The purposes of this study were: (1) to examine the relationship between perceived barriers, self-efficacy, and sociodemographic characteristics among African American males; (2) to examine the relationship between each of the perceived barriers, self-efficacy, and care-seeking behavior while controlling for sociodemographic characteristics; and (3) to examine the relationship between each of the perceived barriers, self-efficacy, and health responsibility while controlling for sociodemographic characteristics. The model used to direct the study was a combination of three models: The Health Belief Model; The Health Promotion Model; and The Theory of Care-Seeking Behavior. Components of the model included perceived barriers to preventive health care, self-efficacy, health responsibility, and sociodemographic characteristics (age and SES). A self-selected sample of 400 African American men was surveyed using a self-report questionnaire. Two-hundred fourteen questionnaires were returned for a response rate of 54%. Data analysis procedures included bivariate correlations and hierarchial stepwise multivariate regressions using care-seeking behavior and health responsibility as dependent variables. Findings suggested that African American men in this study with a high SES index, that is, education, income, and occupational status, experienced a greater sense of self-efficacy, perceived fewer barriers to obtaining preventive services, assumed more responsibility for their own health care, and sought health care sooner than African American males with less education, income and occupational status. Age was not related to perceived barriers or self-efficacy, but significantly related to socioeconomic status. Older men demonstrated higher SES levels. African American men in this study had relatively high levels of self-efficacy. Individuals with low self-efficacy perceived barriers to preventive health care related to the site of care, provider consumer relationships, costs, inconvenience, and fear. The probability of engaging in preventive health behavior was not influenced by SES, age, self-efficacy or perceived barriers. However, probability of assuming responsibility for health was significantly influenced by age, SES, and fear.

Statement of the problem. The purpose of this study was to develop an instrument to measure the content and quality of prenatal care services in a population of low income women. Dimensions of performance as proposed by the Joint Commission on Accreditation of Healthcare Organizations were used to define the quality of prenatal care. The United States Public Health Service Expert Panel Guidelines on the Content of Prenatal Care were used as the standard for the content of care. Methods. The Content and Quality of Prenatal Care Measure (CQPM), a prenatal care record review measure, was developed in this study. An assessment of content validity and intra- and inter-rater reliability was completed. Data collected for the validity sample of 163 records at two county health department sites was scored by content area. The Adequacy of Prenatal Care Utilization Index (APNCU) developed by Kotelchuck was used to categorize each record in the validity sample. Criterion-related validity was assessed with ANOVA using the CQPM scores as the dependent variable and the APNCU groups as the independent variable and by discriminant function analysis using the CQPM content scores as predictors for group membership in APNCU groups. Results. The mean percent agreement for each of the content areas for intra- and inter-rater reliability ranged from 72% to 95% with medical risk assessment having the highest reliability and health promotion having the lowest. Intra and inter-rater percent agreement for items ranking the quality of care was 70% and 51.6%. A significant difference between the groups was found in ANOVA, F(3,157):16.23, p < .00001, confirming criterion-related validity. The discriminant function analysis found an overall Lambda =.451941 (chi2 = 110.79, df 15, p < .00001). The prediction equation accounted for 62% of grouped cases being correctly classified also confirming criterion-related validity. Discussion. These results show that the Content and Quality of Prenatal Care Measure is reliable and valid and may be used to monitor care provided to low income populations and to conduct research on the content of prenatal care. Further research on weighting each item score in the CQPM and the reliability of items for special populations may be indicated.

Background. Interpersonal violence results in severe injuries requiring treatment in emergency departments and trauma units. Previous studies indicate that women who seek care for intentional injuries are more likely than women who seek care for nonintentional injuries to be discharged without further treatment. Women's opportunities to obtain resources to ensure follow-up services in the community may be limited. Women who survive intentional injuries are discharged with histories of victimization, physical and psychological symptoms, and few resources to assist them to address the sequelae of violence. Few studies have examined how these factors influence functional status. Objective. To identify and explore factors that influence functional status in women who survived an intentional injury by an intimate or ex-intimate partner or another person. Design. A retrospective cohort design. Measures. The Women's Health Questionnaire was developed with previously validated instruments on severity of violence, physical and psychological symptoms, substance abuse, trauma recurrence, social support, and functional status. Setting. R Adams Cowley Shock Trauma Center, University of Maryland Medical System. Participants. Most of the 76 participants were young (18-45 years), African-American (70%), and living in poverty; 74% reported annual incomes of less than {dollar}15,000. Results. The effects of violence (physical, psychological, psychosocial) explained 23.8% of the variance in functional status. Almost 60% of the women screened positive for posttraumatic stress disorder (PTSD), 36.8% reported a lifetime history of drug use, and 64.5% reported a lifetime history of intimate partner violence. Women reported that health care providers gave little attention to the mental health effects of violence and their capacity to fully participate in life; 62% of women assaulted by an intimate or ex-intimate partner were not referred to a domestic violence program or shelter. Conclusions. The effects of violence were the strongest predictor of functional status in intentionally injured women. Women reported serious PTSD symptoms, substantial substance abuse, and multiple traumatic events. They also reported that they had not been provided adequate resources to address the effects of violence. This study should challenge nurses and other health care professional to assess survivors of violence, intervene, and refer the survivors to community-based services that will enable them to maintain optimal functioning.

Nosocomial pneumonia is the most common pulmonary complication in trauma patients and the leading cause of death from nosocomial infections. The purposes of this study were to identify underlying dimensions of variables that increase the risk of nosocomial pneumonia and to identify predictors of nosocomial pneumonia in critically ill trauma patients. A prospective cohort study of 246 consecutive critically ill trauma patients evaluated 22 risk factors for nosocomial pneumonia. The incidence of nosocomial pneumonia was 18.3%. A three factor structure identified with exploratory factor analysis using principle components extraction with varimax rotation was verified with confirmatory factor analysis using LISREL 8 (Goodness of Fit Index.97). Four indicators (days of intubation, integrity of endotracheal tube cuff, presence of a nasogastric tube, and receiving continuous enteral feedings) explained 37% of the variance in the treatment construct. Four indicators (Glasgow Coma Score, Abbreviated Injury Score (AIS) of the head, intracranial pressure monitoring, and Injury Severity Score (ISS)) explained 50% of the variance in the head injury construct. ISS and AIS of the chest explained 25% of the variance in the chest injury construct. Treatment construct score > 2.4 (p =.0002), head injury construct (p =.0045), age (p =.015), and no prior use of antibiotics (p<.0001) were identified by forward stepwise logistic regression as significant multivariate predictors of nosocomial pneumonia (Model chi-square = 53.908, df 4, p<.00009). Although the regression model correctly classified 84.6% of subjects, only 33.3% of patients with pneumonia were correctly classified. Study results support the existence of a 3 factor structure underlying risk factors for nosocomial pneumonia in critically ill trauma patients. Further research is indicated to confirm the identified 3 factor structure and regression model in other samples of trauma patients.

The purposes of this critical ethnography were to identify community health promoting strategies; to uncover the influence of power inequality on women's participation in community health promotion; and, to describe visions for change from rural Thai women perspectives. Participant observation was employed. Twenty-one women from one rural village in southern Thailand were interviewed in addition to focus groups during a six months period. Three sources of ethnographic materials were used: taped-recorded verbatim transcriptions from individual interviews and focus groups, field notes from participant observations, and journal entries. The processes of data reduction, data display, and data conclusion and verification were employed for data analysis and synthesis. Ethical issues and rigor of the study were primary considerations. Emerging themes were validated by the participants, two experts in qualitative research, and one expert in community health. The findings were translated into English and validated by three bilingual Thai faculty members. The women identified eight elements of a healthy community: good living, good eating, togetherness, unity, safe and secure environment, pollution-free environment, availability of infrastructure, and accessibility to services. Getting together, balancing power and exercising power were strategies these women employed to create a healthy community. Power inequality due to socio-economic and cultural constraints was described as both productive and oppressive influence on these women's participation in promoting a healthy community. Women in this study believed knowledge is power. They expressed the needs "to know more" and "to be known" as their vision for change. Critical ethnography facilitated the process of enlightenment, empowerment, and emancipation among study participants. Policy implications and imperatives for nursing practice and nursing research were presented. The findings provide the baseline information for planned community health empowerment program for women aggregate in rural Thailand.

The purpose of this study was to determine the relationship of African Americans' socioeconomic status to their perceptions of cancer. Maiman and Becker's (1974) Health Belief Model was adapted as the theoretical framework. Using this theoretical perspective, a descriptive study was designed to determine the relationship of African Americans' socioeconomic status to their perceptions of cancer screening and early cancer detection, perceptions of cancer risk factors, perceived susceptibility to cancer and cancer prevention. African Americans from a large church in an urban area of Maryland participated in the study. The perceptions subscales of the Cancer Awareness Inventory developed by Underwood (1992) was used for data collection. Additional questions were developed by the researcher to obtain additional information pertinent to African Americans: socioeconomic status, past experience with cancer, and demographic data. A total of 139 African Americans completed the questionnaires, of which 39 were male and 100 were female. Data from the questionnaires were analyzed using multiple regression. Participants in this study perceived themselves susceptible to developing cancer; believed that known and/or suspected activities as well as exposure to carcinogens may increase their cancer risks; believed engaging in recommended cancer preventive activities may decrease their cancer risks; believed that early cancer detection may discover cancer in the absence of symptoms; and believed that one could have cancer in the absence of symptoms. When a general multiple regression was performed, SES was related to three of the dependent variables (i.e., detection, risk and prevention). Age was unrelated to all five dimensions and gender was related only to the risk subscale. When age and gender were statistically controlled, SES was significantly related to all five dependent variables, although the control variables were significantly related only to the participants' perceptions of risk. The knowledge gained from this study will be useful in designing and implementing culturally relevant early cancer prevention and detection programs that take into account African Americans' perceptions of cancer.

Although many researchers have demonstrated that childhood cancer has a major psychological impact on the lives of the stricken individual and the family, there are significant gaps in parental coping research due to a number of conceptual as well as methodological issues including cultural variations. The purpose of this study was to enhance the understanding of the psychosocial experiences of Korean mothers who have a child diagnosed as having cancer. A correlational cross-sectional design was employed to identify significant factors that influence coping with childhood cancer and coping outcomes in Korean mothers. A total of 200 Korean mothers of children with cancer participated in this study. Data were analyzed with descriptive statistics, the Pearson product moment correlations, t-tests, multiple regressions, and path analyses. The questionnaires consisted of Family Inventory of Life Events and Changes (FILE), Visual Analogue Scale (VAS), Coping Health Inventory for Parents (CHIP), Personal Resource Questionnaire (PRQ), Psychosocial Adjustment to Illness Scale (PAIS), and selected demographic and illness-related questions. Psychometric tests showed that all of the instruments met the reliability and construct validity criteria for mature scales with the exception of CHIP and PRQ. The respective three- and single-factor structures of CHIP and PRQ were not supported in this sample, when the confirmatory factor analysis approach was used. The results of this study identified several factors that significantly influence maternal coping and adjustment. One of the important findings is the association of a pile-up of events with maternal coping and adjustment, which has not been empirically validated in parents of children with cancer. Although the moderating effect was not supported, the significant role of social support in mitigating the potential for psychosocial problems and in facilitating coping was substantiated by testing the direct effect. While previous psychosocial research involving an American sample has reported the appropriateness of the stress-coping framework in explaining parental responses to childhood chronic diseases such as cancer, this study confirms the usefulness of the stress-coping approach with a sample of Korean mothers. Future research efforts will include a variety of cultural groups addressing gaps in current coping research in parents of children with cancer.

Disruptive behaviors are a prevalent problem among hospitalized elderly patients and a challenge for today's policy-makers. This problem had not been studied in the two subacute care models: hospital and nursing home-based. This study reviewed the responses of 101 licensed nurses working in 8 JCAHO accredited subacute care programs, 5 hospital-based and 3 nursing home-based. A new scale was developed that provided a comprehensive inventory of interventions for the management of disruptive behaviors. The inventory utilized the following categories of management strategies: behavioral, functional, psychological, environmental, and medical (Beck et al., 1993; Taft et al., 1997). Nurses were asked to rate videotapes of the 4 most commonly occurring types of disruptive behaviors, physical aggression, verbal aggression, agitation, and wandering with respect to (a) the effort involved in behavior management; (b) tolerance toward the occurrence of the behavior; (c) frequency of occurrence and (d) the types of primary interventions (actual and ideal) most likely to be instituted in caring for elderly patients in their particular subacute care setting. Analysis of variance indicated no significant differences between the four types of behaviors with respect to perceived effort, although organizational tolerance for agitation-type behavior was significantly higher than for the other three types. Nursing home-based subacute nurses witnessed a greater frequency of physical aggression, verbal aggression, and agitation-related disruptive behaviors, but fewer occurrences of wandering than hospital-based subacute nurses. No significant differences were found between nurses' intervention selections by facility type nor actual and ideal determined by chi square analyses. Stepwise regression analyses were not statistically significant for demographic and professional characteristics of nurses nor type of facility to explain perceived effort, but did reveal there was a significant (R 2 = 0.049; p = 0.026) positive relationship between organizational tolerance and perceived effort for agitation. An important study finding consistent with the Omnibus Reconciliation Act of 1987 was that nurses in both hospital and nursing home-based subacute settings did not select physical or chemical restraints as a primary intervention for managing disruptive behaviors.

In recent years, providing care for individuals with severe mental illness has consumed increasing state and federal financial resources, with State Medicaid systems bearing the heaviest burden. Managed care strategies have been initiated by public mental health systems as a mechanism to control expenses. The state of Maryland implemented a mental health carve-out on July 1, 1997. The purpose of the present study is to describe the effects of the carve-out on access-to-care for individuals using emergency department services in one suburban health care system. Data for this study included all episodes of emergency crisis care in pre-implementation (1996-1997) and post-implementation (1998-1999) time periods. These data were examined within the context of the Behavioral Model of Health Service Use (Andersen, 1995) to describe the interrelationships among external environment, predisposing characteristics, and enabling resources on use of health services. Use of health services was operationalized by four outcomes: disposition, length of stay, number of visits, and recidivism. There were a total of 2986 episodes, initiated by 1928 individuals. Logistic regression demonstrated that when controlling for predisposing characteristics and enabling resources, the likelihood of inpatient admission did not change after initiation of the program. Moreover, there was not a significant change in the number of emergency visits. The assessment of recidivism demonstrated that only psychotic disorders (a predisposing characteristic) were a significant predictor of 30-day repeat visits. Multiple regression models examining the impact of the carve-out on length of stay demonstrated a significant increase in the emergency department length of stay (F = 5.47, p = .05) following the implementation of the carve-out. While benefits associated with improved coordination of services might be expected with the implementation of the carve-out, there was not a change in inpatient admissions, number of emergency visits, or recidivism. Additionally, there was a significant increase in the amount of time required to assess patients and to provide an appropriate disposition. The limited study sample and data prohibit generalizability. Considering that evaluations of mental health carve-outs are limited, this study reflects that anticipated benefits have not been experienced in emergency departments.

People with developmental disabilities are recognized as a vulnerable population and are frequently at increased risk due to their physical, social, economic and societal disparities. Despite these vulnerabilities, the regulations that govern community-based residential settings for the developmentally disabled provide little oversight with regard to home environmental health hazards such as lead, mercury, carbon monoxide, pesticides, radon and volatile organic compounds. Minimal data are available about the environmental health risks experienced by people in residential settings for the developmentally disabled and about how the behaviors and choices of support staff affect the indoor air quality in these residences. This study assessed the home characteristics, household behaviors and practices that place people with developmental disabilities at health risk from environmental hazards in their homes. Homes (N=57) run by three major service providers of residential services for the developmentally disabled in Anne Arundel County, Maryland were selected using random stratified sampling for evaluation. A survey and a home environmental assessment conducted by an observational walk-through of each home were used to assess the presence of neurotoxicants such as lead and mercury in the home, protective devices such as carbon monoxide detectors and radon testing, and the use of behaviors and practices that contribute to indoor pollution from pesticides, environmental tobacco smoke and cleaning products.;Twenty-eight homes (49%) had at least one source of carbon monoxide exposure and 21 (72%) of these homes had no carbon monoxide detector. **Carbon monoxide detectors tended to be more likely in homes with than in homes without carbon monoxide sources. Radon was a concern. Fifty-six of 57 homes were not tested for radon. In 41 of the homes basements, where carbon monoxide and radon are likely to accumulate, were used as living space for staff and developmentally disabled residents. Forty-nine homes reported professional pesticide contracts and 56 homes contained products with volatile organic compounds. Regulation and education of providers is necessary to prevent environmental health risks in this vulnerable population. More research is needed to investigate the home environmental health risks of people with developmental disabilities and their staff living in residential settings.