Publications by authors named "Kyeongra Yang"

38 Publications

Characteristics of electronic cigarette user and traditional smokers: 2017 Youth risk behavior surveillance system.

Public Health Nurs 2021 Jun 8. Epub 2021 Jun 8.

School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Background: Although electronic cigarette (e-cigarette) use among adolescents rapidly has increased over the past decade, which has raised concerns over the corresponding behavioral health risks, the current literature presents limited data for understanding the characteristics of adolescent e-cigarette users.

Objective: The purpose of this study was to (1) identify general characteristics that may be shared between e-cigarette users and traditional cigarette smokers and (2) examine the unique characteristics of e-cigarette users vis-à-vis traditional cigarette smokers.

Design: Cross-sectional descriptive study.

Sample And Data Source: A total of 14,765 9th- to 12-grade students drawn from the CDC 2017 Youth Risk Behavior Surveillance System.

Results: We observed that the prevalence of marijuana, alcohol, and other illicit drug use was higher among e-cigarette users and traditional tobacco users than non-users. Moreover, physically active adolescents were more likely to use e-cigarettes than those who were physically inactive, although the level of the activity did not predict smoking status.

Conclusion: We recommend that primary prevention strategies for e-cigarette use should be incorporated in physical education programs and target adolescents who engage in not only health risk behaviors, but also health promoting behaviors, such as physical activity.
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http://dx.doi.org/10.1111/phn.12936DOI Listing
June 2021

Sleep and Metabolic Syndrome.

Nurs Clin North Am 2021 Jun 10;56(2):203-217. Epub 2021 Mar 10.

School of Nursing, Rutgers, The State University of New Jersey, 65 Bergen Street, Room 1025E, Newark, NJ 07107, USA.

Metabolic syndrome (MetS) refers to the clustering of risk factors for cardiovascular disease and diabetes, including central adiposity, hypertension, dyslipidemia, and hyperglycemia. During the past 20 years, there have been parallel and epidemic increases in MetS and impaired sleep. This article describes evidence on the association between MetS and short sleep duration, circadian misalignment, insomnia, and sleep apnea. Potential mechanisms where impaired sleep desynchronizes and worsens metabolic control and interventions to improve sleep and potentially improve MetS are presented.
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http://dx.doi.org/10.1016/j.cnur.2020.10.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144542PMC
June 2021

Association between physical function and perceived stress among U.S. Chinese older adults.

Am J Aging Sci Res 2020 ;1(1):12-19

Director, Rutgers Institute for Health, Health Care Policy and Aging Research, 112 Paterson St, New Brunswick, NJ, 08901, USA.

Objectives: Physical function impairment can cause great stress to older adults. The purpose of the study is to investigate the association between self-reported and directly-observed physical function on perceived stress among U.S. Chinese older adults.

Methods: Data were from the Population Study of Chinese Elderly in Chicago (PINE) of 3,157 Chinese older adults who were 60 and above in the Greater Chicago Area. Self-reported and directly-observed physical function measures, and Perceived Stress Scale were used.

Results: Participants had a mean age of 72.8 ± 8.3 years old (range 60-105). Higher scores of Katz activities of daily living impairments (odds ratio [OR]=1.77), Lawton instrumental activities of daily living impartments (OR=1.10, <0.01), Rosow-Breslau index of mobility scale (OR=1.39, <0.05), and Nagi index of basic physical activities scale (OR=1.19, <0.001) were associated with higher levels of perceived stress. In addition, higher scores of directly-observed physical function measurements, including chair stand (OR=0.93), tandem stand (OR=0.71, <0.05), timed walk (OR=0.73, <0.001), and the overall measurement (OR= 0.87, <0.01) were associated with lower level of perceived stress.

Discussion: Findings suggested that poor physical function was associated with perceived stress among U.S. Chinese older adults. Longitudinal studies are needed to obtain a more comprehensive understanding of the pathways between physical function and perceived stress.

Implications For Practice: Health care professionals could provide personalized physical activity interventions to encourage older adults to engage in regular exercise in order to maintain and promote older adults' physical function and psychological well-being.
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http://dx.doi.org/10.46439/aging.1.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595296PMC
January 2020

Insomnia and Daily Function in Older Adults With Asthma.

J Gerontol Nurs 2020 Nov;46(11):28-36

The current study examined the prevalence of insomnia and its relationship with daily function in older adults with asthma. Data on 278 older adults with asthma (aged ≥60 years) from the 2005-2008 National Health and Nutrition Examination Survey were analyzed. Insomnia was present in 40% of the study sample and was associated with a greater number of activities of daily living (ADL) and instrumental ADL (IADL) limitations. In multivariate analyses accounting for covariates including depressive symptoms, insomnia was not associated with having at least two ADL/IADL limitations. However, those with co-occurring insomnia and depressive symptoms were more likely to have at least two ADL/IADL limitations compared to those with either condition singly. Insomnia in the presence of depressive symptoms may impede one's ability to perform ADL/IADL. Current findings suggest that assessment and treatment of insomnia and depression in older adults with asthma may be important for maintaining active, independent living. [Journal of Gerontological Nursing, 46(11), 28-36.].
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http://dx.doi.org/10.3928/00989134-20201012-04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830685PMC
November 2020

Social Activities and Health-Related Quality of Life in Rural Older Adults in South Korea: A 4-Year Longitudinal Analysis.

Int J Environ Res Public Health 2020 07 31;17(15). Epub 2020 Jul 31.

Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea.

During later life, inadequate social interactions may be associated with worse quality of life in older adults. Rural older adults are prone to developing unhealthy lifestyles related to social activities, which can lead to a poorer quality of life than that enjoyed by older adults living in urban areas. This study aimed to describe longitudinal changes in social activity participation and health-related quality of life among rural older adults, exploring potential associations with changes to in-person social activity over four years. We used prospective community-based cohort data from the Korean Social Life, Health, and Aging Project (KSHAP) collected between December 2011 and January 2016. The sample included 525 older adults who completed the measure of health-related quality of life. Our results showed a significant change in health-related quality of life according to changes in participation in meeting with friends. Even though an individual's participation in other social activities did not show significant differences in health-related quality of life, our findings imply that in-person social activities may be an important resource to encourage participation in physical activities and to develop other positive outcomes, such as a sense of belonging or satisfaction with later life, among rural older adults.
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http://dx.doi.org/10.3390/ijerph17155553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432541PMC
July 2020

Citizenship and health insurance status predict glycemic management: NHANES data 2007-2016.

Prev Med 2020 10 25;139:106180. Epub 2020 Jun 25.

School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, United States of America.

The prevalence of diabetes in United States (US) immigrants is higher than the general population. Non-citizenship and lack of health insurance have been associated with increased health risks including diabetes, but previous US studies were done in non-representative samples and did not examine the effect on glycemic management. The purpose of this study was to compare demographic, metabolic, and behavioral risk factors for increased blood glucose including citizenship and health insurance status, and determine predictors of poor glycemic management (A1C ≥ 8.0%). Logistic regression was used to analyze data from the 2007-2016 National Health and Nutrition Examination Surveys (NHANES) of persons with diabetes and available citizenship data ages 30 to 70 years (N = 2702), excluding persons with A1C < 5% and pregnant women. Results represent the weighted sample. Among participants, 92% indicated citizenship by birth (81%) or naturalization (11%). Insured rates increased from 83% to 91% between 2007 and 2008 and 2015-2016 (p < .001). Citizenship was positively associated with insurance status, higher income and education, better diet, increased smoking, and more sedentary hours (ps < .05). Non- citizens (OR: 1.74, 95% CI: 1.20-2.51) and uninsured persons (OR: 1.99, 95% CI: 1.53-2.59) were nearly twice as likely to have poor glycemic management than US citizens by naturalization and insured individuals respectively. We conclude that citizenship and absence of health insurance negatively impacts diabetes management. Policy decisions are needed that address primary and secondary prevention strategies for individuals without citizenship and health insurance to reduce diabetes burden in the US.
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http://dx.doi.org/10.1016/j.ypmed.2020.106180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494527PMC
October 2020

Substance Use Patterns Among Adolescents: A Latent Class Analysis.

J Am Psychiatr Nurses Assoc 2020 Nov/Dec;26(6):586-594. Epub 2019 Jun 28.

Brian Greene, EdD, University of Pittsburgh, Pittsburgh, PA, USA.

Substance use among adolescents remains a major public health concern, which is correlated with mortality. The purpose of this study was to (1) examine risk factors predisposing adolescents to substance use and (2) identify patterns of simultaneous drug exploration among adolescents. Data ( = 15,624; collected in 2015) were drawn from the Centers for Disease Control and Prevention, National Youth Risk Behavior Survey, which is a national school-based survey of 9th- to 12th-grade students to monitor health risk behaviors. Substance use was assessed using self-reported questionnaires, and latent class analysis and logistic regression were used for data analysis. Five latent patterns of substance use were identified: (1) (64%); (2) (25%) (i.e., used alcohol, e-cigarettes, and/or marijuana); (3) (6%) (i.e., used alcohol, cigarettes, e-cigarettes, marijuana, synthetic marijuana, and/or prescription pills); (4) (4%), (i.e., used prescription pills); (5) (2%) (i.e., likely to use all assessed substances). Gender, race, grade, and depressive mood were strong predictors of membership in a particular substance use class. Adolescents presenting for care may possess symptoms associated with various substances beyond those being managed. Mental health nurses can leverage these results in reducing adolescent substance use through primary and secondary prevention. A longitudinal study of not only substance use patterns but also the progression to substance use disorders among adolescents is warranted.
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http://dx.doi.org/10.1177/1078390319858658DOI Listing
June 2021

Home care providers' experience of translating evidence-based fall prevention programs into practice.

Home Health Care Serv Q 2019 Jul-Sep;38(3):182-193. Epub 2019 Apr 25.

b Visiting Nurse Service of New York , New York , New York , USA.

The purpose of the study was to obtain exploratory, descriptive information that would provide insights into the barriers to and facilitators of the implementation of fall prevention programs in home care settings. The study employed a qualitative approach through a series of focus groups with home care providers who work with patients with diabetes (N = 29). The study identified teamwork, resistance to change, and patient's readiness as major factors in fall prevention practice at home care. Understanding health-care providers' experiences with fall prevention in home care settings has the potential to facilitate better translation of evidence to practice for community-dwelling older adults.
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http://dx.doi.org/10.1080/01621424.2019.1604460DOI Listing
May 2020

Long Sleep Duration Is Associated With Increased Frailty Risk in Older Community-Dwelling Adults.

J Aging Health 2020 Jan-Feb;32(1):42-51. Epub 2018 Sep 29.

University of Pittsburgh, Pittsburgh, USA.

To examine whether sleep duration is correlated with increased frailty risk and investigate the determinants of frailty status. Data on 3,632 participants from the 2011 to 2014 National Health and Nutrition Examination Survey (NHANES, community-dwelling >60 years, 52.1% prefrail, 13.6% frail, 55% women) were used. Frailty status was categorized by Fried Phenotype (robust, prefrail, and frail) with customized criteria for the NHANES data set. Hours of self-reported sleep duration were categorized as short (⩽6), normal (7-9), and long (⩾10). Multinomial regression analysis identified risk factors for each frailty state. Only long sleep duration was associated with increased odds (2.86 [1.09-7.50]) of being characterized as frail but not prefrail. Frail and prefrail states had shared risk factors but also had many distinct to each state. Sleep duration is a potential, modifiable therapeutic target for frailty management. Multicomponent interventions should be tailored for frailty status.
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http://dx.doi.org/10.1177/0898264318803470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440876PMC
November 2020

Perceived Versus Actual Risk of Type 2 Diabetes by Race and Ethnicity.

Diabetes Educ 2018 Jun 17;44(3):269-277. Epub 2018 Apr 17.

School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.

Purpose The purpose of this study was to examine associations between perceived risk and actual risk of type 2 diabetes by race and/or ethnicity. Methods The study sample included 10 999 adults from the 2011 to 2014 National Health and Nutrition Examination Survey. Sociodemographic, clinical, and behavioral data were collected using interviews and physical examinations. Participants were asked if they felt at risk for diabetes or prediabetes and then asked the reasons why. Data analyses were conducted with SAS to properly analyze complex survey data. Results About 86% of the sample (n = 9496) answered the risk perception question for diabetes, and among those, 28.4% indicated having a high perceived risk. Among this subsample, 38.3% were identified as having an actual risk for prediabetes or diabetes according to the American Diabetes Association guidelines. Across all race groups, the most frequently reported risk factors participants believed to contribute to their risk for diabetes were family history of diabetes, obesity, and poor diet habits. When the percentage of participants with an actual risk factor who correctly perceived it as a risk factor was examined, fewer Asians correctly perceived weight status and physical activity level as a risk for diabetes in contrast to the other racial/ethnic groups. Conclusions Our study showed that when perception was compared to actual risks, associations differed statistically by race. It will be essential to discuss their risk perception to proper screening for diabetes and relevant lifestyle modifications to prevent and delay the onset of diabetes.
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http://dx.doi.org/10.1177/0145721718770983DOI Listing
June 2018

Grieving the Loss of Self: Challenges in Type 2 Diabetes Mellitus Self-Management.

J Dr Nurs Pract 2018 ;11(1):25-34

Pace University, College of Health Professions, Lienhard School of Nursing, New York, NY.

The aim of this study was to understand and describe the experience of diabetes self-management among patients not meeting glycemic control (A1C 9). Type 2 diabetes mellitus (T2DM) is a complex chronic disease process. Diabetes self-management is equally complex and critical to patient outcomes and quality of life. The components for self-management include: knowledge, skills/abilities, and support. Few studies have reported on the experiences of self-management for patients with T2DM to reach and sustain glycemic control. This study used a qualitative descriptive design. Semistructured interviews were conducted with 13 patients receiving care at a diabetic clinic at a major health-care system in New York City. An interview guide was developed based on diabetes self-management which guided the interviews. All data were analyzed using qualitative content analysis. Initially, three themes that describe each component of diabetes mellitus self-management (DMSM) and impact the patients' reaching the desired outcome were identified: acceptance of knowledge, motivation for skills and abilities, and variability and vulnerability of support. Further analysis of the three themes led to the identification of an overarching, theme: loss of self. This overarching theme helped to explain the stages of grief illustrated across the themes in the participants DMSM experiences. The participants in this study identified loss of self, and the accompanying grief and grieving process related to the loss of self in response to their T2DM diagnosis. Participants were "stuck" in a stage of loss of self, which presented challenges to acceptance of their diagnosis, barriers to DMSM, and optimizing glycemic control.
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http://dx.doi.org/10.1891/2380-9418.11.1.25DOI Listing
January 2018

Sleep and other correlates of high-level health in older adults.

Geriatr Nurs 2018 May - Jun;39(3):344-349. Epub 2017 Dec 13.

School of Nursing, University of Pittsburgh, Pittsburgh, PA.

A large sample (N = 1139) of adults ≥75 years from the 2011-2014 NHANES cohorts was used to examine predictors of high-level health. Analyses were done with SAS to control for sample weights and allow results to be reported as population parameters. The majority of participants described their health as high-level (73.6%). Logistic regression found a longer sleep duration, minority status, decreased income, multiple medications, low physical activity, and late stage memory impairment were significant predictors of low-level health (p < .05) while sex, education level, marital status, body mass index, and depression symptoms were not. The assessment of sleep should be expanded to cover dimensions such as sleep quality and sleep disorders to help maintain wellness in older adults. This study supports that the majority of older adults have high-level health and identifies several modifiable factors to maintain wellness.
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http://dx.doi.org/10.1016/j.gerinurse.2017.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995622PMC
October 2018

Oral Health in Low-Income Older Adults in Korea.

J Community Health Nurs 2016 ;33(2):98-106

d Lienhard School of Nursing , Pace University , Pleasantville , New York.

Oral diseases among older adults are prevalent and a major public health problem, but public attention regarding this matter is quite limited. Many older adults experience limited access to oral care services. The study aimed to describe characteristics of oral health conditions, perceived oral health status, and oral health practices and to examine factors related to living status and accessibility to dental health care among 9,660 low-income older adults living in a suburban city in Korea. Approximately 42% of low-income older adults lived alone; 68% perceived their oral health as either excellent or good; and 31% reported difficulty accessing dental services. Lack of accessibility to oral care services was significantly more common in older adults with low incomes, living alone, having poor oral conditions, poor self-perceived oral health, and poor tooth-brushing behavior. Strategies to promote access to dental care services for underserved older adults should be developed to prevent further oral problems and their impact on overall health conditions.
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http://dx.doi.org/10.1080/07370016.2016.1159441DOI Listing
May 2017

Yoga, as a transitional platform to more active lifestyle: a 6-month pilot study in the USA.

Health Promot Int 2016 Jun 18;31(2):423-9. Epub 2014 Dec 18.

Department of Health and Physical Activity, University of Pittsburgh, 140 Trees Hall, Pittsburgh, PA 15260, USA.

A 6-month pilot study explored the effects of a yoga program on the physical activity (PA) level of overweight or obese sedentary adults. Fourteen community-dwelling overweight or obese sedentary adults participated in a 6-month program (2-month yoga program and 4-month follow-up) delivered by two types of instruction [the direct guidance of an instructor (face-to-face group) vs. the self-learning method of using a DVD (DVD group)]. Measurements included program adherence (class attendance and home practice; min/week) and level of PA [metabolic equivalent (MET)-hour/week] at baseline, 2, 4 and 6 months. Descriptive statistics and nonparametric tests were used to describe the sample and examine differences by group and time. There were no significant differences in demographic variables by group assigned. Participants showed significant PA changes from baseline to each measurement point. The direct guidance of an instructor was preferred over the self-learning method. At each time interval, the DVD group showed higher levels of PA than the face-to-face group; the only difference that achieved statistical significance occurred at 4 months. The PA level significantly changed over 6 months in the DVD group, but not in the face-to-face group. The results indicate that a yoga program may be utilized as a 'stepping-stone' toward regular exercise among overweight sedentary adults. Research with a larger sample is needed to further evaluate the effects of the program on the level of PA among this population.
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http://dx.doi.org/10.1093/heapro/dau108DOI Listing
June 2016

Relate better and judge less: poverty simulation promoting culturally competent care in community health nursing.

Nurse Educ Pract 2014 Nov 18;14(6):680-5. Epub 2014 Sep 18.

Southwest PA Area Health Education Center, 5614 Elgin St, Pittsburgh, PA 15206, USA. Electronic address:

The study aim was to evaluate the effectiveness of a poverty simulation in increasing understanding of and attitudes toward poverty and resulting in changes in clinical practice among nursing seniors. A poverty simulation was conducted using a diverse group of nursing professors and staff from local community agencies assuming the role of community resource providers. Students were assigned roles as members of low-income families and were required to complete tasks during a simulated month. A debriefing was held after the simulation to explore students' experiences in a simulated poverty environment. Students' understanding of and attitude toward poverty pre- and post-simulation were examined. Changes in the students' clinical experiences following the simulation were summarized into identified categories and themes. The poverty simulation led to a greater empathy for the possible experiences of low income individuals and families, understanding of barriers to health care, change in attitudes towards poverty and to those living in poverty, and changes in the students' nursing practice. Use of poverty simulation is an effective means to teach nursing students about the experience of living in poverty. The simulation experience changed nursing students' clinical practice, with students providing community referrals and initiating inter-professional collaborations.
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http://dx.doi.org/10.1016/j.nepr.2014.09.001DOI Listing
November 2014

Body mass index self-perception and weight management behaviors during late adolescence.

J Sch Health 2014 Oct;84(10):654-60

Lienhard School of Nursing, College of Health Professions, Pace University, 861 Bedford Road, L306, Pleasantville, NY 10570.

Background: This study examined the relationship between actual body weight and self-perceived weight, and how perception of one's weight affects weight management behaviors among US adolescents.

Methods: Adolescents ages 16-19 years with objectively-measured weight and height and self-reported perception of weight, weight-loss efforts, and health-related behaviors (N = 642) from the 2009-2010 National Health and Nutritional Examination Survey (NHANES) were included. Sociodemographic variables, body mass index percentile, weight perception, weight-loss efforts, and health-related behaviors were examined using Wald chi-square, Student's t test, analysis of variance, and logistic regression.

Results: Approximately 15% were overweight, and 20% were obese; 26% inaccurately perceived their weight. Ethnic minority groups displayed higher rates of overweight and obesity. Overweight adolescents had a higher rate of inaccurate weight perception than obese adolescents. More girls correctly perceived their weight status than boys. Nearly 25% had tried to lose weight during the past year. Among overweight and obese adolescents, accurate weight perception was significantly and positively related to weight-loss efforts after controlling for sociodemographic variables and actual weight.

Conclusions: Accurate body weight perception is a significant factor in adolescents' weight-loss efforts. Targeting counseling for body weight perception and weight management toward boys and overweight adolescents may impact obesity in this age group.
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http://dx.doi.org/10.1111/josh.12195DOI Listing
October 2014

Understanding cultural issues in the diabetes self-management behaviors of Korean immigrants.

Diabetes Educ 2012 Nov-Dec;38(6):835-44. Epub 2012 Sep 26.

Emory University, Atlanta, Georgia (Dr Cha, Ms Min, Dr Dunbar, Dr Jennings)

Purpose: The purpose of this study was to explore potential factors affecting the self-management behaviors of Korean immigrants with type 2 diabetes mellitus (KIT2Ds).

Methods: A qualitative descriptive design guided this study. Semistructured interviews lasting 45 to 60 minutes were conducted with 20 KIT2Ds in the participants' preferred language; in all cases, this was Korean. Each interview was audiotaped, transcribed, and analyzed using conventional content analysis. Data analysis was performed in two steps. The data written in Korean were initially analyzed by 3 bilingual researchers. A qualitative researcher then participated in the analysis to refine the findings for presentation to an English-speaking audience while staying true to the data and preserving the nuanced Korean meanings.

Results: The mean age of the sample was 64. 5 ± 11.6 years (9 men and 11 women). The mean years of staying in the United States and age at diabetes mellitus diagnosis were 23.6 ± 9.7 years and 52.5 ± 12.3 years, respectively. Three major ideas were identified: (1) issues on treatment regimen related to medications and diet, (2) resources that helped or hindered ability to manage diabetes, and (3) the physician-patient relationship.

Conclusions: Important cultural nuances need to be addressed to better prepare KIT2Ds to manage their diabetes more effectively. A culture-specific program should extend beyond a diabetes self-management education delivered in Korean language. Rather, content and education methods need to consider acculturation effects on diabetes management behaviors.
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http://dx.doi.org/10.1177/0145721712460283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753096PMC
September 2013

Relationships between physical activity and awareness and treatment status among adults with low femoral bone density in the United States.

Am J Health Promot 2012 Sep-Oct;27(1):2-9

School of Nursing, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.

Purpose: To examine relationships between physical activity (PA) and awareness and treatment status of low bone mineral density (BMD) among adults.

Design: Cross-sectional.

Setting: Stratified sample of adults living independently in the community.

Subjects: A total of 1928 adults aged 50 years and older who participated in the National Health and Nutrition Examination Survey 2005-2006 were included in the analysis. Among those, about 54% were women, 84% were non-Hispanic whites, 65% were married, and 44% were between 50 and 59 years of age.

Measures: Objective measures: femoral neck BMD and duration of PA and step counts measured by accelerometers. Self-report: strength exercise, and awareness and treatment of low bone density.

Analysis: Multivariate regression analyses using SUDAAN.

Results: Despite a high prevalence of low BMD, self-reported awareness, treatment, and PA were very low. After controlling socio-demographic and health-related factors, those who were aware of their low bone density status and who received treatment for it were less physically active than those who were unaware of their bone condition or who did not have any treatment.

Conclusions: PA levels are below the recommended level for bone health benefits. Health care providers should consider screening individuals at risk of low bone density and encourage them to implement prevention and treatment regimen including increasing daily levels of PA.
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http://dx.doi.org/10.4278/ajhp.110107-QUAN-7DOI Listing
December 2013

Wired at a young age: the effect of caffeine and technology on sleep duration and body mass index in school-aged children.

J Pediatr Health Care 2012 Jul-Aug;26(4):276-82. Epub 2011 Feb 19.

Department of Family and Community Health, University of Maryland School of Nursing, 655 W Lombard St, Suite 675B, Baltimore, MD 21201, USA.

Introduction: Two problems affecting school-aged children in the United States are inadequate sleep and an increased prevalence of obesity. The purpose of this study was to quantify media-related technology use and caffeine consumption in order to assess their potential effects on sleep duration and body mass index (BMI) in children.

Methods: The study was a secondary analysis of children 6 to 10 years of age (N = 625) from the National Sleep Foundation's Sleep in America Poll. Regression analysis was used to assess the relationship between caffeine and technology use, sleep variables, and BMI, adjusting for age, race, gender, and general health.

Results: Almost 30% (29.5%) of the children consumed a daily caffeinated beverage, and 42.4% had a television in the bedroom. Children who drank caffeinated beverages had 15 fewer minutes of sleep per night than did children who did not drink such beverages (b = -0.27, p = .002). Children with three technology items in their bedroom received 45 fewer minutes of sleep than did children without these items in their bedroom (b = -0.75, p = .010). Having adjusted for variables, only drinking caffeinated beverages was associated with a BMI z score.

Discussion: The complex relationships between caffeine intake and the use of technology with shortened periods of sleep and increased BMI need further study. Future research should explore how these risk factors for shortened periods of sleep can be modified in this young population.
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http://dx.doi.org/10.1016/j.pedhc.2010.12.002DOI Listing
November 2012

Psychosocial correlates of weight maintenance among black & white adults.

Am J Health Behav 2012 Mar;36(3):395-407

Duquesne University School of Nursing, Pittsburgh, PA, USA.

Objectives: To investigate (1) weight maintenance among black and white participants and (2) psychosocial correlates (eg, healthy eating barriers, self-efficacy, stress) of weight maintenance 18 months after behavioral weight-loss treatment.

Methods: Linear and logistic regression examined weight change and unsuccessful weight maintenance (>5% weight gain) among 107 black and white adults.

Results: After controlling for socio-demographics, differences in weight maintenance between ethnicities were not generally noted. Healthy eating barriers and stressful life events were associated with weight gain, P<.04.

Conclusions: Strategies to cope with stressful events and overcome barriers to eating healthfully are needed for weight maintenance among both ethnicities.
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http://dx.doi.org/10.5993/AJHB.36.3.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454451PMC
March 2012

Health-related quality of life among participants in the SMART weight loss trial.

Appl Nurs Res 2012 Nov 12;25(4):276-9. Epub 2011 Nov 12.

University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, USA.

Obesity has been associated with a decreased health-related quality of life (HRQoL); however, the association between weight change and HRQoL is unclear. This secondary analysis of the SMART (Self Monitoring And Recording using Technology) trial, a clinical trial of behavioral weight loss treatment, provides evidence that quality of life improves with weight loss.
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http://dx.doi.org/10.1016/j.apnr.2011.08.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294095PMC
November 2012

Collaborative learning among undergraduate students in community health nursing.

Nurse Educ Pract 2012 Mar 5;12(2):72-6. Epub 2011 Aug 5.

Department of Health and Community Systems, School of Nursing, University of Pittsburgh, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA.

Teamwork can benefit students, enhancing their ability to think critically, solve problems creatively, and collaborate effectively. We piloted a collaborative learning project with undergraduate community health nursing students (N = 83) that entailed working in teams to explore epidemiologic data, synthesize the literature, and develop an evidence-based plan for nursing intervention and evaluation pertaining to a public health issue. Project evaluation consisted of pre- and post-project surveys by students, peer evaluation, and formative and summative evaluation by faculty. Having students work in teams, while challenging both for faculty and students, may be a viable strategy for preparing the next generation of nurses for inter- and intraprofessional collaboration. Our experience suggests that instituting a collaborative learning experience as part of an undergraduate course in community health nursing can be an effective way to expose students to constructive approaches to teamwork and prepare them for evidence-based nursing practice in the future.
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http://dx.doi.org/10.1016/j.nepr.2011.07.005DOI Listing
March 2012

Insomnia and physical activity in adults with prediabetes.

Clin Nurs Res 2012 Aug 25;21(3):294-308. Epub 2011 Jul 25.

School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261, USA.

This secondary analysis study examines the relationship between physical activity and symptoms of insomnia among adults with prediabetes (N = 958) from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). The sample of participants were generally obese, middle-aged, and racially diverse. NHANES questions included symptoms of insomnia, sleep duration, and sleep latency. Body mass index (BMI) was calculated from measured height and weight; at least 2 days of ActiGraph activity monitor data determined mean steps walked. Men walked more steps than women; however, women had more insomnia symptoms. There were significant associations between insomnia symptoms and increased sleep latency and decreased sleep duration. Multiple regression analysis showed that younger age, lower BMI, higher self-rated health, high school education, and fewer insomnia symptoms were significantly related to increased steps walked. The findings indicate that insomnia in adults with prediabetes may be a barrier to their adapting an active lifestyle.
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http://dx.doi.org/10.1177/1054773811411295DOI Listing
August 2012

Outcomes of health care providers' recommendations for healthy lifestyle among U.S. adults with prediabetes.

Metab Syndr Relat Disord 2011 Jun 1;9(3):231-7. Epub 2011 Mar 1.

School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15261, USA.

Background: Lifestyle modification (i.e., weight loss, active lifestyle, healthy diet) is a recommended strategy for the prevention of type 2 diabetes and cardiovascular disease. The purpose of this study was to examine the relationship between receiving a health-care provider's recommendation and adherence to behavioral indicators of adaptation of a healthy lifestyle among adults with prediabetes.

Methods: A secondary analysis was conducted using the 2005-2006 National Health and Nutrition Examination Survey (NHANES) data (N=2,853) that included self-reported efforts to improve diet, lose weight, and increase physical activity and objective measures of body mass index, blood tests for lipids, and actigraph data on physical activity.

Results: When demographic variables, metabolic factors, and physical activity level were controlled, central obesity and elevated blood pressure were significantly associated with having prediabetes. Almost 40% of the respondents with prediabetes reported being told by their health-care provider during the previous year to control or lose weight, increase their physical activity, or decrease the fat and calories in their diet. Participants who were counseled to adopt a healthy lifestyle reported high adherence to weight control and diet modification. Selected objective measures supported that the health-care providers' recommendations contributed to improved lifestyle.

Conclusions: These findings indicate that self-reported health-care provider's recommendations for lifestyle modifications are associated with people actually engaging in healthier behavior. The results reinforce the importance of health-care provider's making recommendations to promote adherence to a healthier lifestyle.
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http://dx.doi.org/10.1089/met.2010.0112DOI Listing
June 2011

Physical activity self-monitoring and weight loss: 6-month results of the SMART trial.

Med Sci Sports Exerc 2011 Aug;43(8):1568-74

School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

Introduction: Weight loss has been associated with higher physical activity (PA) levels and frequent dietary self-monitoring. Less is known about how PA self-monitoring affects adherence to PA goals, PA levels, and weight change.

Methods: The SMART Trial is a clinical weight loss trial in which 210 overweight adults were randomized equally to one of three arms: 1) paper record (PR), 2) personal digital assistant with self-monitoring software (PDA), and 3) PDA with daily tailored feedback message (PDA + FB). PA self-monitoring and adherence to PA goals were based on entries in weekly submitted diaries. PA levels were measured via self-report by the past 6-month Modifiable Activity Questionnaire at baseline and 6 months.

Results: Data are presented on 189 participants with complete 6-month PA data (84% female, 77% white, mean age = 47.3 ± 8.8 yr, mean body mass index = 34.1 ± 4.5 kg·m(-2)). Median PA level was 7.96 MET·h·wk(-1) at baseline and 13.4 MET·h·wk(-1) at 6 months, with significant PA increases in all three arms. PDA + FB arm had a higher mean number of weekly self-monitoring entries than the PR arm (3.4 vs 2.4, P = 0.003) and were more likely to maintain high (i.e., 100%) adherence to PA goals over time than the PDA (P = 0.02) or PR arms (P = 0.0003). Both PA self-monitoring and adherence to PA goals were related to higher PA levels at 6 months. A higher mean rate of PA self-monitoring was associated with a greater percentage of weight decrease (ρ = -0.49, P < 0.0001) at 6 months.

Conclusions: PA self-monitoring and adherence to PA goals were more likely in participants in the PDA + FB arm and in turn predicted higher PA levels and weight loss.
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http://dx.doi.org/10.1249/MSS.0b013e31820b9395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266405PMC
August 2011

Development and use of a tool to guide junior faculty in their progression toward promotion and tenure.

J Prof Nurs 2010 Jul-Aug;26(4):207-13

University of Pittsburgh, School of Nursing, Department of Health and Community Systems, Pittsburgh, PA 15261, USA.

Junior faculty have multiple roles and need to participate in a variety of activities that increase their likelihood of achieving promotion and tenure. Yet, these faculty often struggle when deciding how and when to expend effort along their career trajectory. In response to the need for structured guidance when setting priorities and making decisions about time management, faculty from a school of nursing at a research university have developed and begun to use a faculty progression tool. Introduced during orientation, this tool helps junior faculty weigh the relative importance of engaging in specific activities by offering a time frame and suggestions for prioritizing and pacing efforts to accomplish critical milestones. Although primarily aimed at tenure stream faculty in a research-intensive environment, this faculty progression tool serves as a model that may be modified for environments with less focus on research. Likewise, it may provide a foundation for development of a similar tool for nontenure stream faculty.
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http://dx.doi.org/10.1016/j.profnurs.2010.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085879PMC
October 2010

Sleepiness and health in midlife women: results of the National Sleep Foundation's 2007 Sleep in America poll.

Behav Sleep Med 2010 ;8(3):157-71

School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15261, USA.

The 2007 Sleep in America poll, a random-sample telephone survey, provided data for this study of sleep in community-dwelling women aged 40 to 60 years. The majority of the respondents were post- or perimenopausal, overweight, married or living with someone, and reported good health. A subsample (20%) reported sleepiness that consistently interfered with daily life; the sleepy subsample reported more symptoms of insomnia, restless legs syndrome, obstructive sleep apnea, depression and anxiety, as well as more problems with health-promoting behaviors, drowsy driving, job performance, household duties, and personal relationships. Hierarchical regression showed that sleepiness along with depressive symptoms, medical comorbidities, obesity, and lower education were associated with poor self-rated health, whereas menopause status (pre-, peri- or post-) was not. These results suggest that sleep disruptions and daytime sleepiness negatively affect the daily life of midlife women.
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http://dx.doi.org/10.1080/15402002.2010.487462DOI Listing
October 2010

Longitudinal relationship between physical activity and cardiometabolic factors in overweight and obese adults.

Eur J Appl Physiol 2010 Jan 6;108(2):329-36. Epub 2009 Oct 6.

College of Nursing, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-705, South Korea.

Few studies have reported longitudinal relationships between physical activity (PA) and cardiometabolic risk factors over time using repeated assessments in overweight or obese adults. We conducted a longitudinal study in 127 participants (81% with body mass index > 30 kg/m(2)) who completed a 12-month behavioral intervention for weight loss between 2003 and 2005 in Pittsburgh, PA, USA. Using absolute change scores from baseline to each time point (i.e., 6 and 12 months) for all studied variables (Delta = time point - baseline), we performed mixed effects modeling to examine relationships between PA and cardiometabolic risk factors, after adjusting for body weight, energy intake and other covariates (i.e., age, gender, and ethnicity). PA was assessed as energy expenditure (kcal/week) using the Paffenbarger activity questionnaire. Over the 12-month period, energy expenditure increased (Delta1,370 kcal/week at 6 months vs. Delta886 kcal/week at 12 months); body weight decreased (Delta8.9 kg at 6 months vs. Delta8.4 kg at 12 months). The average increase in energy expenditure over 12 months was significantly and independently related to reductions in total cholesterol (F = 6.25, p = 0.013), low-density lipoprotein cholesterol (LDL-C) (F = 5.08, p = 0.025) and fasting blood glucose (F = 5.10, p = 0.025), but not to other risk factors (i.e., fasting insulin, high-density lipoprotein cholesterol, triglycerides, and waist circumference). In conclusion, among overweight and obese adults undergoing a weight loss intervention, increased energy expenditure over 12 months may improve total cholesterol and LDL-C, important coronary risk factors, and fasting blood glucose, a metabolic risk factor.
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http://dx.doi.org/10.1007/s00421-009-1203-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3319046PMC
January 2010

Utilization of 3-month yoga program for adults at high risk for type 2 diabetes: a pilot study.

Evid Based Complement Alternat Med 2011 9;2011:257891. Epub 2011 Jan 9.

School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261, USA.

Various modes of physical activity, combined with dieting, have been widely recommended to prevent or delay type 2 diabetes. Among these, yoga holds promise for reducing risk factors for type 2 diabetes by promoting weight loss, improving glucose levels and reducing blood pressure and lipid levels. This pilot study aimed to assess the feasibility of implementing a 12-week yoga program among adults at high risk for type 2 diabetes. Twenty-three adults (19 Whites and 4 non-Whites) were randomly assigned to the yoga intervention group or the educational group. The yoga group participated in a 3-month yoga intervention with sessions twice per week and the educational group received general health educational materials every 2 weeks. All participants completed questionnaires and had blood tests at baseline and at the end of 3 months. Effect sizes were reported to summarize the efficacy of the intervention. All participants assigned to the yoga intervention completed the yoga program without complication and expressed high satisfaction with the program (99.2%). Their yoga session attendance ranged from 58.3 to 100%. Compared with the education group, the yoga group experienced improvements in weight, blood pressure, insulin, triglycerides and exercise self-efficacy indicated by small to large effect sizes. This preliminary study indicates that a yoga program would be a possible risk reduction option for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach to reducing cardiometabolic risk factors and increasing exercise self-efficacy for this group.
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http://dx.doi.org/10.1093/ecam/nep117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096458PMC
August 2012

Revisiting the association between cardiovascular risk factors and diabetes: data from a large population-based study.

Diabetes Educ 2009 Sep-Oct;35(5):770-7. Epub 2009 Jun 18.

The University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania

Purpose: The purpose of this study was to examine the association between cardiovascular risk factors and the presence of diabetes in a large population-level dataset.

Methods: A secondary analysis was conducted using data from the 2007 Behavioral Risk Factor Surveillance System, a population-based survey (n = 403,137) conducted in the United States.

Results: The majority of the respondents were middle-aged and overweight. Approximately half of the sample reported little or no physical activity. Estimates from a logistic regression model for a weighted sample of white, black, and Hispanic adults revealed that having hypertension or elevated cholesterol was a strong predictor of diabetes even when controlling for age, gender, race, education, income, body mass index, smoking status, and physical activity.

Conclusions: The results confirmed the importance of diabetes educators counseling patients with hypertension or hypercholesterolemia about their increased risk for developing diabetes.
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http://dx.doi.org/10.1177/0145721709338528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894805PMC
December 2009
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