ABSTRACTS
TOWARD A HEALTHIER PICTURE
A RESEARCH CONFERENCE ON IMPROVING THE HEALTH
OF WOMEN & UNDERSERVED POPULATIONS

NOVEMBER 10, 2000 LBJ SCHOOL OF PUBLIC AFFAIRS
Cosponsored by The University of Texas at Austin
Center for Health Promotion Research
Center for Women's Studies
Center for African and African American Studies
African American Nursing Student Association

KEYNOTE ADDRESS
CONTEXTUALIZING THE HEALTH ISSUES OF AFRICAN AMERICAN WOMEN

Helen A. Neville, Ph.D.
Associate Director of the Multicultural Center for Research, Training and Consultation,
University of Missouri-Columbia

The presentation outlined the key health disparities among women of color in the United States, with an emphasis on African American women. An integrated sociocultural model of health was discussed as a way to contextualize the multiple interlocking systems influencing African American women's health (disparities). The sociocultural model incorporates the underlying principles of ecological/contextual, biopsychosocial-stress, and acculturative stress models. Two core assumptions undergirding the proposed model include (a) women's health is influenced by general and culture-specific macro and micro level factors and (b) social identities (e.g., race, class, gender, and their intersection) play determining roles in the development, expression, and outcomes of health related concerns. General health research and specific research on sexual violence was included to illustrate the clinical application of the proposed model. The presentation concluded with identification of concrete strategies to increase the health status of African American women and other women of color.

AFRICAN AMERICAN WOMEN'S PERCEPTION OF SAFE SEX

Elizabeth Abel, PhD, RNCS, ANP/FNP
The University of Texas at Austin School of Nursing

Heterosexual minority women are the fastest growing group in the population diagnosed with HIV/AIDS. Given the prevalence, cost, morbidity and mortality associated with HIV/AIDS it is imperative that effective prevention programs be developed. Studies indicate program are not necessarily effective in changing the sexual risk behaviors. In order to make intervention programs effective to reduce sexual risk behaviors, the meaning and life experience of individuals must be considered. The purpose of this study was to explore what safe sex meant to African-American women. Data (N=16) were used from a larger project among rural and urban African American women residing in the Southeastern United States, which reported a high incidence of HIV/AIDS. Data were analyzed by using a phenomenological approach. Nine subjects were from the urban and seven were from the rural area. Eighty one percent of these women reported having one partner, 341% were married, and 67% used a condom for HIV/AIDS prevention. These women defined safe sex as either physical protection from disease or emotional safety in an intimate relationship. Many women believed that they participated in safe sex if they could protect themselves from HIV/AIDS and other sexually transmitted infections (STIs). Trust and commitment in a mutually monogamous relationship were also considered important factors in a safe sex relationship. Many expressed either there would be no sex if they could not trust their partner or they would use protection until they could trust their partner. Urban women emphasized physical protection from STIs while rural women stressed emotional safety in an intimate relationship.

HEALTH-PROMOTING SELF-CARE IN OLDER ADULTS

Gayle Acton, PhD, Marian Aguilar, PhD, Carolyn Brown, PhD,
Carole Holahan, PhD., Waneen Spirudoso, PhD, Institute of Gerontology Center for
Health Promotion/Disease Prevention Research, The University of Texas at Austin

Rachel Fouladi, PhD
University of Texas MD Anderson Cancer Center Houston, Texas

America continues to gray. As the US population grows older, society is challenged to meet the needs of older adults, especially in the provision of health care. Older adults are the largest consumers of health care and although morbidity increases dramatically as persons age, evidence is mounting that health promotion may reduce or compress morbidity to the time period just before death. Thus, if older adults engage in appropriate health-promoting self-care behavior, their health and well-being might be improved. Much of the health-related research in older adults focuses on response to illness or symptoms. Less research focuses on health-promoting self-care activities. The purpose of this study is to test Pender? theoretical model of health-promoting self-care behavior in community-dwelling older adults. The Pender Health Promotion Model represents the multidimensional aspects of persons in relation to the environment reflecting their health decisions.

Sample: A convenience sample of 313 subjects over the age of 65 participated in the study. The sample, 65% female and 85% Caucasian, had a mean age of 74. Sixty-one percent were married and 25% widowed. Seventy-five percent were retired and 55% were college graduates. Over half the sample had an income higher than $35,000 per year.

Data Analysis: Graphical interaction modeling was used to test the model of health-promoting self-care in older adults. Graphical models illuminate partial correlations and partial covariance structures, allowing for identification of conditional and moderating health-related influences.

Findings: In Pender? Health Promotion Model, personal factors are proposed to directly and indirectly influence both behavior-specific cognitions and health-promoting behavior. In this study, gender had a direct influence on the behavior-specific cognition of importance of health-promoting self-care behavior. Gender had had an indirect influence on health-promoting self-care behavior through importance of health- promoting self-care behavior. Self-esteem had a direct influence on barriers to health-promoting self-care behavior and self-efficacy for health promoting self-care behavior. Self-esteem was the only individual characteristic to have a direct influence on health-promoting self-care behavior. Perceived health status had a direct influence on both barriers to health promoting self-care behavior and self-efficacy for health-promoting self-care behavior. Perceived health status also had an indirect influence on health-promoting self-care behavior through self-efficacy for health-promoting self-care behavior. Residence, education, ethnicity, income, and age had neither a direct or indirect influence on health-promoting self-care behavior. Pender proposed that behavior-specific cognitions will have a direct influence on health-promoting behavior. In this, study both importance of health-promoting self-care behavior and self-efficacy for health-promoting self-care behavior had direct influences on health-promoting self-care behavior. Barriers for health-promoting self-care behavior did not have a direct influence on health-promoting self-care behavior but had an indirect influence through self-efficacy for health-promoting self-care behavior.

These results show that in this sample, self-esteem, importance of health-promoting self-care behavior, and self efficacy of health-promoting self-care behavior are important influences on the practice of health-promoting self-care behavior. Furthermore, gender, perceived health status, and barriers to health-promoting self-care behavior are indirectly related to health-promoting self-care behavior. Future research should explore these variables in more diverse samples of older adults. As important health-related variables are identified and their relationship to health promotion actions are determined, better interventions may be developed in order to move older adults toward decreased morbidity, healthier lifestyles, and increased well-being.

This study was funded by the Center for Health Promotion Research, University of Texas at Austin, School of Nursing, NIH, NINR.

DESCRIPTION OF A COMMUNITY-BASED MODEL TO ENHANCE AFRICAN-AMERICAN WOMEN'S PARTICIPATION IN BREAST CANCER SCREENING SERVICES IN TEXAS

Mary Lou Adams, RN, PhD The University of Texas at Austin School of Nursing

Purpose: To present a logic model depicting a community-based program to enhance African-American women's participation in breast cancer screening outreach and case management services in Texas. Although the benefits of screening for breast cancer are well documented, participation in early detection services for breast cancer are underutilized in the United States overall and by women of color in particular. This pattern also holds true in Texas where screening rates are not as high as they should be for African-American women. There is a need for community-based strategies to increase the numbers of African-American women screened in Texas.

Methodology: To design a culturally sensitive community-based program for outreach and case management using a logic model which depicts three assumptions, to develop the core components of the (1) outreach coordinators, (2) site community and professional advisory committees, and (3) community coalitions.

Results: A logic model has been developed that describes the chain of expected causal linkages between the components. The model identifies the underlying assumptions, project activities, immediate, intermediate and final project goals.

Conclusions: Full implementation of the model will facilitate the identification of barriers, strategies to eliminate them and increase the numbers of African-American women who participate in breast cancer screening program.

For more information please contact: Mary Lou Adams, RN, PhD, Project Director, The University of Texas at Austin School of Nursing, Austin, Texas 78701-1499, Phone 512-471-9091.

HORMONE REPLACEMENT THERAPY AMONG WOMEN WITH PHYSICAL IMPAIRMENTS

Heather Becker, PhD., Dorothy Gordon, RN, DNSc, FAAN, Alexa Stuifbergen, RN, PhD, FAAN
Center for Health Promotion and Disease Prevention Research in Underserved Populations,
The University of Texas at Austin School of Nursing

Purpose: Little is known about how women with physical impairments experience menopause, and how they make key health decisions during this critical phase of their lives. This survey study explored the factors women with physical impairments consider when making decisions about hormone replacement therapy (HRT) within a framework developed by Fishbein and Ajzen? Theory of Planned Behavior and the Health Belief Model. Methods: Women with physical impairments were recruited through contacts with health and disability programs around the United States. Those who expressed interest in completing surveys were sent a survey booklet containing a background information questionnaire, a beliefs about hormone replacement survey, and Annette O?onnor? Knowledge and Decisional Conflict Scales.

Findings: One hundred sixty seven women from 41 states and Puerto Rico completed questionnaires. The typical respondent was fifty-two years old, Anglo, and was either now, or had been married. Most were not now working, but they had at least some college education. Their primary diagnosis was a neuromuscular disorder. The sample had an average of five of the eight functional limitations surveyed in the National Health Interview Survey. Forty-seven percent of the women indicated that they needed mechanical assistance most or all of the time, while only 17% required personal assistance most or all of the time. In terms of reproductive health history, approximately half the sample have had a hysterectomy, and two-thirds have given birth at some time in their lives. Half of those who were menopausal were currently taking HRT, 19% took HRT in the past but not now, 22% have never taken HRT, and 9% indicated they did not? know about HRT. With respect to knowledge and attitudes about HRT, there were statistically significant differences in knowledge and beliefs about HRT outcomes between women who were taking and those not taking HRT. However, many respondents did not know about the likelihood of certain outcomes, particularly those related to medical complications. For example, 56% of the sample indicated they did not know if HRT would produce circulatory problems for them. When asked what resources and supports would help them make a decision about menopause, these women most frequently requested information abut menopause and hormone replacement therapy tailored to their disabling conditions.

Conclusions: The information derived from this exploratory study can help us improve the collaborative decision-making of women with physical impairments and their health care providers about menopausal health care issues.

BREAST CANCER SUPPORT GROUP FACILITATION OF SELF-TRANSCENDENCE

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

Cancer support groups have served many persons since the 1970?, but mechanisms through which such groups are beneficial remain unexplored. Sharing illness experiences in a supportive setting may trigger self-transcendence and meaning-making. Theoretical and descriptive research literature provides support for links among self-transcendence views and behaviors and well-being, but there is no experimental research supporting those links.

Purpose: The purpose of this study was to compare emotional and physical well-being outcomes between women with breast cancer who had attended a support group in which self-transcendence views and behaviors were encouraged with women who did not participate in the support groups.

Method: A quasi-experimental modified randomized design study compared change in self-transcendence and well-being in 22 women with breast cancer participating in an 8 week support group with 27 non-participants. Women with newly diagnosed breast cancer were referred to the investigator from oncology practices and other resources accessed by persons with cancer. Potential participants were asked to agree to be randomized to 1?hour weekly support group sessions or to a control group not participating in the intervention group sessions. Six women permitted randomization; most potential participants voiced strong preference for or against attending a support group during the study time period. Women who had strong preferences were placed in their desired group. The intervention support groups met with three facilitators, an oncology clinical nurse specialist, a psychologist, and a breast cancer survivor. Individual session activities were directed by self-transcendence theory and support group literature. Paper and pencil questionnaires assessed self-transcendence, physical well-being, and emotional well-being at baseline, post-intervention, and 1 year later. All instruments had been used previously in cancer research, and demonstrated acceptable reliability in this study. Quantitative data were analyzed with descriptive statistics, t-tests, and ANOVAs.

Findings: T-tests revealed no differences between groups on background variables. The intervention group had lower outcome measure scores at baseline, obtained scores similar to the comparison group post-intervention, and were lower again (except on physical well-being measures) 1 year later. Narrative data revealed a variety of experiences associated with well-being.
Conclusions: The findings indicate that women with breast cancer choosing to participate in a support group recognized their need for assistance in managing the emotional demands of their cancer diagnosis and treatment. Such women may need to meet together for more than 8 weeks to maintain the temporary gains they made in both self-transcendence views and behaviors and sense of emotional well-being. Physical well-being was not affected by participation in a support group. Findings from both quantitative and qualitative data indicated that there are a variety of ways women make meaning from the adverse situation of a cancer diagnosis.

Funded by the Oncology Nursing Foundation and The University of Texas at Austin.

EFFECT OF COMMUNITY HEALTH NURSING INTERVENTIONS IN FUNCTIONAL STATUS OUTCOMES OF ELDERLY AND STUDENTS SELF-EFFICACY IN PROVIDING HOME-BASED CARE TO ELDERS

Mary Hoenecke, RN, MN, Kathleen Craig, MPH, MSN, CNS, Marilyn Patillo, RN, PhD, Cheryl Wawrzyniak, RN, MSN The University of Texas at Austin School of Nursing

Purposes: Determine if student-delivered, home-based community health nursing interventions have an effect on functional assessment outcomes of elderly clients. Measure student self-efficacy for providing home-based nursing care to elders. Develop student peer-mentoring as a strategy for increasing self-efficacy for home visiting and working with elders.

Methods: A longitudinal study was conducted with a sample of 78 elderly, homebound, low-income, ethnically diverse clients enrolled in the Meals on Wheels Program. The elders were visited by senior second-semester (S2) Community Health Nursing students at The University of Texas at Austin School of Nursing. S2 students administered functional status instruments to both control and treatment groups. The treatment group (N=37) received home visits with nursing interventions from the students for a period of our semesters. The control group (N=6) received only the tool administration and referral to the Meals on Wheels social worker during the first and fourth semester. The peer-mentoring component consisted of junior first-semester (J1) students enrolled in a Concepts of Aging class accompanying S2 students on a home visit to a treatment group participant. Students? self-efficacy for home visiting and working with elders was measured at the start of their J1 semester and at the end of their S2 semester.

Conclusions: The following data will be presented: Relationships between nursing interventions and outcomes. Changes in the functional status of elders over four semesters. Student self-efficacy in home visiting elders and satisfaction with peer mentoring as a teaching strategy. Methodological difficulties encountered in this pilot study with suggestions for future work.

CULTURALLY APPROPRIATE INSTRUMENTATION

Sherry Hendrickson, RN, MSN,CNS, PhD (C)

Purpose: Reaching populations disproportionately represented in unintentional injury statistics is crucial. The purpose of this study is to clarify culturally appropriate response choices for monolingual Latino populations.

Method: The Spanish translation of the Maternal Childhood Injury Health Beliefs (MCIHB) questionnaire consists of five subscales. These measure perceptions of injury susceptibility and seriousness, benefits and barriers related to injury prevention, and self-efficacy for safety behaviors. A bilingual Latina nurse and a clinic pediatrician critiqued the original English tool for use with the intended population. Ambiguous or potentially objectionable questions were rephrased or eliminated. The researcher used parallel translations, with both consultants translating the questions independently, followed by discussion. Interviews were then tape-recorded with three mothers from Cuba, Guatemala and Mexico to capture language used in discussing their child? safety. A bilingual Mexican-American consultant and a clinic pediatrician criticized the original English tool for use with the intended population. Ambiguous or potentially objectionable questions were rephrased or eliminated. The researcher used parallel translations, with both consultants translating the questions independently, followed by discussion. Interviews were then tape-recorded with three mothers from Cuba, Guatemala and Mexico to capture language used in discussing their child? safety. A bilingual Mexican-American consultant unacquainted with the original tool then translated the Spanish version to English. The translated tool was administered to a convenience sample of 60 monolingual mothers, with a four item language-based acculturation scale. The majority of study mothers were of Mexican origin, with between 1-7 years in the US. Respondents were asked to select the preferred response format. A pretest followed with 12 mothers to further assess changes, readability and use of the four different response scale options followed.

Findings: For illiterate Latinas it was difficult to impossible to convey the concept of Likert scale choices. Response choices in order of preference were the 5-point scale (39%), the 3 point scale (36%), and a combined scale (25%). Use of the combined scale first offered answer options of ?o,??aven? thought about it,?or ?on? know.?A ruler was used to represent a 10 point response continuum. Cronbach? alpha coefficients for the subscales in the Spanish questionnaire were comparable at .72-.90 to the original English content.

Conclusions: When possible, develop measures in the language of the target population. Present answer choices vertically on the page, a testing format more frequently used in Mexico. A qualitative format may prove superior with individuals that do not have "?na cultura de lectura,?those unaccustomed to reading. For English-acculturated Tejano individuals, this questionnaire should be offered in English despite bilingual skills of the respondent. The Spanish of English-acculturated Tejanos is different, termed ?ural,?rather than the ?tandard?Spanish spoken by monolingual mothers.

The monolingual test phase of this research was supported by a grant from Motorola.

DEVELOPMENT OF INSTRUMENTS TO MEASURE EXERCISE-RELATED FEELINGS OF MEXICAN AMERICAN ADULTS

S.C. Laffrey, E. Hernandez-Spina, Y.S. Lee, & J. Bartholomew

Previous research has documented beneficial effects of exercise on mood and feelings in adults, but no research was found that measured these variables in Mexican Americans. This population has been shown to be vulnerable to conditions such as obesity and type 2 diabetes mellitus, resulting from sedentary lifestyle. Therefore, research that addresses their exercise and activity is important for meeting the Year 2010 health objectives for the nation. A major difficulty in conducting such studies is the lack of culturally valid and reliable instruments to measure variables of interest in the Mexican American population. Therefore the purpose of this study was to adapt and test two commonly used instruments, the Positive and Negative Affect Scale (PANAS) and the Exercise-Induced Feeling State Inventory (EFI) for use with Mexican Americans. Both instruments had been translated previously, but no reliability or validity data were available for the Spanish versions. The study was conducted in phases: (1) back-translation and examination of the items for cultural validity, focus groups with Mexican American women, and refinement of the items (2) administration of the refined PANAS and EFI by written questionnaire to 188 Hispanic men and women aged 18 to 65; and (3) administration by interview to 40 Mexican American women aged 60 to 79. The adapted Spanish PANAS and EFI were tested for reliability (internal consistency and item-total correlation coefficients) and validity (factor analyses and correlation coefficients among the EFI, PANAS and Spanish Exercise Self-Efficacy Questionnaire). The findings can be used in exercise and activity studies with Mexican American men and women. Further research with the Spanish PANAS and EFI will add to construct validity.

RECRUITING AFRICAN AMERICANS INTO RESEARCH ON COGNITIVE AGING

Graham J. McDougall, Jr., PhD, CS, RN
The University of Texas at Austin School of Nursing

Purpose: This paper reports the recruitment and retention of African-Americans and their measurement results from a study of factors associated with metamemory and memory performance among the aging.

Methods: A total of 218 adults with an average age of seventy-eight years participated in a study of memory performance in community elders. A computer-generated random zip code list of adults > 70 years of age was purchased and a four-phase telephone-screening plan was adopted. In Year 2, the sampling plan had to be changed, and a convenience-sampling plan was adopted to recruit adequate numbers of African American subjects. Subjects who complete the screening procedure then were administered the Memory Self-efficacy questionnaire, Rivermeade Everyday Behavioral Memory, Center for Epidemiological Studies Scale, Medical Outcomes Study Health Scale, and the Metamemory in Adulthood Questionnaire.

Findings: All individuals were living in private homes, subsidized high-rise apartments, or assisted living facilities. Fifty-seven percent of the African American subjects (n= 55) were recruited from random sampling methods as compared to 68% of white subjects (n = 83). Of the African American elders, there were no differences in age, cognition, depression, memory, or memory self-efficacy scores between the random (n = 55) and convenience (n = 41) samples. On the health variables, there were significant differences (p < .05) between the random and convenience sample of African American elders with the convenience sample scoring higher on mental health, (84.59 vs. 75.27), role function, (68.49 vs. 91.85), role physical (73.78 vs. 50.45), and social functioning (90.61 vs. 73.65). The convenience sample was significantly (p < .05) older (80 vs. 76), had more depression (12 vs. 9), had lower physical functioning (46 vs. 65), and less vitality (48 vs. 60). The convenience sample scored significantly lower on memory performance (15 vs. 18), and memory self-efficacy (26 vs. 33). Of the metamemory variables, only three subscale scores were significantly different between the random and convenience samples: achievement, locus, and task. On achievement, the convenience sample scored higher than the random (3.83 vs. 3.68). On locus, the convenience sample scored higher than the random (3.59 vs. 3.35). On task, the random sample scored higher than the convenience (3.75 vs. 3.59).

Conclusions: A major limitation of this study is the representativeness of the sample. With this insight, a convenience sample was used to increase the sample size so that it was more representative of the inner-city population being studies (44% African-American and 56% Caucasian). Our findings indicated that there were no differences in depression, memory performance, memory self-efficacy, and memory strategy use between the convenience and random samples of African American elderly. The high-rise apartment complexes in which the convenience sample lived provided a ready source of social interaction on a daily basis. This is a primary reason why all sampling plans should incorporate cultural sensitivity?t promotes knowledge and growth for the discipline and for the population being studied.

CREATING CONSISTENCY AND CONTROL OUT OF CHAOS:
THE LIVED EXPERIENCE OF PLANNING A PREGNANCY AS AN ADOLESCENT

Kristen S. Montgomery, PhD, RNC, IBCLC

Purpose: Adolescent pregnancy can have devastating effects on both mother and child. However, little is known about the experience of planned pregnancy among adolescents. Methods: This phenomenological study examined how adolescents (14-17 years of age) describe their experiences of planning a pregnancy. Eight adolescents participated in the study.

Findings: Themes that emerged from the interviews were related to planning the pregnancy or the pregnancy itself. Themes related to planning the pregnancy included: 1) the desire to be or be perceived as more grown up, with increased responsibility, independence, and maturity; 2) a long history of desiring pregnancy and the maternal role; 3) never having had anything to call their own and wanting something to care for and love; 4) boredom; 5) the pregnancy was the natural next step in their life or their relationship with their boyfriend; 6) certain important criteria were met for pregnancy including financial, relationship, and age-related goals; 7) planning involved the boyfriend to some extent; 8) environmental issues; and 9) the need for stability. Themes that were related to the pregnancy included: 1) environmental issues, 2) adjustment to the pregnancy, and 3) increased motivation to do well in school and work, so as to provide a good life for their babies.

Conclusion: The experience of planning a pregnancy during adolescence consists of typical adolescent behavior in that these girls demonstrated the need for control, invulnerability, and a present focus to their lives. In addition to this typical behavior, a component manifests itself in which the adolescent girls made reproductive health choices to gain control. By establishing a level of control over their hectic and stressful lives, they are able to add meaning to their lives. The need for consistency and control seem to be linked, since many of the adolescent girls?statements reflected dimensions of both concepts. This initial descriptive study can be used to further explore adolescent pregnancy and to develop interventions that might assist these girls to lead healthy lives.

HEALTH PROMOTION AND INTERACTIVE TECHNOLOGY:
DO GENDER DIFFERENCES MATTER IN MESSAGE DESIGN?

Patricia A. Stout, PhD and Jorge Villegas, Doctoral Candidate Department of Advertising,
University of Texas at Austin

Issues surrounding women's health demand our attention. The notion of differences in communicating health messages to men and women has received scant attention (c.f. Gabbard-Alley 1995), although a significant body of literature addresses gender differences in persuasion and communication (c.f. Meyers-Levy 1989). In this paper we begin to address this disparity by developing a framework for research on gender differences in health promotion and interactive technology. Based on the selectivity model (Meyers-Levy 1989), we outline a set of propositions that address expected differences in health message effectiveness between men and women. We also present a study design for research to assess these differences in interactive Web based health promotion messages.

Use of the Internet as a source for health promotion has soared as popularity of the World Wide Web has grown. While there is the belief that this new technology can help to transform both personal and public health, how interactive technology can best be used to address health-related issues facing individuals is little understood. The impact of the addition of ?nteractivity? into the equation of information processing on message effectiveness remains a puzzle for those studying message processing and consumer behavior. And, while the role of individual differences, like gender, in message processing has received some attention in studies using traditional media (Darley and Smith 1995), how these differences might influence message design for delivery using interactive technology has yet to be seriously addressed.

The selectivity model (Meyers-Levy 1989) provides an explanatory framework for understanding gender differences in communication design. This model proposes that the main source of differences between cognitive abilities of males and females is the different configuration and use of the brain? cortical hemispheres. This difference might explain why females take a holistic approach to processing while males focus on one aspect of the message (Meyers-Levy 1994). Using the selectivity model, researchers like Darley and Smith (1995) have found that in general females grasp the information of a stimulus in a comprehensive fashion using objective and subjective information. Meanwhile, males select information through heuristic processes thereby increasing the possibility of missing not clearly stated informational cues.

In this paper we propose that interactive technology can be a feasible and effective medium for a theory-based approach to health promotion by specifically addressing key variables in theories of health-protective behavior. Street, Jr., et al. (1997) argue that interactive technology fare well compared to other health promotion media on several features that enhance effectiveness: Interactivity, networkability, sensory vividness, modifiability, availability, cost and ease of use. In this paper, we assess these structural features of interactive technology in conjunction with self-efficacy, a central construct in several popular health-protective behavior models (c.f. Baranowski, et al. 1996; Bandura 1982b; Strecher et al. 1986).

References Cited:

Bandura, A. (eds.) (1982). The self and mechanisms of agency. Psychological perspectives on the self (Vol. I). Hillsdale, NJ: Lawrence Erlbaum Associates.

Baranowski, T., Perry, C., & Parcel G. (1996). How individuals, environments, and health behavior interact: Social cognitive theory. In K. Glanz, F. Lewis, & B.K. Rimer (Eds.), Health behavior and health education (3rd ed, pp. 153-178). San Francisco, CA: Jossey-Bass.

Gabbard-Alley, A. S. (1995). Health Communication and Gender: A Review and Critique, in Health Communication, 7(1), 35-54.

Meyers-Levy, J. (1989). Gender Differences in Information Processing: A Selectivity Interpretation, in Patricia Cafferata and Alice Tybout (eds.), Cognitive & Affective Responses to Advertising, Lexington, MA: Lexington Books, pp. 219-260.

Street, Jr., William Gold, and Timothy Manning (1997), Health Promotion and Interactive Technology. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

Strecher, V.J., DeVellis,B. M., Becker, M.H., & Rosenstock, I.M. (1986). The role of self-efficiency in achieving health behavior change. Health Education Quarterly, 13(1), 73-79.

A MODEL FOR PROMOTING WELLNESS IN WOMEN WITH MS

Alexa K. Stuifbergen, PhD, RN, FAAN; Heather Becker, PhD; Gayle Timmerman, PhD, RN,
The University of Texas at Austin School of Nursing

Purpose: Multiple sclerosis (MS) has its onset in young adulthood, a time when heavy work and family responsibilities are common. It occurs more frequently in women than in men with current estimates suggesting that there are approximately 350,000 persons in the US with physician-diagnosed MS, including more than 200,000 women. Although some experience a disease course that is relatively benign, resulting in only mild neurological dysfunction, others experience a progressive course with major neurological losses and disability. In response to increasing interest in wellness programs among both health care providers and persons with disabilities, a unique intervention project was developed to promote wellness for women with MS. The model guiding this intervention proposes that health-promoting behaviors are influenced by a combination of barriers, resources and specific self-efficacy for health behaviors. Consequently an intervention that assisted participants to develop knowledge and skills to reduce barriers and enhance resources and self-efficacy should result in greater participation in health behaviors. Interventions using this model have an informational component, but the major focus is on development of skills and beliefs in one? capability to use those skills (self-efficacy) to achieve desired behavior changes.

Method: The intervention employs three processes to achieve the program goals; Provision of accurate knowledge that is specific to health promotion within the context of MS. Enhancement of self-efficacy for health behavior, and Individualized goal setting and monitoring The three processes of the intervention were integrated into the two phases of the wellness program: an educational/skill building lifestyle change program and a supportive telephone follow-up. General topic areas for the eight sessions included: maximizing health with a chronic disabling condition; lifestyle adjustment; engaging in physical activity for fun, endurance, and strength; eating healthy; stress management; intimacy and sexuality and women's health issues. A group of 113 (56 intervention; 57 control) women with MS participated in the randomized clinical trial of this Wellness Program for Women with MS. Data were collected at baseline, 2 months (post-class), 5 months (post-phone follow-up) and 8 months. The primary outcome variables were indices of self-efficacy for health behaviors, performance of health behaviors and perceptions of health and well-being.

Findings: Preliminary analysis of data using hierarchical linear modeling has supported the effectiveness of the intervention as there are significant time by group interactions for self-efficacy, health promoting behaviors and social health, mental health, pain and emotional role functioning with the treatment group experiencing significant gains on all measures. Conclusions: Findings indicate that participants in the intervention had significant improvements in health behaviors over an 8-month period. A handbook including the educational materials used in the intervention is available to allow the model-based intervention to be implemented in other settings.

This project was supported by R01HD35047 ?National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development and the Office for Research on women's Health.

EXPERIENCES OF HOMELESSNESS AMONG ADOLESCENT WOMEN

Margaret A. Taylor-Seehafer RN, CS, FNP Doctoral Candidate
The University of Texas at Austin School of Nursing

Purpose: American society considers adolescent homelessness an important social problem
m and public issue. Yet, adolescent women's experiences of homelessness are not well understood. The purpose of this preliminary study was to interpret and understand the homeless experience of adolescent women living on the street in Austin, Texas.

Methods: A naturalistic method of inquiry, Interpretive Interactionism (Denzin, 1989), provided the conceptual and methodological orientation for this study. Participants were recruited through Project Phase, an outreach program for homeless adolescents, a collaboration of The Center for Adolescent Health at People? Community Clinic and Youth Options. The participants were women 16 to 20 years of age who self-identified as homeless or living on the street. Data collection involved active listening and semi-structured interviews that were audiotaped and transcribed verbatim. Analysis and coding of the data occurred simultaneously with the interview process. Words and statements were bracketed (first and second level coding) and then constructed into themes.

Findings: Two preliminary themes emerged from the data. Theme I: Living on the street is an art and a risk and Theme II: Friends and self are sources of health and well being. Conclusions: The health and well being of the homeless adolescent women in this study were influenced by self-care activities and by support from their street family and friends. There are few involved adults in the lives of homeless adolescent women living on the street.

References: Denzin, N.K. (1989). Interpretive Interactionism. Newbury Park, CA: Sage.

RELATIONSHIP BETWEEN BASIC NEEDS SATISFACTION AND EMOTIONAL EATING

Gayle M. Timmerman, PhD, RN, Associate Professor
The University of Texas at Austin School of Nursing

Purpose: Obesity is a significant health problem in the United States that contributes to cardiovascular disease, hypertension, and diabetes. Eating in response to emotions rather than hunger may lead to the consumption of excessive calories which typically leads to weight gain. This study examined the relationship between basic need satisfaction as identified in Maslow? hierarchy of needs and emotional eating, specifically testing the assumption that individuals with lower basic need satisfaction are more likely to engage in emotional eating as a way to fulfill their needs.

Methods: Eighty-four subjects were recruited from approximately 750 participants of a senior focus conference sponsored by a local hospital. Participants included professionals caring for elders (i.e., nurses, social workers, occupational therapists, physical therapists and physicians) as well as lay persons over the age of 55. Subjects received the Basic Needs Satisfaction Inventory (BNSI) and the Emotional Eating Scale (EES) in their registration packets and returned the questionnaires either at specified locations at the conference or by mail. Participants ranged in age from 21 to 79 years old, with a mean age of 48.5 years old (SD = 12.5). The majority of the sample was female (87%), Caucasian (85%), and well-educated (68% graduated from college).

Findings: Total score on the EES had a strong, statistically significant correlation to total score on the BNSI (r = -.50 p <.0001). All of the subscales of the BNSI (physical needs, safety and security, love and belonging, self-esteem, and self-actualization) were also significantly (p<.01) and negatively correlated with all of the subscales of the EES (anxiety, depression, and anger/frustration). The needs higher in Maslow? hierarchy (i.e., love and belonging, self-esteem, and self-actualization) had higher correlations with the EES subscales (ranging from r = -0.36 to r = -0.54) than physical needs and safety and security needs (ranging from r = -0.29 to r = -0.38). In summary, it was found that the lower the level of basic need satisfaction, the more likely one engaged in emotional eating.

Conclusions: Relapse from initially successful weight loss interventions is common, making treatment of obesity difficult. To develop long-term, effective interventions for obesity, underlying issues that contribute to overeating and weight gain need to be addressed. Based on the strong correlations between basic need satisfaction and emotional eating, interventions that address basic need satisfaction should be explored. These findings can be used to guide the development of individualized, theory-based interventions for long-term weight loss and prevention of weight gain.

ETHNICITY AND HEALTH BEHAVIORS IN LATE PREGNANCY

Lorraine Walker, EdD, Jeanne Freeland-Graves, PhD, and Sally Wilging, MSN
The University of Texas at Austin

Abstract is available in: Annals of Behavioral Medicine, 22(suppl), 108.

This poster was presented at the 2000 Society of Behavioral Medicine meeting in Nashville, TN. Summary of Abstract: Health behaviors of a tri-ethnic sample of low income women were compared. Using the Self-Care Inventory (SCI), women reported on health behaviors during the last month of pregnancy. Only a limited number of behavioral differences were found. For the most part, Anglo women smoked and drank alcohol more than African American or Hispanic women.
Corresponding author: Lorraine Walker, EdD, The University of Texas at Austin, School of Nursing, 1700 Red River, Austin, TX 78701-1499.