Search PubMed⌕ Search

Biomedical subjects

D R Black

Publications and source records attributed to D R Black.

At least 37 records · Page 2Linked to original sources
PubMed1996

Interest in a stepped approach model (SAM): identification of recruitment strategies for university alcohol programs.

This study evaluates interest in a stepped approach model (SAM) of service delivery and identifies variables to enhance recruitment to alcohol programs. Subjects were 2,443 college student drinkers (1,420 men and 1,023 women) at a large midwestern university (selected by stratified systematic sampling) who completed a questionnaire on drinking behavior and interest in five intervention steps. Results indicated that there was more interest in interventions that required less time, which supports predictions of SAM. Overall lack of interest peaked at 67% for men and 65% for women and did not change significantly across the last three steps of SAM, which included traditional interventions of group and individual counseling. The data suggest that the stepped approach is more viable than conventional approaches, recruitment is unquestionably an exigent research priority because of the overwhelming lack of interest in alcohol programs, and specific variables that were identified may be important for recruiting particular subgroups.

Adolescent↗
PubMed1995

Recruitment to a university alcohol program: evaluation of social marketing theory and stepped approach model.

BACKGROUND: This study was a first initiative to evaluate the application of social marketing theory (SMT) to increase attendance at an alcohol abuse education program for university residence hall students and to ascertain whether aggressive recruitment strategies are necessary as part of the stepped approach model (SAM) of service delivery. METHOD: SMT and public health strategies that include focus groups, in-depth interviews, and intercept interviews were used to develop recruitment materials in a Test Hall. These new recruitment materials were introduced to the residents in the Treatment Hall (N = 727) and were compared to the Usual Care, Control Hall (N = 706) which received the recruitment materials normally provided to residents as well as to three Historical Halls separately and combined which had used the Usual Care recruitment materials in the past. RESULTS: The Treatment Hall percentage attendance was significantly superior (0.001 < p < 0.05) in all comparisons. The percentage attendance did not differ significantly from marketing literature expectations. The projections for campus-wide attendance for residence hall students were between 207 and 243 participants and for nationwide attendance, 36,900 +/- 8,185. CONCLUSIONS: The results suggest that the SMT and public health methods used are helpful in developing recruitment strategies and are an important initial step of the SAM and that a "minimal intervention" recruitment strategy is a cost-effective approach that can have a dramatic impact.

Adolescent↗
PubMed1995

In acute lung injury, inhaled nitric oxide improves ventilation-perfusion matching, pulmonary vascular mechanics, and transpulmonary vascular efficiency.

Acute respiratory distress syndrome continues to be associated with significant morbidity and mortality related to ventilation-perfusion mismatch, pulmonary hypertension, and right ventricular failure. It has been suggested that inhaled nitric oxide, which is a selective pulmonary vasodilator, may be effective in the treatment of acute respiratory distress syndrome; however, the effects of nitric oxide on cardiopulmonary interactions are poorly understood. We therefore developed a model of acute lung injury that mimics the clinical syndrome of acute respiratory distress syndrome. In our model, inhaled nitric oxide significantly reduced pulmonary artery pressure, pulmonary vascular resistance, and pulmonary vascular impedance. In addition, inhaled nitric oxide improved transpulmonary vascular efficiency and ventilation-perfusion matching, which resulted in increased arterial oxygen tension. Although arterial oxygen tension increased, oxygen delivery did not improve significantly. These data suggest that by improving ventilation-perfusion matching and arterial oxygen tension while lowering pulmonary vascular resistance and impedance, nitric oxide may be beneficial in patients with acute respiratory distress syndrome. However, additional measures to enhance cardiac performance may be required.

Administration, Inhalation↗
PubMed1995

A stepwise procedure for evaluating irritant materials in normal volunteer subjects.

1. The cutaneous response to a known irritant has been assessed in human volunteer subjects using both clinical scoring and two non-invasive instrumental methods; erythema measurement using an erythema meter and capillary blood flow using a laser Doppler device. 2. Aqueous solutions (0.5% and 1%) of sodium hydroxide were applied to back skin for 3, 15 and 60 min with assessments immediately after removal and at 1, 24 and 48 hours. 3. Increased erythema was seen with increasing duration of exposure and an increase was also seen at 1 h, 24 h and 48 h after removal of the patch. The results obtained with the erythema meter paralleled the clinical erythema scores. However, the laser Doppler device showed the greatest changes immediately after removal of the patch with subsequent readings showing a gradual decrease. 4. Statistical analysis of the data has been carried out to determine the accuracy and precision of the assessment procedures and to determine the minimum test panel size for detecting irritant reactions. 5. Comparison between back and forearm skin indicated a greater sensitivity to sodium hydroxide on the back. 6. The results of this study define an ethical approach to testing irritant materials in human subjects and provide the basis for the development of a classification system for cutaneous irritants.

Adolescent↗
PubMed1995

Social Problem-Solving Inventory for Adolescents (SPSI-A): development and preliminary psychometric evaluation.

This article describes a multiphase developmental process and psychometric evaluation of the Social Problem-Solving Inventory for Adolescents (SPSI-A). The SPSI-A consists of the following three scales: Automatic Process, Problem Orientation, and Problem-Solving Skills. The three subscales of the Problem Orientation Scale include Cognition, Emotion, and Behavior. The four subscales of the Problem-Solving Skills scale consist of Problem Identification, Alternative Generation, Consequence Prediction, and Implementation/Evaluation/Reorganization. Preliminary internal consistency, stability, content, construct, and criterion validity data are presented for freshmen and sophomore high school students. Collectively, the data provide evidence that the SPSI-A is a promising measure of adolescent problem-solving skills and motivation.

Adolescent↗
PubMed1994

Extremes in body mass index: probability of healthcare expenditures.

BACKGROUND: This study was conducted as a first initiative to investigate the relationship between body mass index [BMI, weight(kg)/height(m)2] and healthcare expenditures by third party providers for lifestyle-related diseases and disorders. METHOD: Data were analyzed for 383 individuals who were continuously employed and covered by the same comprehensive health insurance plan during a 2-year baseline period followed by a 5-year observation period. A multiple logistic regression analysis that adjusted for covariates was used to ascertain whether BMI and baseline expenditure status separately or in combination influenced the probability of healthcare expenditures during the observation period. RESULTS: After controlling for age, gender, and smoking status, probability of healthcare expenditures for lifestyle-related medical problems was significantly (P < 0.04) greater during the observation period for adults with high as well as low BMIs plus baseline expenditures and lowest for subjects whose BMIs were in the midrange regardless of their baseline expenditures. Odds of expenditures increased significantly (P = 0.0079) with age of nonsmokers, but was approximately constant and high for smokers at all ages. The absence of any significant interaction of either smoking status or age with BMI indicated that the relationship between BMI and the log odds of expenditures was consistent across age and smoking categories. CONCLUSIONS: The analyses support the conclusion that the highest probability of expenditures occurs with the combination of baseline insurance expenditures and BMI extremes and the lowest probability occurs when BMIs are near 26 or 27 (approximately 19% above the ideal of 22). The findings also provide further justification for focusing on extremes in body weight as health priorities.

Adult↗
PubMed1994

Is adipose tissue oversold as a health risk?

A high percentage of body fat is considered to be the primary cause of risks associated with high body weight. Yet body fat content per se may not cause the risks. The contribution of obesity to risks may be because overfilled adipose tissue cannot remove offending substances from circulation. The ability to remove excess glucose, lipids, and offending materials from circulation, not the amount of body fat, may be the important factor. People with large, partially filled adipose depots may have less risk than people with small, but filled adipose depots. This concept is supported by many studies. Energy restriction in genetically obese animals greatly increases longevity and slows signs of aging even while the animals remain obese. Weight reduction often corrects weight-associated medical problems in obese persons without returning body-fat levels to normal. Statistically generated desirable body-fat contents or desirable height-weight tables may have little meaning for individuals and may cause more harm than good. Because these standards are not appropriate for some people, they should be discarded as a guide for all. More emphasis should be placed on healthy lifestyles and less on body-fat percentages.

Adipose Tissue↗
PubMed1994

Reducing alcohol consumption among university students: recruitment and program design strategies based on Social Marketing Theory.

Recruitment of program participants and development of appealing comprehensive alcohol abuse prevention programs is an exigent priority for university campuses due to the serious physical and emotional consequences related to alcohol consumption. A sample of 67 students from a large midwestern university completed a survey based on Social Marketing Theory (SMT) which was developed to improve recruitment and enhance the design of comprehensive alcohol abuse prevention programs. The results indicate that recruitment may be optimized by providing a flexible, convenient, low-cost program that encourages friends' participation, communicates alcohol-related risks and offers university credit or refund as participation incentives. The design of alcohol abuse prevention programs may be enhanced by emphasizing the positive outcomes of reducing alcohol consumption, improving the quality and quantity of alternatives to the social atmosphere connected with drinking, and soliciting respected opinion leaders (physicians and parents) to communicate alcohol reduction messages. This project is a first initiative to 'fill the gap' in the social marketing research literature by providing formative information pertinent to recruitment and design of alcohol reduction programs specifically for college students.

Adolescent↗
PubMed1993

Smoking cessation interventions for university students: recruitment and program design considerations based on social marketing theory.

BACKGROUND: Audience variables with social marketing implications for university campuses were investigated to identify prepromotional campaign strategies for the design of smoking cessation interventions and for subject recruitment. METHODS: A first survey based on a stratified systematic probability sample of 2,998 college students at a large midwestern university identified 313 smokers. A total of 263 (response rate = 84%) participated in a second telephone survey, and results were based on the 193 (73%) respondents who still smoked. RESULTS: Recruitment implications indicate that potential participants are predominantly lower classmen in their early 20s who are unmarried, childless, white, full-time domestic students. Smoking habits are moderate but well-established and confined almost exclusively to cigarette smoking. An average of three attempts to quit smoking was reported, and the majority of respondents rated their interest and intention to quit as "somewhat" to "very likely." The best publicity options for programs are campus newspapers as well as grocery stores and gas stations, where most cigarettes are purchased. Program design implications suggest that accessibility, affordability, convenience, flexibility, social support, and behavioral prompts/cues are important factors to consider. CONCLUSIONS: This study is a first initiative to "fill the gap" in the social marketing research literature by providing recruitment and program design information specifically for developing a smoking cessation campaign for university campuses.

Adolescent↗
PubMed1993

Health services at large public institutions: funding, utilization, and staffing.

When a mandatory health fee policy for students on campuses of the State University of New York (SUNY) was instituted in fall 1991, the projection was that the policy, which was at the option of individual institutions, would result in significant changes for SUNY health service operations. The changes would affect funding sources, staffing requirements, utilization rates, and services offered. In the past, the SUNY system had been inconsistent in health fee policies. This study was conducted to assist in implementing the mandatory health service fees. The authors surveyed 53 public higher education institutions viewed as comparable to the University at Buffalo in terms of location in an equivalent state, enrollment of 10,000 or more students, similar academic disciplines, average SAT scores, faculty salaries, and graduate enrollment. Two institutions that no longer met the original criteria were not included. The final tabulation was based on data from 42 institutions, for a return rate of 82%. Survey results showed that public higher education institutions are significantly altering traditional practices associated with student healthcare. Health services are providing more specialty services, increasing the focus on wellness and health education, seeking accreditation, and increasing student representation in decision making. In addition, funding sources have shifted dramatically, with a larger percentage of the student health budget derived directly from fees assessed to students and a much smaller percentage derived from institutional or state appropriations.

Fee Schedules↗
PubMed1991

Purdue stepped approach model: application to pharmacy practice.

The Purdue Stepped Approach Model (PSAM) of service delivery is applied to pharmacy practice. The PSAM offers a method to organize interventions in a systematic and sequential manner according to the amount and type of resources required to achieve optimal patient health status. The model also provides an approach to integrating the expertise of other healthcare professionals into the provision of pharmacy services (e.g., health educators, psychologists, nurse practitioners, exercise physiologists), addresses economic costs and differential modes of reimbursement, and provides suggestions for future research. Examples are included to facilitate application of the PSAM in pharmacy and implications for holistic healthcare or health promotion in pharmacy practice are discussed.

Humans↗
PubMed1991

Identification of campaign recruitment strategies for a stepped smoking cessation intervention for a college campus.

A rapproachement of the Stepped Approach Model of health care delivery and Ajzen's Theory of Planned Behavior was used to identify campaign recruitment strategies for a stepped smoking cessation intervention for a college campus. The study examines outcome expectancies, outcome evaluations, and interest in participating in smoking cessation programs presented in graduated steps of intervention intensity. Telephone surveys were conducted with a probability sample of 191 student smokers. A significant negative trend indicates that the steps are ordered cost-effectively. Scheffé a posteriori tests also reveal that interest in Step 1 (pamphlets and brochures) was significantly higher than interest in any other step, including those representing traditional health care services (i.e., groups and individual treatments). The two strongest predictors of interest in each step were attitudes about participation and control beliefs; normative expectations about program participation discriminated between respondents with high or low interest in Steps 2 through 5. It was concluded that attitudes and control beliefs should be the focus of initial program promotion for college smoking cessation campaigns. Emphasis on attitudes, control beliefs, and especially perceived norms could be helpful in advancing unsuccessful participants to the next more intensive program in a stepped intervention.

Attitude to Health↗
PubMed1991

A time-series analysis of longitudinal weight changes in two adult women.

This study was conducted to examine individual longitudinal serial trends in body weight of two moderately obese adult women. Self-measured daily weights (over 5000 data points for subject 1 and over 3500 for subject 2) were averaged for each month and analyzed using a time-series analysis approach. The best statistical model for both women indicated a significant upward trend (gain 30 and 22 lb, respectively) interrupted by linear decreases (P less than 0.05) during weight loss programs over the 16- and 10-year observation periods, respectively. The women participated in six and eight weight control programs, respectively, and consistently lost weight, averaging 9.17 +/- 1.85 lb and 8.00 +/- 3.57 lb. Both subjects regained weight after dieting, in a period approximately 2.25 times as long as the diet. Numerous weight fluctuations occurred and one subject lost and then regained 10 percent of her body weight during two 5-year periods. Results are examined in terms of a possible weight increase protection benefit, as well as the deleterious medical potential that may occur with numerous weight loss attempts. Suggestions for future research are provided regarding weight cycling, seasonal variations, set point theory, aging effects, and the use of self-directed weight loss initiatives in conjunction with formal weight reduction programs. This study may serve as a prototype for exploring weight fluctuation using time-series analyses and for further investigating the etiology and clinical management of obesity.

Body Mass Index↗
PubMed1990

A meta-analytic evaluation of couples weight-loss programs.

Applied Hedges and Olkin's (1985) statistical meta-analytic procedures to summary data from all published studies that compared behavioral weight-control programs that formally involved partners in treatment (couples programs) to similar programs in which subjects participated alone (subject-alone programs). Based on tests of effect sizes, couples programs are significantly superior to subject-alone programs at posttreatment (p less than .05). A nearly significant (p = .06) statistical superiority for couples programs versus subject-alone programs is also found at 2- to 3-month follow-up, but not thereafter. The couples programs differed in the kinds of social support provided by partners, and the most productive kinds of partner support remain to be identified. In particular, the use of partners in providing social support to subjects after formal therapy has ended is still an area of largely unexplored potential.

Adult↗
PubMed1989

Minimal intervention and arthritis treatment: implications for patient and physician compliance.

A rationale based on a public health perspective for using minimal intervention programs in the treatment of arthritis is presented. Minimal interventions are relatively inexpensive, relatively free from side effects, and produce therapeutic effects that range from statistically significant to clinically important. Empirical evidence regarding the relative efficacy of minimal intervention programs continues to accumulate in general preventive medicine. Extension to arthritis treatment and control is recommended. This will require (1) practitioners to recognize the public health perspective, (2) consensus judgment that a treatment is likely to produce therapeutic benefits at little cost and with minimal side effects, and (3) empirical validation of efficacy based on clinical trial results. It is concluded that the concept of minimal intervention could increase physicians' use of such treatments and thereby increase the therapeutic benefits to patients suffering from arthritic disease.

Arthritis↗
PubMed1989

Partner weight status and subject weight loss: implications for cost-effective programs and public health.

This study examined the difference in body changes of subjects with overweight partners and those with normal weight partners. The 9 subjects with normal weight partners lost significantly more weight than the 14 subjects with overweight partners by the end of the one-year treatment program (27.9 lbs versus 20.2 lbs, respectively) and at 3-month follow-up (29.6 lbs vs. 17.3 lbs, respectively). It was also found that both overweight and normal weight partners lost weight incidental to treatment but as expected, body changes of overweight partners significantly decreased over time whereas body changes of normal weight partners did not. Overweight partners and subjects lost statistical equivalent amounts of weight but there was a significant correlation at posttreatment between body changes of subjects in the overweight partner group and their partners. It was concluded that if body changes of both subjects and their overweight partners are considered, couples programs might be a cost-effective and important public health approach because two individuals lose weight as inexpensively as one and more people are treated. Researchers are encouraged to report weight status and body changes of both subjects and partners in order to understand more fully the relationship between partner weight status and subject weight loss.

Adult↗
PubMed1988

Weight changes in a couples program: negative association of marital adjustment.

This study investigated the difference in weight changes of subjects who rated their marriages as more adjusted vs subjects who rated their marriages as less adjusted. Twenty-six moderately obese subjects were assigned to one of two groups based on their initial scores on the Locke-Wallace Marital Adjustment Scale (MAS). The 10 subjects in the "moderately unhappy" group (MAS less than or equal to 99) lost significantly more weight than the 16 subjects in the "relatively happy" group (MAS greater than or equal to 100) at the end of the one-year treatment program (29.9 lb vs 20.4 lb) and at 3-month follow-up (27.7 lb vs 17.8 lb). Significantly more subjects in the unhappy group also reached ideal weight than subjects in the happy group (50% vs 7.7%). Subjects' initial MAS scores were significantly and negatively correlated with weight changes at post-treatment and follow-up; partners' MAS scores at the end of treatment were also significantly and negatively correlated to subjects' weight losses at post-treatment. None of the couples was initially maritally distressed but one couple met this criterion (MAS less than or equal to 85) by the end of treatment and follow-up. It was concluded that marital counseling is not a prerequisite for weight counseling, couples' marital adjustment does not improve as the subject loses weight and a moderate level of marital dissatisfaction does not seem to be an insurmountable barrier to successful weight loss and may be an advantage for some individuals.

Adult↗