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1.  Use of Complementary Therapies for Health Promotion Among Older Adults 
This article describes the types of complementary therapies used by older adults for health promotion, and delineates the predisposing, enabling, and need factors associated with their use. One-hundred ninety-five African American and White participants (age 65+) completed a baseline interview and up to six sets of three daily follow-up interviews at monthly intervals. Complementary therapies for health promotion included home remedies, specific foods or beverages, herbs, supplements, vitamins, over-the-counter (OTC) medicine, prayer, exercise, and being active. Although gender, ethnicity, education, and trust in doctors were associated with the use of complementary therapies for health promotion, health information seeking was the predisposing factor most often associated. The enabling factors were also associated with their use. Health information seeking, which reflects a wellness lifestyle, had the most consistent associations with complementary therapy use for health promotion. This health self-management for health promotion may have positive effects on future medical expenditures.
doi:10.1177/0733464813495109
PMCID: PMC4033702  PMID: 24652893
health promotion; disease prevention; complementary and alternative medicine; minoirty aging
2.  The association of respiratory symptoms and indoor housing conditions among migrant farmworkers in eastern North Carolina 
Journal of agromedicine  2014;19(4):395-405.
Farm labor housing has been described as among the worst in the nation, oftentimes with poor and unsanitary, indoor living conditions. The objective of this study was to evaluate the association between indoor environmental risk factors and respiratory health among migrant farmworker occupants (N=352) living in employer-provided housing. A cross-sectional sample of adult, Latino male farm laborers were administered a questionnaire to identify the prevalence of major respiratory symptoms. Self-reported and independent observations were made to evaluate environmental respiratory risk factors and indoor housing conditions, including but not limited to, the presence of cockroaches, rodents, pesticides, and visible signs of mold. Spirometry was performed to evaluate lung function using FEV1, FVC and FEV1/FVC ratio. Bivariate analysis was applied to evaluate associations between respiratory symptoms and selected indoor environmental risk factors. Findings for respiratory health included, prevalence of wheeze (11.4%), coughing up phlegm (17.3%), tightness of chest (16.8%) and runny or stuffy nose (34.4%). Respiratory risks identified inside the dwellings included, the use of pesticides or bug sprays for cockroaches (31.5%), rat or mouse poison (19.5%), visible signs of water damage in the bathroom (22.5%) and mold in the sleeping room (11.1%). Spirometry values were normal for most occupants, although statistically significant associations were found between; mold and coughing up phlegm when not having a cold (p=0.0262); presence of mold and asthma (p=0.0084); pesticides used in the home and tightness of chest (p=0.0001) and, use of tobacco and coughing up phlegm (p=0.0131). Although causal inference can be difficult to establish from a cross sectional study, findings from this study represents suggestive evidence that indoor environmental risk factors may be contributory factors for respiratory health problems among this vulnerable population.
doi:10.1080/1059924X.2014.947458
PMCID: PMC4185398  PMID: 25275405
Housing; respiratory health; farmworker; environmental health
3.  Self-Reported Sleep Difficulties and Self-Care Strategies Among Rural Older Adults 
This study examined the use of self-care strategies to address difficulty sleeping among community-dwelling older adults. Data were collected from a series of 18 questionnaires administered to 195 rural African American and white older adults in North Carolina. Participants reported whether they had experienced difficulty sleeping and strategies used to respond to the symptom. The most widely used strategies included ignoring the symptom, staying in bed or resting, and praying. Herb and supplement use were not reported. Ethnicity, income, and education were associated with use of specific self-care strategies for sleep. This variation suggests that older adults may draw on cultural understandings to interpret the significance of difficulty sleeping and influence their use of self-care strategies, including complementary and alternative medicine use. This information may enable health care providers to communicate with the older patients about sleep difficulty strategies to minimize sleep problems.
doi:10.1177/2156587213510005
PMCID: PMC4240534  PMID: 24647377
older adults; sleep; self-care
4.  Variation in the Interpretation of Scientific Integrity in Community-based Participatory Health Research 
Community-based participatory research (CBPR) has become essential in health disparities and environmental justice research; however, the scientific integrity of CBPR projects has become a concern. Some concerns, such as appropriate research training, lack of access to resources and finances, have been discussed as possibly limiting the scientific integrity of a project. Prior to understanding what threatens scientific integrity in CBPR, it is vital to understand what scientific integrity means for the professional and community investigators who are involved in CBPR.
This analysis explores the interpretation of scientific integrity in CBPR among 74 professional and community research team members from of 25 CBPR projects in nine states in the southeastern United States in 2012. It describes the basic definition for scientific integrity and then explores variations in the interpretation of scientific integrity in CBPR. Variations in the interpretations were associated with team member identity as professional or community investigators. Professional investigators understood scientific integrity in CBPR as either conceptually or logistically flexible, as challenging to balance with community needs, or no different than traditional scientific integrity. Community investigators interpret other factors as important in scientific integrity, such as trust, accountability, and overall benefit to the community. This research demonstrates that the variations in the interpretation of scientific integrity in CBPR call for a new definition of scientific integrity in CBPR that takes into account the understanding and needs of all investigators.
doi:10.1016/j.socscimed.2013.08.023
PMCID: PMC3914880  PMID: 24161098
5.  Older Adults’ Fears about Diabetes: Using Common Sense Models of Disease to Understand Fear Origins and Implications for Self-Management 
This study examines older adults’ fears of diabetes complications and their effects on self-management practices. Existing models of diabetes self-management posit that patients’ actions are grounded in disease beliefs and experience, but there is little supporting evidence. In-depth qualitative interviews were conducted with a community-based sample of 74 African American, American Indian, and white older adults with diabetes. Analysis uses Leventhal’s Common Sense Model of Diabetes to link fears to early experience and current self-management. Sixty-three identified fears focused on complications that could limit carrying out normal activities: amputation, blindness, low blood glucose and coma, and disease progression to insulin use and dialysis. Most focused self-management on actions to prevent specific complications, rather than on managing the disease as a whole. Early experiences focused attention on the inevitability of complications and the limited ability of patients to prevent them. Addressing older adults’ fears about diabetes may improve their diabetes self-management practices.
doi:10.1177/0733464811435506
PMCID: PMC4212900  PMID: 25364096
Rural; qualitative methods; common sense model
6.  Muscle Intrusion as a Potential Cause of Carpal Tunnel Syndrome 
Muscle & nerve  2014;50(4):517-522.
Introduction
To determine if there is an association between flexor digitorum and lumbrical muscle intrusion into the carpal tunnel and carpal tunnel syndrome (CTS).
Methods
513 manual laborers (1,026 wrists) were evaluated with ultrasound to determine if those with CTS had more muscle intrusion into the carpal tunnel than those without CTS. 190 of the participants without CTS at baseline (363 wrists) were followed over 1 year to determine if muscle intrusion at baseline predicted the development of CTS.
Results
Participants with CTS had more muscle within the carpal tunnel with the wrist in the neutral (P = 0.026) and flexed positions (P = 0.018) than those without CTS. Baseline muscle intrusion did not predict the development of CTS at 1 year.
Conclusions
Muscle intrusion into the carpal tunnel is associated with CTS, but muscle intrusion alone does not predict the development of CTS over the course of a year.
doi:10.1002/mus.24183
PMCID: PMC4107208  PMID: 24449488
Carpal tunnel syndrome; incidence; prevalence; ultrasound; EMG
7.  Older Adults’ Use of Care Strategies in Response to General and Upper Respiratory Symptoms 
This study examined the use of complementary and medical treatments, both individually and in combination, to address common general and upper respiratory symptoms. Data for the analysis were collected from a series of 18 daily diary questionnaires administered to community-living older African American and white adults living in rural counties in North Carolina. Participants reported symptoms experienced on each diary day and the treatment strategies they used each day in response to the particular symptom(s). Older adults used diverse categories of strategies to treat symptoms; treatment strategies were used inconsistently across symptoms. Use of only complementary strategies, only medical conventional strategies, or both complementary and medical strategies to treat any one symptom rarely corresponded to the use of the same strategy to address other symptoms. Future research would benefit from analyzing how older adults use health care strategies across symptom categories.
doi:10.1177/0733464813478689
PMCID: PMC4102662  PMID: 24652871
aging; complementary medicine; self-care; older adults; rural
8.  Correlates of Physician Trust Among Rural Older Adults with Diabetes 
Objectives
To examine the demographic, health and diabetes management correlates of physicians trust in a rural, multi-ethnic population with diabetes.
Methods
563 older (≥60 years) African American, American Indian and White adults completed in-home surveys, including the 11-item General Trust in Physicians Scale.
Results
Higher trust scores were seen among: older (≥75) participants (p < .01), those with fewer (<3) chronic health conditions (p < .01), and those who adhered to physical activity (p < .05) and dilated eye exam (p < .01) guidelines; the latter remained significant (eye exam, p = .019) or approached significance (physical activity, p = .051) after adjustment for potential confounders.
Conclusions
Physician trust may influence patient adherence to diabetes management recommendations. Efforts should be made to build trust in the patient-provider relationship to enhance patient outcomes.
doi:10.5993/AJHB.37.5.10
PMCID: PMC3761406  PMID: 23985289
physician trust; diabetes self-management; rural older adults; ethnic minority populations
9.  Evaluating the Effectiveness of a Lay Health Promoter-Led, Community-Based Participatory Pesticide Safety Intervention With Farmworker Families 
Health promotion practice  2012;14(3):425-432.
Pesticide safety training is mandated for migrant and seasonal farmworkers. However, none is required for family members, who implement home sanitation to protect against pesticide exposure and need to control pests in substandard housing. Controlled studies have demonstrated the efficacy of pesticide education programs for farmworker families, but no carefully evaluated demonstration projects have shown effectiveness in public health settings. This project evaluates a lay health promoter program to improve pesticide-related knowledge and practices. Promotoras from six agencies recruited families with children to deliver a six-lesson, in-home, culturally and educationally appropriate curriculum. Independently conducted pre- and posttests evaluated changes in knowledge and practices. Adults in 610 families completed the study. Most were from Mexico, with low levels of formal education. Significant improvements in knowledge were observed for all six lessons. Significant improvements were observed in practices related to para-occupational exposure and residential pest control. Lay health promoters with limited training and supervision can have significant impacts on families’ knowledge and practices. They represent a workforce increasingly recognized as a force for reducing health disparities by providing culturally appropriate health education and other services. This study adds to the literature by demonstrating their effectiveness in a public health setting with rigorous evaluation.
doi:10.1177/1524839912459652
PMCID: PMC4116736  PMID: 23075501
community-based participatory research; lay health promoter; demonstration project; migrant and seasonal farmworkers; occupational health and safety; pesticide exposure
10.  “Causes” Of Pesticide Safety Behavior Change in Latino Farmworker Families 
Objective
To identify the source of behavior change resulting from a health education intervention focused on pesticide safety.
Methods
Data were from the La Familia Sana demonstration project, a promotora-delivered pesticide safety education intervention conducted with immigrant Latinos (N = 610).
Results
The La Familia Sana program produced changes in 3 sets of pesticide safety behaviors. Changes in the conceptual targets of the intervention and promotora attributes explained 0.45–6% and 0.5–3% of the changes in pesticide-related behavior, respectively.
Discussion
The conceptual targets of the La Familia Sana program explained the greatest amount of change in pesticide-related behavior. Promotora attributes also contributed to intervention success
doi:10.5993/AJHB.37.4.3
PMCID: PMC3997211  PMID: 23985226
pesticide safety; Latinos; Immigrants; lay health advisors; translational research
11.  Attitudes of Older Adults Regarding Disclosure of Complementary Therapy Use to Conventional Physicians 
Many older adults use complementary therapies in health self-management but do not disclose this use to their physicians. This paper examines factors affecting disclosure of complementary therapy use, and it considers ethnic and gender differences in disclosure. It is based on a systematic qualitative analysis of in-depth interviews conducted with 62 African American and White adults aged 65 and older. Twenty-three of the 39 older adults who acknowledge using complementary therapies disclose this to their physicians. Themes leading to disclosure are believing that physicians are supportive and the importance of sharing information. Themes for not disclosing complementary therapy use include physicians’ negative views, complementary therapy use affecting physicians’ incomes, and the need to protect cultural knowledge. African American women were least likely to disclose use. Disclosure by elders to their physicians is a complex decision process. Medical encounters, including decisions regarding information to disclose, are embedded in broader social structures.
doi:10.1177/0733464812443084
PMCID: PMC4076141  PMID: 24991082
Complementary therapies; patient-provider communication; minority aging
12.  Traditional and Commercial Herb Use in Health Self-Management among Rural Multiethnic Older Adults 
This study analyzes the role of traditional and commercial herbs in older adults’ health self-management based on Leventhal’s Self-Regulatory Model conceptual framework. Sixty-two African American and white adults age 65 and older completed qualitative interviews describing the forms of herbs currently being used, sources of information about them, interpretations of health (acute symptoms or chronic conditions) that lead to their use, and the initiation and suspension of use. Traditional herbs are native to the region or have been traditionally cultivated; usually taken raw or boiled to produce tea; and used for treating mild symptoms. Commercial herbs are prepared as pills, extracts, or teas; they are purchased at local stores or ordered by catalog or internet; and used for health promotion, illness prevention or treatment of chronic conditions. Herbs are widely used among older adults; this analysis differentiates the types of herbs they use and their reasons for herbs use.
doi:10.1177/0733464811424152
PMCID: PMC4076146  PMID: 24991081
Complementary therapies; herbal remedies; rural aging; minority aging
13.  Physical Activity of Preschool-Aged Latino Children in Farmworker Families 
Objective
To describe time spent in sedentary and moderate-to-vigorous physical activity (MVPA) by children in Latino farmworker families; and delineate sources of variation in sedentary and MVPA.
Method
Data were from mother-child dyads (N = 248) in Latino farmworker households in North Carolina. Physical activity was assessed using accelerometers; mothers described their children’s characteristics and their physical and social environments.
Results
Children spent 6.2 hours/day sedentary (Median=369 minutes), and 6.0 minutes/day in MVPA. Children in Head Start spent more time sedentary, whereas children living where dogs roam freely were less sedentary. Children whose mothers limited screen time spent 2 more minutes in MVPA.
Conclusions
Preschool-aged Latino children in farmworker families are sedentary, engaging in very little MVPA.
doi:10.5993/AJHB.38.5.9
PMCID: PMC4060153  PMID: 24933141
preschool-aged children; Latinos; farmworkers; physical activity
14.  Relationship Between Nonprescribed Therapy Use for Illness Prevention and Health Promotion and Health-Related Quality of Life 
Objectives
This study describes the nonprescribed therapy use (prayer, over-the-counter medications [OTC's], home remedies, vitamins, herbs and supplements, and exercise) for health promotion among rural elders. It also delineates the association of such therapy use with physical and mental health-related quality of life (HRQoL).
Method
The sample (N = 200) consisted of African American and White elders from south-central North Carolina. Participants completed baseline interviews and repeated measures of nonprescribed therapy use over a 6-month follow-up.
Results
Prayer had the highest percentage (80.7%) of use for health promotion followed by OTC (54.3%); vitamins only (49.3%); herbs and supplements (40.5%); exercise (31.9%); and home remedies (5.2%). Exercise was significantly associated with better physical HRQoL (p < .05). However, elders who used nonprescribed therapies had poorer mental HRQoL than nonusers, adjusting for potential confounders.
Conclusion
This analysis suggests that use of some nonprescribed therapies for health promotion is associated with poorer mental HRQoL.
doi:10.1177/0733464812453518
PMCID: PMC4059179  PMID: 24781966
nonprescribed therapy use; health-related quality of life (HRQoL)
15.  Pesticides Present in Migrant Farmworker Housing in North Carolina 
Background
Migrant farmworkers are exposed to pesticides at work. Housing provided to migrant farmworkers may also expose them to pesticides, increasing their health risks. This analysis (1) describes the presence of organophosphorous (OP) and pyrethroid pesticides in North Carolina migrant farmworker houses, and (2) delineates associations of farmworker camp characteristics with pesticide detection and concentration.
Methods
In 2010, 186 migrant farmworkers camps in NC were recruited (participation rate of 82.3%); pesticide wipe samples for 176 houses were analyzed. Tobacco is the predominant hand-harvested crop in this region. Two farmworkers per camp completed interviews; a third assisted with a housing inspection. Gas chromatography–mass spectrometry was used to detect OP and pyrethroid pesticides. Covariates of pesticide detection and concentration were determined with ANOVA and Tobit regression.
Results
OPs were found in 166 of 176 houses (average of 2.4/house); pyrethroids were found in 171 houses (average of 4.3/house). The number of different OPs detected in each camp and concentrations of these OPs were not associated with camp and housing characteristics. The number of different pyrethroids detected in each camp and concentrations of these pyrethroids were associated with camps having residents with H2-A visas, a posted North Carolina Department of Labor Certificate of Inspection, no barracks, fewer residents, no bedroom weather protection or floor violations, and no roaches.
Conclusions
Farmworkers are exposed to pesticides where they live. Policy on removing pesticides from farmworker houses is needed. Reducing pesticides in farmworker houses will reduce one health risk confronted by this vulnerable population.
doi:10.1002/ajim.22232
PMCID: PMC4028316  PMID: 24038176
health disparities; vulnerable population; occupational exposures; environmental exposures; agricultural workers; immigrant workers
16.  Recruiting Underserved Mothers to Medical Research: Findings from North Carolina 
Representative samples are required for ethical, valid, and useful health research. Yet, recruiting participants, especially from historically underserved communities, can be challenging. This paper presents findings from in-depth interviews with 40 mothers about factors that might influence their willingness to participate or allow their children to participate in medical research. Saliency analysis organizes the findings. Frequent and important salient themes about research participation included concerns that it might cause participants harm, hope that participants might gain a health benefit, and recognition that time and transportation resources could limit participation. Ultimately, we propose that a theoretical model, such as the Theory of Planned Behavior (TPB), will facilitate more systematic evaluation of effective methods for recruitment and retention of participants in medical research. Future research should explore the utility of such a model for development of effective recruitment and retention strategies.
doi:10.1353/hpu.2013.0157
PMCID: PMC4009167  PMID: 24185171
Health research; recruitment; women; children; underserved populations
17.  Assessment of a Short Diabetes Knowledge Instrument for Older and Minority Adults 
The Diabetes educator  2013;40(1):68-76.
Purpose
The purpose of the study was to assess the performance of a short diabetes knowledge instrument (SDKI) in a large multi-ethnic sample of older adults with diabetes and to identify possible modifications to improve its ability to document diabetes knowledge.
Research Design and Methods
A sample of 593 African American, American Indian, and white female and male adults 60 years and older, with diabetes diagnosed at least two years prior, was recruited from eight North Carolina counties. All completed an interview that included a 16-item questionnaire to assess diabetes knowledge. A subsample of 46 completed the questionnaire a second time at a subsequent interview. Item-response analysis was used to refine the instrument to well-performing items. The instrument consisting of the remaining items was subjected to analyses to assess validity and test-retest reliability.
Results
Three items were removed after item-response analysis. Scores for the resulting instrument were lower among minority and older participants, as well as those with lower educational attainment and income. Scores for test-retest were highly correlated.
Conclusions
The SDKI (13 item questionnaire) appears to be a valid and reliable instrument to evaluate knowledge about diabetes. Assessment in a multi-ethnic sample of older adults suggests that this instrument can be used to measure diabetes knowledge in diverse populations. Further evaluation is needed to determine whether or not this instrument can detect changes in knowledge resulting from diabetes education or other interventions.
doi:10.1177/0145721713508824
PMCID: PMC3946961  PMID: 24163359
18.  A Bayesian Multiple Imputation Method for Handling Longitudinal Pesticide Data with Values below the Limit of Detection 
Environmetrics  2012;24(2):132-142.
Environmental and biomedical research often produces data below the limit of detection (LOD), or left-censored data. Imputing explicit values for values < LOD in a multivariate setting, such as with longitudinal data, is difficult using a likelihood-based approach. A Bayesian multiple imputation (MI) method is introduced to handle left-censored multivariate data. A Gibbs sampler, which uses an iterative process, is employed to simulate the target multivariate distribution within a Bayesian framework. Following convergence, multiple plausible data sets are generated for analysis by standard statistical methods outside of a Bayesian framework. With explicit imputed values available variables can be analyzed as outcomes or predictors. We illustrate a practical application using longitudinal data from the Community Participatory Approach to Measuring Farmworker Pesticide Exposure (PACE3) study to evaluate the association between urinary acephate concentrations (indicating pesticide exposure) and self-reported potential pesticide poisoning symptoms. Additionally, a simulation study is used to evaluate the sampling property of the estimators for distributional parameters as well as regression coefficients estimated with the generalized estimating equation (GEE) approach. Results demonstrated that the Bayesian MI estimates performed well in most settings, and we recommend the use of this valid and feasible approach to analyze multivariate data with values < LOD.
doi:10.1002/env.2193
PMCID: PMC3596170  PMID: 23504271
Bayesian; Gibbs sampler; Left-censoring; Limit of detection; Longitudinal data; Multiple imputation; Multivariate; Non-detections
19.  ULTRASOUND FOR CARPAL TUNNEL SYNDROME SCREENING IN MANUAL LABORERS 
Muscle & nerve  2013;48(1):10.1002/mus.23735.
Introduction
Manual laborers are at increased risk for carpal tunnel syndrome (CTS), and a combination of history, physical examination, and nerve conduction studies is often used to screen for CTS in this population. Neuromuscular ultrasound may be a better screening tool, because it is painless. In this study we compare the accuracy of nerve conduction studies and ultrasound for CTS screening.
Methods
Five hundred thirteen manual laborers were screened prospectively for CTS using nerve conduction studies and neuromuscular ultrasound, and the accuracy of the 2 techniques was compared using the Katz hand diagram as the diagnostic standard.
Results
The ROC curves for the 2 techniques were not significantly different (P = 0.542), indicating that the approaches had similar diagnostic accuracy.
Conclusions
Neuromuscular ultrasound is a painless technique that has diagnostic accuracy similar to nerve conduction studies and can be used to screen large populations at risk for CTS.
doi:10.1002/mus.23735
PMCID: PMC3878605  PMID: 23649357
accuracy; carpal tunnel syndrome; clinical neurophysiology; screening test; ultrasound
20.  Prevalence of bifid median nerves and persistent median arteries and their association with carpal tunnel syndrome in a sample of latino poultry processors and other manual workers 
Muscle & nerve  2013;48(4):10.1002/mus.23797.
Introduction
The prevalence of bifid median nerves and persistent median arteries, their co-occurrence, and their relationship to carpal tunnel syndrome (CTS) are only understood partially.
Methods
We screened 1026 wrists of 513 Latino manual laborers in North Carolina for bifid median nerves and persistent median arteries using electrodiagnosis and ultrasound.
Results
A total of 8.6% of wrists had a bifid median nerve, and 3.7% of wrists had a persistent median artery independent of subgroup ethnicity, age, gender, or type of work. An association with definite carpal tunnel syndrome was not found. The presence of either anatomic variant was associated with a high likelihood of co-occurrence of another variant in the same or the contralateral wrist.
Conclusions
The occurrence of median anatomic variants can be determined in field studies using ultrasound. Persistent median arteries and bifid median nerves tend to co-occur but do not put manual laborers at additional risk of developing CTS.
doi:10.1002/mus.23797
PMCID: PMC3836559  PMID: 24037717
entrapment neuropathy; epidemiology; neuromuscular ultrasound; occupational health; poultry workers
21.  Health and Turnover of Working Mothers After Childbirth Via the Work–Family Interface: An Analysis Across Time 
The Journal of applied psychology  2011;96(5):10.1037/a0023964.
This study examined organizational levers that impact work–family experiences, participant health, and subsequent turnover. Using a sample of 179 women returning to full-time work 4 months after childbirth, we examined the associations of 3 job resources (job security, skill discretion, and schedule control) with work-to-family enrichment and the associations of 2 job demands (psychological requirements and nonstandard work schedules) with work-to-family conflict. Further, we considered subsequent impact of work-to-family conflict and enrichment on women’s health (physical and mental health) 8 months after women returned to work and the impact of health on voluntary turnover 12 months after women returned to work. Having a nonstandard work schedule was directly and positively related to conflict, whereas schedule control buffered the effect of psychological requirements on conflict. Skill discretion and job security, both job resources, directly and positively related to enrichment. Work-to-family conflict was negatively related to both physical and mental health, but work-to-family enrichment positively predicted only physical health. Physical health and mental health both negatively influenced turnover. We discuss implications and opportunities for future research.
doi:10.1037/a0023964
PMCID: PMC3835182  PMID: 21604833
work–family conflict; work–family enrichment; health; turnover; job demands
22.  Medical Skepticism and Complementary Therapy Use among Older Rural African-Americans and Whites 
Journal of health care for the poor and underserved  2013;24(2):10.1353/hpu.2013.0052.
Purpose
This study documents demographic, health, and complementary therapy (CT) correlates of medical skepticism among rural older adults.
Methods
Older (≥65 years) African Americans and Whites in rural North Carolina (N=198) were interviewed. Medical skepticism was assessed using the four items from the Medical Expenditure Survey. Bivariate associations between medical skepticism and demographic and health characteristics and CT use were assessed, and independent effects on CT use.
Findings
Positive responses to medical skepticism questions ranged from 19.7% (can overcome illness without help) to 59.6% (believes own behavior determines their health). Medical skepticism indicators were associated with few demographic and health characteristics, and one CT category.
Conclusions
This study shows a high degree of medical skepticism among rural older adults, but limited associations with demographic and health characteristics and CT use. Further research is needed to understand relationships of attitudes towards conventional care and CT use in this population.
doi:10.1353/hpu.2013.0052
PMCID: PMC3830528  PMID: 23728044
Medical skepticism; complementary therapies; rural older adults; African Americans
23.  Patterns of Complementary Therapy Use for Symptom Management for Older Rural Adults with Diabetes 
Studies on complementary therapy use among adults with diabetes are limited by crude use measures and lack of specificity of use for treating diabetes. Data are from a study including baseline and repeated 3-day assessments of complementary therapy use among rural African American and White older (age ≥64) adults (n=71). Most commonly used complementary therapies for diabetes at baseline included prayer (88.7%), food/beverages (50.7%), herbs (11.3%) and home remedies (9.9%). In repeated measures (1131 interviews), prayer was used on 57.2% of days, followed by food/beverages (12.7%), herbs (3.4%) and home remedies (2.7%). 56.3% who reported praying did so on ≥5 reporting periods; other complementary therapy use was sporadic. These data show, with the exception of prayer and food/beverages, limited complementary therapy use for diabetes treatment among rural older adults, and less inconsistent use patterns of most complementary therapies. Further research is needed to understand the motivations and patterns of complementary therapy use for diabetes patients.
doi:10.1177/2156587212463070
PMCID: PMC3826981  PMID: 24244893
Complementary Therapy Use; Diabetes Mellitus; Rural Older Adults
24.  The Association of Mental Conditions with Blood Glucose Levels in Older Adults with Diabetes 
Aging & mental health  2012;16(8):950-957.
Objectives
People with diabetes must engage in several self-care activities to manage blood glucose; cognitive function and other affective disorders may affect self-care behaviors. We examined the executive function domain of cognition, depressive symptoms, and symptoms of generalized anxiety disorder (GAD) to determine which common mental conditions that can co-occur with diabetes are associated with blood glucose levels.
Methods
We conducted a cross-sectional in-person survey of 563 rural older adults (age 60 years or older) with diabetes that included African Americans, American Indians, and Whites from eight counties in south-central North Carolina. Hemoglobin A1C (A1C) was measured from a finger-stick blood sample to assess blood glucose control. Executive function, depressive symptoms, and symptoms of GAD were assessed using established measures and scoring procedures. Separate multivariate linear regression models were used to examine the association of executive function, depressive symptoms, and symptoms of GAD with A1C.
Results
Adjusting for potential confounders including age, gender, education, ethnicity, marital status, history of stroke, heart disease, hypertension, diabetes knowledge, and duration of diabetes, executive function was significantly associated with A1C levels: every one-unit increase in executive function was associated with a 0.23 lower A1C value (p = 0.02). Symptoms of depression and GAD were not associated with A1C levels.
Conclusions
Low executive function is potentially a barrier to self-care, the cornerstone of managing blood glucose levels. Training aids that compensate for cognitive impairments may be essential for achieving effective glucose control.
doi:10.1080/13607863.2012.688193
PMCID: PMC3434257  PMID: 22640032
A1C; cognitive function; depression; anxiety; aging
25.  Daily Symptom Management Practices for Arthritis Used by Older Adults 
Journal of aging and health  2011;24(4):598-615.
Objective
This article describes the daily self-management practices of older adults with arthritis and examines the association of symptom experience with the use of self-management behaviors.
Method
197 African American and White participants completed a baseline interview and six sets of three follow-up daily-diary interviews at monthly intervals.
Results
Arthritis was reported by 63.5%. Arthritis self-management reported included complementary therapies, over-the-counter (OTC) and prescription medications, foods or beverages, and home remedies. Odds of implementing these self-care practices were greater on days with joint pain, swelling, and stiffness. Although, 78.0% and 72.4% of all participants reported staying in bed or cutting back on activities in response to joint symptoms, these self-management activities were not associated with having arthritis.
Conclusions
Focusing on daily responses to symptoms demonstrates that older adults actively manage arthritis symptoms using a wide variety of measures, including complementary therapies.
doi:10.1177/0898264311428169
PMCID: PMC3805964  PMID: 22173224
self-care; rural; complementary and alternative medicine; daily diary method

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