Skip to main content
eScholarship
Open Access Publications from the University of California

Scholarly Works (8 results)

  • Article
  • Peer Reviewed
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 15, Issue 3 (2014)

Introduction: The primary objective was to identify the most common reasons for intending to cut back on alcohol use, in emergency department (ED) and trauma patient populations. The secondary objective was to determine the association between reason to cut back on alcohol and education level.

Methods: We conducted the study at a level one trauma center in California between 2008 and 2012. This was a retrospective analysis of data collected from computerized alcohol screening and intervention (CASI). We excluded patients who drank too little, and those whose scores were consistent with dependency (Alcohol Use Disorders Identification Test [AUDIT]>19). The CASI database includes the patient’s age, gender, language, education level, an AUDIT score (1-40 scale), a readiness to change score (1-10), and the option to choose any of 10 “reasons to cut back” on their alcohol consumption.

Results: From 10,537 patients, 1,202 met criteria for the study (848 ED, 354 trauma). Overall, the most common reasons cited for cutting back on alcohol were “To avoid health problems” (68.5%), “To avoid getting a DUI” (43.6%), “It could save me money” (42.0%), and “To avoid situations where I could get hurt” (41.0%). Trauma patients cited the following reasons significantly more than ED patients: “To avoid situations where I could get hurt” (46.3% versus 38.8%, respectively), “So I can be in control of my behavior” (40.7% versus 32.2%), and “My partner or spouse wants me to stop” (20.1% versus 15.0%). Additionally, those patients who cited “To avoid health problems” reported 1.2 points higher than average (p<0.001) on the 10-point readiness to change scale. Those who have completed some college or an associate degree cited “To avoid health problems” less often than high school graduates (odds ratio [OR] 0.45), while they cited “To avoid situations where I could get hurt” (OR 2.5) and “To avoid being in a car crash caused by alcohol use” (OR 3.8) more often than high school graduates.

Conclusion: Health, injury, finances, and legal issues remain top concerns for patients, while trauma patients specifically had proportionately more concerns with situations where they could get hurt. [West J Emerg Med. 2014;15(3):337–344.]

    Cover page: Readiness to Change and Reasons for Intended Reduction of Alcohol Consumption in Emergency Department versus Trauma PopulationCreative Commons 'BY-NC' version 4.0 license
    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2006)

    Purpose

    This study examined differences in smoking prevalence and differences in associations between family functioning, self-image and adolescent smoking behavior among four Asian-American subgroups.

    Methods

    Statistical analyses were conducted on responses about their smoking behaviors from 1139 students who self-identified as Chinese-Americans, Filipino-Americans, Korean-Americans, and Vietnamese-Americans.

    Results

    Significant differences in the prevalence of ever-tried smoking and 30-day smoking were found across subgroups, but there were no overall gender differences. Korean-American adolescents reported the highest lifetime smoking and 30-day smoking rates, followed by Vietnamese- and Filipino-Americans. Chinese-Americans reported the lowest smoking rates. There were also differences in the associations between smoking and family functioning and self-image across the four subgroups. High family functioning was inversely associated with smoking for Chinese- and Korean-American adolescents, but not for Filipino- and Vietnamese-Americans. On the other hand, high self-image was associated with decreased risk of smoking for Filipino- and Vietnamese-Americans, but not for the other two subgroups.

    Conclusion

    Findings of this study demonstrate that family functioning and self-image varied across Asian-American subgroups. This suggests the need to understand etiological differences between the groups as well as potential implications for prevention cessation programs.
      Cover page: Effects of Family Functioning and Self-Image on Adolescent Smoking Initiation among Asian-American SubgroupsCreative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (2016)
      This study employed a Multi-Attribute Utility (MAU) model to examine the Pap test decision-making process among Pacific Islanders (PI) residing in Southern California. A total of 585 PI women were recruited through social networks from Samoan and Tongan churches, and Chamorro family clans. A questionnaire assessed Pap test knowledge, beliefs and past behaviour. The three MAU parameters of subjective value, subjective probability and momentary salience were measured for eight anticipated consequences of having a Pap test (e.g., feeling embarrassed, spending money). Logistic regression indicated that women who had a Pap test (Pap women) had higher total MAU utility scores compared to women who had not had a Pap test within the past three years (No Pap women) (adjusted Odds Ratio = 1.10). In particular, Pap women had higher utilities for the positive consequences 'Detecting cervical cancer early, Peace of mind, and Protecting my family', compared to No Pap women. It is concluded that the connection between utility and behaviour offers a promising pathway toward a better understanding of the decision to undergo Pap testing.
        Cover page: Decision making for Pap testing among Pacific Islander women
        • Article
        • Peer Reviewed
        ICTS Publications (2013)
        Background

        The impact of alcohol use has been widely studied and is considered a public health issue. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends Screening and Brief Intervention and Referral Treatment (SBIRT) but the actual practice in the Emergency Department (ED) is constrained due to limited provider time and financial resources.

        Objectives

        To assess the effectiveness of alcohol screening using Computerized Alcohol Screening and brief Intervention (CASI) compared to alcohol screening by triage nurse during Medical Screening Examination (MSE) in the ED.

        Methods

        Retrospective review of CASI/MSE database from January 2008 through December 2009, collected in the tertiary, level I Trauma ED was performed. Inclusion criteria included age ≥18, and completion of both the MSE and CASI. We analyzed the database by comparing age, gender, primary language (English, Spanish), and Alcohol Use Disorders Identification Test (AUDIT) scores using McNemar’s analysis.

        Results

        Data was available for 5,835 patients. CASI showed a significant increase in detection of at-risk drinking over MSE across all ages, gender, and primary language (p<.05). MSE found 2.5% at-risk drinkers while CASI found 11.5% at risk drinkers (Odds ratio 8.88, 95%CI 6.89–11.61). Similar results were found in 18 to 20 year-old patients. MSE identified 1.7% at-risk drinkers and CASI reported 15.94%. (Odds ratio 19.33, 95% CI 6.29–96.74)

        Conclusion

        CASI increased detection of at-risk alcohol drinkers compared with MSE across all ages, gender, and primary language. CASI is a promising innovative method for alcohol screening in the ED for the adult population including under-aged drinkers.

          Cover page: Increased Detection of Alcohol Consumption and At-risk Drinking with Computerized Alcohol Screening
          • Article
          • Peer Reviewed
          ICTS Publications (2013)
          Objective

          To assess drinking patterns of Spanish-speaking patients using a bilingual Computerized Alcohol Screening and brief Intervention (CASI) tablet computer equipped with the Alcohol Use Disorders Identification Test (AUDIT).

          Methods

          This retrospective study was conducted in a tertiary university hospital emergency department (ED) between 2006 and 2010. Data from 1,816 Spanish-speaking ED patients was analyzed using descriptive statistics, the chi-square test for independence, and the Kruskal-Wallis rank sum test for comparisons using quantitative variables.

          Results

          Overall, 15% of Spanish-speaking patients were at-risk drinkers, and 5% had an AUDIT score consistent with alcohol dependency (≥20). A higher percentage of Spanish-speaking males than females were at-risk drinkers or likely dependent. Spanish speaking males exhibited higher frequency of drinking days per week and higher number of drinks per day compared to females. Among older patients, non-drinking behavior increased and at-risk drinkers decreased. The majority of males and females were ready to change their behavior after the CASI intervention; 61% and 69% respectively scored 8-10.

          Conclusions

          This study indicated that CASI was an effective tool for detecting at-risk and likely dependent drinking behavior in Spanish-speaking ED patients. The majority of patients were ready to change their drinking behavior. More alcohol screening and brief intervention tools should be tested and become readily accessible for Spanish-speaking patients.

            Cover page: Assessment of Alcohol Use Patterns Among Spanish-Speaking Patients
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2019)

            Background

            Pap tests remain an essential cervical cancer detection method in the United States, yet they are underutilized among Pacific Islanders (PI) who experience elevated cervical cancer incidence and mortality. This study describes the design, methods, participants, and outcomes of a multiyear (2010-2016), community-based randomized intervention trial in southern California. Based upon strong collectivistic norms, the trial tested the efficacy of a unique social support intervention targeting Chamorro, Samoan, and Tongan women and their male husbands/partners.

            Methods

            A single-session educational intervention was designed and tailored for ethnic- and gender-specific groups to increase men's social support for their female wives/partners to receive a Pap test, and for women to receive a Pap test. The comparison group received preexisting brochures on Pap testing (for women) or general men's health (for men). Pretest and 6-month follow-up data were analyzed.

            Results

            Intervention and comparison groups were mostly equivalent on pretest demographics and outcome variables. Intervention women who were not compliant with Pap screening recommendations at pretest were significantly more likely to have scheduled and received a Pap test at 6-month follow-up. However, 6-month follow-up results indicated no intervention effect on changes in women's Pap testing knowledge, fatalistic attitudes, or perceived social support from their male partner.

            Conclusions

            Ethnic- and gender-tailored community interventions can successfully increase Pap test behaviors for PI women, although more research is needed on the specific pathways leading to behavior change.

            Impact

            Collaborative community-based interventions lead to increases in women's cancer prevention and early detection for Pacific Islander and other collectivistic communities.
              Cover page: Design and Outcomes of a Community Trial to Increase Pap Testing in Pacific Islander Women
              • Article
              • Peer Reviewed
              UC Irvine Previously Published Works (2016)
              Pacific Islanders experience high rates of cervical cancer incidence and mortality. This cross-sectional study examined the extent to which Samoan, Chamorro, and Tongan women's perceived receipt of social support from their husbands or male partners was associated with rates of routine cancer screening- specifically Pap testing. A total of 585 Pacific Islander women who live in the United States completed a self-report survey. Women who reported having a Pap test within the past 3 years had significantly higher scores on support from their husbands/male partners. Furthermore, the relationship of emotional support and informational support with increased Pap testing was significantly stronger for Tongan women. The findings suggest that men play an important role in promoting women's cancer prevention behaviors in Pacific Islander and potentially other collectivistic populations. Incorporating social support messages into interventions may be a simple yet effective strategy to increase women's Pap testing.
                Cover page: Associations Between Women’s Perception of Their Husbands’/Partners’ Social Support and Pap Screening in Pacific Islander CommunitiesCreative Commons 'BY' version 4.0 license
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2015)

                Background

                Pacific Islanders (PIs) experience high cervical cancer rates in the United States. Stage of diagnosis is also later for PIs than non-Hispanic Whites. The Pap test is severely underutilized among PIs: only 71% of Asian American and Pacific Islander women age 25 years or older received a Pap test within the last 3 years (U.S. average, 82%). Community-based participatory research (CBPR) is increasingly seen as an essential approach in designing and conducting culturally relevant and appropriate studies that reduce cancer incidence and other health disparities among minority and other medically underserved populations.

                Purpose

                The purpose of this article is to describe the lessons learned thus far regarding the identification, recruitment, and retention of PI community organizations and members into a CBPR-informed, randomized, community trial promoting Pap testing.

                Methods

                This 5-year study used CBPR to develop and test the efficacy of a social support intervention for Chamorro, Samoan, and Tongan women to increase Pap testing in southern California. Eligible women were between the ages of 21 and 65, and married or in a long-term relationship with a man for at least 5 years. Women and their husbands or significant others received a 2-hour, culturally tailored workshop that include a group activity, information on Pap testing, a video, and corresponding materials. Comparison participants received a brochure about Pap testing. Three waves of data are collected from all participants: pretest (before workshop or brochure), posttest 1 (immediately after workshop or brochure), and posttest 2 (6 months follow-up).

                Results

                Of the 76 organizations approached to participate in the study, 67 (88.2%) eventually agreed to participate. Thus far, 473 women and 419 men completed the study pretest, post-test, education, and 6-month follow-up. Only 242 women and 204 men of the eligible participants have completed the follow-up survey (63.5% of women and 60.5% of men retained after 6 months).

                Lessons learned

                The main strategy to overcome initial recruitment challenges was study staff persistence, because they averaged five contacts with each church or clan leader before receiving confirmation that an educational session can be scheduled. Personal connections provided an introduction to the most appropriate church or clan leader. Other efforts for retention include creation of an online version of the survey, re-attending church services, and creating special events organized around clan activities.

                Conclusions

                Although CBPR improves the cultural competence and relevance of study activities for ethnically diverse populations, selected past research shows that it does not ensure that such designs overcome all of the unique challenges in ethnically diverse communities. PI-specific organizational recruitment and individual retention is influenced by study issues and cultural factors in each community.
                  Cover page: CBPR-Informed Recruitment and Retention Adaptations in a Randomized Study of Pap Testing Among Pacific Islanders in Southern CaliforniaCreative Commons 'BY' version 4.0 license
                  Top