Faculty Bibliography

Disasters disproportionately impact certain segments of the population, including children, pregnant women, people living with disabilities and chronic conditions and those who are underserved and under-resourced. One of the most vulnerable groups includes the community-dwelling elderly. Post-disaster analyses indicate that these individuals have higher risk of disaster-related morbidity and mortality. They also have suboptimal levels of disaster preparedness in terms of their ability to shelter-in-place or evacuate to a shelter. The reasons for this have not been well characterized, although impaired health, financial limitations, and social isolation are believed to act as barriers to preparedness as well as to adaptability to changes in the environment both during and in the immediate aftermath of disasters. In order to identify strategies that address barriers to preparedness, we recently conducted a qualitative study of 50 elderly home care recipients living in San Francisco. Data were collected during in-home, in-person interviews using a semi-structured interview guide that included psychosocial constructs based on the social cognitive preparedness model and a new 13-item preparedness checklist. The mean preparedness score was 4.74 (max 13, range 1-11, SD. 2.11). Over 60 % of the participants reported that they had not made back-up plans for caregiver assistance during times of crisis, 74 % had not made plans for transportation to a shelter, 56 % lacked a back-up plan for electrical equipment in case of power outages, and 44 % had not prepared an emergency contacts list-the most basic element of preparedness. Impairments, disabilities, and resource limitations served as barriers to preparedness. Cognitive processes that underlie motivation and intentions for preparedness behaviors were lacking. There were limitations with respect to critical awareness of hazards (saliency), self-efficacy, outcome expectancy, and perceived responsibility. There was also a lack of trust in response agencies and authorities and a limited sense of community. Participants wanted to be prepared and welcomed training, but physical limitations kept many of them home bound. Training of home care aides, the provision of needed resources, and improved community outreach may be helpful in improving disaster outcomes in this vulnerable segment of the population.

OBJECTIVES: The aim of this study was to test a conceptual model designed to promote the understanding of factors influencing subjective well-being (SWB) in old age. Within this framework, we evaluated the relative influences on elderly Israelis' SWB of health and/or function, personal resources, coping behaviors (reactive and proactive), and changes in all of these factors over time. METHOD: At baseline, 1216 randomly selected elderly persons (75+) were interviewed at home (T1) and 1019 one year later (T2). The conceptual model was evaluated by Structural Equation Modeling (SEM) analysis using AMOS 18. RESULTS: After one year, a relatively high percentage of participants reported decline in health/function (DHF) and in personal resources. The effects of the study variables on T2-SWB were evaluated by a SEM analysis, resulting in a satisfying fit: chi2 = 279.5 (df = 102), p < .001, CFI = .970, NFI = .954, TLI = .955, RMSEA = .046. In addition to significant direct effects of health/function on T2-SWB, health/function was found to indirectly influence T2-SWB. Our analysis showed that health/function had a negative influence on the positive effects of personal resources (function self-efficacy, social support) and the diverse effects of the coping patterns (goal-reengagement - positive; expectations for future care needs - negative; having concrete plans for future care - positive). CONCLUSION: Personal resources and use of appropriate coping behaviors enable elderly people to control their well-being even in the presence of DHF. Evidence-based interventions can help older people to acquire and/or strengthen effective personal resources and coping patterns, thus, promoting their SWB.

Objectives: HIV is a chronic illness for those accessing treatment. Internationally, the palliative approach has reduced HIV symptom burden and improved outcomes in resource-constrained settings. Data presented here are from a study evaluating a curriculum to introduce the palliative approach early (ePA) in patient treatment to improve outcomes for those difficult to engage and retain in care---specifically, young men who have sex with men (yMSM). Methods: Using a quasi-experimental design, serial surveys are collected from yMSM (18-35 years) at two outpatient HIV clinics in one US city with high rates of poverty, violence, and substance abuse. Sociodemographics, psychosocial support, life events, substance use and mental health information are collected. Results: Of 171 patients accrued,77%are African American; 44% employed, 17% disabled; and 27% previously incarcerated. Viral measurement was suppressed (LT 200 copies/cc3) for 62%, although 60% missed a third, or more, of clinic visits in the past 6 months. Recent marijuana use is reported by 57%, 34% have an alcohol problem, and 11% used cocaine recently. High levels of depressive symptomatology are reported, with 44% scoring above the clinical case definition cutoff. On average, these young patients, or someone they knew, experienced nearly 4 of 17 serious adverse events, 44% experienced 3 or more such events. Depressive symptomatology was significantly correlated with the number of life events encountered (r=.302; p< .001) and personally experienced (r=.298; < .001). Those who experienced 3 or more events were twice as likely as those reporting none to have an alcohol problem (48% vs. 24%; 2=10.769, df=1, =.062). Conclusions: A majority of HIV+ yMSM have achieved viral suppression, despite psychosocial vulnerabilities placing them at increased risk for poor physical and psychological outcomes. Given their historical and concurrent needs, maintenance of viral suppression is likely predicated upon clinical services incorporating holistic management. Use of the palliative approach early in HIV disease management may assist staff in focusing their efforts to retain difficult to reach patients

Objective: Human immunodeficiency virus (HIV), a chronic illness for those accessing treatment, requires a paradigm shift moving from viral measurements alone to a perspective that encompasses quality of life as defined by the index person and his support system. HIV positive young men who have sex with men are at high risk for poor outcomes and for spreading disease, in part, because they are difficult to engage and retain in care. Outpatient staff themselves may be a contributing factor. We employed the palliative approach early (ePA) to assist non-palliative outpatient staff in improving outcomes for a difficult to engage and retain HIV population. Methods: Grounded in multidisciplinary, US-based didactic and iterative educational methods, we trained a multidisciplinary coaching team in elements of the palliative approach previously observed applicable to outpatient HIV disease management in international resource-constrained settings. On-site case discussion and coaching, with quarterly in-service educational sessions for all staff, then followed. An independent stakeholder advisory panel gave input at each step of the curriculum refinement. The curriculum was introduced in one US HIV clinic where a second HIV clinic served as the control. Results: The ePA attends to patients' holistic needs at critical life-course transitions. We introduced 8 PA skills: need for staff self-care when learning new skills; basic team building; respect for the individual; P2/S2 assessment (physical; psychoemotional; social; spiritual); communication skills about difficult to discuss topics; calendar driven goal-setting rather than crisis driven; symptom recognition and management; and reflection. Accepted behavior change techniques were employed and challenges observed. Discussion: External factors, such as a syndemic environment, may impact the ability of both patients and staff to form relationships. Point-of-service self-care strategies are critical when introducing new skills. The palliative approach used early may assist HIV staff in understanding the impact of care delivery upon specific patients and facilitate patients' engagement and retention in care

OBJECTIVES: To test the feasibility and efficacy of a culturally-tailored mobile health intervention designed to increase knowledge about, intent to obtain, and receipt of the HPV vaccine. METHODS: A 7-day text message HPV intervention was developed using a quasi-experimental research design for 30 Korean-American women. RESULTS: Participants demonstrated significant increases in knowledge of HPV with an intent to get vaccinated within one year, and 30% of participants received the first dose of the HPV vaccine. CONCLUSIONS: Mobile health technology could be a promising tool in reducing the cancer burden for underserved populations.

The stress of living with cardiac disease can affect a couple's marriage, transforming its character. This article examines the psychosocial impact of cardiovascular disease, delineating the ways in which the illness experience changes the marital relationship. In-depth, semistructured interviews were conducted with 23 spouses of patients (mean age 56) diagnosed with cardiovascular disease. Interviews were transcribed and subjected to content analysis. Two overarching dimensions emerged, depicting positive and negative effects on the marriage. Ongoing care for cardiac patients should include a focus on spousal caregivers, supporting both members of the couple as they jointly face challenges engendered by the illness.

ART CART: SAVING THE LEGACY is an intergenerational, interdisciplinary, interprofessional arts legacy project that connects aging professional artists (62+) with teams of advanced students to undertake the preparation and preservation of their creative work, offering a model of positive aging and an educational experience that will help shape the future of our American cultural legacy. Created from needs documented in research, the project launched in 2010-2011 in New York City, continued in 2012-2013 in New York City and Washington, DC, and will occur in six locations in 2015-2016. Twelve students and six professional visual artists participated; six faculty members in art education, arts administration, occupational therapy, social work and oral history conceptualized the curriculum and prepared the students. The evaluation comments by participating students, artists, their working partners and faculty members highlighted the value of the experiential, interdisciplinary learning environment, and the intergenerational interaction while simultaneously meeting individual program needs. © 2013 Taylor & Francis.

BACKGROUND: Cervical cancer poses a significant threat to Korean American women, who are reported to have one of the highest cervical cancer mortality rates in the United States. Studies consistently report that Korean American women have the lowest Pap test screening rates across US ethnic groups. OBJECTIVE: In response to the need to enhance cervical cancer screening in this vulnerable population, we developed and tested a 7-day mobile phone text message-based cervical cancer Screening (mScreening) intervention designed to promote the receipt of Pap tests by young Korean American women. METHODS: We developed and assessed the acceptability and feasibility of a 1-week mScreening intervention to increase knowledge of cervical cancer screening, intent to receive screening, and the receipt of a Pap test. Fogg's Behavior Model was the conceptual framework that guided the development of the mScreening intervention. A series of focus groups were conducted to inform the development of the intervention. The messages were individually tailored for each participant and delivered to them for a 7-day period at each participant's preferred time. A quasi-experimental research design of 30 Korean American women aged 21 to 29 years was utilized with baseline, post (1 week after the completion of mScreening), and follow-up (3 months after the completion of mScreening) testing. RESULTS: Findings revealed a significant increase in participants' knowledge of cervical cancer (P<.001) and guidelines for cervical cancer screening (P=.006). A total of 23% (7/30) (95% CI 9.9-42.3) of the mScreening participants received a Pap test; 83% (25/30) of the participants expressed satisfaction with the intervention and 97% (29/30) reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention. CONCLUSIONS: This study provides evidence of the effectiveness and feasibility of the mScreening intervention. Mobile technology is a promising tool to increase both knowledge and receipt of cervical cancer screening. Given the widespread usage of mobile phones among young adults, a mobile phone-based health intervention could be a low-cost and effective method of reaching populations with low cervical cancer screening rates, using individually tailored messages that cover broad content areas and overcome restrictions to place and time of delivery.