November 15, 2002
8:30 am to 3:30 pm
Frank Erwin Center
1701 Red River 78701

Co-sponsored by
Sigma Theta Tau Epsilon Theta Chapter
Center for Women's Studies
Gerontology Institute

INDEX

• SAFE SEX BEHAVIOR IN HISPANIC WOMEN
• A Path Model using Codependency and Binge Eating as Mediating Variables with Selected Biographic Correlates to Explain Body Mass Index in a Nursing Sample
• BENEFIT AND COST ANALYSIS OF A DIABETES SELF-MANAGEMENT EDUCATION PROGRAM
• HEALTHCARE PROFESSIONALS’ PERSPECTIVES ON QUALITY OF DIABETES CARE IN HUALIEN, TAIWAN
• THE ROLE OF SELF-EFFICACY IN WIEHGT MANAGEMENT FOR LOW-INCOME MOTHERS
• PHYSICAL ACTIVITY BEHAVIOR IN PERSONS LIVING WITH HIV DISEASE
• A NEW AUTOMATIC DEVICE FOR THE MEASUREMENT OF LARGE ARTERY STIFFNESS
• SELF-TRANSCENDENCE IN BREAST CANCER SUPPORT GROUPS: PRELIMINARY ANALYSES OF DATA
• THE ROLE OF GLUCOSE IN MENOPAUSAL HOT FLASHES: AN EXPERIMENTAL STUDY
• FACILITATORS AND BARRIERS TO WOMEN’S COMPLETION OF A WALKING INTERVENTION
• Diabetes, Mexican-American, Education
• DEVELOPMENT OF THE PRENATAL HEALTH INVENTORY OF BEHAVIORS (PHI-B)
• Korean Women’s Attitudes Toward Physical Activity
• IMPACT OF ASTHMA EDUCATION ON FAMILY ASTHMA CARE
• Native Americans: Health Promoting Behaviors
• Drug resistance videos for high-risk youth: Current study in data analysis stage
• The Effects of Purpose in Life on Functional Decline & Quality of Life in Polio Survivors
• LONGITUDINAL CHANGES IN DIETARY BEHAVIOR BETWEEN PREGNANCY AND POSTPARTUM IN A TRI-ETHNIC SAMPLE OF LOW-INCOME WOMEN
• Survey of Congregational Health Ministries in the Central States Synod, Evangelical Lutheran Church in America (ELCA)
• DIABETES SYMPTOMS AS A PREDICTOR OF QUALITY OF LIFE AND GLYCOSYLATED HEMOGLOBIN
• Enhanced nutrition knowledge may be a trait of those able to lose weight
• Awareness of Blood Pressure among Older Adults 60 to 75 Years
• Pilot Study of a Wellness Intervention for Women with Fibromyalgia
• NURSING RESEARCH IN HEALTH DISPARITIES: PARTICIPANT OUTCOMES OF A RESEARCH INTERNSHIP
• The State of Elementary School Indoor Air Quality In A Texas Border School District
• Pilot Testing an Intervention to Promote Sexual Health in Street Youth
• Cancer Treatment Options for Underserved Populations: Closing the Gap Between Meta-analysis Outcome Evidence and Orthodox Treatment and Palliation
• Social Risk Factors Associated with Substance Abuse Among Gay and Lesbian Youth
• Telehealth Consumer-Provider Interaction: A Chronic Disease Intervention in an Underserved Population
• Predicting Postpartum Weight Retention
• PRAYER ACTIVITIES AND EXPERIENCES IN PEOPLE WITH LUNG CANCER
• Health-Promoting Nursing Intervention: Underserved Women: Institutional National Research Service Award T32 NR07107 from the National Institute of Nursing Research

A Path Model using Codependency and Binge Eating as Mediating Variables with Selected Biographic Correlates to Explain Body Mass Index in a Nursing Sample

Sarah Allison, RN, Ph.D., P/MHNP
The University of Texas at Austin School of Nursing
1700 Red River St, TX 78751
512-303-3069
Sallison@mail.nur.utexas.edu

As presented at the Feb. 2002 Southern Nursing Research Society Meeting in
San Antonio, TX

Purpose: The aim of this cross sectional study was to investigate the hypothesized direct and indirect influences of selected biographic and psychosocial variables of increased body mass index in a triethnic sample of 511 nurses.

Methods: Path analysis guided the research design, and data analysis of this study. Escape theory provided the rationale for the predictive ordering of variables. This study analyzed a preexisting data set collected by the researcher during a nursing codependency instrument development project.

Findings: Descriptive comparisons revealed nurses in the sample to have a higher rate of obesity (27.2% vs. 18.1%) and binge eating (4.7% vs. .7-4%) than women in the general population. Four predictors were retained in the final BMI model: age, binge eating, Black ethnicity, and Asian ethnicity. In determining the adequacy of the trimmed model, the incremental F ratio was conducted to compare the R2 of .16 from the full model with the R2 of .15 from the trimmed model. The difference between these two R2 outcomes was nonsignificant and indicated that the trimmed path model parsimoniously explained the variance in BMI with no loss in predictive power. The results from the path analysis supported the hypotheses that binge eating, age and Black ethnicity are positively correlated with BMI, and Asian ethnicity is negatively correlated with BMI. Binge eating augmented the relationship between codependency and BMI, but reduced the relationship between Black ethnicity and BMI.

Conclusions: The conclusions are that Blacks are overweight for reasons other than binge eating, and nurses in the sample who scored high on the codependency instrument were more likely to binge eat. Unlike women in the general population, in nurses, increased education and increased number of children were not useful predictors of BMI.

BENEFIT AND COST ANALYSIS OF A DIABETES SELF-MANAGEMENT EDUCATION PROGRAM

N.A. Banister, MA,RD,LD, M.B. Gillham, PhD,RD,LD, R.A. Loop, PhD, V. Hebert, MS,RD,LD, The University of Texas at Austin, Austin, TX; S.T. Jastrow, RD,LD, People’s Community Clinic, Austin, TX.

Objective: To assess the clinical outcomes and cost-effectiveness of a community clinic diabetes self-management program.

Subjects/setting: Seventy people with type 2 diabetes enrolled in a diabetes self-management program at a community clinic. Most participants were Hispanic or African American and had been diagnosed with diabetes for more than one year. Mean age and BMI for the participants were 49 ± 10 years and 34 ± 9 kg/m2, respectively.

Design: A prospective analysis of body weight, medication regimen, and glycosylated hemoglobin (A1C) pre and post diabetes self-management education. Program participants were followed for three to twelve months. Total costs of administering the program were computed on a per person per year basis. The program’s cost-effectiveness ratio was computed by dividing the cost per person per year by the mean change in A1C.

Intervention: A four-hour group diabetes self-management education session followed by a one-hour individual consultation with a dietitian. In addition, each subject was provided with a free glucometer, and testing strips were available at a subsidized rate. Follow-up support meetings were offered monthly.

Statistical Analysis: A univariate model Tukey-Kramer adjusted t-test was used to assess differences between initial, intermediate and final A1C. Significance of difference between initial and final body weights was determined by paired t-test. A continuum of medication changes was developed and frequencies reported.

Results: At follow-up ranging from 3 to 12 months post education, mean A1C improved from 9.7 ± 2.3% to 8.2 ± 2.2% (P<.001), a 15% reduction in A1C. During this period, 37% of subjects maintained their weight within five pounds and no significant change was seen for the group as a whole. Forty-seven percent had no change in their medication regimen. The annual per person cost of providing community clinic based self-management education was approximately $280, or $185 for each one point reduction in A1C.

Applications: Diabetes self-management education can improve health outcomes at modest cost.

HEALTHCARE PROFESSIONALS’ PERSPECTIVES ON QUALITY OF DIABETES CARE IN HUALIEN, TAIWAN

Shu-Chaun Chang, RN, MSN
Doctoral Candidate, The University of Texas at Austin School of Nursing

Purpose: The purpose of this dissertation pilot study is to explore how professionals view factors that influence the quality of diabetes care in Hualien, Taiwan. Hualien is a rural area in eastern Taiwan. The population consists of different ethnicities including Han (people from Mainland China who constitute about two-fourths), Hakka (one-fourth), and aborigines (one-fourth). Uneven distribution of health care resources has been reported. The population of Hualien has a similar prevalence of diabetes but a higher mortality rate than that of the country as a whole; thus, the quality of diabetes care in Hualien is a problem and the population in this region may be viewed as underserved.

Methods: Two focus groups and five individual interviews of professionals, including physicians, nurses and dietitians, were conducted to explore their views about the quality of diabetes care in Hualien. Their work sites included primary care clinics, public health stations, and the medical center in Hualien. Participants were asked about the current quality of diabetes care, their ideal quality of care, and barriers to quality diabetes care. The interviews were recorded on audiotape and then transcribed. Using qualitative analysis, factors influencing the quality of diabetes care were categorized into three dimensions: patient characteristics, community environment, and medical environment.

Findings: Age, ethnicity, education, economic status, and gender were thought to be important patient characteristics. The majority of diabetes patients in Hualien are not well educated. Some Aborigines have maintained their traditional food habits of consuming high-fat meat and alcohol. The community environment includes family, workplace, and food stores. Family support and work time and place were reported as barriers for patient adherence to diet, self-monitoring of blood glucose, and insulin-injection regimen. Family is the most important social support resource in the rural area’s culture but family members were rarely involved in patients’ diabetes education. Working times and places were unstable, especially for those working in mountain areas. Patients who were educated about diet control described difficulty selecting appropriate food because of lack of nutritional labels and the inconvenience of diet control. Medical environment factors, the structure and process of care were reported frequently as impeding quality. Lack of integrated diabetes care, lack of manpower for diabetes education, and insufficient professional knowledge about diabetes treatment in primary care were identified. Crowded diabetes subspecialty clinics, lack of interdisciplinary cooperation, inadequate referral systems, and unrealistic self-care regimens were also described. Professionals suggested improvement in professional education, diabetes care guidelines, patient-professional relationships, interdisciplinary collaboration, and the referral system as important. Support from the medical center administrator was expected.

Conclusion: This study reports specific problems and suggestions identified by healthcare professionals as important to the quality of diabetes care in Hualien, Taiwan. Findings support the importance of attending to patient demographic characteristics, community factors, and the structure and process of health care in improving diabetes care quality.

THE ROLE OF SELF-EFFICACY IN WIEHGT MANAGEMENT FOR LOW-INCOME MOTHERS

Kristine K. Clarke, Deborah M. Klohe, Guowen Cai, J. Michael Proffitt, Saroja V. Voruganti, Tracey Milani, Henry Hans-Nuss, Lorraine O. Walker, Jeanne H. Freeland-Graves
University of Texas at Austin, Division of Nutritional Sciences, A2700, Austin, TX 78712
University of Texas at Austin, School of Nursing, Austin, TX

Self-efficacy is the confidence an individual has that they can perform a given activity. The purpose of this study was to evaluate the role of self-efficacy in successful adherence to weight loss. An 8-week dietary and physical activity program for overweight, low-income women was developed and tested. Demographics and a 20-item Weight Efficacy Lifestyle Questionnaire (WEL) were administered to 90 overweight/obese (BMI > 25) low-income mothers (18% African-American, 64% Hispanic, and 18% Caucasian) pre- and post-intervention, and one time to controls (BMI < 25, N=37). Program participants gained more confidence that they could resist eating when experiencing negative emotions (x=23.5 to 25.6, p<0.05), when faced with social pressure to eat (x=24.9 to 27.6, p<0.05), and when food was available (x=21.8 to 25.3, p<0.01). By post-intervention, WEL scores did not differ from scores of the controls. Thus, WEL scores may be used by intervention programs to help clients target situations which may hinder their weight loss. Supported by the Texas Coordinating Board #UTA00-37.

PHYSICAL ACTIVITY BEHAVIOR IN PERSONS LIVING WITH HIV DISEASE

Evelyn M. Clingerman, RN, DNSc,
NSRA Postdoctoral Fellow
The University of Texas at Austin
School of Nursing

Abstract: Health promotion physical activity behaviors may offer substantial health benefits for persons infected with the human immunodeficiency virus (HIV). The purpose of this study was to assess type, frequency, and duration of health promoting physical activity behaviors, and to identify factors associated with participation in physical activity for persons living with HIV disease (PLWHD). The investigator conducted a descriptive correlational study surveying 78 persons (n= 70 men; n = 8 women) from two outpatient settings who self-reported seropositive. Results showed that fewer PLWHD met Healthy People 2010 physical activity recommendations than persons in the general population, and that the number of days per week that participants performed at least 30 minutes of moderate or vigorous physical activity was significantly (r = .37, p <. 0.001) correlated with well-being, and with average functional social support (r = .26, p <0.05) scores. Findings demonstrated that weekly frequency participation in at least 30 minutes of moderate or vigorous physical activity was inversely related to health distress and to the sedentary behavior of watching television.

A NEW AUTOMATIC DEVICE FOR THE MEASUREMENT OF LARGE ARTERY STIFFNESS

Miriam Y. Cortez-Cooper, MA; James A. Supak, BA; Hirofumi Tanaka, Ph.D.
Cardiovascular Aging Research Laboratory
Department of Kinesiology and Health Education
University of Texas at Austin
Austin, TX 78712

Running Head: Automatic arterial stiffness measurements

Abstract: An increase in the stiffness of the central arteries exerts a number of adverse effects on systemic cardiovascular function and increases the risk of disease. In particular, arterial stiffness is the principal cause of increasing systolic and pulse pressure with advancing age1. Recently, arterial stiffness has been identified as an independent risk factor for future cardiovascular disease2. Despite the well-established clinical significance, measurements of arterial stiffness are not conducted outside of vascular laboratories because of equipment cost and necessary technical skill. Purpose. The purpose of this study was to validate an automatic medical device designed to measure arterial stiffness as determined by carotid-femoral arterial pulse wave velocity and carotid augmentation index. Methods. We compared the values obtained with a newly developed automatic device for the measurement of arterial stiffness (Colin VP-2000) with the manual method in 52 subjects varying in age (22-77 yr). The automatic device simultaneously measured bilateral brachial and ankle blood pressures as well as carotid and femoral arterial pulse waves with a multi-sensor tonometer to facilitate proper positioning at the pulse sites. The device required the total time of <5 min, which included set-up, measurement, and analyses. Findings. Carotid augmentation index obtained with the manual and automatic methods demonstrated a strong linear association with r=0.98 (P<0.0001) with a mean difference of 0.2 ± 4.6%. Similarly, carotid-femoral pulse wave velocity using these two methodologies demonstrated a strong association (r=0.97; P<0.0001) with the mean difference of 34±68 cm/sec. Conclusion. The results of the present study indicate that the new automatic device is accurate for the measurement of arterial stiffness. Because of the minimal technical skill and time required, this device has great potential to screen for sub clinical vascular pathology.

Key Words: pulse wave velocity, arterial stiffness, risk factors

Correspondence:
Miriam Cortez-Cooper, MA
Department of Kinesiology and Health Education
University of Texas at Austin
Austin, TX 78712
(512) 471-8594 (Phone)
(512) 471-0946 (Fax)
m.cortez-cooper@mail.utexas.edu (e-mail)

SELF-TRANSCENDENCE IN BREAST CANCER SUPPORT GROUPS:
PRELIMINARY ANALYSES OF DATA

Doris D. Coward, RN, PhD
The University of Texas at Austin School of Nursing, Austin, TX

Purpose: The traditional goals of cancer support groups are to provide basic information about cancer and treatment, offer emotional support, and teach coping mechanisms. The purpose of this experimental design study was to expand those traditional goals by consciously promoting self-transcendence views and behaviors within a support group for women with newly diagnosed breast cancer. It was hypothesized that there would be greater changes on measures of self-transcendence and well-being over an eight month period in 80 women with newly diagnosed breast cancer participating in experimental breast cancer support groups compared with 80 women in traditional cancer support groups.

Methods: The 161 participants (all within six months of diagnosis) were recruited sequentially in groups of nine into experimental and control groups. Experimental group participants attended an 8-session breast cancer support group facilitated by an oncology clinical nurse specialist, a mental health consultant, and a long-term breast cancer survivor. The intervention was developed from theory and research connecting multidimensional expansion of self-concept boundaries with maintaining/restoring well being within adverse situations. Activities promoting expansion of self-concept boundaries were implemented during group sessions. Women were encouraged maintain contact between sessions and after the end of the group. Control group participants were assisted in locating conventional cancer support groups within the local community.

Participants are completing paper and pencil questionnaires three times (at baseline, after the experimental support group or 2-3 months later, and 6 months later). All study instruments (Self-Transcendence Scale, Purpose-in-Life Test, Symptom Distress Scale, Karnovsky Performance Status, Profile of Mood States, Cognitive Well-Being Scale, and Dyadic Adjustment Scale) were used previously with cancer patients and demonstrated acceptable reliability in this study. Fourteen participants are providing additional narrative data. Lymphocyte proliferative status was assessed in a subset of 25 participants. For this poster, quantitative data were analyzed using descriptive statistics, t-test, and Cohen's d effect sizes. Further analyses will include correlations, MANOVA, and ANOVA.

Findings: Preliminary findings support results of previous correlational and phenomenological studies, as well as two preliminary studies. Although t-tests indicated no significant differences between groups on outcome variables, effect-size analyses demonstrated a small effect of the intervention on self-transcendence, purpose in life, cognitive well-being, and dyadic adjustment.

Conclusions: Time 3 data from the last 40 study participants may demonstrate stronger group differences. Findings help oncology nurses recognize the centrality of self-transcendence in the lives of women with breast cancer. Development and implementation within cancer support groups of techniques to facilitate expansion of self-concept boundaries may help survivors more easily find purpose and meaning and healing within the context of a breast cancer diagnosis.

Funded by NIH/NINR & NCCAM

THE ROLE OF GLUCOSE IN MENOPAUSAL HOT FLASHES: AN EXPERIMENTAL STUDY

Sharon L. Dormire, PhD, RNC
Assistant Professor
The University of Texas at Austin
School of Nursing

Purpose: The objective of this study was to evaluate the hypothesis that hot flashes are a counter-regulatory mechanism to increase brain glucose uptake during the menopause transition in response to estrogen-related decline in production of glucose transporter at the blood brain barrier.

Methods: Using a repeated measures experimental design, the relationship between blood glucose and hot flashes was examined during fasting and experimental manipulations of blood glucose concentrations in a sample of 11 postmenopausal women ages 38-55 years withdrawing from hormone replacement therapy. In random order, subjects received an intravenous infusion (glucose or normal saline) over a 3.5-hour period on two consecutive days. Blood glucose levels were evaluated every 5 to 15 minutes according to protocol. Hot flashes were objectively measured using skin conductance monitoring. Comparison of plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) levels before and after each experimental condition provided a biomarker of norepinephrine activity. Insulin and glucagons levels were also drawn before and after each experimental period.

Findings: Under controlled conditions there was a significant difference in hot flash frequency between the glucose infusion period and the normal saline period were found (t = 2.46, df = 10, p<,05). During the glucose infusion period, a total of 4 hot flashes were experienced by 3 participants while 21 hot flashes were experienced by 5 participants during the normal saline infusion. Six participants did not experience any objectively identified hot flashes during the study, although most of this subgroup documented frequent hot flashes (false positive). Participants who did not experience any hot flashes during the study differed from those who had hot flashes by HgbA1c and admission Fasting blood glucose.

Conclusions: These findings support the hypothesis that hot flash frequency is higher during fasting than when blood glucose is experimentally elevated in postmenopausal women. Further study is needed with a larger sample and with a sample of women currently experiencing hot flashes but not receiving hormone therapy for treatment.

FACILITATORS AND BARRIERS TO WOMEN’S COMPLETION OF A WALKING INTERVENTION

Mary Z. Dunn (Kelly), PhD, RN
Colleen S. Keller, PhD, RN
The University of Texas Health Science Center at San Antonio School of Nursing
7703 Floyd Curl Drive, San Antonio, Texas 78229-3900

Purpose: The purpose of this study was to describe factors older African-American women reported as facilitating or hindering their participation in a physical activity intervention study.

Physical activity is a key factor in preserving health. Regular moderate physical activity maintains weight, improves metabolism and insulin efficiency and reduces the risk of chronic conditions such as diabetes, heart disease and osteoporosis. While less than half of the general U.S. population reports regular physical activity, almost two thirds of African American women are sedentary. African-American women may experience facilitators and barriers to physical activity that are specific to their sociocultural milieus, but have not been reported.

Methods: This sub study recruited 13 women between 45 and 68 years of age from a 36 week walking intervention study to participate in one of three focus group discussions. IRB approval and informed consent were obtained prior to the study. Questions by focus group facilitators invited women to describe their research participation experience in terms of difficulties they encountered and the methods they used to manage them as well as motivating and reinforcing factors for maintaining the walking protocol.

Findings: Barriers to walking were identified in terms of care giving responsibilities unique to their family, work, and social role demands; physical limitations associated with overweight, stress and medication side effects; and physical and social environmental factors including safety issues and the motivation they needed from others to maintain activity. Persistent physical activity was associated with commitment to self or God, health concerns and exercise partners.

Conclusions: Barriers to exercise research participation reported by older African American women are similar to those reported by Caucasian women. Women’s personal commitment to program completion was strengthened by affiliations with churches from which they were recruited, having assigned walking partners and social exchanges during research group meetings.

Diabetes, Mexican-American, Education

Velia Michelle Enriquez, UTSN
University of Texas at Austin, School of Nursing
1700 Red River, Austin, TX 78701

The increased threat of Type II Diabetes among the Mexican American community has been found to affect at least 15% of this population. This disorder is the third leading cause of death among females and the fourth among males. Contributing factors, such as cholesterol and glucose, will increase its incidence when consumed in excess over a prolonged period of time.

The purpose of this study is to investigate the relationship between the gender differences and how they apply to the cholesterol and glucose levels among this particular ethnic group. This specific research was supported by an NIH/NINR grant established through the Center for Health Promotion Research at the University of Texas at Austin School of Nursing. The data used to evaluate this relationship is derived from the current research study, Diabetes Education in the Rio Grande Valley, whose principal co-investigator, Dr. Sharon A. Brown has been involved in research in the Rio Grande Valley since the late 1980’s.

A total of 144 Mexican American men and women were randomly deduced from the existing data set. Each individual participated in the Diabetes Education Intervention, which included lab work and assessment; printed, audio, and video material; and instructional classes given by qualified registered nurses and dieticians. All information provided to participants is provided in English and Spanish and incorporates the cultural aspect of this community. Statistical analysis of the baseline data was evaluated with Chi-square and T-tests, which indicated that the cholesterol levels have a clinical significance of 0.018. There were no significant findings in glucose levels within this data set.

DEVELOPMENT OF THE PRENATAL HEALTH INVENTORY OF BEHAVIORS (PHI-B)

Robin Fleschler, PhD, RNC, CNS, NP
The University of Texas at Austin School of Nursing

Purpose: Advances in technology and research on biomedical risk factors have not succeeded in decreasing the 7.4% rate for low birthweight (LBW) infants/1.37% rate for very low birthweight (VLBW) infants in the U.S. Vulnerable groups of women—for example, Black women—suffer
rates even higher: 13.0% for LBW infants, 3.0% for VLBW infants. Decreasing LBW to 5% of all live births and VLBW to 1% of all live births has been identified by Healthy People 2010 as one of its primary research concerns (U.S. Department of Health and Human Services, 2000). Additionally, information systems, including “valid and reliable instruments for screening and for assessing lifestyle,” have been identified as one of three priority areas for research by the National Center for Education in Maternal and Child Health (Lamberty et al., 1996). A comprehensive and scientifically sound instrument that measures the impact of prenatal health behavior on perinatal and birth outcomes does not exist. The purpose of this study was to develop a comprehensive, psychometrically sound inventory to measure women’s health behaviors associated with the preconceptual and pregnancy periods.

Methods: A correlational design was used to conduct a psychometric analysis of the PHI-B. Four phases of the study included: 1) Conceptualization of prenatal health behavior, 2) Item development and instrument construction, 3) Pilot study for refinement of items and initial reliability, and 4) Psychometric testing of the 45-item inventory in a larger longitudinal study to estimate reliability and validity.

Findings: Reliability and validity of the PHI-B was tested in a multi-ethnic sample of 333 pregnant women. Satisfactory test-retest reliability (r = .87) and internal consistency reliability (coefficient alpha = .82) of the PHI-B as a whole was demonstrated, but coefficient alphas for theorized domain subscales ranged from poor to adequate (.15 to .72). Preliminary factor analysis did not support these domains, while a second factor analysis revealed a five-factor solution, somewhat dissimilar from the original theorized domains. The five factors were named Surveillance of Health, Good Health Practices, Ensuring Safety, Balancing Health, and Adherence. Evidence of test-retest reliability for these subscales (r = .71, .79, .8, .77, .85) was found. Evidence of concurrent validity was provided by obtaining Pearson correlations between scores of prenatal health behavior and scores on well-being (r = .35), depressive symptoms (r = -.39), and physical discomforts (r = -.2), while evidence of convergent and divergent validity was found with a general measure of health behaviors (r = .73) and a measure of social desirability (r = -.18), respectively. Assessing the factor-analytic subscales for construct validity revealed interesting associations, particularly for stress management and depressive symptoms.

Conclusions: Reliability and validity testing in the final phase resulted in a 42-item inventory.
Infrequently reported risk avoidance items contributed to diminished variance of the items, while
factor analysis failed to validate the theorized behavioral domains. Regardless, preliminary psychometric analyses revealed adequate internal consistency and reliability for the new inventory; adequate stability for the subscales; and small, moderate to strong evidence of concurrent, convergent, and divergent validity for the total scale and subscales.

Lamberty, G., Papai, J., & Kessel, W. (Eds.). (1996). Proceedings of the Fourth National Title V Maternal and Child Health Research Priorities Conference. Arlington, VA: National Center for Education in Maternal and Child Health. U. S. Department of Health and Human Services. (2000). Healthy People 2010. Rockville, MD: Author.

Korean Women’s Attitudes Toward Physical Activity

Eun-Ok Im, PhD, MPH, & Myoung Ae Choe, PhD
Univ. of Texas at Austin, US & Seoul National University, Seoul, South Korea

Corresponding Address:
Eun-Ok Im, Associate Professor, School of Nursing,
Univ. of Texas at Austin, 1700 Red River, Austin, TX 78701,
(512) 471-7971, eim@mail.nur.utexas.edu

Abstract: Most of the studies on physical activity have focused on only physiological aspects of physical activity. Consequently, very little is known about how women themselves-especially Asian women-perceive the importance of physical activity. The purpose of the study was to explore attitudes toward physical activity of a group of Asian women-Korean women and to give future directions for nursing care for them. As theoretical framework, feminist approach was used. Using theoretical sampling, 17 healthy Korean women, 11 Korean women at risk of muscular atrophy, and 16 Korean immigrant women were recruited. About 2 hour semi-structured In-depth interviews were conducted using an interview guide, and the interviews were audiotaped and transcribed. The qualitative data were analyzed using thematic analysis including textual examination of interview transcripts, line-by-line coding of the transcripts into categories that emerged from researches’ internal cognitive process and reflexive thinking, description of key relationships between the categories, inductive and deductive cognitive process, writing memos, and group discussions were conducted. The findings indicated: (a) the women tended to have a holistic view on physical activity; (b) death was perceived as the opposite of physical activity; (c) exercise was differentiated from physical activity; and (d) the women did not give any attention to physical activity because of their busy schedules. Similarities and differences in the attitudes of the three groups were found, and implications for nursing care will be proposed based on the discussions.

IMPACT OF ASTHMA EDUCATION ON FAMILY ASTHMA CARE

Sharon D. Horner, PhD, RN
The University of Texas at Austin
Funded by: National Institute of Nursing Research, NR04775

Purpose/Design: This pilot study was designed to evaluate changes in parents’ and children’s asthma management after being provided asthma education. A quasi-experimental design; children randomized by schools. Asthma classes were given to small groups of children during the school day; a booklet with asthma management information was sent home to their parents. Data was collected 3 times: Baseline data (T1) was collected after obtaining parental consent and child assent, and again at 6 (T2) and 12 (T3) months after the educational intervention.

Sample: Children with asthma in grades 2 to 5 (n = 58) and their primary caregiver: 16 (28%) Mexican-American, 24 (41%) African American, and 18 (31%) Anglo-American children; 40 (70%) boys, 18 (30%) girls; mean age of 8.9 years (SD = 1.03); 49% were from low income families. Sample attrition at T2 was 6 families and 8 more families at T3 (24% total attrition).

Research Question 1: What is the effect of asthma education on (a) children’s and (b) parents’ asthma management behaviors?

ANOVA results were not significantly different between the treatment and control groups across T1, T2, T3. A positive change in mean scores between T1 and T2 was noted, followed by a plateau or small decrease in scores at T3. Post hoc paired t-tests were run between T1 and T2 data [Bonferonni corrected, significance level = 0.0125].

Research Question 2: Do socioeconomic status (SES) and ethnicity influence family asthma management?

Children from low SES families had significantly higher asthma management scores than children from higher SES families at T2 [F = 5.484, p = .02], but were not signficantly different at T3.

African American families in the treatment group scored significantly higher on parents’ asthma management at T2 [F = 4.077, p = .05] and children’s asthma management at T3 [F = 7.04, p = .02) than the control families. Anglo American and Mexican American families in the treatment group scored higher on asthma management at T2, but the differences were not significant.

Limitations: The small sample size in each ethnic group limits power of the analysis.

Conclusions: The intervention had a greater impact on some families (African American and lower SES) than others. The decline in mean scores between T2 andT3 indicate a need for mechanisms to reinforce asthma education and to address changing family needs.

Native Americans: Health Promoting Behaviors

Holloway, C. and Sykes, S.
University of Mary Hardin Baylor, Belton, TX

Purpose: The Native American (NA) of today experiences severe social, economic, and health problems in comparison with the general United States population (Indian Health Service, 1994) The purpose of this ethnographic study sought to answer the following two questions: 1) How does the culture of Native Americans and Alabama-Coushatta Indians influence their health, health care and health promoting behaviors? 2) Do the Native Americans in general have more health-promoting behaviors than the Alabama-Coushatta Indians on a reservation?

Method: Methodology utilized was a convenience sampling of 10 subjects from the general population of NAs not living on reservations and 10 subjects from tribal members of the Alabama Coushatta Indians in East Texas. Five of the general NA subjects were from various tribal affiliations and were interviewed at a Central Texas tribal group activity and the other five subjects were recruited through community contacts. The Alabama-Coushatta Indians were approached on the reservation in East Texas. Two research instruments were utilized. For transcultural assessment and data collection Giger and Davidhizar’s assessment model “Application of Cultural Phenomena to Nursing Care and Nursing Practice” (Giger and Davidhizar, 1991). A tool (titled Profile) was developed to measure and describe health-promoting behaviors in our cultures. This tool was modeled after Pender’s (1987) Life Style and Health-Habits Assessment and the Lifestyle Profile (Walker, Sechrist and Pender, 1985) which is also titled Health-Promoting Lifestyle Profile (HPLP) This study was a descriptive, non-experimental design.

Findings: The results of the health-promoting behaviors tool interview was quantified and given a percent value. Scores were similar for the two groups except for stress management. In that area the NAs were 20.4% higher. The AC were slightly higher in health promoting behaviors than the general NA sample in the areas of self-actualization, health responsibility, exercise, nutrition, and interpersonal support. Transcultural assessment was evaluated with interview questions regarding the areas of social organization, environmental control, communication, space, time, and biologic variations. In both of the cultures, some individuals are not particularly striving towards self-actualization. They are present oriented. Both groups are dissatisfied with their environment. Both groups demonstrated poor or fair health responsibility. Neither culture sample exercised on a regular basis. In the area of nutrition, the AC’s only had a fair health-promoting behavior score. The NA sample demonstrated positive health-promoting behaviors and effective methods of dealing with stress, such as seeking out the spiritual advisor, meditating, having quiet times and going for walks. On the other hand, the AC’s culture seems to have a negative impact on their stress management.

Conclusions: The research questions were examined in terms of how the responses demonstrate ways the NA or AC’s cultures affect their health, their health practices and health promoting behaviors. The data collected indicates a great need for creative patient and family education especially in the areas of stress management, diet, exercise, and diabetic practices. Health professionals must keep in mind the need to combine the best of the NA and western medicine practices, avoid stereotypical images, and develop a relationship of mutual respect and trust.

Drug resistance videos for high-risk youth
Current study in data analysis stage

Lori K. Holleran, PhD
The University of Texas at Austin
School of Social Work

Purpose and Significance of Project:
Growing evidence indicates that culture and environment impact adolescent substance abuse beliefs and behaviors (Botvin, Schinke, & Orlandi, 1995). The culture of students in traditional education programs varies dramatically from youth in GED programs, low-income community programs, and homeless shelters (Rew, Taylor and Fitzgerald, 2001) In the United States, few substance abuse prevention approaches have proven effective in reducing substance use among adolescents in general, and even fewer have been evaluated for their effectiveness with ethnic minority youths (Forgey, Schinke, and Cole, 1997; Gorman, 1998). Most drug resistance programs are evaluated in traditional school settings, excluding the youth at highest risk for drug use/abuse. Consequently, this study will take place in community settings with youth from high-risk neighborhoods and environmental conditions. In addition, most drug prevention programs are created by and for European Americans and tested primarily on this ethnic group. It has been suggested that the failure of many prevention programs can be traced to their lack of cultural sensitivity (Hansen, Miller, & Leukefeld, 1995; Palinkas, et. al., 1996). Exploring alternative means of prevention intervention delivery, this unique study will include youth from community centers, alternative learning programs, and settings for homeless youth. The proposed project will examine the role of acculturation and ethnic identification in the area of drug attitudes, behaviors and prevention.

Specific Aims:
To determine the role of high risk youths’ acculturative type (i.e., integrated, separated, assimilated, or marginalized) in order to inform the development of culturally appropriate drug prevention strategies.
To examine ethnic identification as it relates to high risk youths’ acculturative type and drug attitudes and behaviors.

Methods:
The research utilizes standardized measures and videos created by adolescents of the Drug Resistance Strategies Project (NIDA, 2RO1 DA05629). The methodology includes a quantitative pretest/posttest quasi-experimental design as well as qualitative focus groups. Acculturation is being measured with the ARSMA-II (Cuellar & Arnold, 1995). Drug attitudes and behaviors are measured with questions adapted from Texas Commission on Alcohol and Drug Abuse (2000). Resistance strategies and responses to the videos will be tested using inquiries regarding the four primary resistance strategies of DRS and the Perception of Performance Scale (Miller, Hecht, & Stiff, 1998) developed and utilized with youths in Arizona attending six high schools. This project will serve as a pilot to a proposed study addressing acculturation and drug prevention with a larger sample of multi-cultural youth in Texas.

Demographics:
Locations: Lifeworks Youth Shelter, American Youthworks alternative learning center, Boys & Girls Club, East Austin.
Age: 11 (11%), 12 (12.2%), 13 (7.3%), 14 (1.2%), 15 (6.1%), 16 (9.8%), 17 (20.7%), 18 (19.5%)
Ethnicity: White (13.4%), Black/African American (45.1%), Hispanic/Mexican/Mexican American (28%), Pacific Islander (2.4%), Native American (1.2%), Other (7.3%).
Gender: 50% boys, 47.6% girls, 2.4% no response

The Effects of Purpose in Life on Functional Decline &
Quality of Life in Polio Survivors

T. Harrison, MSN, RN
Stuifbergen, PhD, RN, FAAN
The University of Texas at Austin
School of Nursing

Purpose: Although the combined social and physical experience of living with the effects of polio has been associated with accelerated aging (Campbell, Sheets & Strong, 1999), finding a purpose in life may diminish the effect (Ryff & Singer, 1998) and provide a higher quality of life (Stuifbergen & Rogers, 1997). The purpose of this study was to explore the effects of ‘purpose in life’ on perceived physical decline and quality of life in a sample of polio survivors.

Method: This study is a secondary analysis using survey data from a national study of polio survivors recruited to evaluate the health promoting behaviors and quality of life in persons with chronic disabling conditions. Depressive symptoms were measured with the CESD-10 and physical impairment was measured with the Kurtzke Incapacity Status Scale (1983). Purpose in life was measured with one item from the Health Promoting Lifestyle Profile II (HPLP, II) (Walker, Sechrist, & Pender, 1995), which asked, ‘how often do you: believe that my life has purpose.’ The Quality of life Index (Ferrans & Powers, 1985) was used to measure variables known to contribute to quality of life and the saliency of each to the individual. Descriptive statistics, Pearson correlation, multiple regression and independent sample t-tests were used to analyze the data.

Findings: Of the sample of polio survivors (N= 2151), the majority was retired (38%), married (66%), female (69%) and white (98%) with a mean age of 62 years. Analyses indicated that perceived functional decline over the past 5 years was significantly higher [t (699)=4.81, p-<0.001) for those with low purpose in life (M=5.76, ±1.34) than for those with a high purpose in life (M=5.41, ±1.45). Physical impairment (Incapacity Status Scale) and depressive symptoms (CESD-10) were significant predictors of quality of life (R2=.38 F (2,2145)=644.47, p<0.001). When purpose in life was added to the equation (R2=.49 F (3, 2145)) =683.39, p<0.001), it provided a significant increase (R2 change = .11) in the explained variance in quality of life, indicating that when the effects of mental and physical health are statistically controlled, purpose in life is a strong positive predictor of quality of life.

Conclusion: This study supported the work of Stuifbergen and Rogers (1997) by confirming that purpose in life was associated with a higher quality of life despite levels of physical and mental impairment. Further work on functional decline and purpose in life among persons aging with chronic disabling conditions is needed to clarify the relationship between these variables.

Grant R01NR03195, National Institute of Nursing Research, NIH, supported this project.

LONGITUDINAL CHANGES IN DIETARY BEHAVIOR BETWEEN PREGNANCY AND POSTPARTUM IN A TRI-ETHNIC SAMPLE OF LOW-INCOME WOMEN

Goldy Chacko George, MS, Jeanne Freeland-Graves, PhD, RD, Henry Hanss-Nuss, BS, Tracey Milani, BS, Minseong Kim, MS, Lorraine O. Walker , EdD, RN.
Division of Nutritional Sciences, Division of Educational Psychology, School of Nursing, The University of Texas at Austin, Austin, TX 78712.

Purpose: The purpose of this study was to compare dietary behavior between pregnancy and postpartum in a tri-ethnic sample of low-income women.

Methods: One hundred and twenty seven Medicaid qualified mothers (27% Anglo, 24% African-American and 49% Hispanic; mean age 23 years) were recruited 0-1 days following delivery of a singleton infant. Dietary choices during pregnancy and the first 6 months postpartum were assessed via validated food frequency questionnaires administered at 6-weeks and 6-months postpartum.

Results: From pregnancy to postpartum, % calories from fat increased (36.8% vs. 38.3%, p<0.01) while those from carbohydrates decreased (48.3% vs. 46.1%, p<0.003). A greater percentage of women met 5-a-day recommendations for fruits and vegetables during pregnancy than during postpartum (53.5% vs. 26.0%, p<0.001). The proportion of women consuming at least one glass of milk daily declined from pregnancy to postpartum in breast- (50% vs. 29.4%, p<0.07) and bottle-feeding (38.8% vs. 20.4%, p<0.004) mothers. Mean % of food prepared at home increased from pregnancy to postpartum (49.1% vs. 54.5%, p<0.02). Women who breast-fed obtained lower % of meals from fast food establishments during pregnancy than those who bottle-fed (16.4% vs. 23.5%). Also, breast-feeding women exhibited a marked decrease in fast food consumption from pregnancy to postpartum (16.4% vs. 9.5%, p<0.05), whereas women who bottle-fed showed less change (23.5% vs. 20.3%, p> 0.05).

Conclusions: The results suggest that the transition from pregnancy to postpartum is associated with alterations in dietary behavior that could ultimately compromise nutritional status in low-income women. Nutritional concern for these women must be extended into the postpartal period to ensure optimal health.

Acknowledgements: This research was supported by a grant from the National Institutes of Health #RO1 NR04679.

Survey of Congregational Health Ministries in the Central States Synod, Evangelical Lutheran Church in America (ELCA)

Carol Gaskamp PhD, RN (University of Texas at Austin School of Nursing)
Co-investigator: Dayna Kerr, BSN, RN (CSS Health Ministry Task Force, Kansas City, KS)

Purpose. The Central States Synod (Kansas and Missouri) of the Evangelical Lutheran Church in America has many congregations comprised of aging members living in rural and medically underserved areas. To address both health care and pastoral care needs in these areas, a synod official proposed having a parish nursing track in the synod’s Parish Ministry Associated (PMA) program that prepares lay ministers. However, little was known about what Central States Synod (CSS) congregations were actually doing in the area of health ministries. The Health Ministry Task force of the CSS surveyed synod congregations in July 2001 to describe the extent of parish nursing activities within the Central States Synod, identify interest in having a Parish Ministry Associate prepared as a parish nurse, and to discover congregations wanting to network with others in the Central States Synod providing congregational health ministries.

Methods. A survey was developed and mailed to all 216 congregations of the CSS; 106 responded, for a 49% response rate.

Findings. 23 congregations (21.7%) reported having a congregational health ministry program and 5 congregations (4.7%) were in the planning stage for a health ministry program. Congregations with health ministries or planning health ministries tended to be younger, have larger attendance, were stable or growing in congregational size, and located in urban settings in comparison with congregations that did not have a health ministry program. Five congregations began their health ministry program between 1985 and 1995; eleven started their programs since 1999. Twenty congregations reported having 76 RNs working in their health ministry program. Sixteen nurses in eleven congregations reported having completed the Basic Parish Nurse Curriculum endorsed by the International Parish Nurse Resource Center. The most common activities of the health ministry programs were blood pressure checks (87%), health education classes (61%), and visitation (61%). Regarding the interest in having a Parish Nurse-PMA, 6.6% of all respondents indicated interest, 45.3% were interested sometime in the future, and 33% were not interested. One note of interest was that 42.3% of the congregations that did not have a health ministry program indicated future interest in a Parish Nurse-PMA. There was interest in networking among congregations regarding health ministry programs: 47.6% of the total sample and 82.6% of those providing health ministries were interested in networking within the Central States Synod. Paper newsletters and Area Ministry Meetings were the most frequently designated means for networking.

Conclusions. Based on the survey results, the Task Force recommended that the synod support efforts to have more parish nurses complete the Basic Parish Nurse Curriculum, and that a mechanism for networking among those interested in health ministry be established.

DIABETES SYMPTOMS AS A PREDICTOR OF QUALITY OF LIFE AND GLYCOSYLATED HEMOGLOBIN

Alexandra A. García, PhD, RN
The University of Texas at Austin
School of Nursing

PURPOSE: The purpose of this study was to investigate diabetes-related symptoms as a predictor of quality of life and diabetes physiologic control as measured by glycosylated hemoglobin (HbA1c) level. Diabetes is a growing threat to Mexican Americans. In Texas, Mexican Americans comprise 17.3% of the population but account for 26.5% of the diabetes caseload. Approximately 50% of people with diabetes experience diabetes symptoms although they may be free of symptoms for several years or may be unaware of the source of symptoms because the symptoms are nonspecific and develop slowly. The role of symptoms in diabetes self-management and the relationship of symptoms to physiologic control of diabetes and quality of life are understudied, especially in the Mexican American population.

METHOD: Eighty-seven Mexican American adults with type 2 diabetes were recruited from two clinics at the time they had their blood drawn for HbA1c testing. They were administered five questionnaires in one-on-one interviews: Demographics, Acculturation, Diabetes Knowledge, Diabetes Symptom Inventory, and Cantril’s Self-Anchoring Striving Scale (a measure of life quality). Hierarchical multiple regression analyses were used to predict HbA1c and quality of life. It was hypothesized that having more symptoms would be associated with higher (worse) HbA1c and lower quality of life.

FINDINGS: The majority of the sample was female (77%) and married (52%); the mean age was 53 years; the mean time since diagnosis with diabetes was 8.9 years; 53% preferred to speak Spanish; 70% had eight years or fewer of education. Sex, acculturation, time since diagnosis, number of diabetes medications, diabetes knowledge, and number of symptoms predicted HbA1c (explaining 18% of the variance) and quality of life (explaining 21% of the variance) although number of symptoms was the only significant predictor in each model after the other predictors were entered. After the other predictors were entered into the model, the number of symptoms increased the explained variance in HbA1c by 5% (p = .033) and quality of life by 12% (p = .001).

CONCLUSIONS: The results lend support for the validity of the Diabetes Symptom Inventory. In addition, the findings of this study suggest the need for further research into the relationship between symptoms and diabetes outcomes. Almost all patients have diabetes-related symptoms . Addressing symptoms and their treatment may significantly improve glycosylated hemoglobin and quality of life.

ACKNOWLEDGEMENT: This study was supported by 1F31NR007407-01 the National Institute of Nursing Research, National Institutes of Health.

Enhanced nutrition knowledge may be a trait of those able to lose weight

Deborah M. Klohe, R.D., Kristine K. Clarke, MPH, R.D., Guowen Cai, J. Michael Proffitt, Saroja V. Voruganti, Henry Hanss-Nuss, Tracey Milani, Lorraine O. Walker, Ph.D., Jeanne H. Freeland-Graves, Ph.D., R.D.

The University of Texas at Austin, Division of Nutritional Sciences, A2700, Austin, Texas 78712,
The University of Texas at Austin, School of Nursing, Austin, Texas 78712

Although it is assumed that nutrition knowledge does not reflect behavior, it may be important for successful weight loss. The purpose of this study was to assess nutrition knowledge in overweight/obese, low-income mothers (BMI=25, x=35.3) participating in a weight loss intervention. Height, weight, and body mass index (BMI) were calculated, and demographics and a nutrition knowledge questionnaire (30 items) were administered pre- and post-intervention to 100 subjects (14% African American, 14% Anglo, 72% Hispanic). Scores on nutrition knowledge were based on total number correct (maximum score = 30). Participants exhibited a 22% increase in knowledge at post-test (x=18 to 22, p<0.001) and increased their knowledge in the following areas: maternal/infant nutrition (p<0.001), heart disease (p<0.001), vitamins and minerals (p<0.01), macronutrients (p<0.001), weight loss (p<0.001), and the Food Guide Pyramid (p<0.001). Although non-significant, Anglos demonstrated greater nutrition knowledge at pre-test (x=20) than African Americans and Hispanics (17.2 and 18.2, respectively). All ethnic groups improved their nutrition knowledge scores comparably (range = 3.2 to 4.9, p<0.01). In general, mothers with higher levels of formal education had higher scores both pre- and post-intervention. Both responders (wt loss>4 lbs) and non-responders (no wt loss) significantly improved their knowledge at post-test (gain of 3.9 and 3.3 points, respectively), but responders scored higher than non-responders pre- (x=19.5 vs 16.4, p<0.001) and post-intervention (x=23.4 vs 19.7, p<0.001) and learned more about sodium, folic acid, weight loss, heart disease, and infant nutrition. In addition, mothers with a normal or underweight child had higher pre- (x=18.7) and post-test (x=22.5) scores than mothers with an overweight child (x=17.1 and x=20.5) and knew more about sodium, vitamin C, folic acid, iron, and fiber. Successful interventions can motivate women to increase nutrition knowledge and lose weight. Supported by TX Coordinating Board #UTA00-377.

Deborah M. Klohe, B.S., R.D.

The University of Texas at Austin
Department of Human Ecology
Division of Nutrition
A2700
Austin, TX 78712

(512) 471-0657
klohed@mail.utexas.edu

Poster previously presented at Experimental Biology Conference in New Orleans, March 2002.

Awareness of Blood Pressure among Older Adults 60 to 75 Years

Young-Shin. Lee, RN, MSN

School of Nursing
The University of Texas at Austin
1700 Red River, Austin, TX 78701
Tel: 512) 232-4761
ys97@mail.utexas.edu.

Though hypertension in the elderly is a common health problem and places people at risk for cardiovascular disease, little information exists about what the elderly know about their blood pressure.

Purpose: The purpose of this study was to describe awareness of blood pressure and the relationship of awareness to actual blood pressure level.

Measurement: Two blood pressure measurements and a 21-item Awareness of Blood Pressure Questionnaire were administered to 30 men and women aged 60 to 75.

Findings: Mean blood pressure was 141/78 mmHg; 60% of the participants knew their blood pressure level, while 80% reported that they asked about their blood pressure on visits to their health provider; and 50% of participants with systolic hypertension did not know their blood pressure level. Only 33% of participants knew that elevated systolic blood pressure is hypertension, while 50% knew that elevated diastolic blood pressure is hypertension. 47% of the participants knew that systolic blood pressure is important. However, 46.7% of participants reported that hypertension is a normal part of aging. Awareness of blood pressure scores did not differ between hypertensives and those with normal blood pressure.

Conclusion: The study revealed that participants’ awareness of their blood pressure did not reflect their actual blood pressure status. Attention is warranted because correct awareness is fundamental to behavior change and blood pressure control.

Pilot Study of a Wellness Intervention for Women with Fibromyalgia

Alexa K. Stuifbergen, PhD, RN, FAAN, Heather Becker, PhD, Tracie Harrison, MSN, RN, Janet Morrison, MSN, RN, Pat Carter, PhD, RN, Gayle Timmerman, PhD, RN & Vicki Kullberg MA

Purpose: Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread musculoskeletal pain, multiple tender points and fatigue. FMS is thought to affect approximately 3 to 6 million Americans and occurs six times more often in women than men. The cause of FMS remains unknown and medical treatment is limited and often ineffective (Soderberg, Lundman, & Norberg, 1999). Although several studies have described the effects of interventions to improve symptoms of FMS, few programs have been designed to assist women with this condition to promote their health. The purpose of this study was to obtain data to refine and adapt an existing intervention developed for women with one chronic condition (multiple sclerosis) for use with women with a different chronic condition (FMS). This study had two sequential phases. Phase I was a focus group and Phase II was an intervention pilot to evaluate an adaptation of the Wellness Program for Women with MS for women with FMS.

Methods: A focus group was held with women with FMS to obtain information that could be used to refine and adapt the content of the lifestyle change/skill building component of the existing MS intervention. Eight women (age 32 – 66) participated in a 90- minute focus group discussion on promoting health in the context of living with FMS. All of the women had completed high school and seven of the eight were Caucasian. The women provided rich descriptions of life with FMS and strategies used to promote their health. Focus group findings were used to modify the intervention materials. The revised materials were reviewed by a panel of experts including a rheumatologist and women with FMS.

A second group of eight women with FMS participated in a pilot of the intervention classes to evaluate the feasibility and efficacy of the wellness intervention. These women (age 40-75) had been diagnosed with FMS from 1 to 9 years. Seven were Caucasian and one was African American. The intervention consisted of eight 90-minute classes over an 8-week period that presented information and guided participants in self-assessment of health behaviors, resources and barriers and incorporated strategies to build self-efficacy for health behaviors. Prior to classes and at the end of the 8-week session, the women completed the Health Promoting Lifestyle Profile II (HPLP II), the Self-Rated Abilities for Health Practices (SRA) and Fibromyalgia Impact Questionnaire (FIQ).

Findings: Seven of the eight women had improvement in self-reported health behaviors with the mean increase being 6% over the 8-week period. The FIQ scores improved for 5 of the 8 subjects with an average decrease of 10%. The women indicated the materials were clear and useful and information was practical. Participants identified group discussion and sharing of successful strategies among the most helpful parts of the sessions.

Conclusion: An innovative intervention to promote health among women with chronic disabling conditions was adapted, refined and pilot-tested with a group of women with FMS. Preliminary findings support testing the refined intervention in a larger group of women with FMS.

This project was supported by funding from P30NRO5051 Center for Health Promotion Research in Underserved Populations, NINR, NIH.

NURSING RESEARCH IN HEALTH DISPARITIES: PARTICIPANT OUTCOMES OF A RESEARCH INTERNSHIP

Elena Silva-Velarde, Michelle Enriquez, Patty Gonzalez, Denise Griffin, Maria Cantu Kind, Amber Kozak, Melanie Long, Nina Ortiz, Angie Page, Randy Walker, Alexa Stuifbergen, RN, PhD, FAAN
The University of Texas at Austin, School of Nursing
1700 Red River, Austin, TX 78701-1499
Nurse Scientist, Health Disparities, Training Programs

Hispanics and other ethnic minorities bear a disproportionate burden of disease and illness (US DHHS, 2000). A culturally diverse workforce is essential to meeting the pressing health care needs of the nation’s increasingly diverse population (HRSA, 2000). While Hispanics represent 13% of the US population, only 2% of the nation’s nurses are of Hispanic background, and among all Hispanic nurses fewer than 1% (n-415) possess doctoral degrees (personal communication, William Spencer, HRSA, March 20, 2001). This poster describes findings from a program designed to increase minority nursing undergraduates’ awareness of and interest in the practice of nursing research.

The Summer Research Internship was a cooperative effort between The University of Texas at Austin and New Mexico State University. Funded by the National Institute of Nursing Research and the National Institutes of Health (3 P30 NR05051-03S1), the four-week summer research internship program (July and August of 2001) gave students an opportunity to work directly with experienced nurse researchers on a daily basis. A cognitive-apprenticeship model was the basis for structuring the activities.

Ten interns participated in the project, six from NMSU and four from UT at Austin. Six students were Hispanic, one was Native American, one was African American, and 2 were White. Nine were undergraduates and one research fellow had a Masters Degree in Nursing. All participants had limited prior exposure to research and virtually no previous "hands-on" opportunities. Two one-hour focus groups were conducted with the group of interns, one during the first week and another on the last day of the internship. Questions for the focus groups were based on constructs common to models describing cognitive apprenticeship. Findings revealed increased understanding of research, the problems encountered by nurse scientists, and the tools available to address those problems. There was evidence of increased awareness of the interdependence of members of a given community of science.

Acknowledgement: This project was supported by 3P30 NR05051-03S1 National Institute of Nursing Research, NIH

The State of Elementary School Indoor Air Quality In A Texas Border School District

M. Sanders, R. Corsi, and V. Torres

Texas Institute for the Indoor Environment, Center for Energy and Environmental Resources,
The University of Texas at Austin, Austin, TX USA
Department of Civil Engineering, The University of Texas at Austin, Austin, TX USA

Purpose: The purpose of this study was to determine whether indoor air quality of elementary schools in a Texas border school district differs from elementary schools in a central Texas school district.

Methods: Indoor air quality, health symptoms of occupants and occupant perceptions were studied in 30 Texas elementary schools. Twenty schools were randomly selected in a large school district in central Texas and ten schools were randomly selected from a school district along the Texas and Mexico border. Surveys of the building construction materials, indoor environmental factors and inventories of the classroom contents were included. The indoor environment investigations included technical building inspections for visible signs of moisture and odors. Air samples were collected for viable fungi, total fungi, viable bacteria, counts of airborne particles, and volatile organic compound levels. Surface samples were also collected for total and viable fungi. Continuous monitoring of temperature, relative humidity, carbon dioxide and carbon monoxide were also included. Occupant perceptions and health information was collected by questionnaires.

Findings: Occupants of the high performance elementary schools reported fewer health symptoms than those reported by the baseline schools. The primary sources of moisture intrusion in both baseline schools and high-performance schools were primarily attributed in rank order to 1) roof leaks, 2) plumbing leaks and 3) flooding. In every classroom in which Aspergillus Var. 1 was detected, the indoor concentrations exceeded the outdoor concentrations. In classrooms in which Alternaria was detected, the indoor concentrations exceeded the outdoor concentrations in approximately one-third of the classrooms. In the border school district, 8% of the occupants reported visible mold growth on the ceiling, whereas only 3.9% of the central Texas school district occupants reported visible mold growth. Additionally, 8.8% of the respondents in the border school district reported visible mold growth on the walls, whereas only 4.2% of the central Texas respondents reported visible mold growth. Mean and peak occupied CO2 concentrations were statistically different (? = 0.05) between the two districts. The mean CO2 concentration for the border school district was 1,763ppm (? = 661) whereas the mean CO2 concentration for the central Texas school district was 1,292ppm (? = 580).

Conclusions: There is a significant difference in CO2 concentrations and visible mold growth of elementary schools between a Texas border school district and a central Texas school district.

Pilot Testing an Intervention to Promote Sexual Health in Street Youth

By Lynn Rew, EdD, RNC, FAAN
Denton & Louise Cooley and Family Centennial Professor in Nursing
And
Jane Kass-Wolff, MSN, RN, Doctoral Candidate
The University of Texas at Austin School of Nursing

PROBLEM: Most sexual health promotion interventions have been developed for and delivered to adolescents who attend public schools. Little is known about what content and strategies are appropriate for adolescents who are at very high-risk for sexually transmitted diseases particularly homeless/street youth.

PURPOSE: The purpose of this study was to determine the feasibility of providing a brief street-based, Sexual Health Promotion Program for Homeless Adolescents (SHPPHA) using content and strategies identified in a conceptual model of sexual health for homeless adolescents (Rew, 2002) and through focus groups with the target population (Rew, Chambers, & Kulkarni, 2002).

METHOD: A pilot of the intervention was conducted with 12 volunteers (6 males and 6 females) aged 16 to 22 years (M= 19) during a 3-week period. Participants were recruited through posters and direct invitation from staff members working in a street outreach program for youth. Four males comprised one intervention group and four females comprised a second intervention group. The other four youth (two females and two males) were assigned to the control group who met with project staff during the same hours as the intervention and participated in another group activity. Each session was one hour in length and consisted of sharing information about a specific topic, engaging participants in activities to relate the information to their experiences, and role-playing to reinforce learning. At the conclusion of each session, participants were reminded of the date, time, and place for the next group meeting, received a snack, a pair of clean socks, and a payment of $10. Participants who attended all three sessions each week received an additional $5 in the first week, $10 in the second week, and $15 in the third week. A group facilitator’s manual of learning objectives, activities, and materials was developed to guide the intervention process. Facilitators and social workers met prior to and immediately following each session to review content and process.

FINDINGS: Participants were bored by much of the information about STDs, AIDS, safer sex, and correct condom usage but were very interested in other aspects of sexual health such as self-examinations for cancer and testicular health (males), hepatitis B and C, and body piercing. The women were particularly interested in the long-term effects of STDs, such as pelvic inflammatory disease (PID), and the relationship to infertility. Both males and females noted that self-respect was an important component of sexual health but was difficult to think of when one was desperate for food or shelter. Because the control group had little structure, the four participants originally assigned to it did not attend sessions regularly and none were at the final session for post-intervention testing. Of the eight assigned to intervention groups, six attended the final session, at which post-intervention testing was done. Mean scores on knowledge, self-efficacy to use condoms, and the major behavioral outcome of safe sex behaviors increased from pre- to post-testing. However, mean scores on measures of social connectedness, assertive communication, and intention to use condoms decreased slightly.

CONCLUSIONS: Content and strategies used in the intervention were of sufficient interest to participants to insure their attendance at the majority of the sessions. Increases in knowledge, self-efficacy to use condoms, and safe sex behaviors from pre- to post-testing are encouraging. The intervention is now ready for testing in a larger sample.

Cancer Treatment Options for Underserved Populations:
Closing the Gap Between Meta-analysis Outcome Evidence
and Orthodox Treatment and Palliation

John Powell and Glynn Harmon, Ph.D.
Graduate School of Library and Information Science
The University of Texas at Austin

The purpose of this preliminary dissertation research is fourfold:(1) to conduct an analysis of the successes and failures of America’s thirty year War on Cancer, including an assessment of outcomes for underserved populations; (2) to explore possible statistical gaps between current outcome evidence and the ongoing use of most frequently prescribed interventions for treatment and palliation; (3) to clarify treatment and palliation options for underserved populations using quality of life and survival odds data in the light of individual socioeconomic circumstances; and (4) to analyze how cancer information services might better provide evidence-based findings to underserved populations about treatment and palliation options.

The methods employed involve (1) an historical analysis to assess outcomes of the America’s three-decade War on Cancer and its impact on underserved populations; (2) collection of treatment and palliation outcome data on selected, specific types of high incidence cancers from the Evidence Based Medicine Reviews databases; (3) meta-analysis of survival and quality of life outcome data for each selected type of cancer; and (4) a tabulation of consumer cancer information services available and their adaptation to underserved populations.

Preliminary findings reveal that (1) despite some notable successes in the War on Cancer, the overall incidence of cancer has increased dramatically over the last three decades. The battle continues to be waged, essentially with successive variations of orthodox treatment strategies, huge private and public expenditures, and generally disappointing outcomes; (2) sample outcome evidence suggests that, for some types of cancer, improvements in survival durations and rates of patients treated with chemotherapy and radiation are very slight, and that the outcomes of palliative therapy appear to be understudied; (3) the basic options for insured or subsidized cancer patients are to either agree to a treatment of choice; seek complementary, alternative or integrative treatment; join a clinical trial; or pursue self care. Members of underserved populations tend to be underinsured and less informed, and obviously more restricted. Survival and quality of life outcomes of treated underserved populations are being analyzed; (4) consumer information services for cancer patients have become much more available in recent years, including Internet services through libraries and schools, a profusion of cancer web sites, and the availability of cancer information published in different languages.

Conclusion: The War on Cancer continues, essentially through the use of successive variations of toxic chemotherapy, surgery and radiation, and huge private and public expenditure. Generally, survival durations and rates over the last 30 years have improved only marginally, as has patient quality of life. Underserved populations should have access to treatment and palliation outcome data vis-à-vis survival and quality of life indicators. Such notable general information services as MEDLINEplus and PDQ are geared to ease of use and low cost access, but evidence-based resources oriented to lay and underserved audiences have yet to be developed and implemented.

Social Risk Factors Associated with Substance Abuse Among Gay and Lesbian Youth
CENTER FOR HEALTH PROMOTION RESEARCH Pilot Study 2002-2003

Yolanda C. Padilla, PhD, MSSW, University of Texas at Austin, School of Social Work, PI. Co-PIs: Donna Lynn Rew, EdD, MSN, University of Texas at Austin, School of Nursing;
James Alan Neff, PhD, MPH, University of Texas at Austin, School of Social Work;
Catherine Crisp, PhD, MSSW, University of Kansas, School of Social Welfare

Background and Significance
Despite a higher risk for substance abuse among gay, lesbian, bisexual, and transgender (GLBT) youth, there is limited research on the factors that influence the use of alcohol and drugs by GLBT youth. Little is known about factors related to the coming out process, self-esteem, social support, and sense of community that may contribute to or detract from the likelihood that GLBT youth will or will not use substances such as cigarettes, alcohol, cocaine, and other illegal drugs. Expanding our knowledge in this area will allow for the design of more effective health promotion interventions to enhance the well-bring of this population.

Purpose of Study and Research Questions
The purpose of this project is to conduct a pilot study by analyzing an existing data set of 5281 gay, lesbian, bisexual and questioning (GLB/Q) youth aged 25 and under to examine one specific health risk behavior in this population, substance use, and determine the social risk factors and protective factors associated with its use across multiple contexts. Accordingly, the specific aims of the study are to:

1. Examine the relationship between factors at the individual/personal level and risk of substance use;
2. Examine the relationship between factors at the level of family/other social relationships and risk of substance use;
3. Examine the relationship between factors at the community level and risk of substance use;
4. Examine the direct/indirect effects of protective/risk mechanisms at all 3 levels on the risk of substance abuse; and
5. Test whether the effects of individual, family, and community factors on the risk of substance abuse differ by age, gender, race/ethnicity, and sexual orientation identification (gay, lesbian, bisexual or questioning)

Data and Methodology
To accomplish these aims, we will use national-level data from the Internet Survey of Queer and Questioning Youth conducted by OutProud, the National Coalition for Gay, Lesbian, Bisexual, and Transgender Youth. This data set represents one of the largest bodies of data collected on GLBT youth and in contrast to prior studies on GLBT youth, was not limited to a specific geographic area and includes respondents from all 50 states and Puerto Rico. The data set consists of 537 variables, including eight variables about substance use.

Preliminary Descriptive Analysis
The poster will include (a) a conceptual model of the study, and (b)preliminary descriptive analyses of alcohol and substance use by key variables: demographic, individual family, and community characteristics.

Telehealth Consumer-Provider Interaction: A Chronic Disease Intervention in an Underserved Population

Richard F. Nauert, BS, MS, PT, MSHCA, and Glynn Harmon. Ph.D.
Graduate School of Library and Information Science
The University of Texas at Austin

Purpose: This dissertation research explores the efficacy of telehealth intervention for management of the chronic disease diabetes mellitus. The research targets an underserved, predominantly Hispanic population in Laredo, Texas and surrounding counties. This area has one of the highest diabetes-related morbidity and mortality rates in Texas. This investigation seeks to determine the benefits of a technological intervention that recreates and augments traditional information dissemination. Telehealth allows diabetic care management to be delivered to individuals who are not otherwise receiving care. Appropriate telehealth interventions can also potentially reduce
healthcare costs by increasing the volume of patients who can be managed and receive timely intervention in the form of clinical or behavioral direction. The daily transfer of clinical information and health behavioral training, to diabetics, despite their location, might prove to be the catalyst for improving health and promoting long-term behavioral change.

Method: Data from the records of test subjects (n=133) were retrospectively analyzed to assess the initial, 18 month usage impact of individual, computerized instructional and communications devices on their diabetic status, and their frequency of outpatient, inpatient and emergency clinic utilization. Control subjects (n=71) did not receive the devices, but were instead instructed about the management of their diabetes through scheduled appointments with a clinical nurse consultant or physician. Both groups received equivalent pre- and post-intervention consultation. The objective was to determine (1) if this new communication device intervention resulted in improved health, as measured by Hb1Ac diabetic test values, and (2) if it served to cut costs through decreased resource utilization.

Findings: Preliminary findings reveal a mean 21 % reduction in Hb1Ac values for the test subjects as compared to an 11 % decline for controls. Encounters declined by 31% for the test cohort while increasing by 3% for controls (p<=.05). After matching utilization days, the adjusted charge per individual per patient year declined from $11,529 to $5,800 for the test group (50%), as compared to a decrease from $11,892 to $10,837 (9%) for controls. Additional regression analysis is underway. A growth model was used to predict post mean cost per encounter; the model successfully predicted a significant reduction in charge per encounter among tests and controls (p?.05).

Conclusion: Improvements in Hb1Ac levels appear to be related to the continuous availability of individualized, interactive diabetes management information that the devices provide. The main cost savings appear to be associated with a reduction of inpatient utilization (11% decline for test, while 50% increase for controls) and a 10% drop in the charge associated with the encounter for test versus a 1% increase in charge for controls. This may signify that even when the test group required hospitalization, their medical condition was not as severe. Although extended longitudinal studies are required to truly assess the value of such interventions, this initial impact study reveals that benefits (improved health, decreased resource use, virtual care) can be achieved relatively early.

Predicting Postpartum Weight Retention

Milani T. B.S., Chacko-George G. M.S., Hanss-Nuss H. B.S., Walker L.O. Ed.D.,
Freeland-Graves, J.H. R.D., Ph.D.

Address for Tracey Milani, Goldy Chacko-George, Henry Hanss-Nuss and Jeanne Freeland-Graves: Division of Nutrition, A2700, The University of Texas at Austin
Address for Lorraine Walker: School of Nursing, D001, The University of Texas at Austin

Purpose: The purpose of this research was to create a scale to predict the % of pre-pregnancy weight lost/retained at 6-mos postpartum in order to identify women at risk for obesity.

Methods: Subjects were 187 low-income women recruited the day after birth. A demographic survey was administered in the hospital and weights obtained. At 6-wks postpartum questionnaires concerning food habits, attitudes/beliefs, and psychosocial factors were collected; at 6-mos weight was measured again. Percent weight change was calculated as: ((6 mo lbs - pre-preg lbs)/pre-preg lbs) x 100.
Findings: Average % change was -0.17, but varied from -40 to +24% of pre-pregnancy weight. Only 11 of 203 questions from the questionnaires were significantly correlated to % weight change (r=0.14-0.24, p<0.05), 6 were included in the final scale. Three categories of % change were created: <0% (N=89), 0>10% (N=66), and >10% (N=32) of initial body weights; with average scale scores of 65, 71 and 81, respectively.

Conclusions: This risk scale is an easily administered instrument that can be used to recognize women at risk for excess postpartum weight retention. Supported by NIH #R01NR04679.

PRAYER ACTIVITIES AND EXPERIENCES IN PEOPLE
WITH LUNG CANCER

Purpose: The purpose of this descriptive study was to examine spirituality, specifically prayer activities and experiences, in people with lung cancer. The current five year survival rate for people diagnosed with lung cancer is only 14% making it a life-threatening cancer. The presence of metastasis at the time of diagnosis, along with a generally poor response rate to conventional treatment, contribute to lung cancer being the leading cause of cancer deaths in both men and women. The diagnosis of a life-threatening cancer can initiate considerable distress in people. Some people have found that their spirituality, in particular prayer, provides them with resources to withstand the physical and psychological crises brought on by the diagnosis and treatment of cancer. The theoretical framework guiding the study is derived from the nursing theory of Modeling and Role-modeling, the Motivational Theory of Meaning, and the concept of prayer.

Methods: Survey questionnaires assessed background information, characteristics of cancer, prayer activities, prayer experiences, attitudes toward prayer within cancer, and psychological well-being. Data were analyzed using frequency distributions and Pearson correlations. Participants’ responses to open-ended questions about prayer within the context of their lung cancer were categorized by thematic analysis.

Findings: Participants were 60 adults ranging from 33 to 83 years of age with mean age of 58 years old (SD = 11). The majority of participants had non-small cell lung cancer (70%) with metastasis (55%) and were female (61%), Caucasian (83%), and older than 50 (80%). Prayer scores were positively related to psychological well-being scores (r = .39; p< 0.001). In addition, responses to the open-ended questions about prayer demonstrated influence of prayer on psychological well-being. Thematic analysis of responses revealed four themes of prayer, which represented each of the human dimensions: physical, psychological, social, and spiritual.

Conclusions: Results suggest prayer activities and experiences have a positive influence on psychological well-being for people with lung cancer. Study findings of the four themes of prayer in lung cancer provide further support of the influence of prayer. This study provides knowledge to guide nursing care of people with lung cancer. The theoretical framework was supported by the study findings thus the framework demonstrated usefulness as a guide for nursing education, practice, and research.

Health-Promoting Nursing Intervention: Underserved Women
Institutional National Research Service Award T32 NR07107
from the National Institute of Nursing Research

Lorraine Walker, Lynn Rew, Alexa Stuifbergen, Sharon Brown, Susan Grobe
School of Nursing, The University of Texas at Austin

Health promotion research is an important component of women's health equity. Nursing scientists are needed who have advanced research training in health promotion of women. In striving to reduce health disparities through health promoting interventions, women who are underserved are an important target group, especially those of ethnic minority backgrounds and with chronic disabling conditions.

The aims of the postdoctoral component of this Institutional NRSA are to:

1. Enhance capabilities to design and conduct intervention research that integrates dimensions of women's health promotion across the life span;

2. Develop capabilities to design, conduct, and analyze research that is sensitive to contextual factors affecting the health of underserved women;

3. Promote interdisciplinary collaboration between nursing and disciplines involved in the study of health-promoting interventions for women; and

4. Develop skills and capabilities in the areas of scientific writing and publication, grant-preparation, and issues related to research with underserved populations.

This postdoctoral program is significant because it provides training opportunities for nurses in the South Central US, a region of the country that has large ethnic minority populations but that is only beginning to develop its potential for nursing research with underserved populations. The focus on health-promoting nursing intervention holds promise for improving the health of two groups in particular: women of ethnic minority backgrounds and women with chronic disabling conditions. For both of these groups health promotion nursing interventions offer the promise of maximizing women's health by increasing the self-care capabilities, and improving access to care, appropriateness of care, and continuity of care.