers and Practitioners in the Field of Aging and Alzheimer's Disease: A Scoping Review of Program Characteristics.

J Aging Health 2021 Jan 31;33(1-2):48-62. Epub 2020 Aug 31.

Office for the Study of Aging, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.

Diversity is needed within the aging and Alzheimer's disease and related dementias (ADRD) research and practice workforce to comprehensively address health inequities faced by underrepresented minority (URM) older adults. We conducted a scoping review of training programs designed to diversify the pool of researchers and practitioners in the field of aging and ADRD. Online database searches yielded 3976 articles published from 1999 to 2019. Fourteen studies met the inclusion criteria. All programs were from the United States and included URM populations. Nine programs included students, one targeted university faculty, and four targeted clinical staff. Only five programs were guided by theory. Our review identified URMs' desire for culturally diverse and representative mentorship, the need for career development support at various training stages, and the importance of incorporating theory to program design. It also identified key characteristics for future program development, creation of systematic evaluation standards, and opportunities for promotion.
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http://dx.doi.org/10.1177/0898264320953345DOI Listing
January 2021

Factors influencing chemotherapy knowledge in women with breast cancer.

Appl Nurs Res 2020 12 23;56:151335. Epub 2020 Jul 23.

University of South Carolina, College of Nursing, 1601 Greene Street, Columbia 29208, SC, USA. Electronic address:

Background: Chemotherapy knowledge is linked to managing side effects, reducing exposure to potential infection, and adjusting lifestyle behaviors while going through treatment. However, no research exists regarding the influence of patients' personal attributes on chemotherapy knowledge. Aim The aim of this study was to describe the relationships of health literacy and demographics on chemotherapy knowledge among women with breast cancer undergoing treatment.

Method: We used a descriptive, exploratory design with convenience sampling of women with breast cancer receiving intravenous chemotherapy who completed one mandatory education session. Participants completed a demographic questionnaire and three instruments: 1) Rapid Estimate of Adult Literacy - Short Form (REALM-SF); 2) Shortened Test of Functional Health Literacy in Adults (S-TOFHLA); and 3) Leuven Questionnaire on Patient Knowledge of Chemotherapy (L-PaKC). We used univariate linear regression and ANOVA to identify how health literacy and demographics influenced chemotherapy knowledge.

Results: The REALM-SF (p = .022) and S-TOFHLA (p = .023) scores were significantly associated with chemotherapy knowledge. Chemotherapy knowledge scores were affected by marital status (p = .018) and income (p < .001) where married women had significantly higher chemotherapy knowledge scores (M = 92.6, SD = 6.6) than women who were divorced (M = 83.3, SD = 16.7) with a knowledge score difference of -9.3 between the groups (p = .02). Comparisons showed significant differences of chemotherapy knowledge between women with differing income levels.

Conclusions: This study highlights the relevance of considering patients' health literacy and personal attributes such as marital status and income when teaching about chemotherapy.
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http://dx.doi.org/10.1016/j.apnr.2020.151335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722178PMC
December 2020

"Talk About Cancer and Build Healthy Communities": How Visuals Are Starting the Conversation About Breast Cancer Within African-American Communities.

Int Q Community Health Educ 2021 Apr 13;41(3):267-274. Epub 2020 Jul 13.

Department of Health Promotion, Education, and Behavior, University of South Carolina.

African-American (AA) women are at higher risk of breast cancer mortality than women of other races. Factors influencing breast cancer risk, including exogenous environmental exposures, and debate around timing of exposure and dose-response relationship, can cause misunderstanding. Collaboration with priority populations encourages culturally relevant health messaging that imparts source reliability, influences message adoption, and improves understanding. Through six focus groups with AA individuals in rural and urban counties in the southeastern United States, this study used a community-engaged participatory approach to design an innovative visual tool for disseminating breast cancer information. Results demonstrated that participants were generally aware of environmental breast cancer risks and were willing to share new knowledge with families and community members. Recommended communication channels included pastors, healthcare providers, social media, and the Internet. Participants agreed that a collaboratively designed visual tool serves as a tangible, focused "conversation starter" to promote community prevention and education efforts.
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http://dx.doi.org/10.1177/0272684X20942076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854839PMC
April 2021

"You Gotta Choose Your Words Carefully": Findings from Interviews with Environmental Health Scientists about Their Research Translation Perceptions and Training Needs.

J Health Commun 2020 05 6;25(5):454-462. Epub 2020 Jul 6.

Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina, USA.

Scientists are trained to communicate research in a technical manner but often lack the skills to communicate scientific findings to the general public. Effective communication and research translation are increasingly important competencies for researchers and have broader benefits to scientists and society. The aim of the study was to assess the perceptions, experiences, and training needs relative to science communication and research translation of project investigators associated with the Center for Oceans and Human Health and Climate Change Interactions at the University of South Carolina. In-depth, semi-structured interviews were conducted with the Center's investigators. Interview transcripts were coded and analyzed for emergent themes related to science communication and research translation. Investigator descriptions of their research varied in length, and researchers mentioned multiple target audiences. Most investigators preferred in-person and written communication channels and felt "comfortable" communicating uncertain findings to the public despite no formal science communication training. Investigators suggested training focused on plain language development for target communities, assessment of audience needs, and formatting research findings for various groups. Working with multiple target audiences that have preferred communication channels necessitates a comprehensive approach to science communication training to enhance two-way communication between scientists and stakeholders.
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http://dx.doi.org/10.1080/10810730.2020.1785060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416540PMC
May 2020

Implementing Community-Based Prostate Cancer Education in Rural South Carolina: a Collaborative Approach Through a Statewide Cancer Alliance.

J Cancer Educ 2020 Jun 20. Epub 2020 Jun 20.

Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.

The purpose of this study was to evaluate the impact of implementing community-based prostate health education programs in rural communities. Prostate cancer (PrCA) remains one of the most common cancers among men, and a growing body of literature demonstrates that large interracial differences in PrCA incidence and mortality rates consistently disfavor African Americans in comparison to European Americans. It also is evident, despite the overall decrease in cancer death rates in the USA in recent decades, rural areas are experiencing a reduction in death rates much more slowly. In this study, education session content focused on PrCA risk factors, symptoms, screening, healthy diet and exercise, treatment options, and provider communication strategies. Forty individuals participated and completed pre/post-education program surveys to assess changes in PrCA knowledge and cancer decision-making. Participants showed improvements in education and awareness following the session, and overall impressions of the program were consistently positive as exhibited by participants' answers on a satisfaction survey. The findings demonstrate the real need both in terms of research to understand the underlying problem and to provide practical solutions that can be implemented to reverse the current situation. The results obtained support community-based education programs as an effective means of delivering PrCA prevention, screening, and treatment information to rural communities.
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http://dx.doi.org/10.1007/s13187-020-01800-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749809PMC
June 2020

Do words really matter? A focus on communication and aging.

J Women Aging 2020 Jul-Aug;32(4):361-364. Epub 2020 May 18.

Arnold School of Public Health, University of South Carolina , Columbia, South Carolina, USA.

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http://dx.doi.org/10.1080/08952841.2020.1764298DOI Listing
May 2020

How Do African-American Community Members' Perceptions About Environmental Risks of Breast Cancer Compare with the Current State of the Science?

J Cancer Educ 2020 Apr 20. Epub 2020 Apr 20.

Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA.

African-American (AA) women experience higher mortality from breast cancer than any other racial group. Understanding community-held perceptions of environmental contaminants as risk factors for breast cancer can inform the development of tailored prevention and education efforts for improve health outcomes. Six focus groups were conducted with AA participants in two counties in South Carolina, and themes were identified using open and axial coding. Perceived environmental risks for breast cancer most frequently discussed by participants were compared to findings from published systematic reviews. Frequently discussed environmental risk factors by participants were deodorants containing aluminum, plastics, pesticides, and air and water pollution. While perceptions of aluminum and air pollution as risk factors did not align with the state of the science, perceived risk factors of chemicals in plastics and pesticides were found to be in alignment. There is some congruence between perceived environmental risks for breast cancer within the AA community and the current state of the science; however, there is a need to communicate information that reflects current science regarding commonly held misconceptions. Development of evidence-based, clear, and culturally appropriate messaging that reflects the current state of the science is warranted.
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http://dx.doi.org/10.1007/s13187-020-01748-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572772PMC
April 2020

After Ringing the Bell: Receptivity of and Preferences for Healthy Behaviors in African American Dyads Surviving Lung Cancer.

Oncol Nurs Forum 2020 05;47(3):281-291

Ralph H. Johnson VA Medical Center.

Purpose: To explore receptivity of and preferences for risk-reducing health behavior changes among African American survivors of early-stage lung cancer and their family members.

Participants & Setting: 26 African American non-small cell lung cancer survivor-family member dyads were recruited from two cancer programs in the southeastern United States.

Methodologic Approach: Social cognitive theory principles guided the design and implementation of focus groups. Descriptive statistics were used to summarize the data, and thematic analysis was used to interpret the transcripts from the focus groups.

Findings: The following four themes were identified.

Implications For Nursing: Participants emphasized the need for improved provider communication. Pragmatic communication interventions for providers, survivors, and family members may facilitate behavior change and improve outcomes among underserved populations.
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http://dx.doi.org/10.1188/20.ONF.281-291DOI Listing
May 2020

Terms and Measures of Cognitive Health Associated With Dementia and Alzheimer's Disease: A Scoping Review.

Res Aging 2020 Jun-Jul;42(5-6):174-185. Epub 2020 Mar 20.

Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.

(2007) called on the research community to disseminate its work on cognitive aging and cognitive health. The purpose of this scoping review was to (1) identify terminology that cognitive, social, and behavioral scientists use to describe cognitive aging and cognitive health, in association with dementia and Alzheimer's disease, among older adults; (2) demonstrate how such terms are defined; and (3) illustrate how these constructs are measured in research settings. Empirical studies published 2007-2018 were examined for terminology, definitions, disciplinary orientation, and measurement mechanisms. Analysis of the corpus and a detailed review of the terms "cognitive impairment" and "mild cognitive impairment" reveal that formal definitions are provided infrequently and measurement of constructs ranges widely. Overall, the variability in terminology, definitions, and measures reflects a need for greater specificity in research communication, such that cross-disciplinary collaboration can be facilitated.
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http://dx.doi.org/10.1177/0164027520911284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785029PMC
March 2020

Knowledge evaluation instruments for dementia caregiver education programs: A scoping review.

Geriatr Gerontol Int 2020 May 4;20(5):397-413. Epub 2020 Mar 4.

Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.

With the increase in our older adult population, there is a need for dementia training for informal and formal dementia caregivers. The objective of this scoping study is to assess dementia knowledge instruments utilized in educational programs and interventions intended for formal and informal dementia caregivers. Scoping review methodology was used to search PubMed, PsycInfo, CINAHL and Web of Science with tailored database search terms. The search yielded 8101 results, with 35 studies meeting inclusion. Studies were conducted in eight countries, had varying study designs (randomized controlled trials [RCTs] = 9, non-RCTs = 6, one-group study design = 20) and utilized previously published (19) and author developed (16) instruments. Furthermore, the studies were internationally diverse, conducted in the United States (n = 18), Australia (n = 7), UK (n = 3), China (n = 2), Canada (n = 2), Taiwan (n = 1), Brazil (n = 1) and multi-country (n = 1). Only two studies focused on minority populations. While author-developed instruments may be more relevant and timesaving, studies should strive to validate instruments or use previously published instruments to help standardize findings across studies and understand better the effects of educational programs on caregiver knowledge. Geriatr Gerontol Int 2020; 20: 397-413.
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http://dx.doi.org/10.1111/ggi.13901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7748382PMC
May 2020

Cervical cancer screening behaviors and proximity to federally qualified health centers in South Carolina.

Cancer Epidemiol 2020 04 5;65:101681. Epub 2020 Feb 5.

Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States. Electronic address:

Introduction: Lack of participation in cervical cancer screening in underserved populations has been attributed to access to care, particularly among women in rural areas. Federally Qualified Health Centers (FQHCs) were created to address this need in medically underserved populations. This study observed proximity to three health centers in relation to cervical cancer screening rates in South Carolina.

Methods: Data were obtained from FQHC patient visits (from 3 centers) between 2007-2010 and were limited to women eligible for cervical cancer screening (n = 24,393). ArcGIS was used to geocode patients addresses and FQHC locations, and distance was calculated. Modified Poisson regression was used to estimate relative risk of obtaining cervical cancer screening within one yearor ever, stratified by residential area.

Results: Findings differed markedly by center and urban/rural status. At two health clinics, rural residents living the furthest away from the clinic (∼9 miles difference between quartile 4 and quartile 1) were more likely to be ever screened (RRs = 1.05 and 1.03, p-values < 0.05), while urban residents living the furthest away were less likely to be ever screened (RR = 0.85, p-value < 0.05). At the third center, only urban residents living the furthest away were more likely to be ever screened (RR = 1.02, p-value < 0.05).

Conclusions: Increased travel distance significantly increased the likelihood of cervical cancer screening at two FQHC sites while significantly decreasing the likelihood of screening at the 3rd site. These findings underscore the importance of contextual and environmental factors that impact use of cervical cancer screening services.
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http://dx.doi.org/10.1016/j.canep.2020.101681DOI Listing
April 2020

Understanding Community-based HIV/AIDS Service Organizations: An Invaluable Source of HPV-related Cancer Information for At-risk Populations.

J Health Commun 2020 8;25(1):23-32. Epub 2020 Jan 8.

Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA.

To describe non-clinical HIV service providers (NCHSPs) as surrogate seekers and health information mavens for people living with HIV (PLWH), men who have sex with men (MSM), and other vulnerable populations.In May/June 2016, we recruited 30 NCHSPs from three community-based HIV/AIDS service organizations. NCHSPs completed a 118-item self-administered, paper-and-pencil survey about HPV, cancer, and health communication. Data were analyzed using Stata/SE 14.1.Almost all (97%) NCHSPs were surrogate seekers and had looked for HIV/AIDS (97%), STD (97%), and cancer (93%) information. Most (60%) cancer information seekers had looked for information about HPV. The Internet (97%) and healthcare providers (97%) were health information sources almost all NCHSPs trusted. Nearly all NCHSPs (93%) were completely or very confident about their ability to find health information. The mean health information mavenism score (17.4 ± 2.1) was significantly higher than the scale's high-score cutoff (15.0) ( < 0 .001).NCHSPs look for and share health information with the vulnerable populations (e.g., PLWH, MSM) they serve. More research is needed to understand what NCHSPs' know and think about the health information they are sharing with vulnerable populations.
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http://dx.doi.org/10.1080/10810730.2019.1697397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703688PMC
February 2021

Mortality-to-incidence ratios by US Congressional District: Implications for epidemiologic, dissemination and implementation research, and public health policy.

Prev Med 2019 12 1;129S:105849. Epub 2019 Nov 1.

University of South Carolina, Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, United States of America. Electronic address:

The mortality-to-incidence ratio (MIR) can be computed from readily accessible, public-use data on cancer incidence and mortality, and a high MIR value is an indicator of poor survival relative to incidence. Newly available data on congressional district-specific cancer incidence and mortality from the U.S. Cancer Statistics (USCS) database from 2011 to 2015 were used to compute MIR values for overall (all types combined), breast, cervix, colorectal, esophagus, lung, oral, pancreas, and prostate cancer. Congressional districts in the South and Midwest, including MS, AL, and KY, had higher (worse) MIR values for all cancer types combined than for the U.S. as a whole. For all cancers combined, there was a positive correlation between each district's percent of rural residents and the MIR (r = 0.47; p < .001). The MIR for all cancer types combined was lower in districts within states that expanded Medicaid vs. those states that did not expand Medicaid (0.36 vs. 0.38; p < .001). A positive correlation was seen between the proportion of non-Hispanic Black residents and MIR (r = 0.15; p < .01 for all cancers). Lower MIRs were observed in districts in New England and in states that expanded Medicaid. However, there also were some interesting departures from this rule (e.g., Wyoming, South Dakota, parts of Wisconsin and Florida). Rural congressional districts have generally higher MIRs than more urban districts. There is some concern that poorer, more rural states that did not expand Medicaid may experience greater disparities in MIRs relative to Medicaid expansion states in the future.
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http://dx.doi.org/10.1016/j.ypmed.2019.105849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393609PMC
December 2019

A systematic review of interventions for loneliness among older adults living in long-term care facilities.

Aging Ment Health 2020 12 11;24(12):1945-1955. Epub 2019 Oct 11.

Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.

Objectives: This study aimed to review loneliness interventions for older adults living in long-term care (LTC) facilities over the past 10 years, to categorize interventions by type, and to compare effectiveness of loneliness interventions in these settings.

Methods: Systematic review followed PRISMA guidelines. Articles matching search criteria were collected from PubMed, PsycINFO, and Web of Science from 2009 to 2019. The inclusion criteria were as follows: 1) English language, 2) intervention studies with a quantitative measure that compares pre-trial to post-trial changes, 3) loneliness as a primary or secondary outcome 4) subjects age >65, and 5) subjects living in a LTC facility, such as a nursing home, assisted-living, or hospice.

Results: A total of 15 intervention studies qualified for systematic review. Most of these interventions were psychological therapies and leisure/skill development interventions. Approximately, 87% of studies reported significant decreases in loneliness following intervention. Laughter therapy, horticultural therapy, and reminiscence therapy were associated with the greatest decreases in loneliness.

Discussion: Results suggest that, although less common than interventions in the community, there are several effective interventions to reduce loneliness among older adults living in LTC facilities. Lack of standardized measures and high-quality studies limits comparisons between intervention types and generalizability to different populations.
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http://dx.doi.org/10.1080/13607863.2019.1673311DOI Listing
December 2020

An application of the Science Impact Framework to the Cancer Prevention and Control Research Network from 2014-2018.

Prev Med 2019 12 31;129S:105821. Epub 2019 Aug 31.

University of Washington, Department of Health Services, 1959 NE Pacific Street, Magnuson Health Sciences Bldg, Box 357660, Seattle, WA 98195, USA.

The Cancer Prevention and Control Research Network (CPCRN) is a strategic collaborative effort focused on accelerating the dissemination and implementation of evidence-based cancer prevention and control interventions to communities. In 2014, the CPCRN Coordinating Center began collecting information in alignment with the Centers for Disease Control and Prevention's (CDC) Science Impact Framework. The Science Impact Framework is a CDC-developed approach to trace and link CDC science to events and/or actions recognized as influential to public health, beyond peer-reviewed publications. The purpose of this paper is to highlight the impact of CPCRN activities using key indicators guided by the CDC's Science Impact Framework. We reviewed annual progress reports submitted by CPCRN centers from 2014 to 2019 to identify the impact indicators. The CPCRN activities were linked to four domains from the Science Impact Framework and its key indicators: Disseminating Science (presentations, training, general communication, and other communication reports), Creating Awareness (requests for expertise, and feedback), Catalyzing Action (grant applications, partnerships and collaborations, research & development, advocacy groups, office practice/point of care changes, and technology creating), and Effecting Change (building public health practice, creation of registries/surveillance, legal/policy changes, and change instilled). Overall, CPCRN activities demonstrate impact beyond peer-reviewed publications and thus should continue building scientific impact to ultimately influence health outcomes.
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http://dx.doi.org/10.1016/j.ypmed.2019.105821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925321PMC
December 2019

The Experience of Chemotherapy Teaching and Readability of Chemotherapy Educational Materials for Women with Breast Cancer.

J Cancer Educ 2021 Feb;36(1):47-55

College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA.

Chemotherapy is one of the most common forms of treatment for women with breast cancer. While chemotherapy is often effective, managing side effects can be challenging. Chemotherapy education is critical in assisting patients to manage side effects and to improve the treatment experience. However, materials are often not thoroughly assessed for readability and format which could be problematic for patients learning self-care while in treatment. We used a mixed-method design to illuminate chemotherapy teaching and focused on readability and format of education materials. We scored the materials using three readability assessments: (1) Flesch Reading Ease (FRE), (2) Flesch-Kincaid (F-K), and (3) a Simple Measure of Gobbledygook (SMOG). We evaluated the format of the materials using Suitability Assessment of Materials (SAM) guidelines. Lastly, we used thematic analysis to describe the experience of 37 women with breast cancer undergoing chemotherapy education. The mean readability of the materials ranged from "difficult" to "fairly difficult" based on the FRE scoring, and the material was written on a 9th- to 13th-grade reading level. Most of the materials scored as "adequate" using SAM guidelines but lacked incorporation of graphics or illustrations. The thematic analysis revealed three major findings: (1) finding control in learning, (2) receiving unexpected support, and (3) learning in unforeseen ways. Nurses need to supplement chemotherapy education materials with individualized teaching to ensure comprehension. Additionally, nurses and website developers may want to consider implementing culturally appropriate information and use videos to combat challenging readability.
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http://dx.doi.org/10.1007/s13187-019-01596-1DOI Listing
February 2021

Examining the Role of Twitter in Response and Recovery During and After Historic Flooding in South Carolina.

J Public Health Manag Pract 2019 Sep/Oct;25(5):E6-E12

Department of Health Promotion, Education, and Behavior, Arnold School of Public Health (Drs Brandt, Turner-McGrievy, and Friedman and Ms Schrock), and Technology Center to Promote Healthy Lifestyles (TecHealth) (Dr West), University of South Carolina, Columbia, South Carolina; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina (Dr Gentile); and Department of Health and Human Performance, Berea College, Berea, Kentucky (Dr Thomas).

Context: Social media has played an increasing role in the response to emergency situations through information exchange and efforts to promote recovery. Understanding more about how social media users share and re-share information is particularly important to help emergency response entities determine best strategies for expanding reach and impact through social media in disseminating emergency messages.

Objective: This study examined the role and use of Twitter as a response and recovery strategy before, during, and after historic rainfall and flooding in the Midlands region of the greater Columbia, South Carolina, area in October 2015.

Design: A cross-sectional, thematic, and descriptive examination of Twitter data across 4 time periods (before the historic rainfall and flooding, during, immediately after a boil water advisory period, and 6 months later) was conducted.

Setting: Twitter posts containing "#SCFlood" with a focus on the Midlands region were extracted and analyzed.

Results: The most common themes of tweets across all 4 time periods were weather conditions, devastation description, resource distribution, volunteerism, actions to reduce threats to health, and appreciation. Tweets mostly originated from individual users, followed by media outlets, governmental agencies, and nonprofit agencies. Tweets from the first 3 time periods were largely focused on built and natural environment devastation and action to reduce threats to health, and tweets from the fourth time period were primarily focused on cleanup and repair.

Conclusions: Twitter was utilized widely as a communication tool to provide time-sensitive and critical information before, during, and after the event. Ensuring that key social media users have developed disaster communication strategies inclusive of Twitter seems important in aiding response to and recovery from natural disasters.
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http://dx.doi.org/10.1097/PHH.0000000000000841DOI Listing
June 2020

Physical Activity and Brain Health: An Analysis of Messages From Organizations and Caregiver Perceptions.

Gerontol Geriatr Med 2019 Jan-Dec;5:2333721419855794. Epub 2019 Jun 13.

University of South Carolina, Columbia, USA.

Growing research suggests regular physical activity as a strategy for reducing risk of Alzheimer's disease (AD); however, there is little research available regarding public messages about the connection between physical activity and brain health. This study aimed to (a) examine the volume and content of regular physical activity and brain health messages being distributed by national organizations, and (b) explore how informal caregivers perceive and comprehend brain health messages. Methods included (a) a content analysis of 155 online documents related to physical activity and aging that were located on national physical activity organizations' websites, and (b) a thematic analysis of transcripts and observer notes from two focus groups with 10 informal caregivers recruited at a support organization for AD caregivers in the southeastern United States. Content analysis results revealed limited information about the physical activity and brain health connection. Focus group results revealed that caregivers had limited exposure to information about the physical activity and brain health connection and were concerned about the credibility of this information. Further research is needed regarding brain health and physical activity messages and the potential benefits of collaboration among physical activity organizations, researchers, and health care professionals in delivering consistent and credible messages to the public.
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http://dx.doi.org/10.1177/2333721419855794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572898PMC
June 2019

Physical Activity Communication: A Scoping Review of the Literature.

Health Promot Pract 2019 05 4;20(3):344-353. Epub 2019 Mar 4.

2 University of South Carolina, Columbia, SC, USA.

Engaging in regular physical activity can help prevent chronic disease and enhance quality of life. Unfortunately, less than 20% of American adults meet the recommended physical activity guidelines, perhaps indicating ineffective communication efforts around physical activity. In preparation for the release of the second edition of the Physical Activity Guidelines for Americans, and using the physical activity guidelines as a cornerstone of our approach, we conducted a scoping review of physical activity communication research to understand the scholarly efforts related to communicating about physical activity. Using a social-ecological perspective, we identified studies using the keywords physical activity* OR exercise* AND health communication* in three public health and communication databases and retained studies conducted in the United States and published in English from 1995 through 2015. Sixty-seven articles included a mention of physical activity guidelines, a health communication focus, and media channels used in promoting physical activity. Half of the studies were published in health/science communication journals. One third of the studies mentioned physical activity guidelines. Only 19% of the studies featured mental health benefits of physical activity while more than 64% emphasized physical health benefits. Nearly all the studies (96%) mentioned the use of persuasion to encourage engagement in physical activity. More effort is needed to study the influence of communicating physical activity guidelines to the public. Best practices for future physical activity communication are discussed for both researchers and practitioners.
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http://dx.doi.org/10.1177/1524839919834272DOI Listing
May 2019

Health behavior changes in African American family members facing lung cancer: Tensions and compromises.

Eur J Oncol Nurs 2019 Feb 7;38:57-64. Epub 2018 Dec 7.

College of Nursing, University of South Carolina-Salkehatchie Campus, East Campus, P.O. Box 1337, 807 Hampton St., Walterboro, SC, 29488, USA.

Purpose: Behavioral interventions targeting cancer survivors often fail to address the clustering of unhealthy behaviors among family members and friends, and the impact of close relationships on behavior change. The study's aim was to identify factors associated with receptivity and preferences for lifestyle behavior change among family members of African-American survivors of lung cancer.

Methods: Principles of social cognitive theory guided the design. A descriptive, qualitative study recruited 26 African-American family members of lung cancer survivors from two teaching hospitals in the southeastern United States. A 20-item Information Form collected demographic, health status, and health behavior information. Family members participated in one of three semi-structured focus group discussions.

Results: Four major themes emerged: family members and survivors both resisted the caregiver role; dramatic changes evoked by the diagnosis of lung cancer were facilitators and barriers to lifestyle choices; leaning on faith was the primary source of support; and these families live with a constant threat of multiple cancers. Findings emphasize the importance of meaningful conversations among health-care providers, survivors, and family members during the time of diagnosis, treatment, and recovery, so that family members are better prepared to cope with anticipated changes.

Conclusions: This study highlights the stressors that affect family members and sheds light on their unique needs. The stressors limit their ability to change health behaviors. Family members need basic education, skills training, and support related to the lung cancer diagnosis and other cancers. Current methods to provide these services are limited in their accessibility, availability, and effectiveness.
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http://dx.doi.org/10.1016/j.ejon.2018.12.002DOI Listing
February 2019

False-positive mammography and mammography screening intentions among black women: the influence of emotions and coping strategies.

Ethn Health 2020 05 24;25(4):580-597. Epub 2019 Jan 24.

Pitts Radiology, Columbia, SC, USA.

Abnormal mammograms confirmed as benign are known as false-positive mammography (FPM) results. Research indicates that a history of FPM results may be linked to diagnostic delays in Black women, yet much of the research on FPM has focused on White women. The purpose of this study was to examine: 1) The influence of FPM on breast cancer (BrCa) screening beliefs and intentions among Black women and 2) Whether emotional states, personality traits or coping behaviors altered the previously described relationships. BrCa-free, Black women, aged 40 and older who completed screening mammograms in 2016 were recruited for a case-control study from 2016 to 2017. Women with FPM results were cases, and women with normal results served as matched controls. Print surveys assessing demographics, personality traits, emotions, BrCa screening history, BrCa beliefs, and africentric coping behaviors were mailed to participants. The final sample consisted of 118 respondents (55 cases, 63 controls). Ordinary least squares (OLS) models were constructed. Personality traits and emotions were tested as mediators and coping behaviors as moderators of the relationship between FPM results and BrCa beliefs. FPM status was associated with a higher perception of barriers to mammography, and an elevated perception of barriers was associated with lower intentions to complete mammography. Collective coping behaviors functioned as a moderator and were associated with a decreased perception of mammography barriers in women with FPM results. FPM status had a detrimental impact on mammography intention indirectly through the perception of mammography barriers, but the use of africentric coping behaviors moderated the relationship between FPM status and perceived barriers to mammography. Culturally specific research focused on Black women is needed to explore influences on BrCa screening beliefs and mammography completion in this population.
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http://dx.doi.org/10.1080/13557858.2019.1571563DOI Listing
May 2020

How Is Literacy Being Defined and Measured in Dementia Research? A Scoping Review.

Gerontol Geriatr Med 2018 Jan-Dec;4:2333721418812246. Epub 2018 Nov 25.

University of South Carolina, Columbia, USA.

Literacy plays an important role in Alzheimer's disease and related dementias (ADRD); however, less is known about how literacy is being used and defined in ADRD studies. This study reviewed terminology being used to describe types and definitions of literacy and instruments used to assess literacy in ADRD research. Among the 219 studies retrieved from 3 databases, 50 met our inclusion criteria. Literacy terms used in ADRD studies varied: literacy ( = 28), health literacy ( = 9), and dementia literacy ( = 7) were the most often used terms, followed by financial literacy ( = 4), dementia knowledge ( = 3), AD knowledge ( = 2), mental health literacy ( = 2), AD literacy, digital literacy, health literacy about incontinence, and financial knowledge ( = 1 each). Thirty studies did not define literacy terms used. Among the 20 studies defining literacy, definitions were inconsistent across studies even when they used the same term. Surveys ( = 30), open-ended questions, vignettes, or focus groups ( = 10), self-perceived ( = 3) or interviewer assessed ( = 1) literacy levels were used to assess literacy. Ten studies did not specify literacy measurement. Various literacies have been examined in ADRD research with unclear definitions and some inadequate measures. Well-defined terms with valid measures are needed to better understand the role of literacies in ADRD research.
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http://dx.doi.org/10.1177/2333721418812246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256312PMC
November 2018

Experiences of caregivers by care recipient's health condition: A study of caregivers for Alzheimer's disease and related dementias versus other chronic conditions.

Geriatr Nurs 2019 Mar - Apr;40(2):181-184. Epub 2018 Oct 24.

University of Washington, Seattle, Washington, USA.

This study described experiences of caregivers of persons with Alzheimer's disease and other dementias (ADRD) and caregivers of persons with other chronic conditions on self-reported health, type of assistance they provide, perceptions of how caregiving interferes with their lives, and perceived level of support. A secondary analysis was conducted of the 2013 Porter Novelli SummerStyles survey data. Of the 4033 respondents, 650 adults self-identified as caregivers with 11.6% caring for people with ADRD. Over half of all caregivers reported that caregiving interfered with their lives to some extent. The greater the perceived support caregivers reported, the less they thought that caregiving interfered with their lives (p < .001). No significant differences were found between ADRD and non-ADRD caregivers regarding general health, types of assistance they provided, and perceived level of support. These findings have the potential to inform future research and practice in the development of supportive services for caregivers.
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http://dx.doi.org/10.1016/j.gerinurse.2018.09.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469986PMC
August 2019