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Objectives: To investigate trends in racial/ethnic differences in nursing home (NH) residents’ quality of life (QoL) and assess these patterns within and between facilities. Method: Data include resident-reported QoL surveys ( n = 60,093), the Minimum Data Set, and facility-level characteristics ( n = 376 facilities) for Minnesota. Hierarchical linear models were estimated to identify differences in QoL by resident race/ethnicity and facility racial/ethnic minority composition for 2011–2015. Results: White residents in low-proportion racial/ethnic minority facilities reported higher QoL than both minority and white residents in high-proportion minority facilities. While the year-to-year differences were not statistically significant, the point estimates for white–minority disparity widened over time. Discussion: Racial/ethnic differences in QoL are persistent and may be widening over time. The QoL disparity reported by minority residents and all residents in high-proportion minority facilities underscores the importance of examining NH structural characteristics and practices to ultimately achieve the goal of optimal, person-centered care in NHs.

This study examined the utilization of clinical breast examinations (CBEs) and mammograms among Korean American immigrant women and investigated how the six constructs of Health Belief Model (HBM) are associated with the receipt of breast cancer screening. Using a quota sampling strategy, 202 Korean American immigrant women were recruited in metropolitan areas in the northeastern United States. Approximately 64% of the participants reported having had at least one CBE in their lifetime, and about 81% of the sample had undergone at least one mammogram in their lifetime. Women who perceived themselves to be susceptible to breast cancer were more likely to have undergone a CBE, and women who had lower barriers to screening or demonstrated a higher level of confidence were more likely than their counterparts to undergo a mammogram. Findings suggest that HBM constructs such as susceptibility, barriers, and confidence should be considered when designing interventions aimed at promoting breast cancer screening.

Positive changes in one health behavior may be accompanied by other constructive health behavior changes. Thus, the authors investigated the association of smoking reduction and cessation to changes in fruit and vegetable (FV) intake and engaging in walking for exercise. This study included 539 Black light smokers (≤10 cigarettes per day ≥25 days/month) enrolled in a 2 × 2 factorial study (placebo vs. nicotine gum, health education vs. motivational interviewing). Reducing cigarette consumption ( p = .02) and quitting smoking ( p < .01), as well as receiving the nicotine gum ( p = .04), was associated with increased FV intake, after controlling for baseline FV intake. Compared with those who did not reduce their smoking, both reducers ( p < .001) and quitters ( p < .001) were more likely to walk for exercise at follow-up, after controlling for baseline walking status ( p = .01). Thus, addressing one health risk behavior may prompt other positive health behaviors, which may argue for developing interventions targeting multiple health risk behaviors.

Background Although smoking prevalence remains strikingly high in homeless populations (~70% and three times the US national average), smoking cessation studies usually exclude homeless persons. Novel evidence-based interventions are needed for this high-risk subpopulation of smokers. Purpose To describe the aims and design of a first-ever smoking cessation clinical trial in the homeless population. The study was a two-group randomized community-based trial that enrolled participants ( n = 430) residing across eight homeless shelters and transitional housing units in Minnesota. The study objective was to test the efficacy of motivational interviewing (MI) for enhancing adherence to nicotine replacement therapy (NRT; nicotine patch) and smoking cessation outcomes. Methods Participants were randomized to one of the two groups: active (8 weeks of NRT + 6 sessions of MI) or control (NRT + standard care). Participants attended six in-person assessment sessions and eight retention visits at a location of their choice over 6 months. Nicotine patch in 2-week doses was administered at four visits over the first 8 weeks of the 26-week trial. The primary outcome was cotinine-verified 7-day point-prevalence abstinence at 6 months. Secondary outcomes included adherence to nicotine patch assessed through direct observation and patch counts. Other outcomes included the mediating and/or moderating effects of comorbid psychiatric and substance abuse disorders. Results Lessons learned from the community-based cessation randomized trial for improving recruitment and retention in a mobile and vulnerable population included: (1) the importance of engaging the perspectives of shelter leadership by forming and convening a Community Advisory Board; (2) locating the study at the shelters for more visibility and easier access for participants; (3) minimizing exclusion criteria to allow enrollment of participants with stable psychiatric comorbid conditions; (4) delaying the baseline visit from the eligibility visit by a week to protect against attrition; and (5) regular and persistent calls to remind participants of upcoming appointments using cell phones and shelter-specific channels of communication. Limitations The study’s limitations include generalizability due to the sample drawn from a single Midwestern city in the United States. Since inclusion criteria encompassed willingness to use NRT patch, all participants were motivated and were ready to quit smoking at the time of enrollment in the study. Findings from the self-select group will be generalizable only to those motivated and ready to quit smoking. High incentives may limit the degree to which the intervention is replicable. Conclusions Lessons learned reflect the need to engage communities in the design and implementation of community-based clinical trials with vulnerable populations.

Given the relationship between depression and smoking, we compared the two-item Patient Health Questionnaire (PHQ-2) and 10-item Center for Epidemiological Studies Depression Scale (CESD-10) in assessing depressive symptoms among African American light smokers in a clinical trial of bupropion. Of 539 participants, 21.3 percent reported significant depressive symptoms on the PHQ-2, 31.0 percent screened positive per CESD-10, 36.8 percent reported symptoms on either, and 15.6 percent screened positive on both ( r = 0.47, p < .001). Having depressive symptoms was associated with less education, decreased positive affect and social support, and greater levels of negative affect and perceived stress. Cessation treatment should assess depression and address these symptoms.

Self-efficacy is a known predictor for behavior change. Little is known about the association of self-efficacy with walking ability in individuals with diabetes mellitus and peripheral arterial disease (PAD). The objective of this study was to determine the association of self-efficacy with walking ability in individuals with diabetes mellitus and PAD. In this cross-sectional study, baseline data were analyzed from individuals with diabetes mellitus type 1 or 2 and PAD who were enrolled in a walking intervention clinical trial. As part of the baseline assessment, individuals completed questionnaires to ascertain self-efficacy and co-existing illnesses. In addition, participants completed a treadmill walking test and a 6-minute walking test. A total of 145 individuals were enrolled (mean age 66.5 ± 10.1 years) with diabetes mellitus and PAD; 45 (31%) were women. The mean ankle—bracial index was 0.70 (range − 0.18—2.20) and the mean glycosylated hemoglobin value was 7.1 (SD 1.2). The mean distance walked, as per the treadmill walking test, was 418 meters (SD 258) and the mean distance walked, as per the 6-minute walking test, was 272 meters (SD 74). As measured by the treadmill walking test and the 6-minute walking test, self-efficacy was associated with treadmill walking distance, coefficient 33.0 (95% CI 11.0, 55.1; p = 0.0036), and the 6-minute walking test, coefficient 10.4 (95% CI 3.0, 17.7; p = 0.0061), after adjusting for comorbidities, social habits, and disease severity. In conclusion, self-efficacy, a psychosocial mediator for behavior change, was significantly associated with walking ability in individuals with diabetes mellitus and PAD. Future studies should determine the benefits of targeting self-efficacy to improve adherence to walking therapy in patients with PAD.

Despite a decline in cigarette smoking over the past few decades, rates remain unacceptably high for certain segments of the population, such as urban African Americans (AAs). AA smokers, on average, smoke fewer cigarettes per day than European American samples; however, AA smokers are less likely to achieve abstinence during a quit attempt. Outcome expectancies have previously been association with cessation outcomes, but prior research has not examined expectancies among treatment-seeking AA light smokers. The 33-item Smoking Consequences Questionnaire–Adult (SCQ-A) was evaluated among 751 AA light smokers (i.e., ≤ 10 cigarettes per day) enrolled in a cessation trial. Exploratory factor analyses replicated the original 10-factor solution. Factors were significantly correlated ( r = −.06–51, P < .001) and associated with expected demographic, psychosocial, and tobacco-related variables. Results provide initial validation of the SCQ-A among AA light smokers seeking cessation treatment and highlight the association of smoking expectancies with other tobacco-related and psychosocial factors in this sample.

Purpose. Colorectal cancer (CRC) screening is effective, but only one-half of age-eligible adults adhere to national guidelines. Lower socioeconomic status (SES) groups are less likely to be screened. Methods. Baseline data from a prospective study were used to examine the associations among CRC screening screening barriers, and SES. A convenience sample of adults (N = 291) aged 40 years and older was recruited from a federally qualified health center. Questionnaires were administered orally and included demographics, health, health behavior, and screening barriers. Results. In logistic regression, having health insurance was associated with greater odds of screening. Bivariate analyses detected few differences in fecal occult blood test (FOBT) barriers, but several endoscopy barriers were more common among the lowest SES groups. For example, fear of injury from endoscopy was more likely among low-income and uninsured participants. Discussion. The impact of SES on cancer screening is complex, but low-SES participants more often reported certain barriers than their higher-SES counterparts. This was more evident for endoscopy than for FOBT. Programs targeted at low-SES patients may need to focus on barriers that are not fully addressed in traditional promotion efforts.

The purpose of this qualitative study was to explore perceptions and beliefs about body size, weight, and weight loss among obese African American women in order to form a design of weight loss intervention with this target population. Six focus groups were conducted at a community health clinic. Participants were predominantly middle-aged with a mean Body Mass Index of 40.3 ± 9.2 kg/m2. Findings suggest that participants (a) believe that people can be attractive and healthy at larger sizes; (b) still feel dissatisfied with their weight and self-conscious about their bodies; (c) emphasize eating behavior as the primary cause for weight gain; (d) view pregnancy, motherhood, and caregiving as major precursors to weight gain; (e) view health as the most important reason to lose weight; (f) have mixed experiences and expectations for social support for weight loss; and (g) prefer treatments that incorporate long-term lifestyle modification rather than fad diets or medication.

Purpose. This study describes the design, recruitment, and baseline data of the first smoking-cessation clinical trial for African-American light smokers, Kick It at Swope II (KIS-II). Design. KIS-II was a randomized trial testing the efficacy of nicotine gum (vs. placebo gum) in combination with counseling (motivational interviewing or health education). Setting. This study was conducted at an urban community-based clinic serving predominantly lower-income African-Americans. Subjects. African-Americans who smoked 1 to 10 cigarettes per day were eligible. Of 1933 individuals screened, 1012 (52%) were eligible and 755 (75%) were enrolled in the study. Measures. Baseline assessment included smoking history and psychometric measures. Analysis. The majority of participants were women (67%) with a mean age of 45.1 years (SD = 10.7). Participants smoked on average 7.6 cigarettes (SD = 3.21) per day, had a mean exhaled carbon monoxide level of 13.9 ppm (SD = 8.9) and a mean serum cotinine level of 244.2 ng/mL (SD = 154.4), and reported high levels of motivation and confidence to quit smoking. Conclusion. African-American light smokers were motivated to stop smoking and to enroll in a smoking-cessation program. Characteristics of our sample suggest African-American light smokers are an appropriate group for inclusion in smoking-cessation interventions.

This study examines the efficacy of targeted versus standard care smoking cessation materials among urban African American smokers. Five hundred smokers (250 to each group) are randomized to receive a culturally targeted or standard care videotape and print guide. Both groups receive 8 weeks of nicotine patches and reminder telephone calls at Weeks 1 and 3. Process outcomes include material use and salience at 1 and 4 weeks postbaseline. Smoking outcomes include 7-day abstinence, smoking reduction, and readiness to quit at 4 weeks and 6 months postbaseline. Despite greater use of the targeted guide (68.8% vs. 59.6%, p < .05), intervention participants do not perceive the targeted materials as more salient, and no significant differences are found between groups on the smoking outcomes. Findings point to the importance of greater audience segmentation and individual tailoring to better match intervention materials to the needs of the priority population.

When addressing tobacco control and smoking cessation measures, the homeless have been perceived as a difficult to reach population. The purpose of this study was to examine the smoking characteristics of a homeless population. Data were derived from a larger study that examined smoking among inner–city residents. Homeless smokers (n = 107) were compared to nonhomeless smokers (n = 491) on sociodemographics, smoking characteristics, motivation to quit, and smoking cessation experiences. Results showed that homeless smokers were more likely to be white, smoke more cigarettes per day, initiate smoking at a younger age, and have a longer smoking history. Knowledge about the risks of smoking and the benefits of quitting was equally high in both groups. Homeless smokers were less likely to be preparing to quit smoking compared to nonhomeless smokers. These factors place homeless smokers at increased risk of tobacco–related diseases. Programs are needed to design and test effective cessation interventions for homeless smokers.

Despite smoking fewer cigarettes per day, African Americans extract more nicotine per cigaretts smoked, and have higher than expected tobacco-related morbidity and mortality. The present study explores perceptions about smoking and motivations for smoking cessation among African American light smokers. Four focus groups consisting of 22 adults were conducted at an inner-city community health center. Participants were recruited through flyers and referral by clinic staff. Two major themes were identified: (1) similar smoking patterns, and (2) perceived differences from heavy smokers. Many participants perceived themselves as addicted to nicotine, experienced withdrawal symptoms with past quit attempts, and are interested in smoking cessation. Perceptions about nicotine addiction, difficulty with quitting, and interest in smoking cessation suggest a need to design and test cessation interventions among this understudied population.