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Biomedical subjects

Patricia Dolan Mullen

Publications and source records attributed to Patricia Dolan Mullen.

At least 19 recordsLinked to original sources
PubMed2007

Preventing alcohol-exposed pregnancies: a randomized controlled trial.

BACKGROUND: Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities in the United States. DESIGN: A randomized controlled trial (2002-2005; data analyzed 2005-2006) of a brief motivational intervention to reduce the risk of an alcohol-exposed pregnancy (AEP) in preconceptional women by focusing on both risk drinking and ineffective contraception use. SETTING/PARTICIPANTS: A total of 830 nonpregnant women, aged 18-44 years, and currently at risk for an AEP were recruited in six diverse settings in Florida, Texas, and Virginia. Combined settings had higher proportions of women at risk for AEP (12.5% overall) than in the general population (2%). INTERVENTIONS: Participants were randomized to receive information plus a brief motivational intervention (n=416) or to receive information only (n=414). The brief motivational intervention consisted of four counseling sessions and one contraception consultation and services visit. MAIN OUTCOME MEASURES: Women consuming more than five drinks on any day or more than eight drinks per week on average, were considered risk drinkers; women who had intercourse without effective contraception were considered at risk of pregnancy. Reversing either or both risk conditions resulted in reduced risk of an AEP. RESULTS: Across the follow-up period, the odds ratios (ORs) of being at reduced risk for AEP were twofold greater in the intervention group: 3 months, 2.31 (95% confidence interval [CI]=1.69-3.20); 6 months, 2.15 (CI=1.52-3.06); 9 months, 2.11 (CI=1.47-3.03). Between-groups differences by time phase were 18.0%, 17.0%, and 14. 8%, respectively. CONCLUSIONS: A brief motivational intervention can reduce the risk of an AEP.

Adult↗
PubMed2006

The effects of smoking cessation counseling by midwives on Dutch pregnant women and their partners.

OBJECTIVE: Smoking during pregnancy is an important problem in the Netherlands. We tested the effectiveness of a health counseling method by midwives using a RCT. METHODS: Four provinces with 42 practices including 118 midwives were randomly assigned to the experimental or control condition. Midwives in the experimental group provided brief health counseling, self-help materials on smoking cessation during pregnancy and early postpartum, and a partner booklet. Controls received routine care. The main outcome measures were 7-day abstinence, continuous abstinence, and partner smoking at 6 weeks post-intervention (T1) and 6 weeks postpartum (T2). RESULTS: Multi-level analysis revealed significant differences between both conditions at T1 and T2 using intention-to-treat analysis. Nineteen percent of the experimental group reported 7-day abstinence compared to 7% of the control group at T1, and 21 and 12%, respectively, at T2. For continuous abstinence these percentages were 12% in the experimental group and 3% in the control group. The partner intervention was not successful. CONCLUSION: The intervention resulted in significant effects on smoking behavior for pregnant women, but not for partner smoking. PRACTICE IMPLICATIONS: The program realized short-term effects. An important precondition is that midwives need a proper training.

Adult↗
PubMed2006

The promise and pitfalls of systematic reviews.

The systematic review "movement" that has transformed medical journal reports of clinical trials and reviews of clinical trials has taken hold in public health, with the most recent milestone, the publication of the first edition of The Guide to Community Health Services in 2005. In this paper we define and distinguish current terms, point out important resources for systematic reviews, describe the impact of systematic review on the quality of primary studies and summaries of the evidence, and provide perspectives on the promise of systematic reviews for shaping the agenda for public health research. Several pitfalls are discussed, including a false sense of rigor implied by the terms "systematic review" and "meta-analysis" and substantial variation in the validity of claims that a particular intervention is "evidence based," and the difficulty of translating conclusions from systematic reviews into public health advocacy and practice.

Evidence-Based Medicine↗
PubMed2006

Computer-based decision support for pediatric asthma management: description and feasibility of the Stop Asthma Clinical System.

Clinical guidelines can assist in the management of asthma. Decision support systems (DSSs) can enhance adherence to clinical guidelines but tend not to provide clinicians with cues for behavioral change strategies to promote patient self-management. The Stop Asthma Clinical System (SACS) is a DSS designed for this purpose. To assess feasibility, seven clinicians used SACS to guide well visits with 26 predominantly persistent pediatric asthma patients. Data were collected via survey and in-depth semi-structured interviews. SACS improved assessment of asthma severity and control, classification of and intervention in medicine and environmental trigger management problems, and development of an action plan (all p < 0.05). Clinician-patient communication was enhanced. The primary challenge was that SACS increased clinic visit time. SACS can enhance clinician behavior to improve patient asthma self-management, but more studies are indicated to mitigate temporal constraints and evaluate impact on clinician and patient communication and behavior as well as clinical outcomes.

Algorithms↗
PubMed2006

Measures used in studies of informed decision making about cancer screening: a systematic review.

Interventions to promote informed decision making (IDM) for cancer screening are increasingly common. The resulting body of literature provides an opportunity for a systematic review of measures in use. We searched standard databases for intervention trials and other studies of screening decisions and decision aids, finding 2,110 unique citations (most with abstracts) that we reduced to 104 full-text articles; 36 studies met inclusion criteria (prostate = 20, colorectal = 9, breast = 6, cervical = 1). Two independent coders abstracted data on study characteristics, constructs, and measures. Our findings revealed that most studies measured screening (or intention) and knowledge; fewer measured recommended IDM-related constructs and none measured all outcomes proposed for evaluating IDM interventions. Validity and reliability of measures received inadequate attention in study reports, and conceptual overlap exists among measures. Few IDM measures have been developed/carefully adapted from treatment measures and tested for cancer screening or in diverse populations. We recommend that new and in-progress studies emphasize outcomes beyond knowledge-participation in decision making according to personal preference, satisfaction with the process, and consistency between decisions and values. Also needed is better use of theory to guide conceptualization and operationalization of measures, greater attention to reliability and validity (particularly in diverse populations), more thorough reporting of sources and operating characteristics of measures, and increased emphasis and resources focused on these issues by funders, researchers, and journal editors.

Decision Making↗
PubMed2005

Contraception or abortion? Inaccurate descriptions of emergency contraception in newspaper articles, 1992-2002.

BACKGROUND: Media portrayals of emergency contraception (EC) may influence public health policy and the public's acceptance of this reproductive health option. OBJECTIVES: We investigated the accuracy of newspaper coverage of EC, 1992-2002. METHODS: We conducted a content analysis of a sample of 1077 articles in 113 newspapers discussing both EC and abortion and determined the frequency of confusion between the two. RESULTS: Of all articles, 44.5% (n = 479) included at least one instance of confusion between EC and medical abortion. Inaccurate portrayal of the mode of action of EC as medical abortion occurred in 31.8% (n = 343) of articles; 13.1% (n = 141) inappropriately applied terms such as "abortifacient postcoital contraceptives" for EC. CONCLUSIONS: Errors were prevalent, persisted over time and may have contributed to incorrect beliefs about a form of contraception that is used infrequently, despite its potential to deter unintended pregnancy and abortion.

Abortion, Induced↗
PubMed2005

Predictors of perceiving smoking cessation counselling as a midwife's role: a survey of Dutch midwives.

BACKGROUND: Smoking during pregnancy can have many serious consequences. As the usual providers of pregnancy care in the Netherlands, midwives could serve as effective counsellors to pregnant women about cigarette smoking. The aim of the present study was to identify relevant factors that hamper or promote the provision of effective smoking cessation advice and counselling. METHODS: Questionnaires were mailed to midwives; 237 (64.4%) were returned. Questions were asked about advantages and disadvantages of giving smoking cessation advice, perceived health benefits for mother and child, smoking behaviour and normative beliefs of colleagues, self-efficacy and role definition of midwives with regard to giving smoking cessation advice. RESULTS: Midwives who have a more positive role definition regarding giving smoking cessation advice are more convinced of the advantages of giving advice, the advantages of quitting for their clients and perceive more support from their colleagues with regard to giving advice. CONCLUSION: In general, midwives were motivated to provide their clients with smoking cessation advice. They were less comfortable with guiding women through the cessation process. Therefore, effective materials and training should be developed to facilitate and stimulate midwives in their role as effective counsellors.

Adult↗
PubMed2005

Acculturation and mammography screening among Hispanic women living in farmworker communities.

The relationship between acculturation and mammography screening practices among Hispanic women is unclear due to inconsistent study findings. The purpose of this research was to further investigate the effect of acculturation on mammography screening practices among Hispanic women and to explore the effect of biculturalism on mammography screening. Hispanic female farmworkers (N = 716) who were 50 years of age and older living in communities in Texas, New Mexico, and California were interviewed at their homes. Data collection was conducted from November 2001 to February 2002. Logistic regression models showed no significant effect for acculturation for the entire sample. Post hoc stratified analysis found that bicultural study participants in California were 3 times more likely to be adherent to screening compared to those with low acculturation. Study findings suggest that distinct differences might exist for Hispanic women living in farmworker communities in California, and perhaps other communities not on the United States-Mexico border. Women in such communities with low levels of acculturation can be targeted for interventions to increase mammography adherence.

Acculturation↗
PubMed2005

Correlates of mammography screening among Hispanic women living in lower Rio Grande Valley farmworker communities.

Factors contributing to the underuse of mammography screening by female Hispanic farmworkers aged 50 years and older in the Lower Rio Grande Valley were determined through home-based, Spanish-language personal interviews (N = 200). Questions covered adherence to screening mammography guidelines (mammogram within 2 years), healthcare access, sociodemographic characteristics, and theoretical constructs related to breast cancer screening in the literature. Multivariate findings indicated that adherent women were 3.6 times more likely to have health insurance. Self-efficacy for obtaining a mammogram and decisional balance were also significantly related to adherence; age, income, and education variables were not associated, perhaps because of restricted variation. Results indicate continuing efforts are needed to ensure that medically underserved migrant farmworker women have access to health care services. In addition, efforts to increase their self-efficacy in obtaining a mammogram and to counter negative attitudes and opinions by stressing the positive prognosis associated with early detection are warranted.

Aged↗
PubMed2004

How can more smoking suspension during pregnancy become lifelong abstinence? Lessons learned about predictors, interventions, and gaps in our accumulated knowledge.

UNLABELLED: Maintenance of abstinence from cigarettes during pregnancy yields important benefits for both women and children, yet only 20%-30% of pregnancy cessation lasts 1 year postpartum. This paper reviews accumulated knowledge about factors that influence restarting smoking and the effectiveness of interventions to decrease it. Evidence from six trials and six multivariate predictor studies is provided, supplemented by qualitative and more focused quantitative studies. Studies were international, with diverse candidate predictors, intensity and timing of interventions, theory, designs, and measures of quitting and of maintenance postpartum. RECOMMENDATIONS: (a). Partner smoking must be addressed in interventions with cessation messages. (b). Intervention studies should include women of lower socioeconomic status and Black women. (c). Program developers and researchers should adopt a consistent standard for cessation. (d). Communication laboratory methods should test ways to increase intrinsic reasons for abstinence and success attributions to stable, internal causes. (e). Staging for postpartum smoking should supplant relapse prevention alone. (f). Among those whose intention it is to maintain nonsmoking postpartum, standard relapse prevention treatment is insufficient to combat environmental cues that also have been suspended for the pregnancy and typical problems of sleeplessness, stress, depression, and weight concern. (g). Interventions ideally should begin in late pregnancy, when postpartum smoking goals can be revised and plans made to manage postpartum issues. (h). Innovative methods for reducing postpartum problems should be tested. (i). Study of incentives for pregnancy cessation should include varying patterns, carryover to early postpartum months, and focus on their impact on long-term change.

Adult↗
PubMed2003

Continuing medical education: what delivery format do physicians prefer?

BACKGROUND: Although physicians are in a unique position to prevent life-threatening outcomes by counseling patients to stop smoking, many of them miss the opportunity to intervene in their patients' use of tobacco. Nicotine Dependence Across the Lifespan was developed as a continuing medical education (CME) program to teach and encourage physicians to deliver effective tobacco prevention and tobacco cessation counseling. METHODS: This CME program was offered to Texas physicians, free of charge, in three formats: live lectures, videotapes, and World Wide Web-based training. The program targeted physicians in four rural areas of Texas (San Angelo, Harlingen, Tyler, and Lubbock), where high smoking rates are prevalent and the number of professional smoking cessation services is low. We examined the sociodemographic characteristics of the participating physicians, factors in their decisions to participate in the program, and the extent to which their reported CME format preferences were associated with age, gender, race, profession, and location. RESULTS: The four factors identified--professional development, cost, personal control, and convenience/complexity--explained 76.9% of the variance describing the reasons physicians participated in the CME offering. The physicians' preferred CME format was live lectures; based on responses, this did not differ across age, gender, race/ethnicity, and location. DISCUSSION: Live lecture continues to be a preferred format of CME for physicians in four rural areas of Texas, yet research continues to show that lecture results in only the lowest level of behavioral change.

Chi-Square Distribution↗
PubMed2003

Feasibility of implementation of a Dutch smoking cessation and relapse prevention protocol for pregnant women.

A cross-sectional design was used to asses whether Dutch midwives trained to use a smoking cessation counseling protocol appreciated it and could implement it in routine care. Midwives received a questionnaire after the implementation period of the effectiveness study was finished. In total, 118 midwives from 42 practices participated in the study, 69 midwives (58.5%) returned the questionnaire. To validate the results collected among midwives, clients who participated in the study were also questioned about the information they received about smoking cessation from their midwife. Experimental midwives more often reported giving the advice to quit (B=0.50, S.E.=0.24, P<0.05), setting a quit date with clients who indicated to be motivated to quit (B=1.69, S.E.=0.28, P<0.001) and discussing aftercare (B=1.10, S.E.=0.25, P<0.001). These results were confirmed by data collected among clients. This easy-to-implement program is recommended for broad dissemination. Further investigation is needed to improve the partner and postpartum component.

Adult↗
PubMed2003

An exploratory study of control of smoking in the home to reduce infant exposure to environmental tobacco smoke.

This study examined control of environmental tobacco smoke (ETS) exposure in the home by new mothers and identified factors related to the establishment of home smoking control rules. Pregnant women who, at 28 weeks gestation, reported they had not smoked in the past 28 days were enrolled in a randomized smoking cessation study. Telephone interviews were conducted at 6 weeks, 3 months, 6 months, and 12 months postpartum. A Home Smoking Control Index, composed of four items (whether the mother smokes in the home, the partner smokes in the home, other household smokers are asked to smoke outside, and visitors who smoke are asked to smoke outside), was used to classify homes as having a home smoking policy in effect, no policy or an incomplete policy, or no policy needed. Sociodemographic variables and maternal self-efficacy were examined in relation to the index data among 325 women who had need to exercise control of smoking in the home: 63% had a home smoking policy in effect at 3 months, 60% at 6 months, and 64% at 12 months postpartum. Predictors of policy at 6 and 12 months included (a) having a policy in effect at the previous assessment, (b) confidence in limiting infant ETS exposure in the home, and (c) perceived difficulty in preventing exposure. Early establishment of a policy appears to be important for ensuring sustained infant ETS avoidance over time. The index measures key actions that influence infant exposure and warrants further testing for use in intervention trials.

Adolescent↗
PubMed2002

A profile of U.S.-based trials of behavioral and social interventions for HIV risk reduction.

We describe 99 (experimental and certain quasi-experimental) U.S.-based trials, reported or published since 1988, of behavioral and social interventions that measured prespecified behavioral and biologic outcomes and aimed to reduce risk for HIV infection. Studies identified through June 1998 by the HIV/AIDS Prevention Research Synthesis project were grouped into 4 risk behavior areas: drug-related (k [number of studies] = 48), heterosexual youth (k = 24), heterosexual adult (k = 17), and same-sex (k = 10). We compared the studies in the 4 areas by variables key to the development, evaluation, and transfer of interventions. Participants comprised injection drug users (43% of studies), drug users out of treatment (29%), African Americans (18%), clinic patients (18%), youth in schools (10%), and drug users in treatment (10%). Most studies were randomized (85%), provided another intervention to the control or comparison groups (71%), and evaluated behavioral interventions (92%). On average, interventions were conducted in 5 sessions (total, 8 hours) during 3 months. The theoretical basis of the intervention was not noted in 57% of the reports. At least one variable from each of the 3 outcome classifications was measured in 8% of the studies: behavioral, biologic, and psychosocial. Distinct profiles exist for the 4 risk areas. Addressing gaps in research and reporting would be helpful for analytical and program activities. This sizable portfolio of evaluated interventions contributes to effectiveness reviews and to considerations of transfer to program practice.

Acquired Immunodeficiency Syndrome↗
PubMed2002

A protocol for the analytical aspects of a systematic review of HIV prevention research.

Quantitative analysis can reveal the consistency of intervention effects across studies, as well as the variation of effects according to study-level characteristics. After consulting with project experts in methods and content, and reviewing the literatures on research synthesis and on HIV prevention, we developed a systematic protocol of analytical methods for synthesis of behavioral and biologic outcome data from HIV intervention studies. This protocol included procedures for identifying eligible studies; defining, characterizing, and prioritizing outcomes; abstracting and calculating estimates of effect; adjusting for baseline distributions and intraclass correlation; transforming estimates to a common metric; summarizing effects; examining differences in effectiveness among groups of studies; and translating these results into terms useful to HIV prevention practitioners and researchers. We applied these procedures to transform outcome data reported in many different statistical formats into odds ratios that could be combined and compared across studies. We analyzed data on behaviors related to sexual risk for HIV infection (unprotected sex, condom use, and number of partners) as well as data on biologic outcomes (incidence of HIV and other sexually transmitted infections). This framework may be useful for meta-analyses of prevention research in other fields, particularly when primary research features diverse outcome measures and methods of analysis.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States.

To estimate the effect of behavioral and social interventions on sexual risk of HIV among sexually experienced adolescents in the United States and to assess factors associated with variation in outcomes, we selected studies from the HIV/AIDS Prevention Research Synthesis project database. Twenty studies published or reported during the years 1988 through 1998 met criteria: 16 presented sufficient data; of these, 15 evaluated behavioral interventions and 1 a social intervention. Summary odds ratios (ORs) and 95% confidence intervals (CIs), weighted by study precision, indicated significantly less sex without condoms (number of studies, k, 13; OR, 0.66; CI, 0.55-0.79) and lower behavioral risk (k, 2; OR, 0.66; CI, 0.50-0.88), but no difference in number of partners (k, 8; OR, 0.89; CI, 0.76-1.05) or STDs (k, 2; OR, 1.18; CI, 0.48-2.86). A composite sexual risk behavior variable (k, 16; 1 outcome per study; preferred order, sex without condoms, number of partners, risk index) was used for heterogeneity and publication bias tests and stratified analyses. Overall, these interventions had a significant protective effect on sexually experienced adolescents (k, 16; OR, 0.65; CI, 0.50 - 0.85), although there was a suggestion of publication bias. Study design and intervention variables did not explain outcome variation. An exploratory finding may merit investigation: interventions tested with single ethnic groups out-of-class (k, 5) had larger effects than in-class interventions with mixed ethnic groups (k, 11), whether the mixed groups were in- (k, 6) or out-of class (k, 5).

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Jails as important but constrained venues for addressing women's health.

Women in US jails have many social and health risks that merit attention from public health agencies. This article: (1) reviews national and local data on this population for indicators of social disadvantage and of several health risks/conditions (substance abuse, risky sex, and mental illness), (2) describes the impact of federal mandatory sentencing for drug violations and recent developments in states on the numbers of incarcerated women, (3) outlines the similarities and differences between jails and prisons, focusing on characteristics of jails that facilitate and constrain intervention and evaluation activities, and (4) adds lessons learned in six years of experience in county and state jails in Texas.

Adult↗