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Telling the readers of CHEST about the serious need for people to quit smoking may be preaching to the choir. It is unlikely that any chest physician or patient in [...]

Background: During the past 15 years, programs to improve self-management practices in adults with asthma have reported improvement in functional status and reduction of inappropriate use of health care services. However, these programs usually represent an ideal approach, applying multiple patient education methods. Consequently, when these programs are found to be efficacious, it is important to replicate the programs as well as to evaluate less complex methods that may be more appropriate for nonacademic health care settings. Methods: We compared the following 3 standardized self-management treatments in a randomized, controlled that: (1) a replication of the self-management program developed at a university medical center that was previously shown to be efficacious; (2) a modified version of this program including only the core elements; and (3) a usual-care program. Outcome measures included medication and inhaler regimen adherence, asthma symptoms, respiratory illness, functional status, and use of health care resources. Results: All 3 groups improved on measures of respiratory illnesses, use of health care services, and functional status. Patients in both education groups did no better than the usual-care group. Conclusions: The results are inconsistent with the results of the first asthma self-management study at this institution and with those of efficacy studies of similar programs. Two factors, selection of the patient population and historical changes in asthma treatment, most likely contributed to the lack of impact of the self-management programs. As a result of the improved standards for usual care due to both factors, the opportunity to effect patient outcomes was substantially reduced. Arch Intern Med. 1999; 159:2422-2428

Asthma is a chronic, possibly life-threatening disease for which effective treatments are continually studied and made available. It is difficult to imagine a chest physician seeing a patient for some [...]

Context A large racial disparity exists in organ donation.Objective To identify factors associated with becoming a registered organ donor among African Americans in Alabama.Methods Concurrent mixed methods design guided by the Theory of Planned Behavior to analyze African Americans' decisions to become a registered organ donor by using both qualitative (focus groups) and quantitative (survey) methods.Results The sample consisted of 22 registered organ donors and 65 nonregistered participants from 6 focus groups completed in urban (n = 3) and rural (n = 3) areas. Participants emphasized the importance of the autonomy to make one's own organ donation decision and have this decision honored posthumously. One novel barrier to becoming a registered organ donor was the perception that organs from African Americans were often unusable because of the high prevalence of chronic medical conditions such as diabetes and hypertension. Another novel theme discussed as an advantage to becoming a donor was the subsequent motivation to take responsibility for one's health. Family and friends were the most common groups of persons identified as approving and disapproving of the decision to become a donor. The most common facilitator to becoming a donor was information, whereas fear and the lack of information were the most common barriers. In contrast, religious beliefs, mistrust, and social justice themes were infrequently referenced as barriers to becoming a donor.Conclusion Findings from this study may be useful for prioritizing organ donation community-based educational interventions in campaigns to increase donor registration.

Context The Organ Donor Breakthrough Collaborative recommended high-leverage changes including “master effective requesting.”Objective To measure who approaches decedent families to request organ donation and to determine whether trained specialists will solicit authorization at equal frequency regardless of donor characteristics.Methods Retrospective analysis of data from 2006 to 2009 in an organ center's donor database. Decedents were stratified into 2 groups: those that met the Organ Procurement and Transplantation Network's eligible death criteria (ED donors) and those that did not (not eligible death [NED] donors).Results Of decedents whose families were approached for authorization, 46% were ED donors and 54% were NED donors. Trained specialists solicited authorization from 76% of the total population but were more likely to solicit authorization from ED donors than NED donors (86% vs 68%, P< .001). Trained specialists were more likely to solicit authorization from donors whose cause of death was overrepresented in ED donors and donors less than 50 years old. Trained specialists were more likely than others to obtain authorization from families of all donors. Multivariable modeling demonstrated that having a trained specialist approach the decedent's family was associated with the highest odds of obtaining authorization.Conclusions Trained specialists approached most families of decedents for authorization, but disproportionately approached fewer families of NED donors. Having a trained specialist approach the decedent family has the strongest impact on obtaining donor authorization. These data suggest that fewer resources are allocated to NED donors, which may adversely affect the supply of deceased donor organs.

Studies have demonstrated that African American race is a strong predictor of nondonation. However, it is often and correctly argued that African American race is a crude explanatory variable that is a surrogate marker of socioeconomic status, education, and access to health care. We hypothesized that, when controlling for these factors, African American race would cease to be a predictor of organ donation.

To investigate practices, barriers, and facilitators of universal pre-school vision screening (PVS) at pediatric primary care offices.

Purpose. Examine the effectiveness of a community-based, multimedia intervention on medication adherence among hypertensive adults.Design. Randomized controlled trial.Setting. Rural south Alabama.Subjects. Low-income adults (N = 434) receiving medication at no charge from a public health department or a Federally Qualified Health Center.Intervention. Both interventions were home-based and delivered via computer by a community health advisor. The adherence promotion (AP) intervention focused on theoretical variables related to adherence (e.g., barriers, decisional balance, and role models). The cancer control condition received general cancer information.Measures. Adherence was assessed by pill count. Other adherence-related variables, including barriers, self-efficacy, depression, and sociodemographic variables, were collected via a telephone survey.Analysis. Chi-square analysis tested the hypothesis that a greater proportion of participants in the AP intervention are ≥80% adherent compared to the control group. General linear modeling examined adherence as a continuous variable.Results. Participants receiving the intervention did not differ from individuals in the control group (51% vs. 49% adherent, respectively; p = .67). Clinic type predicted adherence (p < .0001), as did forgetting to take medications (p = .01) and difficulty getting to the clinic to obtain medications (p < .001).Conclusions. Multilevel interventions that focus on individual behavior and community-level targets (e.g., how health care is accessed and delivered) may be needed to improve medication adherence among low-income rural residents.

In response to calls to improve public health education and our own desire to provide a more relevant educational experience to our Master of Public Health students, the University of Alabama at Birmingham (UAB) School of Public Health designed, developed, and instituted a fully integrated public health core curriculum in the fall of 2001.This curriculum combines content from discipline-specific courses in biostatistics, environmental health, epidemiology, health administration, and the social and behavioral sciences, and delivers it in a 15 credit hour, team-taught course designed in modules covering such topics as tobacco, infectious diseases, and emergency preparedness. Weekly skills-building sessions increase student competence in data analysis and interpretation, communication, ethical decision-making, community-based interventions, and policy and program planning.Evaluations affirm that the integrated core is functioning as intended: as a means to provide critical content in the core disciplines in their applied context. As public health education continues to be debated, the UAB public health integrated core curriculum can serve as one model for providing quality instruction that is highly relevant to professional practice.

Abstract: Cocaine use, marijuana use, alcohol use, and polysubstance use (e.g., alcohol and cocaine, alcohol and marifuana) are associated with high-risk sexual behavior and higher rates of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). The purpose of this study was to examine readiness for using condoms among three groups (cocaine users, noncocaine drug users, and non-drug users) of African Americans living in low-income urban settings. African Americans in this sample differed in sex risk behaviors according to their drug use status. Noncocaine drug users reported higher levels of sex risk behaviors than non-drug users, and cocaine users reported the highest levels of risk. Cocaine users also reported lower levels of condom use with their main and nonmain sexual partners than both other groups. Results of multivariate analyses indicate that, compared to the other two groups, cocaine users are at earlier stages of readiness for condom use with main partners. Cocaine users have accurate perceptions of their HIV risk, but are more likely to factor into their decisions for using condoms cost and the trouble that it takes to get condoms. Different approaches to sexually transmitted disease and human immunodeficiency virus prevention will be necessary to meet the needs of these three different subgroups.

This study examined the reliability of an inventory measuring AIDS-related knowledge among 553 black drug users. Data were collected from a socially high-risk community in Birmingham, Alabama. The KR–20 reliability scores were computed from the inventory for each drug-use group. The KR–20 reliabilities ranged from .39 to .57. These findings may suggest that the inconsistent reports of the predictive power of AIDS knowledge among drug users reported in previous studies might be related to the low internal consistencies of the inventory.

Poor adherence to recommended regimens is a substantial problem in the clinical management of adults with asthma and other chronic diseases. Research on adherence assessment is complicated by methodological difficulties including limitations associated with the use of self-report measures. In this study, psychometric techniques were used to analyze two self-report scales for assessing adherence to recommended medication and inhaler use regimens in adults with asthma. Results indicated that the two scales had standard deviations large enough to detect variation adherence, had adequate reliability, and reflected the impact of an intervention designed to improve adherence. The results supported the usefulness of these scales for research on adherence. Additional analyses indicated that the two scales could be combined if the research goal required an overall measure of adherence.

Health education programs developed in academic medical centers are not optimally disseminated to community clinical settings. Strategies are needed to translate the findings of research on health education programs into programs useful in a wide range of health care settings. Focus group techniques were used to provide data for revising a successful university-based asthma self-management program to make it more practical for use by community physicians. Physicians representing a variety of specialties attended the sessions and provided feedback on the utility of various components of the original program. The discussions revealed that many physicians felt they did not have the time or resources to conduct the original program and identified elements viewed as impractical. This

Knowledge in reproductive endocrinology and infertility is fundamental to the delivery of quality women's health care. In 1991, the American Fertility Society formed a resident education committee to gather data on the current status of reproductive endocrinology and infertility training and develop an ideal curriculum.

Given that poor asthma management leads to such devastating rates of morbidity and mortality in this country, efforts must be made to increase the knowledge, skills, and behaviors of persons with asthma. The suggestions and recommendations provided here represent a blend of academic opinion and practical advice on methods to implement an asthma education program. In developing an asthma education program, consideration must be given to what content should be included, how and by whom that content should be taught, and when education should take place. The identification of a key clinical staff member to take the lead in translating these and other asthma education guidelines will be a critical next step for clinicians committed to developing an effective asthma education program.

During graduate training, students often undertake some teaching responsibilities, which provides useful experience for a future career in academia. However, they receive little guidance to prepare them for this role. This article describes some of the attempts that have been made to overcome this deficiency, with emphasis on the specially developed teaching course offered to graduate students at the University of Kentucky; this provides instruction on planning, implementing and evaluating instruction, and classroom training in instructional skills. Evaluation suggests that the programme is relevant and effective, and provides a useful model for other medical schools.

Improved outcome measures for asthma research, especially measures of functional status and quality of life, have become increasingly important. This research describes one such measure, the University of Alabama at Birmingham (UAB) Functional Impairment Scale. This scale consists of eight items to assess the impact of asthma on various aspects of daily living. The psychometric properties of the UAB Scale were assessed in two samples. The coefficient alpha reliabilities were high in both samples (.83 and .84), and the item-total correlations indicated all items were measuring the same trait. The score distributions covered the entire range of possible scores, and the central tendencies and dispersions confirmed the presence of enough variation to detect differences in functional impairment among individuals. Correlations between the UAB Scale and other asthma-related measures support construct validity. All of these results support the potential usefulness of the UAB Scale.