Biomedical subjects

K M Cummings

Publications and source records attributed to K M Cummings.

158 records · Page 9Linked to original sources

PubMed1978

Construct validation of the health belief model.

A multitrait-multimethod design was employed to assess the construct validity of the Health Belief Model. The data were obtained from a nonrepresentative sample of 85 graduate students at The University of Michigan's School of Public Health. The traits consisted of the respondents' perceptions of: health interest, locus of control, susceptibility to influenza, severity of influenza, benefits provided by a flu shot, and the barriers or costs associated with getting a flu shot. Each trait was measured by three methods: a seven-point Likert scale, a fixed-alternative multiple choice scale, and a vignette. The results indicate that the Health Belief Model variables can be measured with a substantial amount of convergent validity using Likert or multiple choice questionnaire items. With regard to discriminant validity, evidence suggests that subjects' perceptions of barriers and benefits are quite different from their perceptions of susceptibility and severity. Perceptions of susceptibility and severity are substantially but not entirely independent. Perceived benefits and barriers demonstrate a strong negative relationship which suggests the possibility that these two variables represent opposite ends of a single continuum and not separate health beliefs. These preliminary results provide the basis for developing brief health belief scales that may be administered to samples of consumers and providers to assess educational needs. Such needs assessment, in turn, could then be used to tailor messages and programs to meet the particular needs of a client group.

Attitude to Health↗

PubMedDate not supplied

Measurement of current exposure to environmental tobacco smoke.

Reports of recent exposure to environmental tobacco smoke (ETS) and urinary cotinine levels were obtained on 663 never- and ex-smokers who attended a cancer screening clinic in Buffalo, New York, in 1986. Study objectives included determining the prevalence of exposure to ETS using urinary cotinine and identifying questionnaire exposure measures predictive of cotinine. Findings demonstrate that exposure to environmental tobacco smoke is extremely prevalent, even among those not living with a smoker. A total of 76% of subjects reported exposure to ETS in the 4 d preceding the interview. The most frequently mentioned sources of exposure were at work (28%) and at home (27%). Cotinine was found in the urine of 91% of subjects. Cotinine values increased significantly with the number of exposures reported. Among the different questionnaire measures of exposure that were evaluated, the single best predictor of cotinine was the number of friends and family members seen regularly by the subject who smoke.

Adolescent↗

PubMedDate not supplied

Nursing informatics needs assessment. Are distance programs needed?

Nursing informatics is a small but growing specialty area in nursing. The authors describe the results of a needs assessment designed to determine interest in a distance-based master's degree and certificate program in nursing informatics. Information was also collected on computer and Internet proficiency for a large sample of BSN graduates. Results suggest that there is an interest in informatics, although somewhat less than was found previously. Respondents indicated that a knowledge of nursing informatics could provide additional career opportunities and that there was a general lack of programs available.

Adult↗

PubMedDate not supplied

Population-based tobacco control: progress and prospects.

One in four U.S. adults smokes. Downstream cognitive-behavioral interventions coupled with effective pharmacotherapy can produce 40% quit rates, particularly for those least addicted, most highly motivated, and without psychiatric comorbidity. Effective midstream school-based prevention activities delay youth use. Worksite programs and physician "quit smoking" advice can be cost-effective, although these are not sufficiently widespread. Community strategies show promise of preventing youth use and helping addicted users quit. Despite failed federal tobacco control legislation, great strides have been made upstream, including proposed regulation of nicotine as a drug, the state master settlement agreement with the tobacco industry, and excise tax increases funding statewide tobacco control programs. Wider dissemination of effective programs and better coordination with upstream policies hold great potential to significantly reduce future use rates and related disease.

Health Promotion↗

PubMedDate not supplied

Tobacco advertising in retail stores.

Recent studies have described tobacco advertising in the print media, on billboards, and through sponsorship of cultural and sporting events. However, little attention has been given to another common and unavoidable source of tobacco advertising, that which is encountered in retail stores. In July 1987, we conducted a survey of 61 packaged goods retail stores in Buffalo, NY, to assess the prevalence and type of point-of-sale tobacco advertising. In addition, store owners or managers were surveyed to determine their store's policy regarding tobacco advertising, receipt of monetary incentives from distributors for displaying tobacco ads, and willingness to display antitobacco ads. Six types of stores were involved in the study: 10 supermarkets, 10 privately owned grocery stores, 9 chain convenience food stores that do not sell gasoline, 11 chain convenience food stores that sell gasoline, 11 chain pharmacies, and 10 private pharmacies. Two-thirds of the stores displayed tobacco posters, and 87 percent had promotional items advertising tobacco products, primarily cigarettes. Larger stores, and those that were privately owned, tended to display more posters and promotional items. Eighty percent of tobacco product displays were for cigarettes, 16 percent for smokeless tobacco products, and 4 percent for cigars and pipe tobacco. Convenience stores selling gasoline had the most separate tobacco product displays. Of tobacco product displays, 24 percent were located adjacent to candy and snack displays. Twenty-nine of the 61 store owners or managers indicated that their store had a policy regulating the display of tobacco ads and tobacco product displays. Policies dealt primarily with the location of tobacco posters (for example, no ads in the window) and number of product displays. Only 14 shop owners or managers indicated that they had previously displayed antitobacco information; more than half (31 of 61) said that they would be willing to display antitobaccoads.In many stores space availability is a barrier to displaying antitobacco information. Materials should be designed that have some utility for the store, such as posters that list store hours or directional information (that is, in and out signs).Antitobacco messages could also be displayed on check out dividers, check out mats, shopping carts,shopping bags, and milk cartons. In chain stores,decisions regarding the display of antitobacco information are likely to be made at the corporate level. Standards encouraging retailers to adopt more responsible policies related to advertising and sale of tobacco products should be established.

Advertising↗

PubMedDate not supplied

Years of potential life lost among a Native American population.

The determination of years of potential life lost (YPLL) can aid in monitoring changes in premature mortality among various population groups. While premature mortality has been shown to differ among blacks and whites, patterns of YPLL have not been well established among other racial groups. The Seneca Nation of Indians (SNI) is a Native American group residing primarily in western New York State (NYS). A review of SNI necrology records revealed that 55 percent (510 of 924) of the deaths between 1955 and 1984 occurred before 65 years of age. The proportion of premature deaths among males exceeded the proportion in females. SNI males demonstrated an increased risk of premature death (odds ratio = 1.43) relative to SNI females. Both the percentage of premature deaths and the number of YPLL per death were greater among SNI members compared with NYS residents. Almost one-half of all YPLL among the SNI were attributable to accidents and injuries. Heart disease, digestive diseases, and malignant neoplasms also represented important contributors to YPLL for both SNI males and females. This investigation identifies important causes of premature death among a Native American population and underscores the preventable nature of premature loss of life.

Age Factors↗

PubMedDate not supplied

Adoption of smoking policies by automobile dealerships.

Despite an increase in policies regulating smoking at the workplace, little research has been conducted on organizational factors that may be associated with the adoption of those policies. In November 1986, a survey assessing tobacco use habits was sent to 3,432 employees of 68 auto dealerships in western New York. Managers at the worksites were surveyed by telephone in 1986 and 1 year later to assess their attitudes about smoking by employees and changes in smoking policy implementation. At the time of the initial survey, 21 percent (N = 14) of businesses had smoking restrictions. Among the 54 worksites with no smoking restrictions, 14 (26 percent) adopted smoking policies within a year. The strongest predictor of policy adoption was an interaction between the presence of floating smoking restrictions (not tied to a specific area) and the manager's willingness to impose smoking restrictions on employees. Adoption of policies was also more likely to occur among worksites with younger employees. That adoption of smoking policies was more likely to occur among worksites with floating smoking policies underscores the idea that focusing efforts at the managerial level within an organization can accelerate the diffusion process. In addition, the presence of unions and employee concerns about smoking policies are likely to impact upon management's decisions regarding implementation of policies. Given the potential of smoking prohibitions to influence the smoking habits of employees, future studies should begin to focus on ways to facilitate the adoption of smoking policies in worksites.

Administrative Personnel↗

PubMedDate not supplied

Cigarette advertising and black-white differences in brand preference.

Anecdotal evidence indicates that the cigarette industry is targeting the sale of specific brands, notably menthol cigarettes, to black consumers. This paper presents data on the types of cigarettes smoked by white and black smokers. The cigarette brand preferences of two populations of smokers were examined. The first comprised 70 white and 365 black adult smokers seen at the Deaconness Family Medicine Center located in Buffalo, NY. The second population included 1,070 white and 92 black smokers who called a Stop Smoking Hotline in Buffalo. The results showed that, in both populations, blacks were twice as likely to smoke mentholated cigarettes compared with whites. In an attempt to evaluate the targeting of cigarette ads to black smokers as a possible explanation for black-white differences in brand preferences, cigarette ads appearing in magazines targeted to predominantly white or black readers were compared. Cigarette ads appearing in seven magazines were reviewed, four directed to predominantly white readers (Newsweek, Time, People, Mademoiselle) and three with wide circulation among black audiences (Jet, Ebony, Essence). The results showed that the magazines targeted to black readers contained significantly more cigarette ads and more ads for menthol brand cigarettes than magazines similar in content but targeted to white readers. The observation that a higher percentage of blacks smoke menthol cigarettes than do whites is consistent with the findings regarding differences in the type of cigarette ads appearing in magazines intended for black or white readers. However, it is not possible to determine from this study whether cigarette advertising is the cause of the differences in preference of cigarette brands between white and black smokers. Future research focusing on understanding the reasons for cigarette brand preferences may provide ideas for anti smoking campaigns aimed at specific target groups.

Adolescent↗

PubMedDate not supplied

Physician advice to quit smoking: who gets it and who doesn't.

This is a study of physicians' stop-smoking advice to patients in a university-affiliated family medicine outpatient center. The study population consisted of 311 cigarette-smoking patients of 28 family-practice residents. Patients were monitored for three months to assess changes in their smoking habits and to measure the effects of advice from their physicians. Reports of advice were correlated with both patient and physician characteristics. Forty-one percent of the patients said they had been told by their physician to stop smoking during the three-month follow-up period. Heavy smokers (more than 26 cigarettes a day) (p = .02) and those being treated for tobacco-related conditions (p = .06) were most likely to report that their physician had advised them to quit smoking. Patients seen by a physician who was a cigarette smoker were less likely to report stop-smoking advice than patients seen by a nonsmoking physician (26 percent versus 44 percent, p = .02). Selectivity in the types of patients advised to quit smoking appears to reflect the physicians' personal judgments about the patients' likelihood of following their advice.

Adolescent↗

PubMedDate not supplied

An appointment reminder system's effect on reducing the number of hypertension patients who drop out from care.

We evaluated the effects of an appointment reminder system on the appointment-keeping behavior and blood pressure control status of hypertensive patients receiving care in an urban medical clinic. The study population consisted of 973 adult hypertensive patients receiving medical care at a family practice clinic affiliated with the Wayne State University School of Medicine, Detroit, Michigan. Of the 973 patients enrolled in the study, 486 were randomly assigned to a group that received appointment reminder cards and telephone calls to reschedule missed appointments, and 487 were assigned to a nonintervention control group. Patients were followed-up with regard to their appointment-keeping behavior and blood pressure control status, five to eight months after being entered in the study. The study results indicate that patients in the appointment reminder group kept significantly more appointments and were less likely to drop out of treatment than patients in the control group. The dropout rate was 46 percent lower among patients in the appointment reminder group than in the control group. Patients in the appointment reminder group also demonstrated slightly better blood pressure control at the end of the study compared with patients in the control group, although none of the differences in blood pressure levels between groups were statistically significant at the 5 percent level.

Adult↗

PubMedDate not supplied

Family physicians' beliefs about screening for colorectal cancer using the stool guaiac slide test.

The stool guaiac slide test (SGST) is a relatively recent innovation in screening for colorectal cancer. The test detects occult blood in the stool that may indicate the presence of cancer. In recent years, the SGST has been widely promoted as a screening test to aid in the detection of colorectal cancer. However, data from public and mass screening programs indicate that many people are unaware of the test and that few have actually taken it. The findings from these studies suggest that many physicians may not be using the test in their medical practices. The literature on diffusion theory suggests that acceptance of an innovation is influenced by the potential adopter's perception of the innovation's relative advantages over those of the ideas it supersedes, its perceived complexity, and its compatibility with the existing values and practices of the receiver. This research examined these factors as they relate to use of the SGST among a sample of 131 family physicians in New York State. Eighty-two percent of these physicians reported that they provide guaiac slides to at least some of their patients to collect stool specimens at home. The test was reportedly more commonly used for older patients than for younger ones. The physicians' beliefs about the relative effectiveness of the test in detecting early-stage colorectal cancer, compared with the effectiveness of alternative screening tests, and their perceptions about patients' willingness and ability to do the test at home were found to be important factors distinguishing between physicians who said they used the test and physicians who did not. The findings from this study suggest that future efforts aimed at promoting the use o1 theSGST among primary care physicians should emphasize the relative merits of the test in comparison with those of alternative screening procedures, especially with regard to its effectiveness in detecting early stage cancers, its simplicity, and its acceptance by patients.

Adult↗

PubMedDate not supplied

Determinants of drug treatment maintenance among hypertensive persons in inner city Detroit.

Drug treatment maintenance among a group of 206 hypertensive persons was examined in relation to their health beliefs, knowledge about hypertension, barriers to receiving medical care, health status, and personal characteristics. The data came from a cross-sectional survey of approximately 800 adults living in Detroit, Mich., which included blood pressure measurements of respondents. Treatment maintenance was defined as continuing to take antihypertensive medication following a diagnosis of hypertension. Twenty-one percent of the 206 hypertensives interviewed reported discontinuing drug treatment for their high blood pressure without being advised by a physician to do so. The only factor that distinguished drop-outs from nondrops was the respondents' perception of their health status; the poorer a person perceived his or her health to be, the more likely the person was to remain in treatment. Among persons who dropped out of drug treatment, the most common reason given for discontinuing was that they felt well without the medicine. Given the asymptomatic nature of hypertension, it is suggested that many of those who stop taking medication do so because they see no need to continue therapy. The findings from this study point out the need for providers to emphasize to their hypertensive patients the reasons for continuing on treatment even when they feel well.

Black or African American↗

PubMedDate not supplied

Effects of sociodemographic and attitudinal factors on mother-initiated medication behavior for children.

Little is known about the therapies that people initiate for their health problems, and the available research on self-medication has focused primarily on adult populations. Only a few studies have specifically addressed mothers' independent use of medications for their children, and none has described such behavior in depth (for example, relating-perceived symptoms and conditions in the child or attempting to provide an explanation for mothers' decisions in these situations). A stratified systematic random sample of 100 mothers of children between 6 months and 12 years old was obtained at each of 3 pediatric ambulatory care clinics. Mothers were interviewed about their use of medications for their children, their concerns about their children's health, and their medication-related attitudes. The study results suggest that income and education are related to the types of medication and medical appliances mothers keep to treat the various health problems of their children. Mothers' perceptions of their children's potential susceptibility to health problems are related to possession of what they believe are relevant remedies for those problems (as well as to keeping a greater variety of medications on hand). Socioeconomic status appears to be one determinant of the number of different remedies (and especially the number of different medical appliances) that are purchased. Certain attitudes held by mothers about medications also play a role in explaining how great a variety of remedies are kept available for children in the event that they become ill, and these medication-related attitudes are highly correlated with socioeconomic status.

Adolescent↗

PubMedDate not supplied

Patterns and predictors of smoking cessation among users of a telephone hotline.

Most former cigarette smokers in the United States have stopped without formal assistance. However, a large proportion of smokers desire and seek help other than by attending formal programs. It is important to recognize what factors are likely to influence the effectiveness of smoking cessation attempts among these persons. The authors report results of a prospective cohort study of 1,552 smokers who called a stop smoking hotline to request self-help smoking cessation information. The participants were classified into three groups based on reports at the 6-month followup: 242 quitters, 497 recidivists, and 813 nonquitters. Baseline and followup data were used to evaluate three comparisons: quitters versus nonquitters, quitters versus recidivists, and recidivists versus nonquitters. Nonquitters appear to be less motivated and more doubtful of their abilities to quit successfully compared with the other two groups. Quitters appear to live in a supportive environment for smoking cessation. Heavier smokers are more hesitant to try to quit, but once they make an attempt they are as likely to succeed as lighter smokers, when other factors are kept constant. Efforts to promote environments supportive of smoking cessation are likely to result in a larger number of successful quitters. Similarly, efforts to strengthen motivation and belief in personal ability to quit are likely to encourage more nonquitters to attempt to stop smoking. Finally, it appears that some smokers need a previous quit attempt before they are able to maintain cessation successfully.

Adult↗