Health changes in Hispanic older adults in a Spanish arthritis self -management education program

Arthritis is the most common chronic condition affecting older people and is a major cause of limited activity. Arthritis education programs in English have demonstrated a positive impact on health but these programs have not reached the Hispanic communities where arthritis is the leading cause of disability. Minorities, such as Hispanics, have traditionally been reluctant to pursue self-help programs, and have been identified as an under-served population in terms of medical care. This study examined the effectiveness of one community health adult education program targeting Hispanic older adults with arthritis, the Spanish Arthritis Self Management Education Program (SASMEP), by evaluating changes in the participants' general health, pain, disability, self-efficacy, health perceptions, frequency of physician visits, and exercise. A pre and post control group experimental design and analyses of covariance were used to determine the pre and post differences in health status and health behaviors for a group participating in the SASMEP and a group who did not using gender and age as covariates. A repeated measures design was also used, and repeated measures analyses of variance and post hoc tests were done on health status and health behavior data collected pre, post and one-year post education to determine long-term differences. ^ Results indicated the participants' health status significantly improved in general health, significantly decreased in pain, and significantly decreased in arthritic disability immediately following the education. Self-efficacy and health perceptions increased for both groups but not significantly. The participants' health behaviors showed significantly fewer physician visits and significantly increased time spent performing stretching and strengthening exercise and time spent performing aerobic exercise. No group differences were found in the frequency of arthritis physician visits. ^ The improvements seen immediately after the SASMEP participation were not reflected in the post one-year scores. No significant differences were found for the participants' health status or health behaviors one year following the education. Health status and health behaviors did not return below baseline scores after one year suggesting the participants' health, although not improved, did not deteriorate. Therefore, the SASMEP education provided short-term health benefits for older Hispanic adults with arthritis, but not long-term health benefits. ^

A determination of the effects of a ropes course on the self -esteem of undergraduate and graduate students

The purpose of this study was to evaluate the impact of the ropes course on the self-esteem of undergraduate and graduate students. The ropes course provides challenging experiential activities that facilitate personal confidence and group teamwork. The study relates to adult education, experiential education, and program evaluation within the context of hospitality and tourism management education. Quantitative data were based on the assessment of self-esteem through the completion of the Coopersmith Self-Esteem Inventory (SEI-C) modified for this study. Qualitative data were based on assessment of participants' reflective papers stating their perceptions of the ropes course. ^ The study compared a treatment group (31 undergraduate and 25 graduate students) which participated in the ropes course, and a control group (31 undergraduate and 25 graduate students) which did not participate. Both groups completed the pre- and post-treatment SEI-C at the same time intervals. The quantitative data were analyzed using a two-way repeated-measures analysis of variance (ANOVA). The qualitative data, comprised of reflective papers voluntarily written by 44 (79%) of the treatment group, were coded using four major themes reflecting the students' perceptions about the ropes course. ^ Scores on the pretest and posttest of the SEI-C were not significantly different for the two groups. The qualitative data showed a favorable impact of the ropes course. The discrepancy in the outcomes based on these two measures suggests that the SEI-C self-report paper-and-pencil instrument may not be sufficiently refined to evaluate the complex issue of self-esteem. The SEI-C, if used, should be supplemented by other evaluation measures, since the two measures may be evaluating different components of self-esteem. They may be also differentially affected by bias in scoring, or by statistical characteristics of reliability and validity. ^

Self -management factors, influences, and conditions for type 2 diabetes among Black ethnic groups in Miami, Florida and Abidjan, Cote d'Ivoire

The Dahlgren and Whitehead ecological theory provides the framework for a cross-sectional design to compare socio-demographic characteristics, living and working conditions, and lifestyle daily habits as well as cultural and ecological factors among six diabetic multiethnic Black groups in Miami and Abidjan. Approximately 180 Black Americans (African-, Caribbean-, and Haitian-) and 180 Black Africans (Akan, Malinke, and Krou) aged 20 years and older were surveyed. During the preliminary of this study participants' attitudes and behaviors were qualitatively assessed (N=60) and a tool was developed to describe, in the main study (N=360), differences in participants' strength of commitment to diabetes lifestyle self-management. Despite similarities found in terms of age and gender, statistically significant differences were also found within and among groups in terms of living and working conditions, education level, and religion. African American groups were more likely to participate in more diabetes classes than Haitian Americans and Caribbean Americans. However, African Americans were less likely to adhere to daily dietary and weight control regimens. Although, Black African groups reported limited access to equipment, facilities, and financial support they were more likely to follow dietary and weight control recommendations than Black American groups. Overall, African American participants showed the poorest attitudes towards recommended foods, Caribbean American respondents reported the best attitudes and behaviors towards weight control regimens, and the Malinke group had significantly more strength of commitment to successful weight control. Furthermore, Black African groups had significantly more strength of commitment to successful dietary adherence and significantly less support for weight control than Black American groups. ^ Significant differences found within Black groups suggest that understanding each patient's conditions may help healthcare professionals in initiating individualized appropriate counseling before goal setting, and in developing culturally relevant type 2 diabetes management programs. Moreover, significant differences exist in strength of commitment to lifestyle adherence among Black groups in Miami and Abidjan. Cultural, socio-demographic factors and self-management habits may explain differences in participants' outcomes. At the policy level, Black groups should not be approached as a homogenous group and assessment of the vulnerability of each ethnic group may be necessary in the decision-making process.^

Identity as a moderator of guided -self change treatment outcomes with adolescents

Despite recent calls to examine the possible moderating effects of developmental variables on treatment outcomes with adolescents, most research has continued to focus on age as a main developmental variable. Building upon the theoretical notion that identity development is a central task of adolescence, this study investigated whether adolescents' response to an alcohol and other drug (AOD) use reduction intervention, Guided-Self Change (GSC), was influenced by their approach to self-defining questions and situations. While past research has established associations between maladaptive identity development and alcohol and other drug use, very little research attention has been given to the potential relationship that may exist between identity variables and AOD treatment response. Given GCS's promotion of self-reflective, self-exploring, and problem-focused coping skills as a way of addressing AOD problems, it was hypothesized that adolescents with positive identity development (i.e., greater identity coherence and adaptive identity processing styles) would respond more positively to GCS's change producing therapeutic techniques than their counterparts. This hypothesis was tested with an ethnically diverse sample of 134 adolescents between the ages of 14-18 years who were randomly assigned to either a GSC intervention or a comparison control group. Results revealed that identity development was significantly associated with AOD use, such that adolescents with diffused/avoidant styles and high levels of distress over identity-related issues used more alcohol at the baseline assessment than those with more positive identity development. Results also indicated that while identity distress or identity coherence did not moderate GSC treatment outcomes, high scores for a diffused/avoidant style did moderate treatment outcomes and thus proved to be a significant predictor of treatment response. These results indicate that identity development influences adolescents' alcohol use and that while use of certain approaches to self-defining questions does not predict treatment outcomes, high use for negative approaches does moderate intervention-related change. ^

Social-cognitive antecedents of ambidextrous orientation in family-owned startups: The role of family ties, achievement motivation, and internal locus of control

Regulatory Focus Theory predicts that the motivation to self-regulate goal-directed thought and behavior depends on two distinct regulation strategies: a promotion focus based on attaining gains and a prevention focus based on avoiding losses. This study took a social-cognitive approach predicting that regulatory focus has an impact on how family startups (several family related founders) explore "new ideas", exploit "old certainties" and achieve the balance of both (ambidexterity), compared to lone founder startups (only one founder present). It was proposed that the social context of family ties among founders leads them to a prevention focus concerned with avoiding the loss of the socio-emotional benefits of those ties. In order to avoid such a loss, family founders were expected to increase their risk perceptions and thus, explore less than lone founders, who lack such socio-emotional ties. It was also proposed that two commonly used psychological traits in entrepreneurship research —achievement motivation and internal locus of control, predispose entrepreneurs to a promotion focus. Founders with a promotion focus, in turn, were hypothesized to lead startups to more risk-seeking behaviors and to more explorative orientation. The previous argument was used as a springboard to derive hypotheses about ambidexterity (the ability to exploit and explore simultaneously) and survival hazards. Using Regulatory Focus Theory, exploitative orientation, conceptualized as the motivational strength to continue on previous paths of action, was hypothesized to be not significantly different from that of lone founder startups. Taking previous arguments together, lone founder startups were hypothesized to be more ambidextrous than family startups. Finally, ambidexterity and internal locus of control were hypothesized to reduce survival hazards in family startups. The findings suggested that family startups explore less than lone founder startups even after controlling for group effects. Interesting but contradictory findings revealed that internal locus of control have both a positive direct effect and a positive interaction that increases the explorative and ambidextrous orientation gap of family startups over lone founder startups. As expected, ambidexterity and internal locus of control reduced survival hazards on family startups. Implications for practitioners were derived based on a sample of 470 nascent entrepreneurs.

The effects on students' self-efficacy beliefs regarding their comprehension of American literature when aesthetic reading and reader response strategy are implemented

High-stakes testing and accountability have infiltrated the education system in the United States; the top priority for all teachers must be student progress on standardized tests. This has resulted in the predominance of reading for test-taking, (efferent reading), in the English, language arts, and reading classrooms. Authentic uses of print activities, like aesthetic reading, that encourage students to engage individually with a text, have been pushed aside. ^ During a 3-week time period, regular level, English 3/American literature students in a Title I magnet high school, participated in this quasi-experimental study (N = 62). It measured the effects of an intervention of reading American literature texts aesthetically and writing aesthetically-evoked reader responses on students' self-efficacy beliefs regarding their comprehension of American literature. One trained teacher and the researcher participated in the study: student participants were pre- and post- tested using the Confidence in Reading American Literature Survey which examined their self-efficacy beliefs regarding their comprehension of American literature. Several statistical analyses were performed. The results of the linear regression analyses partially supported a positive relationship between aesthetically-evoked reader responses and students' self-efficacy beliefs regarding their comprehension of American literature. Additionally, the results of the 2 (sex) x 2 (treatment) ANCOVAs conducted to test group differences in self-efficacy beliefs regarding the comprehension of American literature between treatment and control groups indicated a main effect for treatment (but not sex; nor was there a significant sex x treatment interaction), suggesting the treatment was partially effective in increasing students' self-efficacy beliefs. Seven of the twelve ANCOVAs indicated a statistically significant increase in the treatment group's adjusted group mean self-efficacy belief scores as a result of being exposed to the intervention. In six of these seven analyses, increases in self-efficacy beliefs occurred in tasks that required three or more higher-order levels of thinking/learning. The results are discussed in terms of theoretical, empirical and practical significance. Future research is recommended to extend the intervention beyond the narrow confines of a Title I magnet school to settings where the intervention could be tested longitudinally, e. g., honors and gifted students, elementary and middle schools.^

The Role of Family/Friend Social Support in Diabetes Self-Management for Minorities with Type 2 Diabetes

This study investigated how ethnicity, perceived family/friend social support (FSS), and health behaviors are associated with diabetes self-management (DSM) in minorities. The participants were recruited by community outreach methods and included 174 Cuban-, 121 Haitian- and 110 African-Americans with type 2 diabetes. The results indicated that ethnicity and FSS were associated with DSM. Higher FSS scores were associated with higher DSM scores, independent of ethnicity. There were ethnic differences in several elements of FSS. DSM was highest in Haitian- as compared to African-Americans; yet Haitian Americans had poorer glycemic control. The findings suggest FSS together with ethnicity may influence critical health practices. Studies are needed that further investigate the relationships among minorities with diabetes, their intimate network (family and friends) and the diabetes care process.

Medical Advice and Diabetes Self-Management Reported by Mexican-American, Black- and White-Non-Hispanic Adults Across the United States

Background: Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods: We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 MexicanAmericans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with ‘undiagnosed diabetes’ [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants’ diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results: Although medical advice to the patient is considered a standard of care for diabetes, approximately onethird of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats. Conclusions: Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.

Acculturation and Diabetes Self-management of Cuban Americans: Is Age a Protective Factor?

Migration to the United States has been linked to obesity and poor diet quality. We investigated the relationship among diabetes self-management, diet, age and acculturation factors for 182 Cuban-Americans (Females = 110, Males = 72) with type 2 diabetes recruited from a randomized mailing list in South Florida. Inadequate glycemic control (β = 0.257), BMI (β = 0.251), total fat intake (β = 0.251), and smoking (β = 0.200), were positively associated, while understanding of overall diabetes care (β = -0.165), was negatively associated with migration (N = 162, adj.R2 = 0.286, F = 14.65, p < 0.001). These associations suggest that effective diabetes education targeting acculturation issues is lacking.

Diabetes Self Management: Are Cuban Americans Receiving Quality Health Care?

Objectives: We investigated the relationship among factors predicting inadequate glucose control among 182 Cuban-American adults (Females=110, Males=72) with type 2 diabetes mellitus (CAA). Study Design: Cross-sectional study of CAA from a randomized mailing list in two counties of South Florida Methods: Fasted blood parameters and anthropometric measures were collected during the study. BMI was calculated (kg/ m2). Characteristics and diabetes care of CAA were self-reported Participants were screened by trained interviewers for heritage and diabetes status (inclusion criteria: self-reported having type 2 diabetes; age  35 years, male and female; not pregnant or lactating; no thyroid disorders; no major psychiatric disorders). Participants signed informed consent form. Statistical analyses used SPSS and included descriptive statistic, multiple logistic and ordinal logistic regression models, where all CI 95%. Results: Eighty-eight percent of CAA had BMI of ≥ 25 kg/ m2. Only 54% reported having a diet prescribed/told to schedule meals. We found CAA told to schedule meals were 3.62 more likely to plan meals (1.81, 7.26), p<0.001) and given a prescribed diet, controlling for age, corresponded with following a meal plan OR 4.43 (2.52, 7.79, p<0.001). The overall relationship for HbA1c < 8.5 to following a meal plan was OR 9.34 (2.84, 30.7. p<0.001). Conclusions: The advantage of having a medical professional prescribe a diet seems to be an important environmental support factor in this sample’s diabetes care, since obesity rates are well above the national average. Nearly half CAA are not given dietary guidance, yet our results indicate CAA may improve glycemic control by receiving dietary instructions.

Diet Self-efficacy and Physical Self-concept of College Students at Risk for Eating Disorders

Background: Both eating disorders and body image dissatisfaction affect a high proportion of college students. Self-esteem and self-efficacy may be protective factors for eating disorders. The aim of this study was to evaluate diet self-efficacy, the confidence to maintain or lose weight, and its association with physical selfconcept using data from an online survey of health literacy, body image, and eating disorders. Study Population and Methods: This cross-sectional study collected online survey data from college students within the United States. The inclusion criteria allowed for 1612 college students, ages 17-35 years (597 males, 1015 females) belonging to the following racial/ethnic categories: Black (187); White, non-Hispanic (244), Hispanic (1035), and other (146). Specifically, the study aimed to examine (a) whether and to what degree diet self-efficacy and physical self-concept were associated with risk of eating disorders; (b) the interaction of gender by ethnicity on diet self-efficacy, physical self-concept and risk of eating disorders; and, (c) the relationship of diet self-efficacy with physical self-description and body mass index (BMI) in college students. Results:Low diet self-efficacy was associated with a lower score on physical self-concept (B = −0.52 [−0.90, −0.15], P = 0.007). Males had a higher physical self-concept as compared to females (B = 14.0 [8.2, 19.8], P Conclusion: College students in this study who had a poor body image were less confident with diet control. Poorer body image and low diet selfefficacy were associated with higher BMI. These findings suggest lifestyle management interventions may be of value to improve physical self-concept and lower risk of eating disorders for college students.

Glycemic Control: Risk Factors, Quality of Life, Workforce Participation, and Mortality Among US Adults with Type 2 Diabetes

Despite research showing the benefits of glycemic control, it remains suboptimal among adults with diabetes in the United States. Possible reasons include unaddressed risk factors as well as lack of awareness of its immediate and long term consequences. The objectives of this study were to, using cross-sectional data, 1) ascertain the association between suboptimal (Hemoglobin A1c (HbA1c) ≥7%), borderline (HbA1c 7-8.9%), and poor (HbA1c ≥9%) glycemic control and potentially new risk factors (e.g. work characteristics), and 2) assess whether aspects of poor health and well-being such as poor health related quality of life (HRQOL), unemployment, and missed-work are associated with glycemic control; and 3) using prospective data, assess the relationship between mortality risk and glycemic control in US adults with type 2 diabetes. Data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys were used. HbA1c values were used to create dichotomous glycemic control indicators. Binary logistic regression models were used to assess relationships between risk factors, employment status and glycemic control. Multinomial logistic regression analyses were conducted to assess relationships between glycemic control and HRQOL variables. Zero-inflated Poisson regression models were used to assess relationships between missed work days and glycemic control. Cox-proportional hazard models were used to assess effects of glycemic control on mortality risk. Using STATA software, analyses were weighted to account for complex survey design and non-response. Multivariable models adjusted for socio-demographics, body mass index, among other variables. Results revealed that being a farm worker and working over 40 hours/week were risk factors for suboptimal glycemic control. Having greater days of poor mental was associated with suboptimal, borderline, and poor glycemic control. Having greater days of inactivity was associated with poor glycemic control while having greater days of poor physical health was associated with borderline glycemic control. There were no statistically significant relationships between glycemic control, self-reported general health, employment, and missed work. Finally, having an HbA1c value less than 6.5% was protective against mortality. The findings suggest that work-related factors are important in a person’s ability to reach optimal diabetes management levels. Poor glycemic control appears to have significant detrimental effects on HRQOL.

The Effects on Students' Self-Efficacy Beliefs Regarding Their Comprehension of American Literature When Aesthetic Reading and Reader Response Strategy are Implemented

High-stakes testing and accountability have infiltrated the education system in the United States; the top priority for all teachers must be student progress on standardized tests. This has resulted in the predominance of reading for test-taking, (efferent reading), in the English, language arts, and reading classrooms. Authentic uses of print activities, like aesthetic reading, that encourage students to engage individually with a text, have been pushed aside. During a 3-week time period, regular level, English 3/American literature students in a Title I magnet high school, participated in this quasi-experimental study (N = 62). It measured the effects of an intervention of reading American literature texts aesthetically and writing aesthetically-evoked reader responses on students’ self-efficacy beliefs regarding their comprehension of American literature. One trained teacher and the researcher participated in the study: student participants were pre- and post- tested using the Confidence in Reading American Literature Survey which examined their self-efficacy beliefs regarding their comprehension of American literature. Several statistical analyses were performed. The results of the linear regression analyses partially supported a positive relationship between aesthetically-evoked reader responses and students’ self-efficacy beliefs regarding their comprehension of American literature. Additionally, the results of the 2 (sex) x 2 (treatment) ANCOVAs conducted to test group differences in self-efficacy beliefs regarding the comprehension of American literature between treatment and control groups indicated a main effect for treatment (but not sex; nor was there a significant sex x treatment interaction), suggesting the treatment was partially effective in increasing students’ self-efficacy beliefs. Seven of the twelve ANCOVAs indicated a statistically significant increase in the treatment group’s adjusted group mean self-efficacy belief scores as a result of being exposed to the intervention. In six of these seven analyses, increases in self-efficacy beliefs occurred in tasks that required three or more higher-order levels of thinking/learning. The results are discussed in terms of theoretical, empirical and practical significance. Future research is recommended to extend the intervention beyond the narrow confines of a Title I magnet school to settings where the intervention could be tested longitudinally, e. g., honors and gifted students, elementary and middle schools.

Social-cognitive Antecedents of Ambidextrous Orientation in Family-owned Startups: The Role of Family Ties, Achievement Motivation, and Internal Locus of Control

Regulatory Focus Theory predicts that the motivation to self-regulate goal-directed thought and behavior depends on two distinct regulation strategies: a promotion focus based on attaining gains and a prevention focus based on avoiding losses. This study took a social-cognitive approach predicting that regulatory focus has an impact on how family startups (several family related founders) explore “new ideas”, exploit “old certainties” and achieve the balance of both (ambidexterity), compared to lone founder startups (only one founder present). It was proposed that the social context of family ties among founders leads them to a prevention focus concerned with avoiding the loss of the socio-emotional benefits of those ties. In order to avoid such a loss, family founders were expected to increase their risk perceptions and thus, explore less than lone founders, who lack such socio-emotional ties. It was also proposed that two commonly used psychological traits in entrepreneurship research --achievement motivation and internal locus of control, predispose entrepreneurs to a promotion focus. Founders with a promotion focus, in turn, were hypothesized to lead startups to more risk-seeking behaviors and to more explorative orientation. The previous argument was used as a springboard to derive hypotheses about ambidexterity (the ability to exploit and explore simultaneously) and survival hazards. Using Regulatory Focus Theory, exploitative orientation, conceptualized as the motivational strength to continue on previous paths of action, was hypothesized to be not significantly different from that of lone founder startups. Taking previous arguments together, lone founder startups were hypothesized to be more ambidextrous than family startups. Finally, ambidexterity and internal locus of control were hypothesized to reduce survival hazards in family startups. The findings suggested that family startups explore less than lone founder startups even after controlling for group effects. Interesting but contradictory findings revealed that internal locus of control have both a positive direct effect and a positive interaction that increases the explorative and ambidextrous orientation gap of family startups over lone founder startups. As expected, ambidexterity and internal locus of control reduced survival hazards on family startups. Implications for practitioners were derived based on a sample of 470 nascent entrepreneurs.