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1.  Longitudinal Associations Between Health Behaviors and Mental Health in Low-Income Adults 
Background
Although there are established relationships between physical and mental health, few studies have explored the relationship between health behaviors and mental health over time.
Purpose
To explore rates of health compromising behaviors (HCBs) and the longitudinal relationship between HCBs and depression, anxiety, and stress.
Method
Five waves of data were collected over 1 year from 482 patients at an urban public health clinic (47% female, 68% African American, Mage = 28).
Results
Smoking (61%), binge drinking (52%), illegal drug use (53%), unprotected sex with non-primary partners (55%), and fast food consumption (71%) were common, while consumption of fruits or vegetables (30%) and breakfast (17%) were rare. Cross-lagged models identified within-time associations between HCBs and depression/anxiety and stress. Additionally, depression/anxiety and stress predicted later HCBs, but HCBs did not predict later mental health.
Conclusions
Results suggest that targeting mental health may be important to promoting improvements across multiple health behaviors.
doi:10.1007/s13142-012-0189-5
PMCID: PMC3717991  PMID: 23997836
health behavior; mental health; depression; anxiety; perceived stress
2.  Changes in Women’s Condom Use over the First Year of College 
Journal of sex research  2012;50(2):10.1080/00224499.2011.642024.
Most college students are sexually active, engage in serially monogamous relationships, and use condoms inconsistently. Little is known about how condom use changes during college and even less about variables predicting changes in use. We used latent growth modeling (LGM) to examine changes in condom use during the first year of college among 279 women (Mage = 18.0, 74% White) who provided monthly reports on condom use frequency. At study entry, participants also reported on theoretically-suggested risk and protective factors. We examined predictors of changes in use after controlling for use of alternative contraception and partner type. LGMs showed that women decreased their condom use during the first year of college. Levels of condom use were lower initially among women with strong alcohol-sexual risk expectancies, women with more previous sexual partners, women who did not smoke marijuana, and African-American women. Decreases in condom use were greater among women with lower GPAs, women from lower SES families, and women who engaged in binge drinking. Reductions in condom use may place women at greater risk of unplanned pregnancy and sexually transmitted infections. Identification of factors associated with decreases in condom use will enable targeted educational and intervention efforts.
doi:10.1080/00224499.2011.642024
PMCID: PMC3865869  PMID: 22235757
3.  Exposure to Different Types of Violence and Subsequent Sexual Risk Behavior among Female STD Clinic Patients: A Latent Class Analysis 
Psychology of violence  2012;2(4):339-354.
Objective
Diverse forms of violence, including childhood maltreatment (CM), intimate partner violence (IPV), and exposure to community violence (ECV), have been linked separately with sexual risk behaviors. However, few studies have explored multiple experiences of violence simultaneously in relation to sexual risk-taking, especially in women who are most vulnerable to violent experiences.
Methods
Participants were 481 women (66% African American, Mage = 27 years) attending a publicly-funded STD clinic who reported on their past and current experiences with violence and their current sexual risk behavior. We identified patterns of experience with violence using latent class analysis (LCA) and investigated which combinations of experiences were associated with the riskiest sexual outcomes.
Results
Four classes of women with different experiences of violence were identified: Low Violence (39%), Predominantly ECV (20%), Predominantly CM (23%), and Multiply Victimized (18%). Women in the Multiply Victimized and Predominantly ECV classes reported the highest levels of sexual risk behavior, including more lifetime sexual partners and a greater likelihood of receiving STD treatment and using substances before sex.
Conclusions
Women with different patterns of violent experiences differed in their sexual risk behavior. Interventions to reduce sexual risk should address violence against women, focusing on experiences with multiple types of violence and experiences specifically with ECV. Additional research is needed to determine the best ways to address violence in sexual risk reduction interventions.
doi:10.1037/a0027716
PMCID: PMC3634364  PMID: 23626921
sexual risk behavior; child sexual abuse; child abuse; intimate partner violence; community violence
4.  Longitudinal associations between health behaviors and mental health in low-income adults 
ABSTRACT
Although there are established relationships between physical and mental health, few studies have explored the relationship between health behaviors and mental health over time. To explore rates of health-compromising behaviors (HCBs) and the longitudinal relationship between HCBs and depression, anxiety, and stress, five waves of data were collected over 1 year from 482 patients at an urban public health clinic (47 % female, 68 % African-American, Mage = 28). Smoking (61 %), binge drinking (52 %), illegal drug use (53 %), unprotected sex with non-primary partners (55 %), and fast food consumption (71 %) were common, while consumption of fruits or vegetables (30 %) and breakfast (17 %) were rare. Cross-lagged models identified within-time associations between HCBs and depression/anxiety and stress. Additionally, depression/anxiety and stress predicted later HCBs, but HCBs did not predict later mental health. Results suggest that targeting mental health may be important to promoting improvements across multiple health behaviors.
doi:10.1007/s13142-012-0189-5
PMCID: PMC3717991  PMID: 23997836
Health behavior; Mental health; Depression; Anxiety; Perceived stress
5.  Predicting Condom Use Using the Information-Motivation-Behavioral Skills (IMB) Model: A Multivariate Latent Growth Curve Analysis 
Background
The Information-Motivation-Behavioral Skills (IMB) model often guides sexual risk reduction programs even though no studies have examined covariation in the theory’s constructs in a dynamic fashion with longitudinal data.
Purpose
Using new developments in latent growth modeling, we explore how changes in information, motivation, and behavioral skills over 9 months relate to changes in condom use among STD clinic patients.
Methods
Participants (N = 1281, 50% female, 66% African American) completed measures of IMB constructs at three time points. We used parallel process latent growth modeling to examine associations among intercepts and slopes of IMB constructs.
Results
Initial levels of motivation, behavioral skills, and condom use were all positively associated, with behavioral skills partially mediating associations between motivation and condom use. Changes over time in behavioral skills positively related to changes in condom use.
Conclusions
Results support the key role of behavioral skills in sexual risk reduction, suggesting these skills should be targeted in HIV prevention interventions.
doi:10.1007/s12160-011-9284-y
PMCID: PMC3179537  PMID: 21638196
Condoms; HIV; IMB; Sexual risk behavior; STD
6.  Using Growth Mixture Modeling to Identify Heterosexual Men who Reduce Their Frequency of Unprotected Sex Following a Behavioral Intervention 
AIDS and Behavior  2012;16(6):1501-1510.
Using growth mixture modeling, two 12-month trajectories of unprotected sex were identified in 210 heterosexual men (76% African American, Mage = 33.2 years) attending a sexual risk reduction intervention. Risk Reducers (46%) reported fewer acts of unprotected sex following intervention, whereas Risk Maintainers (54%) reported continuously high levels of unprotected sex. These groups did not differ with respect to demographic characteristics or intervention type. However, Risk Maintainers were more likely than Risk Reducers to report lifetime sex work, forced sex in the past year, and alcohol use before sex at baseline. They had higher levels of peak alcohol use, poorer condom skills, and scored lower on stage of change for condom use at baseline. Risk Maintainers were also more likely to have steady partners at baseline and less likely to change partner status following intervention. Understanding factors distinguishing these groups can contribute to the development of targeted risk reduction interventions.
doi:10.1007/s10461-012-0187-0
PMCID: PMC3402644  PMID: 22543674
sexual risk reduction; HIV prevention; sexually transmitted disease; unsafe sex; longitudinal studies
7.  Measuring cancer care coordination: development and validation of a questionnaire for patients 
BMC Cancer  2011;11:298.
Background
Improving the coordination of cancer care is a priority area for service improvement. However, quality improvement initiatives are hindered by the lack of accurate and reliable measures of this aspect of cancer care. This study was conducted to develop a questionnaire to measures patients' experience of cancer care coordination and to assess the psychometric properties of this instrument.
Methods
Questionnaire items were developed on the basis of literature review and qualitative research involving focus groups and interviews with cancer patients, carers and clinicians. The draft instrument was completed 686 patients who had been recently treated for a newly diagnosed cancer, including patients from metropolitan, regional and rural areas of New South Wales, Australia. To assess test-retest reliability, 119 patients completed the questionnaire twice. Unreliable items those with limited variability or high levels of missing data were eliminated. Exploratory factor analysis was conducted to define the underlying factor structure of the remaining items and subscales were constructed. Correlations between these and global measures of the experience of care coordination and the quality of care were assessed.
Results
Of 40 items included in the draft questionnaire, 20 were eliminated due to poor test-retest reliability (n = 4), limited response distributions (n = 8), failure to load onto a factor (n = 7) or detrimental effect on the internal consistency of the scale (n = 1). The remaining 20 items loaded onto two factors named 'Communication' and 'Navigation', which explained 91% of the common variance. Internal consistency was with high for the instrument (Cronbach's alpha 0.88) and each subscale (Cronbach's alpha 0.87 and 0.73 respectively). There was no apparent 'floor' or 'ceiling' effect for the total score or the Communication subscale, but evidence of a ceiling effect for the Navigation subscale with 21% of respondents achieving the highest possible score. There were moderate positive associations between the total score and global measures of care coordination (r = 0.57) and quality of care (r = 0.53).
Conclusions
The instrument developed in this study demonstrated consistency and robust psychometric properties. It may provide a useful tool to measure patients' experience of cancer care coordination in future surveys and intervention studies.
doi:10.1186/1471-2407-11-298
PMCID: PMC3151230  PMID: 21756360
cancer; coordination of cancer care; questionnaire; psychometrics
8.  Weight and pregnancy 
BMJ : British Medical Journal  2007;335(7612):169.
Women who maintain a normal healthy weight, before, during, and after pregnancy have better outcomes
doi:10.1136/bmj.39267.518808.80
PMCID: PMC1934487  PMID: 17656509
9.  What are the current barriers to effective cancer care coordination? A qualitative study 
Background
National cancer policies identify the improvement of care coordination as a priority to improve the delivery of health services for people with cancer. Identification of the current barriers to effective cancer care coordination is needed to drive service improvement.
Methods
A qualitative study was undertaken in which semi-structured individual interviews and focus groups were conducted with those best placed to identify issues; patients who had been treated for a range of cancers and their carers as well as health professionals involved in providing cancer care. Data collection continued until saturation of concepts was reached. A grounded theory influenced approach was used to explore the participants' experiences and views of cancer care coordination.
Results
Overall, 20 patients, four carers and 29 health professionals participated. Barriers to cancer care coordination related to six aspects of care namely, recognising health professional roles and responsibilities, implementing comprehensive multidisciplinary team meetings, transitioning of care: falling through the cracks, inadequate communication between specialist and primary care, inequitable access to health services and managing scarce resources.
Conclusions
This study has identified a number of barriers to coordination of cancer care. Development and evaluation of interventions based on these findings is now required.
doi:10.1186/1472-6963-10-132
PMCID: PMC2891740  PMID: 20482884
10.  A randomised control trial of low glycaemic index carbohydrate diet versus no dietary intervention in the prevention of recurrence of macrosomia 
Background
Maternal weight and maternal weight gain during pregnancy exert a significant influence on infant birth weight and the incidence of macrosomia. Fetal macrosomia is associated with an increase in both adverse obstetric and neonatal outcome, and also confers a future risk of childhood obesity. Studies have shown that a low glycaemic diet is associated with lower birth weights, however these studies have been small and not randomised [1,2]. Fetal macrosomia recurs in a second pregnancy in one third of women, and maternal weight influences this recurrence risk [3].
Methods/Design
We propose a randomised control trial of low glycaemic index carbohydrate diet vs. no dietary intervention in the prevention of recurrence of fetal macrosomia.
Secundigravid women whose first baby was macrosomic, defined as a birth weight greater than 4000 g will be recruited at their first antenatal visit.
Patients will be randomised into two arms, a control arm which will receive no dietary intervention and a diet arm which will be commenced on a low glycaemic index diet.
The primary outcome measure will be the mean birth weight centiles and ponderal indices in each group.
Discussion
Altering the source of maternal dietary carbohydrate may prove to be valuable in the management of pregnancies where there has been a history of fetal macrosomia. Fetal macrosomia recurs in a second pregnancy in one third of women. This randomised control trial will investigate whether or not a low glycaemic index diet can affect this recurrence risk.
Current Controlled Trials Registration Number
ISRCTN54392969
doi:10.1186/1471-2393-10-16
PMCID: PMC2876071  PMID: 20416041
11.  CRTAP AND LEPRE1 MUTATIONS IN RECESSIVE OSTEOGENESIS IMPERFECTA 
Human mutation  2008;29(12):1435-1442.
Autosomal dominant osteogenesis imperfecta (OI) is caused by mutations in the genes (COL1A1 or COL1A2) encoding the chains of type I collagen. Recently, dysregulation of hydroxylation of a single proline residue at position 986 of both the triple-helical domains of type I collagen α1(I) and type II collagen α1(II) chains has been implicated in the pathogenesis of recessive forms of OI. Two proteins, CRTAP, or cartilage-associated protein, and prolyl-3-hydroxylase-1 (P3H1, encoded by the LEPRE1 gene) form a complex that performs the hydroxylation and brings the prolyl cis-trans isomerase cyclophilin-B (CYPB) to the unfolded collagen. In our screen of 78 subjects diagnosed with OI type II or III, we identified three probands with mutations in CRTAP and sixteen with mutations in LEPRE1. The latter group includes a mutation in patients from the Irish Traveller population, a genetically isolated community with increased incidence of OI. The clinical features resulting from CRTAP or LEPRE1 loss of function mutations were difficult to distinguish at birth. Infants in both groups had multiple fractures, decreased bone modeling (affecting especially the femurs), and extremely low bone mineral density. Interestingly, “popcorn” epiphyses may reflect underlying cartilaginous and bone dysplasia in this form of OI. These results expand the range of CRTAP/LEPRE1 mutations that result in recessive OI and emphasize the importance of distinguishing recurrence of severe OI of recessive inheritance from those that result from parental germline mosaicism for COL1A1 or COL1A2 mutations.
doi:10.1002/humu.20799
PMCID: PMC2671575  PMID: 18566967
Osteogenesis Imperfecta; Prolyl 3-Hydroxylation; CRTAP; LEPRE1
12.  Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial 
Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group.
Design Randomised controlled trial.
Setting Maternity hospital in Dublin, Ireland.
Participants 800 women without diabetes, all in their second pregnancy between January 2007 to January 2011, having previously delivered an infant weighing greater than 4 kg.
Intervention Women were randomised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy.
Main outcomes The primary outcome measure was difference in birth weight. The secondary outcome measure was difference in gestational weight gain.
Results No significant difference was seen between the two groups in absolute birth weight, birthweight centile, or ponderal index. Significantly less gestational weight gain occurred in women in the intervention arm (12.2 v 13.7 kg; mean difference −1.3, 95% confidence interval −2.4 to −0.2; P=0.01). The rate of glucose intolerance was also lower in the intervention arm: 21% (67/320) compared with 28% (100/352) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L (P=0.02).
Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age infants in a group at risk of fetal macrosomia. It did, however, have a significant positive effect on gestational weight gain and maternal glucose intolerance.
Trial registration Current Controlled Trials ISRCTN54392969.
doi:10.1136/bmj.e5605
PMCID: PMC3431285  PMID: 22936795

Results 1-12 (12)