Environmental tobacco smoke and children's use of health services.
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Asthma↗
Biomedical subjects
Lisa M Klesges
Publications and source records attributed to Lisa M Klesges.
The future of health behavior change research: what is needed to improve translation of research into health promotion practice?
BACKGROUND: It is well documented that the results of most behavioral and health promotion studies have not been translated into practice. PURPOSE: In this article, reasons for this gap, focusing on study design characteristics as a central contributing barrier, are discussed. METHODS: Four reviews of recent controlled studies in work sites, health care, school, and community settings are briefly discussed and summarized. Their implications for future research and for closing the gap between research and practice are then discussed. RESULTS: These reviews come to consistent conclusions regarding key internal and external validity factors that have and have not been reported. It is very clear that moderating variables and generalization issues have not been included or reported in the majority of investigations, and that as a consequence little is known about the representatives or the robustness of results from current studies. CONCLUSIONS: To significantly improve the current state of affairs, substantial changes will be required on the part of researchers, funding agencies, and review and editorial boards. In conclusion, recommendations for each of these entities are provided.
Algorithms↗
RE-AIM: evidence-based standards and a Web resource to improve translation of research into practice.
BACKGROUND: Health services data indicate that under present conditions evidence-based medical and preventive practices are not consistently implemented in clinical practice and affect the quality of care provided to patients. Operating with similar conditions and resources, it is unlikely that evidence-based behavioral medicine (EBBM) practices will be more successfully implemented. PURPOSE: In this article we propose ways to help improve the implementation of EBBM practice. METHODS: This article describes the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework that is available on a free-use Web site (http://www.re-aim.org), which offers practical research translation tools, resources, and support for program planners, community leaders, and researchers. The material located at www.re-aim.org can be used to help anticipate and overcome likely barriers to dissemination and to estimate eventual public health impact. RESULTS: Data on Web site utilization and lessons learned thus far in its implementation are presented. CONCLUSIONS: Scientists and public health leaders should devote greater attention to reporting practice-oriented issues such as generalizability, breadth of application, and pragmatic and setting or contextual issues in addition to the current focus on internal validity issues. We hope that this and similar efforts will assist EBBM interventions to have broader applications, be consistently implemented, and be sustained.
Behavioral Medicine↗
TREND: an important step, but not enough.
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Behavioral Research↗
Use of nicotine replacement therapy in adolescent smokers and nonsmokers.
BACKGROUND: Assessing whether and how adolescents use nicotine replacement therapy (NRT) will be important given recent recommendations to make NRT more accessible by lowering its price, increasing its distribution, and advising health care professionals to suggest its use for smoking cessation. OBJECTIVES: To report the prevalence, ease of access, and reasons for NRT use and describe inappropriate use in adolescent smokers and nonsmokers. DESIGN: Cross-sectional survey of 4078 high school students during the school term of 1998. SETTING: City schools in Memphis, Tenn. MAIN OUTCOME MEASURES: Community-based self-reported prevalence of NRT use and characteristics of those using NRT. RESULTS: Approximately 5% of adolescents reported trying or using nicotine gum or patches. Females were less likely than males and African Americans were less likely than others to use NRT. For African American smokers, NRT use was highest at lower smoking levels, while other smokers showed the opposite pattern. Almost 40% of former smokers reported using NRT to try to quit smoking; however, 75% of current smokers endorsed using NRT for reasons other than trying to quit smoking. Other inappropriate use of NRT was reported; 18% of NRT users reported themselves as never smokers. More than 50% of students reported that it would be easy for them to get NRT. CONCLUSIONS: Nicotine replacement therapy is used by adolescent smokers and nonsmokers, is easily accessible, and is used for reasons other than trying to quit smoking. Efforts are needed to discourage NRT use in nonsmoking youth and to encourage appropriate use of NRT in young smokers to maximize its potential for successful cessation.
Adolescent↗
Reporting of validity from school health promotion studies published in 12 leading journals, 1996-2000.
A targeted review was conducted of school-based, controlled intervention studies that promoted good nutrition, physical activity, or smoking cessation/prevention, and were published in one of 12 leading health behavior journals between 1996 and 2000. The RE-AIM framework was used to evaluate the extent to which each paper reported on elements of reach, efficacy, adoption, implementation, and maintenance. Thirty-two publications were reviewed. Reporting rates across the RE-AIM dimensions varied substantially: Reach = 59.3%; Efficacy = 100%; Adoption = 14.8%; Implementation = 37%; Maintenance = 25.9% for individuals, 0% for schools. Few studies reported if characteristics of the study sample were representative of those found in the broader population of students or schools. Among studies reporting on the RE-AIM dimensions, participation rates generally were high (median 82%), adoption rates were moderate (median 72.5%), and reports of implementation were high (87%). To increase the potential to translate controlled research to "real-world" practice conditions, a stronger emphasis should be placed on reporting the representativeness of the sample of students and schools.
Child↗
Behavior change intervention research in healthcare settings: a review of recent reports with emphasis on external validity.
BACKGROUND: Information to judge both the internal and external validity of health behavior research conducted in healthcare settings is vital to translate research findings to practice. This paper reviews the extent to which this research has reported on elements of internal and external validity, with emphasis on the extent to which research has been conducted in representative settings with representative populations. METHODS: A comprehensive review was conducted of controlled interventions for dietary change, physical activity, or smoking cessation conducted in healthcare settings and published in 12 leading health behavior journals between 1996 and 2000. Using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, the characteristics and results of these studies were summarized to document the extent to which intervention reach, adoption, implementation, and maintenance were reported and what has been learned about each of these dimensions. RESULTS: A total of 36 studies qualified for review. Participation rates among eligible patients were reported in 69% of studies and were generally quite high; in contrast, only 30% of studies reported on participation rates among either healthcare settings or providers. Implementation data were reported in 77% of the studies and these rates were generally high, with the caveat that intervention was often delivered by paid research staff. Long-term maintenance results were reported very consistently at the individual level, but program continuation was almost never reported at the setting level. CONCLUSIONS: We conclude that a much stronger emphasis needs to be placed on the representativeness of providers and settings that are studied. Examples of how this can be done and recommendations for future research are provided.
Feeding Behavior↗
Response from the Behavior Change Consortium Representatives and Translation Work Group: the issue is one of impact, not of world view or preferred approach.
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Health Behavior↗
Utilization of counseling and supportive services by female victims of domestic abuse.
Increasing attention to the high prevalence of domestic violence (DV) and its impact on women's physical and mental health has resulted in expanded services for abused women. Abused women appear to underutilize the formal counseling services available in many communities, however, and further research is needed to identify factors related to service utilization. In the present study, 1,746 women assaulted by a male intimate partner were identified from a larger pool of women interviewed by Pretrial Services following the arrest of their spouse/partner on domestic abuse charges. The women were selected for the current study if they reported prior physical assaults perpetrated by the same spouse/partner listed in the instant offense. In addition to describing previous physical assaults and psychological abuse by their current spouse/partner, women were also asked whether they had ever sought "formal counseling/supportive services" to address the abuse. Consistent with the prior literature, only a minority of the victims reported prior use of these services (14.9%). Additional analyses indicated that the likelihood of having accessed services varied as a function of victim demographic factors (race, relationship to the offender, income), characteristics of the prior DV (prior injury by partner, forced sexual activity, prior psychological abuse), and whether the victim's children witnessed the fighting. Limitations of the study and implications for service providers and the courts are discussed.
Adult↗
Practical and relevant self-report measures of patient health behaviors for primary care research.
PURPOSE: With increasing evidence for the value of behavior change counseling, there is a need for health behavior measurements that can be implemented in primary care research. This article discusses criteria for and reviews self-report measures to briefly assess cigarette smoking, eating patterns, physical activity, and risky drinking across the life course. It then proposes pragmatic measures for use in practice-based research. METHODS: Drawing from literature reviews, previous multisite studies, personal communications with experts in the field, and guidance from an expert panel, we identified self-report behavior change measures and gave priority to items that addressed Healthy People 2010 goals, as well as those that were practical (ie, shorter, and easier to score and use for intervention), were sensitive to change, and produced results that could directly inform primary care intervention. RESULTS: Separate recommendations are described for measures for adults and for children/adolescents. We recommend a set of 22 items for adults and 16 items for adolescents to track succinctly their status on the 4 health behaviors above. Perfected measures remain elusive: newly developed measures of physical activity and eating patterns are recommended, and in general, the brief measures for adults are currently better validated than are the child measures. CONCLUSIONS: A set of totally satisfactory practical instruments for measuring behavior change in primary care settings does not yet exist. There is sufficient progress to encourage use of and further research on the proposed items. Use of a common set of items across different interventions and projects will help to advance clinical and behavioral research in primary care settings.
Adolescent↗
Health promotion referrals in an urban clinic: removing financial barriers influences physician but not patient behavior.
PURPOSE: This study describes the prevalence and characteristics of physician health promotion referrals and patient adherence to referrals in a community-based primary care clinic and associated wellness facility. The role of reimbursement for attendance to the wellness facility was specifically examined. DESIGN: Retrospective cohort study. SETTING: The Church Health Center of Memphis, Tennessee: a low-income urban clinic and its affiliated wellness center. SUBJECTS: Patients were primarily African-American, lower-income, urban residents of Shelby County, Tennessee. MEASURES: All study data came from existing medical clinic and wellness facility records of utilization, patient history, and diagnoses. RESULTS: Of 6321 clinic patients, 16.7% (n = 1069) received a provider health promotion referral. Logistic regression analyses identified that physician referral was related to patient factors of access to free wellness-facility membership, employment status, receiving a behavior-related diagnosis, and being African-American and female. Of patients receiving a referral 17.2% (n = 184) adhered to this advice and visited the wellness facility. New patients were more likely to adhere to a referral than established patients. CONCLUSION: Demographic, financial, and patient characteristics influenced whether health behavior change referrals were made by primary care physicians in a community clinic. Removing financial barriers did not influence patient adherence, but new patients were more likely to follow the recommendation than those previously seen at the clinic.
Adult↗