Biomedical subjects

S A McGraw

Publications and source records attributed to S A McGraw.

14 recordsLinked to original sources

PubMed1996

A self-efficacy scale for HIV risk behaviors: development and evaluation.

To measure self-efficacy with respect to risk behaviors for HIV infection, a set of questionnaire items was developed regarding condom use, drug use with friends, and negotiations with potential sex partners. These items were tested with a sample of Latinos aged 14 to 22 years in two New England cities. A nine-item self-efficacy scale was found to have a high level of internal consistency (Cronbach's alpha = .77). Reliability coefficients were similar for men, women, and both English- and Spanish-speaking respondents. Strong associations with recent performance accomplishments, as specified in Bandura's social cognitive theory, support the construct validity of the scale.

Adolescent↗

PubMed1994

Design of process evaluation within the Child and Adolescent Trial for Cardiovascular Health (CATCH).

Process evaluation complements outcome evaluation by providing data to describe how a program was implemented, how well the activities delivered fit the original design, to whom services were delivered, the extent to which the target population was reached, and factors external to the program that may compete with the program effects. The process evaluation system used in the Child and Adolescent Trial for Cardiovascular Health (CATCH) is presented in this paper. The conceptual model underlying the CATCH process evaluation system is described, and process measures and data collection protocols are reviewed. Functions of process evaluation data in the trial include: (1) describing the implementation of the program, (2) quality control and monitoring, and (3) explaining program effects. The importance of incorporating process evaluation into final outcome analyses and assessments of program impact is emphasized.

Adolescent↗

PubMed1994

CATCH: classroom process evaluation in a multicenter trial.

The purpose of this paper is to describe the process evaluation model for the classroom curricula of the Child and Adolescent Trial for Cardiovascular Health (CATCH) Project. The process evaluation plan specifically targets how much each curriculum was implemented, to what degree it was implemented as designed, and the barriers to implementation. Additionally, the rationale for each of the process evaluation measures and the instrument development process are presented. Data resulting from these measures will be essential in order to answer questions regarding the internal validity of the main outcomes of the project. Specific examples and sample results are provided from the CATCH third-grade classroom curriculum, which was implemented the first year of CATCH. A discussion also is presented of how the findings from a sample of these measures were used to gain additional insight on the salient features of the curriculum, and how those features may be related to student outcomes.

Adolescent↗

PubMed1994

CATCH: process evaluation of environmental factors and programs.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multicenter trial designed to test the effectiveness of school and family-based cardiovascular health promotion for preadolescents. CATCH interventions target multiple cardiovascular health behaviors such as dietary intake of fat and sodium, physical activity, and tobacco use. Evaluation includes physiological, psychosocial, behavioral, and process measures. An important aspect of the process evaluation is the assessment of environmental factors and "secular events" in both intervention and control schools that may affect outcomes independently of the CATCH interventions. With such information, CATCH investigators are able to isolate the impact of the CATCH intervention from competing (non-CATCH) factors as well as "track" proximal (i.e., immediate and short term) changes related to the intervention that may in turn lead to "distal" (long-term) behavior change. The School Health Questionnaire, the major process evaluation tool for monitoring secular and environmental changes in the schools, is described in detail, and data describing tobacco-related environmental factors and secular events are presented.

Adolescent↗

PubMed1994

Does the promotion and distribution of condoms increase teen sexual activity? Evidence from an HIV prevention program for Latino youth.

OBJECTIVES: Opponents of condom availability programs argue that the promotion and distribution of condoms increases adolescent sexual activity. This assertion was tested empirically with data from the evaluation of a human immunodeficiency virus (HIV) prevention program for Latino adolescents. METHODS: The onset of sexual activity, changes in the frequency of sex, and changes in the proportion of respondents with multiple partners were compared for intervention and comparison groups. Multivariate regression analysis was used to assess the effect of the intervention on these outcomes after adjustment for baseline differences between the intervention and comparison groups. RESULTS: Male respondents in the intervention city were less likely than those in the comparison city to initiate first sexual activity (odds ratio [OR] = 0.08). Female respondents in the intervention city were less likely to have multiple partners (OR = 0.06). The program promoting and distributing condoms had no effect on the onset of sexual activity for females, the chances of multiple partners for males, or the frequency of sex for either males or females. CONCLUSIONS: An HIV prevention program that included the promotion and distribution of condoms did not increase sexual activity among the adolescents in this study.

Adolescent↗

PubMed1994

Do blacks and whites differ in their use of health care for symptoms of coronary heart disease?

OBJECTIVES: The purpose of this study was to identify the role of race in seeking and receipt of care for symptoms of coronary heart disease. METHODS: Data on medical care, sociodemographic characteristics, symptoms, risk factors, income, and insurance were collected in a telephone interview for a random sample of 2030 Black and White adults in inner-city Boston. Rates of care-seeking for symptoms, amounts of delay in seeking care, and rates of receipt of care were compared for Blacks and Whites after adjustment for other characteristics. RESULTS: Before and after adjustment for other factors, Blacks and Whites were equally likely to seek care. Average delay time was shorter for Blacks, particularly Black women. With the exception of a lower rate of referral to cardiologists among Blacks, receipt of care was similar for Blacks and Whites who sought medical attention for symptoms. CONCLUSIONS: In an urban population of Blacks and Whites who were similar in socioeconomic status and access to medical care, there were few racial differences in coronary heart disease-related care patterns.

Black or African American↗

PubMed1993

HIV risk among Latino adolescents in two New England cities.

OBJECTIVES: Latino adolescents in two urban New England areas were surveyed to assess risk of human immunodeficiency virus (HIV) transmission. METHODS: Probability of HIV infection during the previous 6 months was estimated from self-reported sexual contacts, condom usage rates, and number of partners. Teens were also asked to show condoms in their possession to the interviewer to validate self-reports of condom use. RESULTS: Overall, 8% of the 586 respondents were classified as high risk for HIV infection (estimated infection probability greater than .0001), 34% were at moderate risk, and the remaining 58% were classified as not at risk (no sexual activity or needle sharing). Teens who said they had purchased condoms or claimed to have used them recently were more likely than others to have condoms in their possession at the time of the interview. CONCLUSIONS: These estimates suggest that a small percentage of Latino adolescents may be at substantial risk for HIV infection over periods as short as 6 months, that self-reports of recent condom use are strongly related to condom possession, and that questionnaire items regarding condom use at last intercourse are poor surrogates for HIV risk.

Adolescent↗

PubMed1993

Do blacks and whites differ in reporting Rose Questionnaire angina? Results of the Boston Health Care Project.

We investigated the prevalence of angina (as determined by the Rose Questionnaire) in a random sample of African-American and white adults, aged 44 to 75 years, in three Boston (Mass) neighborhoods. Telephone interviews were completed by 2030 eligible subjects (response rate = 87.9%). A sample of 737 persons who had never been hospitalized for a heart attack also participated in a home visit. The prevalence of Rose angina was 7.0% in black women, 4.8% in white women, 5.0% in black men, and 5.7% in white men (P = .37). In both racial groups, respondents with diagnosed cardiovascular conditions, those taking cardiovascular medications, and those living alone were more likely to report angina than were other respondents. Blacks were more likely to report angina if they felt they were not getting needed medical care. Risk of angina declined with age among whites. In the home visit sample, the presence of major electrocardiogram abnormalities was also associated with angina. Rose angina appears to be influenced by similar risk factors in both blacks and whites.

Adult↗

PubMed1992

Health survey methods with minority populations: some lessons from recent experience.

Until recently, minority populations have been inadequately or inaccurately represented in health research. Researchers are now recognizing the need to improve the validity and reliability of data on the health status and health-related behaviors of minorities. This paper discusses important methodological issues in conducting health survey research in minority communities: construction of an appropriate sampling frame, response rates, attrition from panel studies, and response patterns. These themes are illustrated with data from three field studies at the New England Research Institute. Two of these studies focus on inner-city Puerto Rican youth, a group rapidly increasing in size. The extent and multiplicity of problems experienced by this group affect the complexity of survey protocols. The third study is a random-digit-dial telephone survey on health care utilization for coronary heart disease by black and white adults from three inner-city neighborhoods in Boston. The conclusions drawn from the Institute's experience are corroborated by other scientific studies. First, the sociocultural characteristics of the community or group selected for study must be considered in planning and implementing any survey research on minority populations. Second, ensuring the quality of field work with minority groups may be expensive because of high residential mobility and lack of preexisting sampling frames. Third, there is no reason to expect any diminution of data quality with minority groups, provided the resources for data collection are adequate. The quality of data is undoubtedly proportional to the field efforts expended, but the costs of high-quality survey work are often not appreciated. The paper questions the utility of the term "minority research," for it disregards the considerable variation between and within minority groups and subcultures.

Black or African American↗

PubMed1991

Sociocultural factors associated with smoking behavior by Puerto Rican adolescents in Boston.

This study examined cigarette smoking among Puerto Rican adolescents in the Boston area in its sociocultural context by describing who uses cigarettes, and by identifying factors that encourage or discourage cigarette use. The study, conducted from 1986-87, used two approaches. The first was to survey 605 Puerto Rican households with adolescents 11-20 years old. Households were identified from a random sample of census blocks in five neighborhoods. In each household, interviews were completed with one adolescent and his or her female caretaker. The second approach was to conduct ethnographic interviews with 40 adolescents selected through a purposive sample of survey respondents from three of the study neighborhoods. Bivariate and multivariate statistical analyses were used to examine the relationships between smoking behavior and characteristics of the adolescents. The results of these analyses were examined in light of the ethnographic data. Overall, 13.7% reported smoking in the month preceding the interview. Smoking was most prevalent among males 17-20. Patterns of smoking were associated with teens' social networks. The Puerto Rican adolescents in this study were more likely to smoke when their friends and household members smoked, if they participated in recreational activities such as sports or unsupervised games, and if they were not in school. These effects varied according to the gender of the respondent.

Adolescent↗

PubMed1987

Evaluation of two community-wide smoking cessation contests.

The Pawtucket (Rhode Island) Heart Health Program is designed to effect a community-wide change in heart disease morbidity and mortality by reducing smoking prevalence and other behavioral risks for this disease. The initial emphasis of the Pawtucket Heart Health Program was on the development of risk factor programs within specific churches, work sites, and other organizations in the community. At the end of 9 months of programming, however, only one organization had elected to begin a stop-smoking program. Given the community smoking prevalence of 43.4%, it was decided that larger-scale interventions would be required if a significant public health impact was to be realized. Therefore, a community-wide campaign was mounted to recruit as many participants as possible into the "Up in Smoke" cessation program. A lottery was attached to this program, with the contingency based on program attendance rather than cessation per se. One hundred three participants, including residents of neighboring communities, enrolled in three Up in Smoke lottery groups. At a 3-month follow-up, only 11 (7%) of smokers from the Up in Smoke lottery reported that they were not smoking (10% of those actually contacted). For a variety of reasons, the "Quit and Win" approach was later adopted by the Pawtucket Heart Health Program as the primary smoking intervention. One month after the end of the contest, 20% of those contacted reported not smoking. The percentage of quitters for the Up in Smoke program increased while the Quit and Win rate decreased over longer periods of follow-up. These and other data were compared with those of participants of a screening program conducted concurrently. Lotteries in general and face-to-face recruitment in large crowds were shown to be effective recruiting methods for large-scale smoking cessation programs.

Adult↗

PubMed1986

Organizational and community approaches to community-wide prevention of heart disease: the first two years of the Pawtucket Heart Health Program.

The Pawtucket Heart Health program (PHHP) is a federally funded research and demonstration project for the primary prevention of coronary heart disease (CHD) in a community. This article presents a discussion of the first 26 months of this intervention, divided into its three phases. PHHP staff initially approached the intervention city through local organizations to accomplish risk-factor behavior change in the population. After 11 months, PHHP complemented its programs in organizations with activities open to all city residents, in order to accelerate participation by the population. Seven months into this phase, it was decided that community activities should be the major focus of the intervention approach to assure a level of participation adequate to make a measurable impact. The third has shown the greatest percentage of public participation, demonstrating the complementary nature of organization and community interventions and of the translation of social learning theory into principles for primary prevention in a community.

Advertising↗

PubMed1986

Community intervention to lower blood cholesterol: the "Know Your Cholesterol" campaign in Pawtucket, Rhode Island.

Sufficient data exist to support approaches to lowering cardiovascular disease risk which target population-wide reductions in elevated blood cholesterol levels. Within the context of a multifactorial cardiovascular disease prevention program, a 2-month cholesterol education campaign was launched to encourage citizens to "Know Your Cholesterol" by attending screening, counseling, and referral events (SCOREs) held throughout the community. These events featured assessment of dietary fat and cholesterol, rapid blood cholesterol analyses with a fingerstick procedure and the Kodak Ektachem DT60, and immediate dietary counseling by trained volunteers. A total of 1439 persons attended 39 SCOREs: nearly 60% were found to have blood cholesterol levels that exceeded recommended goal levels. At a 2-month follow-up of 1040 of these same individuals, 600 had lowered their blood cholesterol level by an average of 29.1 mg/dl. This experience suggests that similarly modeled campaigns may have a significant impact on the distribution of blood cholesterol levels in the entire U.S. population.

Cholesterol↗

PubMed1979

Laryngeal papillomatosis: anesthetic management.

We reviewed the anesthetic management of all children admitted with laryngeal papillomatosis during a six-year period. This included 147 endoscopies on 16 patients, most referred with advanced disease after initial care in other hospitals. Onset of the disease before age 2 was associated with the most severe upper airway involvement. Eight patients required tracheostomy at some time during treatment, and management of the shared airway during surgical manipulation was particularly difficult in these children. Inhalational induction with halothane was used rountinely, with surprisingly few instances of laryngospasm or upper airway obstruction. Topical lidocaine spray and orotracheal intubation were preferred; insufflation technics were frequently abandoned when attempted. Extubation under deep anesthesia after clearing the glottis of secretions was usually followed by smooth emergence and minimal airway difficulties. There was only one instance of postoperative stridor suggesting croup. A standard anesthetic approach can be recommended, on the basis of the experience in this series, but possible variations in technic are also discussed for particular clinical applications.

Adolescent↗