This qualitative study examined the acceptability of female condoms in urban India, with a focus ... more This qualitative study examined the acceptability of female condoms in urban India, with a focus on sexual pleasure. We conducted focus group discussions with 50 women and 19 men, as well as a small number of individual interviews with women ( n = 3), in Chennai and New Delhi. Perceived benefits of female condoms included protection against unintended pregnancy and sexually transmitted infections, increased sense of empowerment for women, and simple clean up. The most common drawback was reduced sensation. Participants suggested structural changes to the female condom to ease insertion and use. Consent and privacy were discussed as increasing sexual pleasure. Pleasure should be acknowledged in design and education efforts to increase female condom use.
Purpose-This study examines whether ambivalence towards mammography screening, as moderated by to... more Purpose-This study examines whether ambivalence towards mammography screening, as moderated by total amount of thought given to the reasons for and against getting mammograms at recommended intervals, predicts greater delay in obtaining subsequent screening mammograms. Methods-A sample of 3,430 insured women with recent (within the last 8-9 months) screening mammograms completed telephone interviews as part of a five year intervention study to achieve sustained adherence to annual-interval mammography. Delay was assessed by the number of days between mammograms. Results-Controlling for demographic factors and perceived screening barriers, days between mammograms increased as ambivalence and thought increased. Thought moderated ambivalence: among women who were most ambivalent, women obtained mammograms a month earlier for each unit increase in thought.
Background-As obesity rates rise, new weight loss methods are needed. Little is known about the u... more Background-As obesity rates rise, new weight loss methods are needed. Little is known about the use of podcasting (audio files for a portable music player or computer) to promote weight loss, despite its growing popularity. Design-A 12-week randomized controlled trial. Setting/Participants-Overweight men and women (body mass index, 25-40 kg/m 2) (n=78) in the Raleigh-Durham, NC area. Intervention-In 2008, participants were randomly assigned to receive 24 episodes of a currently available weight loss podcast (control podcast) or a weight loss podcast based on social cognitive theory (SCT) designed by the researchers (enhanced podcast) for 12 weeks. Main outcome measures-Weight was measured on a digital scale at baseline and follow-up. Both groups also completed questionnaires assessing demographic information, food intake, physical activity, and SCT constructs at the introductory and 12-week meetings. Additional questionnaires at the 12-week meeting assessed perceptions of the intervention.
Background-Regular adherence to mammography screening saves lives yet few women receive regular m... more Background-Regular adherence to mammography screening saves lives yet few women receive regular mammograms. Design-RCT. Setting/participants-Participants were recruited through a state employee health plan. All were women aged 40-75 years and had recent mammograms prior to enrollment (n=3,547). Data were collected from 2004 to 2009. Intervention-The efficacy was tested of a two-step adaptively designed intervention to increase mammography adherence over 4 years. The first intervention step consisted of three reminder types: enhanced usual care reminders (EUCR), enhanced letter reminders (ELR), both delivered by mail, and automated telephone reminders (ATR). After delivery of reminders, women who became offschedule in any of the 4 years received a second step of supplemental interventions. Three supplemental intervention arms contained priming letters and telephone counseling: barriers only (BarriCall), barriers plus positive consequences of getting mammograms (BarriConCall+), and barriers plus negative consequences of not getting mammograms (BarriConCall−). Main outcome measures-Average cumulative number of days non-adherent to mammography over 4 years based on annual screening guidelines (analyses conducted in 2009) Results-All reminders performed equally well in reducing number of days of non-adherence. Women randomized to receive supplemental interventions had significantly fewer days of nonadherence compared to women who received EUCR (p=0.0003). BarrConCall+ and BarrConCall− conditions did not significantly differ in days non-adherent compared to women in the barriers-only condition (BarriCon).
To describe the development of a peer support intervention and test an enhanced version compared ... more To describe the development of a peer support intervention and test an enhanced version compared to a standard protocol. Participants (N = 36 females) were assigned to an Enhanced Peer Support (PS) vs Standard weight loss group for 4 months. The PS component consisted of skills training and practice between sessions using social networking. The PS group perceived significantly more peer support and experienced higher levels of social interaction. When meeting frequency decreased, the PS group showed an increase in overall types of support from group members. Findings suggest that an intervention targeting peer support skills results in greater feelings of peer support.
The Centers for Disease Control and Prevention recommends that health departments in all 50 state... more The Centers for Disease Control and Prevention recommends that health departments in all 50 states deliver AFIX (Assessment, Feedback, Incentives, and eXchange) consultations to 25% of federally funded vaccine providers each year. AFIX effectively raises vaccination coverage among young children. WHAT THIS STUDY ADDS: AFIX consultations achieved short-term gains in coverage for 11-to 12-year-olds for vaccines in the adolescent platform. No gains occurred for older adolescents or over the long term. Consultations were equally effective when delivered in-person or by webinar.
Background: In Uganda, just like in many sub-Saharan countries, studies on Intimate Partner Viole... more Background: In Uganda, just like in many sub-Saharan countries, studies on Intimate Partner Violence (IPV) among married women are limited. The aim of this paper was to determine the correlates of emotional, sexual, physical IPV and any form of IPV among married women in Uganda. Methods: The 2016 Uganda Demographic and Health Survey (UDHS) data was used, and a weighted sample of 6879 married women were selected from the Domestic Violence module. Frequency distributions were used to describe the characteristics of respondents. Chi-square tests were used to establish the association between IPV and the explanatory variables. Binary logistic regressions were used to establish the factors that were associated with IPV among married women in Uganda. Results: More than half (56%) of the married women experienced some form of IPV. Sexual IPV was the least prevalent (23%) and 4 in 10 women (41 and 40%) experienced physical and emotional IPV, respectively. Factors associated with all the different forms of IPV included, age, region, witnessing parental violence, partner's controlling behaviors, duration of the relationship, and frequency of intoxication of the male partner. Conclusion: IPV among Ugandan married women is far too common. This calls for collective efforts to reduce IPV in Uganda by addressing excessive alcohol consumption, controlling behaviors, and lack of awareness of the issue. Interventions aimed at preventing perpetration and tolerance of violence in the home settings should be promoted.
Sixty-six women participated in this study, which compared two 16-week motivationally enhanced we... more Sixty-six women participated in this study, which compared two 16-week motivationally enhanced weight loss interventions. Both intervention groups, which are entitled "Minimal" and "Enhanced" throughout the description that follows, received a motivationally enhanced initial face-to-face weight loss session. The initial session was followed by a 16-week Internet behavioral weight loss program, which included a study website with weekly lessons, an online self-monitoring diary form, web links to related sites, and separate message boards. The Enhanced group also received weekly moderated online chat group sessions led using motivational techniques. Both groups lost weight over time (p<0.001), however the group by time interaction was non-significant (p=0.19). The Minimal group lost 5.22+/-4.72 kg and the Enhanced group lost 3.71+/-4.46 kg. In the Enhanced group, online chat session attendance averaged 8.0 of the 16 chats offered. Greater program utilization was associated with greater weight loss in both groups. The addition of weekly motivationally enhanced online chats did not increase weight loss in this study. Further research is needed on the type and frequency of group support that is most desirable and beneficial in Internet weight loss interventions and could also explore building motivation for program utilization.
Background-This study compares the efficacy of three types of reminders in promoting annual repea... more Background-This study compares the efficacy of three types of reminders in promoting annual repeat mammography screening. Design-RCT. Setting and participants-Study recruitment occurred in 2004-2005. Participants were recruited through the North Carolina State Health Plan for Teachers and State Employees. All were aged 40-75 years and had a screening mammogram prior to study enrollment. A total of 3547 women completed baseline telephone interviews. Intervention-Prior to study recruitment, women were assigned randomly to one of three reminder groups: (1) printed enhanced usual care reminders (EUCRs); (2) automated telephone reminders (ATRs) identical in content to EUCRs; or (3) enhanced letter reminders that included additional information guided by behavioral theory. Interventions were delivered 2-3 months prior to women's mammography due dates. Main outcome measures-Repeat mammography adherence, defined as having a mammogram no sooner than 10 months and no later than 14 months after the enrollment mammogram. Results-Each intervention produced adherence proportions that ranged from 72% to 76%. Postintervention adherence rates increased by an absolute 17.8% from baseline. Women assigned to ATRs were significantly more likely to have had mammograms than women assigned to EUCRs (p=0.014). Comparisons of reminder efficacy did not vary across key subgroups. Conclusions-Although all reminders were effective in promoting repeat mammography adherence, ATRs were the most effective and lowest in cost. Health organizations should consider using ATRs to maximize proportions of members who receive mammograms at annual intervals.
Moms and Teens for Safe Dates (MTSD) is a dating abuse (DA) prevention program for teens exposed ... more Moms and Teens for Safe Dates (MTSD) is a dating abuse (DA) prevention program for teens exposed to domestic violence. In a randomized controlled trial (RCT), MTSD prevented certain types of DA victimization (psychological and physical) and perpetration (psychological and cyber) among teens with higher, but not lower, exposure to domestic violence. We built on these findings by using moderated mediation analysis to examine whether level of teen exposure to domestic violence conditioned the indirect effects of MTSD on these types of DA through targeted mediators. MTSD consisted of six mailed activity booklets. Mothers who had been former victims of domestic violence delivered the program to their teens. Mother and teen pairs were recruited into the RCT through community advertising and completed baseline and 6-month follow-up interviews (N = 277 pairs). As expected, MTSD had significant favorable effects for teens with higher but not lower exposure to domestic violence on several mediators that guided program content, including teen conflict management skills and mother-perceived severity of DA, self-efficacy for enacting DA prevention efforts, and comfort in communicating with her teen. MTSD had significant main effects on other mediators including teen feeling of family closeness and cohesion and mother-perceived susceptibility of her teen to DA. As expected, all significant indirect effects of MTSD on DA outcomes through mediators were for teens with higher exposure to domestic violence. Findings have implications for developing DA victimization and perpetration prevention programs for teens with high exposure to domestic violence.
Background. Violence against women (VAW) is widespread and linked to negative public health and s... more Background. Violence against women (VAW) is widespread and linked to negative public health and social outcomes. Research on VAW, however, has largely been limited to convenience samples and on variable definitions of violence, hindering our ability to fully characterize this important problem nationally and among subgroups of women.
Adolescents exposed to domestic violence are at increased risk of dating abuse, yet no evaluated ... more Adolescents exposed to domestic violence are at increased risk of dating abuse, yet no evaluated dating abuse prevention programs have been designed specifically for this high-risk population. This article describes the process of adapting Families for Safe Dates (FSD), an evidenced-based universal dating abuse prevention program, to this high-risk population, including conducting 12 focus groups and 107 interviews with the target audience. FSD includes six booklets of dating abuse prevention information, and activities for parents and adolescents to do together at home. We adapted FSD for mothers who were victims of domestic violence, but who no longer lived with the abuser, to do with their adolescents who had been exposed to the violence. Through the adaptation process, we learned that families liked the program structure and valued being offered the program and that some of our initial assumptions about this population were incorrect. We identified practices and beliefs of mothe...
Domestic violence protective orders (DVPOs) are the nation&am... more Domestic violence protective orders (DVPOs) are the nation's most widely used intimate partner violence (IPV)-related legal intervention, and there is emerging evidence that DVPOs are effective. However, little is known about DVPO defendants. We examined a population-based sample of male DVPO defendants. Most had previous IPV-related offenses, mental health issues, and alcohol and drug-use histories. Court personnel should be aware of the severity of violence plaintiffs are likely experiencing, and the potential danger posed by defendants, and ensure that expedited and appropriate protection is awarded. Concurrent treatment for substance abuse and mental health may enhance the effectiveness of DVPOs.
Online cancer-related support is an under-studied resource that may serve an important function i... more Online cancer-related support is an under-studied resource that may serve an important function in the information seeking, care, and support of cancer patients and their families. With over 9.8 million cancer survivors (defined as anyone living with cancer) in the United States alone and the number growing worldwide, it is important to understand how they seek and use online resources to obtain the information they need, when they need it, and in a form and manner appropriate to them. These are stated cancer communication goals of the US National Cancer Institute. Our purposes are to (1) present background information about online mailing lists and electronic support groups, (2) describe the rationale and methodology for the Health eCommunities (HeC) study, and (3) present preliminary baseline data on new subscribers to cancer-related mailing lists. In particular, we describe subscribers' use of mailing lists, their reasons for using them, and their reactions to participating shortly after joining the lists. From April to August 2004, we invited all new subscribers to 10 Association of Cancer Online Resources mailing lists to complete Web-based surveys. We analyzed baseline data from the respondents to examine their perceptions about cancer-related mailing lists and to describe how cancer patients and survivors used these lists in the period shortly after joining them. Cumulative email invitations were sent to 1368 new mailing list subscribers; 293 Web surveys were completed within the allotted time frame (21.4% response rate). Most respondents were over age 50 (n = 203, 72%), white (n = 286, 98%), college graduates (n = 161, 55%), and had health insurance (n = 283, 97%). About 41% (n = 116) of new subscribers reported spending 1 to 3 hours per day reading and responding to list messages. They used the mailing lists for several reasons. Among the most frequently reported, 62% (n = 179) strongly agreed they used mailing lists to obtain information on how to deal with cancer, 42% (n = 121) strongly agreed they used mailing lists for support, and 37% (n = 109) strongly agreed that they were on the mailing lists to help others. Smaller proportions of new subscribers strongly agreed that others on the mailing lists had similar cancer experiences (n = 23, 9%), that they could relate to the experiences of others on the lists (n = 66, 27%), and that others on the list gave them good ideas about how to cope with cancer (n = 66, 27%). Cancer-related online mailing lists appear to be an important resource, especially for information seeking but also for support of cancer survivors. These were the primary motivators most members reported for joining mailing lists. The modest proportion of subscribers who strongly agreed that they could relate to others' cancer experiences (as well as similar responses to other process questions) is undoubtedly due at least in part to the short duration that these subscribers were involved with the mailing lists. Emerging data, including our own, suggest that mailing lists are perhaps under-used by minority patients/survivors. These preliminary data add to a growing body of research on health-related online communities, of which online mailing lists are one variant.
Whereas both popular and public health attention regarding homicide and violence have focused on ... more Whereas both popular and public health attention regarding homicide and violence have focused on urban areas and male victims, very little is known about the magnitude of female homicide in rural areas, or how the situations in which these fatalities occur may differ from urban violence. This study addresses this gap by using data abstracted from the North Carolina State Medical Examiner System to identify how the rates and circumstances of female homicide differ for women living in rural counties compared with women living in the state's urban and intermediate counties. The study identified a nonlinear pattern, with the intermediate counties having the highest female homicide rate, followed by the urban, and then the rural counties. Additional findings suggest that a greater proportion of rural female victims are killed by intimate partners, and that the effects of urban-rural status are eclipsed by race and, to a lesser extent, by age.
In this article, research-based strategies used in a web-based study to assess the impact of part... more In this article, research-based strategies used in a web-based study to assess the impact of participation in cancer-related mailing lists on cancer survivors and caregivers are highlighted. The paper presents alternative methods of measuring response rates in Internet surveys. Response rate estimation, based on American Association for Public Opinion Research guidelines, ranged between 15% and 24.9% for the study. Several strategies were implemented to increase survey participation and reduce item nonresponse. Few participants opted for a telephone survey as an alternative to a web-administered design (mixed-mode administration). Using time-stamp data to diagnose places in the questionnaire where respondents prematurely exited or broke off survey participation, we were able to decrease premature break offs. A lottery was also implemented to increase response rates. The experience of obtaining institutional review board approval for the lottery is also described. Preliminary data indicate slight increases in response rates subsequent to implementing the lottery. r
Background: Cheerleaders suffer nearly half of catastrophic injuries observed in female scholasti... more Background: Cheerleaders suffer nearly half of catastrophic injuries observed in female scholastic athletes in the United States. However, incidence of noncatastrophic injury in this population has not been described. Hypothesis: Coach, athlete, and injury circumstance variables may predict the injury rate among cheerleaders. Study Design: Prospective cohort. Methods: The authors investigated injury incidence in a sample of North Carolina female cheerleaders who competed interscholastically from 1996 to 1999. Injury, exposure, and demographic data were collected from squads that participated in the North Carolina High School Athletic Injury Study. Results: Cheerleaders suffered 133 injuries during 1701 athlete seasons. More than 21 % of the injuries were ankle sprains. The injury rate was 8.7; the 95% confidence interval (CI) was 6.5 to 11.7 per 10,000 athlete exposures. In a multivariate Poisson regression model, cheerleaders supervised by coaches with the most education, qualifications, and training (coach EQT) had a nearly 50% reduction in injury risk (rate ratio [RR], 0.5; 95% CI, 0.3-0.9), and cheerleaders supervised by coaches with medium coach EQT had a nearly 40% reduction in injury risk (RR = 0.6; 95% CI, 0.3-1.2) compared to cheerleaders supervised by coaches with low coach EQT.
This qualitative study examined the acceptability of female condoms in urban India, with a focus ... more This qualitative study examined the acceptability of female condoms in urban India, with a focus on sexual pleasure. We conducted focus group discussions with 50 women and 19 men, as well as a small number of individual interviews with women ( n = 3), in Chennai and New Delhi. Perceived benefits of female condoms included protection against unintended pregnancy and sexually transmitted infections, increased sense of empowerment for women, and simple clean up. The most common drawback was reduced sensation. Participants suggested structural changes to the female condom to ease insertion and use. Consent and privacy were discussed as increasing sexual pleasure. Pleasure should be acknowledged in design and education efforts to increase female condom use.
Purpose-This study examines whether ambivalence towards mammography screening, as moderated by to... more Purpose-This study examines whether ambivalence towards mammography screening, as moderated by total amount of thought given to the reasons for and against getting mammograms at recommended intervals, predicts greater delay in obtaining subsequent screening mammograms. Methods-A sample of 3,430 insured women with recent (within the last 8-9 months) screening mammograms completed telephone interviews as part of a five year intervention study to achieve sustained adherence to annual-interval mammography. Delay was assessed by the number of days between mammograms. Results-Controlling for demographic factors and perceived screening barriers, days between mammograms increased as ambivalence and thought increased. Thought moderated ambivalence: among women who were most ambivalent, women obtained mammograms a month earlier for each unit increase in thought.
Background-As obesity rates rise, new weight loss methods are needed. Little is known about the u... more Background-As obesity rates rise, new weight loss methods are needed. Little is known about the use of podcasting (audio files for a portable music player or computer) to promote weight loss, despite its growing popularity. Design-A 12-week randomized controlled trial. Setting/Participants-Overweight men and women (body mass index, 25-40 kg/m 2) (n=78) in the Raleigh-Durham, NC area. Intervention-In 2008, participants were randomly assigned to receive 24 episodes of a currently available weight loss podcast (control podcast) or a weight loss podcast based on social cognitive theory (SCT) designed by the researchers (enhanced podcast) for 12 weeks. Main outcome measures-Weight was measured on a digital scale at baseline and follow-up. Both groups also completed questionnaires assessing demographic information, food intake, physical activity, and SCT constructs at the introductory and 12-week meetings. Additional questionnaires at the 12-week meeting assessed perceptions of the intervention.
Background-Regular adherence to mammography screening saves lives yet few women receive regular m... more Background-Regular adherence to mammography screening saves lives yet few women receive regular mammograms. Design-RCT. Setting/participants-Participants were recruited through a state employee health plan. All were women aged 40-75 years and had recent mammograms prior to enrollment (n=3,547). Data were collected from 2004 to 2009. Intervention-The efficacy was tested of a two-step adaptively designed intervention to increase mammography adherence over 4 years. The first intervention step consisted of three reminder types: enhanced usual care reminders (EUCR), enhanced letter reminders (ELR), both delivered by mail, and automated telephone reminders (ATR). After delivery of reminders, women who became offschedule in any of the 4 years received a second step of supplemental interventions. Three supplemental intervention arms contained priming letters and telephone counseling: barriers only (BarriCall), barriers plus positive consequences of getting mammograms (BarriConCall+), and barriers plus negative consequences of not getting mammograms (BarriConCall−). Main outcome measures-Average cumulative number of days non-adherent to mammography over 4 years based on annual screening guidelines (analyses conducted in 2009) Results-All reminders performed equally well in reducing number of days of non-adherence. Women randomized to receive supplemental interventions had significantly fewer days of nonadherence compared to women who received EUCR (p=0.0003). BarrConCall+ and BarrConCall− conditions did not significantly differ in days non-adherent compared to women in the barriers-only condition (BarriCon).
To describe the development of a peer support intervention and test an enhanced version compared ... more To describe the development of a peer support intervention and test an enhanced version compared to a standard protocol. Participants (N = 36 females) were assigned to an Enhanced Peer Support (PS) vs Standard weight loss group for 4 months. The PS component consisted of skills training and practice between sessions using social networking. The PS group perceived significantly more peer support and experienced higher levels of social interaction. When meeting frequency decreased, the PS group showed an increase in overall types of support from group members. Findings suggest that an intervention targeting peer support skills results in greater feelings of peer support.
The Centers for Disease Control and Prevention recommends that health departments in all 50 state... more The Centers for Disease Control and Prevention recommends that health departments in all 50 states deliver AFIX (Assessment, Feedback, Incentives, and eXchange) consultations to 25% of federally funded vaccine providers each year. AFIX effectively raises vaccination coverage among young children. WHAT THIS STUDY ADDS: AFIX consultations achieved short-term gains in coverage for 11-to 12-year-olds for vaccines in the adolescent platform. No gains occurred for older adolescents or over the long term. Consultations were equally effective when delivered in-person or by webinar.
Background: In Uganda, just like in many sub-Saharan countries, studies on Intimate Partner Viole... more Background: In Uganda, just like in many sub-Saharan countries, studies on Intimate Partner Violence (IPV) among married women are limited. The aim of this paper was to determine the correlates of emotional, sexual, physical IPV and any form of IPV among married women in Uganda. Methods: The 2016 Uganda Demographic and Health Survey (UDHS) data was used, and a weighted sample of 6879 married women were selected from the Domestic Violence module. Frequency distributions were used to describe the characteristics of respondents. Chi-square tests were used to establish the association between IPV and the explanatory variables. Binary logistic regressions were used to establish the factors that were associated with IPV among married women in Uganda. Results: More than half (56%) of the married women experienced some form of IPV. Sexual IPV was the least prevalent (23%) and 4 in 10 women (41 and 40%) experienced physical and emotional IPV, respectively. Factors associated with all the different forms of IPV included, age, region, witnessing parental violence, partner's controlling behaviors, duration of the relationship, and frequency of intoxication of the male partner. Conclusion: IPV among Ugandan married women is far too common. This calls for collective efforts to reduce IPV in Uganda by addressing excessive alcohol consumption, controlling behaviors, and lack of awareness of the issue. Interventions aimed at preventing perpetration and tolerance of violence in the home settings should be promoted.
Sixty-six women participated in this study, which compared two 16-week motivationally enhanced we... more Sixty-six women participated in this study, which compared two 16-week motivationally enhanced weight loss interventions. Both intervention groups, which are entitled "Minimal" and "Enhanced" throughout the description that follows, received a motivationally enhanced initial face-to-face weight loss session. The initial session was followed by a 16-week Internet behavioral weight loss program, which included a study website with weekly lessons, an online self-monitoring diary form, web links to related sites, and separate message boards. The Enhanced group also received weekly moderated online chat group sessions led using motivational techniques. Both groups lost weight over time (p<0.001), however the group by time interaction was non-significant (p=0.19). The Minimal group lost 5.22+/-4.72 kg and the Enhanced group lost 3.71+/-4.46 kg. In the Enhanced group, online chat session attendance averaged 8.0 of the 16 chats offered. Greater program utilization was associated with greater weight loss in both groups. The addition of weekly motivationally enhanced online chats did not increase weight loss in this study. Further research is needed on the type and frequency of group support that is most desirable and beneficial in Internet weight loss interventions and could also explore building motivation for program utilization.
Background-This study compares the efficacy of three types of reminders in promoting annual repea... more Background-This study compares the efficacy of three types of reminders in promoting annual repeat mammography screening. Design-RCT. Setting and participants-Study recruitment occurred in 2004-2005. Participants were recruited through the North Carolina State Health Plan for Teachers and State Employees. All were aged 40-75 years and had a screening mammogram prior to study enrollment. A total of 3547 women completed baseline telephone interviews. Intervention-Prior to study recruitment, women were assigned randomly to one of three reminder groups: (1) printed enhanced usual care reminders (EUCRs); (2) automated telephone reminders (ATRs) identical in content to EUCRs; or (3) enhanced letter reminders that included additional information guided by behavioral theory. Interventions were delivered 2-3 months prior to women's mammography due dates. Main outcome measures-Repeat mammography adherence, defined as having a mammogram no sooner than 10 months and no later than 14 months after the enrollment mammogram. Results-Each intervention produced adherence proportions that ranged from 72% to 76%. Postintervention adherence rates increased by an absolute 17.8% from baseline. Women assigned to ATRs were significantly more likely to have had mammograms than women assigned to EUCRs (p=0.014). Comparisons of reminder efficacy did not vary across key subgroups. Conclusions-Although all reminders were effective in promoting repeat mammography adherence, ATRs were the most effective and lowest in cost. Health organizations should consider using ATRs to maximize proportions of members who receive mammograms at annual intervals.
Moms and Teens for Safe Dates (MTSD) is a dating abuse (DA) prevention program for teens exposed ... more Moms and Teens for Safe Dates (MTSD) is a dating abuse (DA) prevention program for teens exposed to domestic violence. In a randomized controlled trial (RCT), MTSD prevented certain types of DA victimization (psychological and physical) and perpetration (psychological and cyber) among teens with higher, but not lower, exposure to domestic violence. We built on these findings by using moderated mediation analysis to examine whether level of teen exposure to domestic violence conditioned the indirect effects of MTSD on these types of DA through targeted mediators. MTSD consisted of six mailed activity booklets. Mothers who had been former victims of domestic violence delivered the program to their teens. Mother and teen pairs were recruited into the RCT through community advertising and completed baseline and 6-month follow-up interviews (N = 277 pairs). As expected, MTSD had significant favorable effects for teens with higher but not lower exposure to domestic violence on several mediators that guided program content, including teen conflict management skills and mother-perceived severity of DA, self-efficacy for enacting DA prevention efforts, and comfort in communicating with her teen. MTSD had significant main effects on other mediators including teen feeling of family closeness and cohesion and mother-perceived susceptibility of her teen to DA. As expected, all significant indirect effects of MTSD on DA outcomes through mediators were for teens with higher exposure to domestic violence. Findings have implications for developing DA victimization and perpetration prevention programs for teens with high exposure to domestic violence.
Background. Violence against women (VAW) is widespread and linked to negative public health and s... more Background. Violence against women (VAW) is widespread and linked to negative public health and social outcomes. Research on VAW, however, has largely been limited to convenience samples and on variable definitions of violence, hindering our ability to fully characterize this important problem nationally and among subgroups of women.
Adolescents exposed to domestic violence are at increased risk of dating abuse, yet no evaluated ... more Adolescents exposed to domestic violence are at increased risk of dating abuse, yet no evaluated dating abuse prevention programs have been designed specifically for this high-risk population. This article describes the process of adapting Families for Safe Dates (FSD), an evidenced-based universal dating abuse prevention program, to this high-risk population, including conducting 12 focus groups and 107 interviews with the target audience. FSD includes six booklets of dating abuse prevention information, and activities for parents and adolescents to do together at home. We adapted FSD for mothers who were victims of domestic violence, but who no longer lived with the abuser, to do with their adolescents who had been exposed to the violence. Through the adaptation process, we learned that families liked the program structure and valued being offered the program and that some of our initial assumptions about this population were incorrect. We identified practices and beliefs of mothe...
Domestic violence protective orders (DVPOs) are the nation&am... more Domestic violence protective orders (DVPOs) are the nation's most widely used intimate partner violence (IPV)-related legal intervention, and there is emerging evidence that DVPOs are effective. However, little is known about DVPO defendants. We examined a population-based sample of male DVPO defendants. Most had previous IPV-related offenses, mental health issues, and alcohol and drug-use histories. Court personnel should be aware of the severity of violence plaintiffs are likely experiencing, and the potential danger posed by defendants, and ensure that expedited and appropriate protection is awarded. Concurrent treatment for substance abuse and mental health may enhance the effectiveness of DVPOs.
Online cancer-related support is an under-studied resource that may serve an important function i... more Online cancer-related support is an under-studied resource that may serve an important function in the information seeking, care, and support of cancer patients and their families. With over 9.8 million cancer survivors (defined as anyone living with cancer) in the United States alone and the number growing worldwide, it is important to understand how they seek and use online resources to obtain the information they need, when they need it, and in a form and manner appropriate to them. These are stated cancer communication goals of the US National Cancer Institute. Our purposes are to (1) present background information about online mailing lists and electronic support groups, (2) describe the rationale and methodology for the Health eCommunities (HeC) study, and (3) present preliminary baseline data on new subscribers to cancer-related mailing lists. In particular, we describe subscribers' use of mailing lists, their reasons for using them, and their reactions to participating shortly after joining the lists. From April to August 2004, we invited all new subscribers to 10 Association of Cancer Online Resources mailing lists to complete Web-based surveys. We analyzed baseline data from the respondents to examine their perceptions about cancer-related mailing lists and to describe how cancer patients and survivors used these lists in the period shortly after joining them. Cumulative email invitations were sent to 1368 new mailing list subscribers; 293 Web surveys were completed within the allotted time frame (21.4% response rate). Most respondents were over age 50 (n = 203, 72%), white (n = 286, 98%), college graduates (n = 161, 55%), and had health insurance (n = 283, 97%). About 41% (n = 116) of new subscribers reported spending 1 to 3 hours per day reading and responding to list messages. They used the mailing lists for several reasons. Among the most frequently reported, 62% (n = 179) strongly agreed they used mailing lists to obtain information on how to deal with cancer, 42% (n = 121) strongly agreed they used mailing lists for support, and 37% (n = 109) strongly agreed that they were on the mailing lists to help others. Smaller proportions of new subscribers strongly agreed that others on the mailing lists had similar cancer experiences (n = 23, 9%), that they could relate to the experiences of others on the lists (n = 66, 27%), and that others on the list gave them good ideas about how to cope with cancer (n = 66, 27%). Cancer-related online mailing lists appear to be an important resource, especially for information seeking but also for support of cancer survivors. These were the primary motivators most members reported for joining mailing lists. The modest proportion of subscribers who strongly agreed that they could relate to others' cancer experiences (as well as similar responses to other process questions) is undoubtedly due at least in part to the short duration that these subscribers were involved with the mailing lists. Emerging data, including our own, suggest that mailing lists are perhaps under-used by minority patients/survivors. These preliminary data add to a growing body of research on health-related online communities, of which online mailing lists are one variant.
Whereas both popular and public health attention regarding homicide and violence have focused on ... more Whereas both popular and public health attention regarding homicide and violence have focused on urban areas and male victims, very little is known about the magnitude of female homicide in rural areas, or how the situations in which these fatalities occur may differ from urban violence. This study addresses this gap by using data abstracted from the North Carolina State Medical Examiner System to identify how the rates and circumstances of female homicide differ for women living in rural counties compared with women living in the state's urban and intermediate counties. The study identified a nonlinear pattern, with the intermediate counties having the highest female homicide rate, followed by the urban, and then the rural counties. Additional findings suggest that a greater proportion of rural female victims are killed by intimate partners, and that the effects of urban-rural status are eclipsed by race and, to a lesser extent, by age.
In this article, research-based strategies used in a web-based study to assess the impact of part... more In this article, research-based strategies used in a web-based study to assess the impact of participation in cancer-related mailing lists on cancer survivors and caregivers are highlighted. The paper presents alternative methods of measuring response rates in Internet surveys. Response rate estimation, based on American Association for Public Opinion Research guidelines, ranged between 15% and 24.9% for the study. Several strategies were implemented to increase survey participation and reduce item nonresponse. Few participants opted for a telephone survey as an alternative to a web-administered design (mixed-mode administration). Using time-stamp data to diagnose places in the questionnaire where respondents prematurely exited or broke off survey participation, we were able to decrease premature break offs. A lottery was also implemented to increase response rates. The experience of obtaining institutional review board approval for the lottery is also described. Preliminary data indicate slight increases in response rates subsequent to implementing the lottery. r
Background: Cheerleaders suffer nearly half of catastrophic injuries observed in female scholasti... more Background: Cheerleaders suffer nearly half of catastrophic injuries observed in female scholastic athletes in the United States. However, incidence of noncatastrophic injury in this population has not been described. Hypothesis: Coach, athlete, and injury circumstance variables may predict the injury rate among cheerleaders. Study Design: Prospective cohort. Methods: The authors investigated injury incidence in a sample of North Carolina female cheerleaders who competed interscholastically from 1996 to 1999. Injury, exposure, and demographic data were collected from squads that participated in the North Carolina High School Athletic Injury Study. Results: Cheerleaders suffered 133 injuries during 1701 athlete seasons. More than 21 % of the injuries were ankle sprains. The injury rate was 8.7; the 95% confidence interval (CI) was 6.5 to 11.7 per 10,000 athlete exposures. In a multivariate Poisson regression model, cheerleaders supervised by coaches with the most education, qualifications, and training (coach EQT) had a nearly 50% reduction in injury risk (rate ratio [RR], 0.5; 95% CI, 0.3-0.9), and cheerleaders supervised by coaches with medium coach EQT had a nearly 40% reduction in injury risk (RR = 0.6; 95% CI, 0.3-1.2) compared to cheerleaders supervised by coaches with low coach EQT.
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Papers by J. Bowling