Publications by authors named "Frances McCarty"

60 Publications

National Center for Health Statistics Data Presentation Standards for Proportions.

Vital Health Stat 2 2017 Aug(175):1-22

The National Center for Health Statistics (NCHS) disseminates information on a broad range of health topics through diverse publications. These publications must rely on clear and transparent presentation standards that can be broadly and efficiently applied. Standards are particularly important for large, cross-cutting reports where estimates cannot be individually evaluated and indicators of precision cannot be included alongside the estimates. This report describes the NCHS Data Presentation Standards for Proportions. The multistep NCHS Data Presentation Standards for Proportions are based on a minimum denominator sample size and on the absolute and relative widths of a confidence interval calculated using the Clopper-Pearson method. Proportions (usually multiplied by 100 and expressed as percentages) are the most commonly reported estimates in NCHS reports.
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August 2017

Racial and Ethnic Differences in a Linkage with the National Death Index.

Ethn Dis 2017 20;27(2):77-84. Epub 2017 Apr 20.

National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, United States.

Objectives: Differences in the availability of a Social Security Number (SSN) by race/ethnicity could affect the ability to link with death certificate data in passive follow-up studies and possibly bias mortality disparities reported with linked data. Using 1989-2009 National Health Interview Survey (NHIS) data linked with the National Death Index (NDI) through 2011, we compared the availability of a SSN by race/ethnicity, estimated the percent of links likely missed due to lack of SSNs, and assessed if these estimated missed links affect race/ethnicity disparities reported in the NHIS-linked mortality data.

Methods: We used preventive fraction methods based on race/ethnicity-specific Cox proportional hazards models of the relationship between availability of SSN and mortality based on observed links, adjusted for survey year, sex, age, respondent-rated health, education, and US nativity.

Results: Availability of a SSN and observed percent linked were significantly lower for Hispanic and Asian/Pacific Islander (PI) participants compared with White non-Hispanic participants. We estimated that more than 18% of expected links were missed due to lack of SSNs among Hispanic and Asian/PI participants compared with about 10% among White non-Hispanic participants. However, correcting the observed links for expected missed links appeared to only have a modest impact on mortality disparities by race/ethnicity.

Conclusions: Researchers conducting analyses of mortality disparities using the NDI or other linked death records, need to be cognizant of the potential for differential linkage to contribute to their results.
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http://dx.doi.org/10.18865/ed.27.2.77DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398181PMC
July 2019

Emergence of a Discipline? Growth in U.S. Postsecondary Bioethics Degrees.

Hastings Cent Rep 2016 Mar-Apr;46(2):19-21

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http://dx.doi.org/10.1002/hast.543DOI Listing
May 2016

Characteristics of Physician Office Visits for Obesity by Adults Aged 20 and Over: United States, 2012.

NCHS Data Brief 2016 Mar(237):1-8

In 2011–2014, current asthma prevalence was higher among adults with obesity compared with adults in lower weight categories. This pattern was consistent across most demographic subgroups, except among men, for whom no statistically significant difference in current asthma prevalence by weight status was observed. Other epidemiologic studies of asthma prevalence have shown conflicting results about whether obesity is a risk factor for asthma among males. By race and Hispanic origin, current asthma prevalence was highest among adults with obesity for all groups. Patterns differed slightly among groups. For non-Hispanic black and Hispanic adults, prevalence for those with obesity was higher than for those in the normal weight and overweight categories. For non-Hispanic white adults, there was no signficant difference in asthma prevalence between the obese and overweight categories. For all age groups, current asthma prevalence was highest among adults with obesity, and there was no significant difference in asthma prevalence between those in the normal weight and overweight categories. There was an increasing trend in asthma prevalence as weight increased that was observed most clearly in the 60 and over age group. From 2001 to 2014, there was an increasing trend in current asthma prevalence among adults overall and among overweight adults. However, no significant trend was observed among adults in other weight categories. Findings from an American Thoracic Society workshop on obesity and asthma concluded that obesity is a major risk factor for asthma, and that obesity-related asthma is likely different from other types of asthma (e.g., allergic, occupational, exercise-induced, nocturnal, aspirin-sensitive, and severe asthma).
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March 2016

Pathways That Affect Wives' HIV Risk Among Serodiscordant Couples in India: Results From the Positive Jeevan Saathi Study.

Qual Health Res 2016 Sep 4;26(11):1531-42. Epub 2016 Feb 4.

Emory University, Atlanta, Georgia, USA.

This study examined factors that mitigate or heighten HIV risk among HIV-negative wives in serodiscordant relationships in Gujarat, India. Grounded theory was used to analyze 46 interviews (23 couples) where husbands were HIV-positive and wives were HIV-negative. A conceptual framework emerged from analysis from which we identified five pathways and four key behaviors: (a) safer sex, (b) no sex, (c) coercive sex, and (d) unprotected sex. Most couples either practiced safe sex or abstained from sex. Factors such as wives' assertiveness, a wife's fear of acquiring HIV, mutual understanding, positive sex communication, and a husband's desire to protect wife influenced safe sex/sexual abstinence. Factors such as desire for children, a husband's alcohol use, and intimate partner violence influenced coercive and unprotected sex. Counseling topics on sex communication, verbal and non-verbal safer sex strategies, as well as addressing intimate partner violence and alcohol use may be important in preventing risk to HIV-negative wives.
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http://dx.doi.org/10.1177/1049732315626694DOI Listing
September 2016

Racial disparities in prostate cancer incidence rates by census division in the United States, 1999-2008.

Prostate 2015 May 25;75(7):758-63. Epub 2015 Jan 25.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland.

Background: Black men have a higher incidence of prostate cancer than white men in the U.S., but little is known whether incidence or racial differences vary geographically. Understanding these differences may assist future studies on causes of prostate cancer. To address such, we leverage the unique resource of the National Program of Cancer Registries (NPCR) combined with Surveillance, Epidemiology and End Results (SEER).

Methods: Prostate cancer counts and population denominators by race (black, white), age, calendar year, and U.S. census division, for the period 1999-2008, were extracted from NPCR and SEER. We calculated age-standardized incidence rates (ASR) and estimated annual percent changes (EAPC) by race and census division. We assessed black-to-white incidence rate ratios (BWIRR) by census division and by calendar period.

Results: This analysis included 1,713,471 prostate cancer cases and 1,217 million person-years. Black ASRs ranged from 176 per 100,000 person-years in Mountain division to 259 in Middle Atlantic. BWIRRs ranged from 1.20 in Western divisions to 1.72 in Southeastern divisions. EAPCs indicated that prostate cancer incidence is not decreasing in East South Central, unlike all other divisions. White EAPCs displayed similar variations by census division, resulting in modest temporal changes in BWIRRs.

Conclusions: Within the U.S., there exists significant geographic variability in prostate cancer incidence rates. Although there are large geographic differences in BWIRRs, temporal trends are fairly stable. This may indicate that primary factors affecting prostate cancer incidence rates vary geographically but affect both black and white men to a similar degree.
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http://dx.doi.org/10.1002/pros.22958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419784PMC
May 2015

Factors related to rural young adolescents' participation in outdoor, noncompetitive physical activity.

Res Q Exerc Sport 2014 Dec;85(4):509-18

a University of Georgia.

Purpose: Young adolescents who have little interest in participating in competitive team sports are at an increased risk for physical inactivity. Noncompetitive outdoor physical activity can provide young adolescents with increased opportunities to participate in physical activities that appeal to them and have positive health effects. The purpose of this study was to examine factors related to rural young adolescents' participation in noncompetitive outdoor physical activity to inform intervention design.

Method: Young adolescents aged 10 to 14 years old (N = 1,032) from 1 rural county completed a self-administered questionnaire assessing constructs from self-determination theory (SDT) and the theory of planned behavior (TPB) related to noncompetitive outdoor physical activity. Structural equation modeling was used to examine an integrated conceptual model of hypothesized relationships among constructs.

Results: The hypothesized conceptual model provided a good fit to the data with greater perceptions of autonomy support and self-determined motivation having statistically significant positive indirect effects on participation in noncompetitive outdoor physical activity mediated by the constructs of the TPB. All direct paths in the model were statistically significant; however, the direct effect of attitudes on intention was weak (.08) and self-determined motivation had no indirect effect on intention through attitudes (.03).

Conclusions: Constructs of SDT and TPB should be accounted for by interventions targeting noncompetitive outdoor physical activity among young adolescents. More research is needed to determine young adolescents' preferences for noncompetitive and competitive physical activity and the potential influence that noncompetitive outdoor physical activity may have on total daily physical activity.
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http://dx.doi.org/10.1080/02701367.2014.961049DOI Listing
December 2014

Perpetration of physical and sexual abuse and subsequent fathering of pregnancies among a cohort of young South African men: a longitudinal study.

BMC Public Health 2014 Sep 12;14:947. Epub 2014 Sep 12.

School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.

Background: Young men's involvement in fathering pregnancies has been substantially neglected in unintended pregnancy research. Gender norms give men substantial power and control over sexual encounters, suggesting that understanding men's role is imperative. We tested the hypothesis that young, unmarried South African men who had perpetrated intimate partner violence (IPV) have a greater incidence of fathering pregnancies.

Methods: The data for this study were collected from 983 men aged 15 to 26 who participated in a 2-year community randomized controlled HIV prevention trial in the rural Eastern Cape. Multivariate Poisson models investigated the associations between baseline perpetration of IPV and fathering subsequent pregnancies, while controlling for age, number of sexual partners, socio-economic status, educational attainment, problematic alcohol use, exposure to the intervention, and time between interviews.

Results: Of the men in this study, 16.5% (n = 189) had made a girlfriend pregnant over two years of follow up. In addition, 39.1% had perpetrated physical or sexual intimate partner violence and 24.3% had done so more than once. Men who at baseline had perpetrated IPV in the previous year had an increased incidence of fathering, for a first perpetration in that year IRR 1.67 (95% CI 1.14-2.44) and among those who had also been previously violent, IRR 1.97 (95% CI 1.31-2.94). Those who had ever been violent, but not in the past year, did not have an elevated incidence. The incidence among men who had ever perpetrated physical abuse was less elevated than among those who had perpetrated physical and sexual violence IRR 1.64 (95% CI 1.18-2.29) versus IRR 2.59 (95% CI 1.64-4.10) indicating a dose response.

Conclusion: Young men's perpetration of partner violence is an important predictor of subsequently fathering a pregnancy. The explanation may lie with South African hegemonic masculinity, which valorizes control of women and displays of heterosexuality and virility, and compromises women's reproductive choices.
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http://dx.doi.org/10.1186/1471-2458-14-947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177689PMC
September 2014

Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women.

Glob Health Action 2014 21;7:23719. Epub 2014 Aug 21.

Rollins School of Public Health, Behahioral Sciences and Health Education, Emory University, Atlanta, GA, USA.

Background: Although teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort.

Objective: Teenage girls, aged 15-18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status.

Results: Overall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21-0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05-2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07-0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58-0.83 and OR 0.78; 95% CI 0.64-0.96). Believing that the teenage girl and her boyfriend were mutual main partners doubled the odds of reporting both an unplanned and unwanted pregnancy (OR 2.58 95% CI 1.07-6.25, and OR 2.21 95% CI 1.13-4.29).

Conclusion: Although some of the measures of gender inequity were not associated with unplanned and unwanted pregnancies, there is evidence of the role of both gender power and socioeconomic status. This was evident in teenage girls who experienced physical violence being more likely to have an unwanted pregnancy. Interventions to prevent teenage pregnancies need to be tailored by socioeconomic status because some teenagers may see having a pregnancy as a way to have a more secure future. Interventions that engage with relationship dynamics of teenagers are essential if unwanted and unplanned pregnancies are to be prevented.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141943PMC
http://dx.doi.org/10.3402/gha.v7.23719DOI Listing
April 2015

Characteristics associated with genetic counseling referral and BRCA1/2 testing among women in a large integrated health system.

Genet Med 2015 Jan 19;17(1):43-50. Epub 2014 Jun 19.

Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Background: Evidence shows underutilization of cancer genetics services. To explore the reasons behind this underutilization, this study evaluated characteristics of women who were referred for genetic counseling and/or had undergone BRCA1/2 testing.

Methods: An ovarian cancer risk perception study stratified 16,720 eligible women from the Henry Ford Health System into average-, elevated-, and high-risk groups based on family history. We randomly selected 3,307 subjects and interviewed 2,524 of them (76.3% response rate).

Results: Among the average-, elevated-, and high-risk groups, 2.3, 10.1, and 20.2%, respectively, reported genetic counseling referrals, and 0.8, 3.3, and 9.5%, respectively, reported having undergone BRCA testing. Personal breast cancer history, high risk, and perceived ovarian cancer risk were associated with both referral and testing. Discussion of family history with a doctor predicted counseling referral, whereas belief that family history influenced risk was the strongest BRCA testing predictor. Women perceiving their cancer risk as much higher than other women their age were twice as likely (95% confidence interval: 2.0-9.6) to report genetic counseling referral.

Conclusion: In a health system with ready access to cancer genetic counseling and BRCA testing, women who were at high risk underutilized these services. There were strong associations between perceived ovarian cancer risk and genetic counseling referral, and between a belief that family history influenced risk and BRCA testing.
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http://dx.doi.org/10.1038/gim.2014.68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522900PMC
January 2015

Cognitive and affective influences on perceived risk of ovarian cancer.

Psychooncology 2015 Mar 11;24(3):279-86. Epub 2014 Jun 11.

Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, CDC, Atlanta, GA, USA.

Introduction: Studies suggest that both affective and cognitive processes are involved in the perception of vulnerability to cancer and that affect has an early influence in this assessment of risk. We constructed a path model based on a conceptual framework of heuristic reasoning (affect, resemblance, and availability) coupled with cognitive processes involved in developing personal models of cancer causation.

Methods: From an eligible cohort of 16 700 women in a managed care organization, we randomly selected 2524 women at high, elevated, and average risk of ovarian cancer and administered a questionnaire to test our model (response rate 76.3%). Path analysis delineated the relationships between personal and cognitive characteristics (number of relatives with cancer, age, ideas about cancer causation, perceived resemblance to an affected friend or relative, and ovarian cancer knowledge) and emotional constructs (closeness to an affected relative or friend, time spent processing the cancer experience, and cancer worry) on perceived risk of ovarian cancer.

Results: Our final model fit the data well (root mean square error of approximation (RMSEA) = 0.028, comparative fit index (CFI) = 0.99, normed fit index (NFI) = 0.98). This final model (1) demonstrated the nature and direction of relationships between cognitive characteristics and perceived risk; (2) showed that time spent processing the cancer experience was associated with cancer worry; and (3) showed that cancer worry moderately influenced perceived risk.

Discussion: Our results highlight the important role that family cancer experience has on cancer worry and shows how cancer experience translates into personal risk perceptions. This understanding informs the discordance between medical or objective risk assessment and personal risk assessment. Published in 2014. This article is a U.S. Government work and is in the public domain in the USA.
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http://dx.doi.org/10.1002/pon.3593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522899PMC
March 2015

Individual and interpersonal characteristics that influence male-dominated sexual decision-making and inconsistent condom use among married HIV serodiscordant couples in Gujarat, India: results from the positive Jeevan Saathi study.

AIDS Behav 2014 Oct;18(10):1970-80

Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road Northeast, Atlanta, GA, 30329, USA,

Approximately 40 % of new infections occur among married women. No studies have examined the factors that may contribute to HIV transmission among HIV-negative wives in HIV serodiscordant relationships in Gujarat, India. In 2010, a cross-sectional survey with 185 HIV serodiscordant, married couples (i.e. 185 HIV-positive husbands and their 185 HIV-negative wives) in Gujarat was conducted. Socio-demographic, individual, and interpersonal characteristics of HIV-positive husbands and their HIV negative wives were examined. The association of these characteristics with inconsistent condom use and male-dominated sexual decision-making, were examined using multivariate logistic regression analyses. Approximately 10 % of couples reported inconsistent condom use in the past 3 months and 20 % reported intimate partner violence (IPV). Reports of IPV were associated with a higher odds of inconsistent condom use among HIV-positive husbands (aOR = 6.281). Husbands who reported having received couples counseling had a lower odds of male-dominated decision making about condom use (aOR = 0.372). HIV-negative wives who reported sex communication had a lower odds of male-dominated decision making about condom use (aOR = 0.322) with their HIV-positive husbands. Although condom use is a traditional measure of risk behavior, other factors that facilitate risk, such as male-dominated sexual decision-making need to be considered in analyses of risk.
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http://dx.doi.org/10.1007/s10461-014-0792-1DOI Listing
October 2014

A trial of family partnership and education interventions in heart failure.

J Card Fail 2013 Dec 29;19(12):829-41. Epub 2013 Oct 29.

Department of Psychology, University of Rochester, Rochester, New York.

Background: Lowering dietary sodium and adhering to medication regimens are difficult for persons with heart failure (HF). Because these behaviors often occur within the family context, this study evaluated the effects of family education and partnership interventions on dietary sodium (Na) intake and medication adherence (MA).

Methods And Results: HF patient and family member (FM) dyads (n = 117) were randomized to: usual care (UC), patient-FM education (PFE), or family partnership intervention (FPI). Dietary Na (3-day food record), urinary Na (24-hour urine), and MA (Medication Events Monitoring System) were measured at baseline (BL) before randomization, and at 4 and 8 months. FPI and PFE reduced urinary Na at 4 months, and FPI differed from UC at 8 months (P = .016). Dietary Na decreased from BL to 4 months, with both PFE (P = .04) and FPI (P = .018) lower than UC. The proportion of subjects adherent to Na intake (≤2,500 mg/d) was higher at 8 months in PFE and FPI than in UC (χ(2)(2) = 7.076; P = .029). MA did not differ among groups across time. Both FPI and PFE groups increased HF knowledge immediately after intervention.

Conclusions: Dietary Na intake, but not MA, was improved by PFE and FPI compared with UC. The UC group was less likely to be adherent with dietary Na. Greater efforts to study and incorporate family-focused education and support interventions into HF care are warranted.
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http://dx.doi.org/10.1016/j.cardfail.2013.10.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869235PMC
December 2013

Recruiting women for a study on perceived risk of cancer: influence of survey topic salience and early versus late response.

Prev Chronic Dis 2013 May 9;10:E75. Epub 2013 May 9.

Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA.

Introduction: Understanding the characteristics of early and late survey responders has implications for recruitment efforts and for informing potential response bias. The main objective of this analysis was to examine survey responder status (ie, early vs late response) by sociodemographic characteristics and by salience of study variables among respondents.

Methods: We analyzed data from a survey on family cancer history and perceived cancer risk among women at a large managed health-care organization. For baseline and 12-month follow-up surveys, we defined early versus late responder status according to the 95th percentile of the number of days it took to obtain completed interviews.

Results: We found no significant associations between responder status and sociodemographic characteristics at baseline or follow-up. At baseline, early responders were significantly more likely than late responders to have a personal history of breast cancer (5.2% vs 3.4%, P = .04) and to have been referred for genetic counseling (4.6% vs 2.0%, P = .004). The association between personal history of breast cancer and responder status persisted at follow-up; only 3.5% of late responders at baseline were also late responders at follow-up. Follow-up survey nonresponse rates did not vary by baseline responder status.

Conclusion: Survey topic salience is associated with early response and is important for recruitment. However, once recruited, late responders do not remain late responders at follow-up, suggesting that extra efforts made to recruit late responders are worthwhile. Health-related agencies that conduct surveys should consider survey salience in survey administration and recruitment strategies.
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http://dx.doi.org/10.5888/pcd10.120293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664209PMC
May 2013

Measuring the degree of closeness to the cancer experience: development and initial validation of the CONNection to the Experience of Cancer Scale (CONNECS).

Patient Educ Couns 2012 Nov 30;89(2):292-9. Epub 2012 Aug 30.

Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control, Atlanta, GA 30341, USA.

Objective: To describe the development and psychometric testing of items measuring connection to the cancer experience through a close friend or relative.

Methods: Ten items assess four aspects of connection to cancer: emotional and cognitive involvement, kind and amount of shared experience, perceived similarity to the affected person, and negative change witnessed. Interviews were conducted with 2200 women close to someone with cancer. The sample was split into two samples for exploratory and confirmatory factor analysis. Sample 1 (n=1342) was used to examine the underlying structure of the items. Sample 2 (n=858) was used for CFA. Internal consistency and reliability analysis were also conducted.

Results: Three factors with moderate correlation were extracted: general closeness, resemblance, and cognitive processing. Results from the CFA analysis confirmed a good fit of the three-factor model (Bentler-Bonett NIF=0.973, Bentler-Bonett NNFI=0.975, RMSEA=0.040 and CFI=0.984) and all path coefficients were statistically significant.

Conclusion: Findings provide preliminary evidence for the reliability and construct validity of the CONNECS scale in measuring individuals' connection to the cancer experience through a close friend or relative.

Practice Implications: CONNECS may be a useful tool for examining the impact of the cancer experience on risk perceptions, cancer worry, and medical decision making.
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http://dx.doi.org/10.1016/j.pec.2012.08.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334758PMC
November 2012

Feasibility study of social media to reduce intimate partner violence among gay men in metro atlanta, georgia.

West J Emerg Med 2012 Aug;13(3):298-304

Georgia State University, Institute of Public Health, Atlanta, Georgia.

Intimate Partner Violence (IPV) is a major public health issue occurring in the United States and globally. While little is known in general about IPV, understanding about the prevalence of physical IPV among gay men is even more obscure. There is a clear disparity in violence research attention focused on this vulnerable segment of society. This cross-sectional survey study was conducted to examine the feasibility of enrolling 100 gay men from Atlanta into an IPV survey study. The survey was administered via Facebook. Ninety-nine usable surveys were collected. Chi-square tests reveal that minority ethnic status, illicit drug use, and non-disclosed orientation status were all significantly associated with positive IPV reports--in terms of both victimization as well as perpetration. Overall, the majority of the study sample indicated that they believe IPV is a health problem in the Atlanta gay community. These findings bear importance for the Atlanta gay community and public health professionals who must address this nearly invisible yet increasing public health issue.
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http://dx.doi.org/10.5811/westjem.2012.3.11783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426372PMC
August 2012

Condoms "contain worms" and "cause HIV" in Tanzania: Negative Condom Beliefs Scale development and implications for HIV prevention.

Soc Sci Med 2012 Nov 27;75(9):1685-91. Epub 2012 Jul 27.

Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Suite 467, Atlanta, GA 30322, USA.

Condom promotion remains a key component of HIV prevention programs, complimenting recent successes in biomedical HIV prevention. Although condom use has increased in much of East Africa, it remains substantially below optimal levels. Negative rumors about condoms have been documented in East Africa, yet the prevalence and effects of belief in the negative rumors have not been explored. This study evaluated levels of belief in negative rumors about condoms, developed a Negative Condom Beliefs Scale, and assessed its accuracy in predicting willingness to use condoms. A cross-sectional, cluster survey (n = 370) was conducted representing adults in two rural districts in Northern Tanzania in 2008. Item agreement ranged from 35 to 53% for the following rumors regarding condoms: causing cancer, having holes, containing HIV, having worms, and the worms causing HIV. Items loaded on a single latent factor and had high internal consistency and convergent validity. In a multivariate model, negative condom score (AOR = 0.67, 95% CI = 0.6, 0.8) was the strongest single predictor of willingness to use condoms, followed by greater perceived anonymity in acquiring condoms (AOR = 4.36, 95% CI = 2.2, 8.6) and higher condom self-efficacy (AOR = 4.24, 95% CI = 2.0, 8.9). Our findings indicate high levels of subscription to negative beliefs about condoms, with two out of three respondents affirming belief in at least one negative condom rumor. This study highlights the relation between condom rumor beliefs and willingness to use condoms, and indicates avenues for future research and means for improving the design of HIV prevention programs.
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http://dx.doi.org/10.1016/j.socscimed.2012.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3432708PMC
November 2012

Excessive drinking among African American men: individual and contextual correlates.

J Ethn Subst Abuse 2012 ;11(2):113-29

Georgia State University, Atlanta, Georgia, USA.

In this article, the authors explored associations of multiple domains with regular drinking and getting drunk among adult African American men. Questionnaire-based, computer-assisted interviews were conducted with 484 men in Atlanta, Georgia. Data analysis involved multivariate logistic regression analyses. Findings show that being older increased the odds of both drinking behaviors. Sensation seeking increased the odds of regular drinking, and having experienced childhood sexual and physical abuse increased the odds of getting drunk. Having health insurance reduced the odds of both outcomes. Insurance coverage and the heterogeneity among adult African American men must be considered in risk reduction efforts.
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http://dx.doi.org/10.1080/15332640.2012.675227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391578PMC
October 2012

Prevalence and predictors of complementary and alternative medicine use in African-Americans with acquired immune deficiency syndrome.

Focus Altern Complement Ther 2012 Mar 16;17(1):33-42. Epub 2012 Feb 16.

Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, 1518 Clifton Road, Atlanta, GA 30322.

BACKGROUND: The use of complementary and alternative medicine (CAM) among Human Immunodeficiency Virus (HIV)-positive individuals is becoming increasingly widespread. Unfortunately, some CAM therapies may jeopardize the efficacy of conventional HIV medication, making it critical to understand CAM use among this population. OBJECTIVE: To investigate the prevalence and predictors of CAM use in a theory-driven, multidimensional manner. METHODS: African-American individuals who had received a diagnosis of acquired immune deficiency syndrome (AIDS) were recruited. The computer-administered survey asked questions about participants' CAM use and various psychosocial and socio-demographic characteristics. Participants' most recent CD4+ cell counts and HIV RNA levels were abstracted from medical records. Linear regression analyses, adjusted for potential confounders, were conducted to assess the independent contribution of various factors in explaining frequency of CAM use. RESULTS: One hundred and eighty two subjects participated in the survey. Results indicate that most (94%) participants used at least one type of CAM therapy. The majority of participants (79.7%) used CAM therapies as a complement (rather than an alternative) to their HIV medications though half had not discussed these therapies with their healthcare providers. Female sex, high yearly income, high health literacy and high HIV RNA levels were associated with a greater frequency of CAM use, while stronger emotional well-being was associated with a lower frequency of CAM use. CONCLUSIONS: The implications of these findings are discussed and suggestions for future research are provided.
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http://dx.doi.org/10.1111/j.2042-7166.2011.01140.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3346672PMC
March 2012

A qualitative study examining the perceived barriers and facilitators to medical healthcare services among women with a serious mental illness.

Womens Health Issues 2012 Mar 15;22(2):e217-24. Epub 2011 Dec 15.

Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia, USA.

Objective: This qualitative study investigates the barriers and facilitators to accessing and utilizing healthcare services among women with a serious mental illness (SMI).

Methods: A purposive sample of 30 poor, urban, predominantly African-American women with a diagnosis of an SMI was recruited. Interviews were audio-taped and transcribed verbatim. Data analysis was guided by a modified constant comparison approach.

Results: The findings highlight a variety of nonmedical factors that serve as both barriers and facilitators to accessing and utilizing medical healthcare services, such as a trusting relationship with a mental health provider and a women's social network.

Conclusion: Nonmedical factors and personal circumstances seem to be important factors influencing pathways to healthcare services among women with an SMI. Efforts to better engage and retain women with an SMI into healthcare will need to better acknowledge and incorporate the larger social context of the women's lives.
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http://dx.doi.org/10.1016/j.whi.2011.10.001DOI Listing
March 2012

A survey of georgia adult protective service staff: implications for older adult injury prevention and policy.

West J Emerg Med 2011 Jul;12(3):357-64

Georgia State University, Institute of Public Health, Atlanta, GA.

Background: The aging population is a rapidly growing demographic. Isolation and limited autonomy render many of the elderly vulnerable to abuse, neglect and exploitation. As the population grows, so does the need for Adult Protective Services (APS). This study was conducted to examine current knowledge of older adult protection laws in Georgia among APS staff and to identify training opportunities to better prepare the APS workforce in case detection and intervention.

Methods: The Georgia State University Institute of Public Health faculty developed a primary survey in partnership with the Georgia Division of Aging Services' leadership to identify key training priority issues for APS caseworkers and investigators. A 47-item electronic questionnaire was delivered to all APS employees via work-issued email accounts. We conducted descriptive analyses, t-tests and chi-square analyses to determine APS employees' baseline knowledge of Georgia's elder abuse policies, laws and practices, as well as examine associations of age, ethnicity, and educational attainment with knowledge. We used a p-value of 0.05 and 95% confidence intervals to determine statistical significance of analyses performed.

Result: Ninety-two out of 175 APS staff responded to the survey (53% response rate). The majority of respondents were Caucasian (56%) women (92%). For over half the survey items, paired sample t-tests revealed significant differences between what APS staff reported as known and what APS staff members indicated they needed to know more about in terms of elder abuse and current policies. Chi-square tests revealed that non-Caucasians significantly preferred video conferencing as a training format (44% compared to 18%), [χ(2)(1) = 7.102, p < .008], whereas Caucasians preferred asynchronous online learning formats (55% compared to 28%) [χ(2)(1) =5.951, p < .015].

Conclusion: Results from this study provide the Georgia Division of Aging with insight into specific policy areas that are not well understood by APS staff. Soliciting input from intended trainees allows public health educators to tailor and improve training sessions. Trainee input may result in optimization of policy implementation, which may result in greater injury prevention and protection of older adults vulnerable to abuse, neglect and exploitation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117614PMC
July 2011

Adherence, sexual risk, and viral load in HIV-infected women prescribed antiretroviral therapy.

AIDS Patient Care STDS 2011 Jul 11;25(7):431-8. Epub 2011 Jun 11.

Nell Hodgson School of Nursing, Emory University, Atlanta, Georgia.

Abstract The purpose of this study was to determine if there was a connection between adherence to antiretroviral therapy (ART) and use of risk reduction behaviors (RRB) in HIV-infected women who were prescribed antiretroviral therapy. The sample consisted of 193 predominately African American women with an average age of 44 who had been on ARV for approximately 9 years and had low annual incomes. All women were participating in a behavioral clinical trial focused on these dual outcomes. Using a risk index developed for this study, we examined the relationship of a composite of risk behaviors to electronically measured and self-reported adherence over the approximately 13-month study period. Women were categorized based on levels of adherence and risky behaviors, and we sought to determine if these classifications were associated with clinical outcomes of HIV viral load and CD4 counts. High levels of adherence were correlated with low risk behaviors (abstinence, consistent use of condoms, etc.). Those classified as high adherence and low-risk behavior (HALR) as well as those classified as high adherence and high-risk behavior (HAHR) had lower mean viral loads and higher CD4 counts than those in the other categories. Women in the low adherence and high-risk category (LAHR) had detectable viral loads and the lowest CD4 counts and are at higher risk for transmitting HIV to partners and unborn children. Our findings underscore the importance of addressing adherence to both ART and RRB in HIV clinical settings to improve clinical outcomes and reduce HIV transmission.
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http://dx.doi.org/10.1089/apc.2010.0331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125575PMC
July 2011

A day in the life of women with a serious mental illness: a qualitative investigation.

Womens Health Issues 2011 Jul-Aug;21(4):286-92. Epub 2011 Feb 18.

Department of Behavioral Sciences and Health Education, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA.

Purpose: Few studies have taken a holistic perspective to the lives of women with a serious mental illness (SMI). This qualitative study of women with an SMI describes and interprets women's experiences and provides a new understanding about the nature and needs of these women.

Methods: A convenience sample of 30 poor, urban, predominantly African-American women with a diagnosis of an SMI was recruited from an ongoing National Institutes of Mental Health study. Data collection involved face-to-face, in-depth interviews. The interviews were audio-recorded and transcribed verbatim. Data analysis occurred concurrently with data collection using a modified constant comparative method.

Results: The majority of the women self-identified as African American, single, having completed high school, and at the time of the interview were either unemployed or on disability. The most common SMI was major depression. A common topic in the women's reflections on their lives was that of social disadvantage both before being diagnosed as well as after to their diagnosis with an SMI. Salient themes of their stories included social isolation, experiencing loss, and having a lack of control over one's own life decisions.

Conclusion: The findings from this study revealed varied experiences among these women as well as the complexity of their situation. The enhanced understanding of women's situation will allow mental health professionals to improve the quality of life for women with an SMI by taking a contextual approach to the treatment of their mental illness.
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http://dx.doi.org/10.1016/j.whi.2010.11.003DOI Listing
February 2012

Serum vitamin D concentrations are related to depression in young adult US population: the Third National Health and Nutrition Examination Survey.

Int Arch Med 2010 Nov 11;3:29. Epub 2010 Nov 11.

Division of Nutrition, School of Health Professions, College of Health and Human Sciences, Georgia State University, 140 Decatur Street, Atlanta, GA 30302, USA.

Background: Vitamin D receptors have been mapped throughout the brain suggesting a role for vitamin D in psychosomatic disorders. Results from previous epidemiological studies on relation between vitamin D status and depression are equivocal. Also, limited information is available relating vitamin D status with depression in young adult US population.

Methods: Data from the third National Health and Nutrition Examination Survey were used to assess association between serum vitamin D and depression in 7970 non-institutionalized US residents, aged 15-39 y. Assessment of depression was done using the Diagnostic Interview Schedule developed by the National Institute of Mental Health. After accounting for several confounding variables in multivariate logistic regression analysis, we estimated odds ratios (OR) for having depression in vitamin D deficient persons in comparison to vitamin D sufficient persons.

Results: Women, non-Hispanic blacks, persons living below poverty, persons who did not consume supplements, persons living in South and West regions and in urban areas, persons with higher BMI, and persons with current depression had higher prevalence of vitamin D deficiency compared to their counterparts. OR for having current depressive episodes in persons with serum vitamin D ≤ 50 nmol/L is significantly higher relative to those with serum vitamin D ≥ 75 nmol/L (OR = 1.85; P = 0.021).

Conclusions: In this large population based study, likelihood of having depression in persons with vitamin D deficiency is significantly higher compared to those with vitamin D sufficiency. Early diagnosis and intervention are paramount because coexistence of vitamin D deficiency and depression has serious negative consequences on health.
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http://dx.doi.org/10.1186/1755-7682-3-29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996356PMC
November 2010

Validity of self-reported solar UVR exposure compared with objectively measured UVR exposure.

Cancer Epidemiol Biomarkers Prev 2010 Dec 12;19(12):3005-12. Epub 2010 Oct 12.

Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

Background: Reliance on verbal self-report of solar exposure in skin cancer prevention and epidemiologic studies may be problematic if self-report data are not valid due to systematic errors in recall, social desirability bias, or other reasons.

Methods: This study examines the validity of self-reports of exposure to ultraviolet radiation (UVR) compared to objectively measured exposure among children and adults in outdoor recreation settings in 4 regions of the United States. Objective UVR exposures of 515 participants were measured using polysulfone film badge UVR dosimeters on 2 days. The same subjects provided self-reported UVR exposure data on surveys and 4-day sun exposure diaries, for comparison to their objectively measured exposure.

Results: Dosimeter data showed that lifeguards had the greatest UVR exposure (24.5% of weekday ambient UVR), children the next highest exposures (10.3% ambient weekday UVR), and parents had the lowest (6.6% ambient weekday UVR). Similar patterns were observed in self-report data. Correlations between diary reports and dosimeter findings were fair to good and were highest for lifeguards (r = 0.38-0.57), followed by parents (r = 0.28-0.29) and children (r = 0.18-0.34). Correlations between survey and diary measures were moderate to good for lifeguards (r = 0.20-0.54) and children (r = 0.35-0.53).

Conclusions: This is the largest study of its kind to date, and supports the utility of self-report measures of solar UVR exposure.

Impact: Overall, self-reports of sun exposure produce valid measures of UVR exposure among parents, children, and lifeguards who work outdoors.
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http://dx.doi.org/10.1158/1055-9965.EPI-10-0709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005549PMC
December 2010

Validity of self-reported solar UVR exposure compared with objectively measured UVR exposure.

Cancer Epidemiol Biomarkers Prev 2010 Dec 12;19(12):3005-12. Epub 2010 Oct 12.

Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

Background: Reliance on verbal self-report of solar exposure in skin cancer prevention and epidemiologic studies may be problematic if self-report data are not valid due to systematic errors in recall, social desirability bias, or other reasons.

Methods: This study examines the validity of self-reports of exposure to ultraviolet radiation (UVR) compared to objectively measured exposure among children and adults in outdoor recreation settings in 4 regions of the United States. Objective UVR exposures of 515 participants were measured using polysulfone film badge UVR dosimeters on 2 days. The same subjects provided self-reported UVR exposure data on surveys and 4-day sun exposure diaries, for comparison to their objectively measured exposure.

Results: Dosimeter data showed that lifeguards had the greatest UVR exposure (24.5% of weekday ambient UVR), children the next highest exposures (10.3% ambient weekday UVR), and parents had the lowest (6.6% ambient weekday UVR). Similar patterns were observed in self-report data. Correlations between diary reports and dosimeter findings were fair to good and were highest for lifeguards (r = 0.38-0.57), followed by parents (r = 0.28-0.29) and children (r = 0.18-0.34). Correlations between survey and diary measures were moderate to good for lifeguards (r = 0.20-0.54) and children (r = 0.35-0.53).

Conclusions: This is the largest study of its kind to date, and supports the utility of self-report measures of solar UVR exposure.

Impact: Overall, self-reports of sun exposure produce valid measures of UVR exposure among parents, children, and lifeguards who work outdoors.
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http://dx.doi.org/10.1158/1055-9965.EPI-10-0709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005549PMC
December 2010

Development and evaluation of a complementary and alternative medicine use survey in African-Americans with acquired immune deficiency syndrome.

J Altern Complement Med 2010 May;16(5):569-77

Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA 30322, USA.

Objectives: The purpose of the current study was to develop and evaluate the psychometric properties of a culturally- and stage-of-disease-appropriate measure of complementary and alternative medicine (CAM) use among a population of African-American individuals with acquired immune deficiency syndrome (AIDS) using a mixed-method design.

Design: Data were collected in two phases. In phase 1, qualitative data were used to refine an existing CAM measure for the specific study population in the present study. In phase 2, this refined instrument was implemented in a larger sample. The resulting numeric data were analyzed to evaluate the psychometric properties of the revised CAM instrument.

Setting: Data were collected from patients who were receiving care from the infectious disease clinic of a large, public, urban hospital in the Southeastern United States.

Subjects: Patients were eligible to participate if they (1) were receiving their care from the clinic, (2) had an AIDS diagnosis, (3) were identified as African-American, (4) were > or =21 years of age, (5) spoke English, and (6) were not cognitively impaired.

Measures: Focus groups in phase 1 were conducted with a semistructured focus group guide. Participants also completed a basic sociodemographic survey. Phase 2 participants used programmed laptops to answer questions about their CAM use and several sociodemographic questions.

Results: Information from the focus groups prompted some substantive revisions in the already-existing CAM survey. The revised instrument had satisfactory face validity and adequate test-retest reliability (r = 0.79). Furthermore, the instrument factored in a manner that was interpretable and consistent with prior findings.

Conclusions: In order for human immunodeficiency virus health care providers to provide the best care to their patients, they need to be informed about the types and frequency of CAM use among their patients. This can be accomplished by methodologically developing CAM instruments, rigorously implementing and assessing these instruments, and then disseminating the findings to researchers and practitioners.
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http://dx.doi.org/10.1089/acm.2009.0329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110866PMC
May 2010

Knowledge and awareness of heat-related morbidity among adult recreational endurance athletes.

Int J Biometeorol 2010 Jul 22;54(4):441-8. Epub 2010 Jan 22.

Institute of Public Health, Georgia State University, Atlanta, GA, USA.

Adults have been increasingly motivated to compete in recreational endurance sports events. Amateurs may lack a complete understanding of recommended strategies for handling heat and humidity, making heat-related illnesses increasingly possible. This is compounded by global climate change and increasing average surface and air temperatures, especially in urban areas of industrialized nations in Europe and North America that have hosted most events to date. We conducted an on-line, secure survey at the 2nd Annual ING Georgia Marathon and Half-Marathon in Atlanta, Georgia, in 2008. We included previously validated questions on participant socio-demographics, training locations, and knowledge and awareness of heat-related illnesses. Participants were aware of heat illnesses, and of heat stroke as a serious form of heat stress. However, the majority, across age and gender, did not understand the potential severity of heat stroke. Furthermore, 1-in-5 participants did not understand the concept of heat stress as a form of heat-related illness, and how heat stress may result from buildup of muscle-generated heat in the body. Adult recreational endurance athletes are another susceptible, vulnerable population sub-group for applied research and public health educational interventions, especially in urban areas of industrialized nations in Europe and North America.
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http://dx.doi.org/10.1007/s00484-009-0295-3DOI Listing
July 2010

Content and characteristics of goals created during a self-management intervention for people with epilepsy.

J Neurosci Nurs 2009 Dec;41(6):312-21

Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.

Goals are presented in the chronic illness literature as effective strategies to help people adopt self-management behaviors; however, not much is known about the types and characteristics of individuals' goals. The purpose of this study was to examine goal setting among people with epilepsy who participated in the WebEase program. WebEase is an Internet-based, theory-driven, self-management program with modules on medication adherence, stress management, and sleep habits. Participants had the opportunity to create and evaluate goals over the course of 6 weeks, with 2 weeks for each module. The goals were analyzed using three dimensions: content, specificity, and proximity. Most participants in the sample wrote goals for each week of the program. Several main content areas emerged within the modules. Goal quality, measured by specificity and proximity, did not differ according to readiness for behavior change. Readiness to change did not differ between those who wrote a goal and those who did not. The diversity of goal content and quality indicates that individuals should be supported in goal development and encouraged to set their own self-management goals, regardless of their readiness for behavior change.
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http://dx.doi.org/10.1097/jnn.0b013e3181b6bec5DOI Listing
December 2009

Development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test.

J Cardiovasc Nurs 2009 Nov-Dec;24(6):500-9

Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.

Background And Research Objective: Several heart failure (HF) knowledge tools have been developed and tested over the past decade; however, they vary in content, format, psychometric properties, and availability. This article details the development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test (A-HFKT) as a standardized instrument for both the research and clinical settings.

Participants And Methods: Development and psychometric testing of the A-HFKT were undertaken with 116 New York Heart Association (NYHA) class II and III community-dwelling HF patients and their family members (FMs) participating in a family intervention study. Internal consistency, reliability, and content validity were examined. Construct validity was assessed by correlating education level, literacy, dietary sodium ingestion, medication adherence, and healthcare utilization with knowledge.

Results: Content validity ratings on relevance and clarity ranged from 0.55 to 1.0, with 81% of the items rated from 0.88 to 1.0. Cronbach alpha values were .84 for patients, .75 for FMs, and .73 for combined results. Construct validity testing revealed a small but significant correlation between higher patient and FM knowledge on sodium restriction questions and lower ingested sodium, r = -0.17, P = .05 and r = -0.19, P = .04, respectively, and between patient knowledge and number of days that medications were taken correctly (diuretics: r = 0.173, P < .05, and angiotensin-converting enzyme: r = 0.223, P = .01). Finally, patients seeking emergency care or requiring hospitalization in the 4 months before study entry were found to have significantly lower FM knowledge using both t test and logistic regression modeling.

Conclusions: The A-HFKT was revised using the content and construct validity data and is available for use with HF patients and FMs. The construct validity testing indicates that patient knowledge has a significant relationship to aspects of self-care. Furthermore, family knowledge may influence patient adherence with sodium restriction and healthcare utilization behavior.
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http://dx.doi.org/10.1097/JCN.0b013e3181aff0b0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828039PMC
January 2010