We are currently not able to contact all our patients consistently by phone. VOC and VOP were rev... more We are currently not able to contact all our patients consistently by phone. VOC and VOP were reviewed. Phone contact inconsistencies impact patient care, continuity and take extra office resources and time. The process was reviewed with a SIPOC. This process starts with check in for an appointment when contact information is updated each visit and concludes with updated information.
We are currently not able to contact all our patients consistently by phone. VOC and VOP were rev... more We are currently not able to contact all our patients consistently by phone. VOC and VOP were reviewed. Phone contact inconsistencies impact patient care, continuity and take extra office resources and time. The process was reviewed with a SIPOC. This process starts with check in for an appointment when contact information is updated each visit and concludes with updated information.
Although the co-occurrence of multiple risk factors increases the risk of cardiovascular disease ... more Although the co-occurrence of multiple risk factors increases the risk of cardiovascular disease (CVD) morbidity/mortality, few studies have examined the prevalence of risk factor clustering among African Americans in community-based faith settings. This study examined the prevalence and clustering of CVD risk factors in a sample of church members from South Carolina. Cross-sectional analysis of baseline data from a faith-based intervention, Faith, Activity, and Nutrition (FAN). African Methodist Episcopal churches in four geographically-defined districts in South Carolina. 1119 church members. Self-reported presence or absence of healthcare provider diagnosed diabetes, high cholesterol, and hypertension. Objectively measured blood pressure, height, and weight (body mass index) were also taken. The prevalence of single, multiple, and clustering of risk factors was computed. 62% of participants were obese, 64% had hypertension, 23% had diabetes, and 39% had high cholesterol; 15% had ...
The potential benefit of physical activity (PA) programs delivered through churches is largely un... more The potential benefit of physical activity (PA) programs delivered through churches is largely unexamined. This study examined availability of PA programs, interpersonal support for PA, and PA participation in African-American churches. Individuals from a random sample of 20 churches in South Carolina participated in a telephone survey (N = 571). Forty two percent of respondents reported PA programs at their churches. Walking programs (20%), aerobics (22%) or a combination of both (20%) were most common. Respondents who reported having these programs were more likely to meet PA recommendations than those who did not (p = 0.05). Larger churches were more likely to offer PA programs (p = 0.02) than small or medium sized churches. Only 24% of respondents had spoken with the health director at their church about participating in a PA program, and only 25% and 33% had ever spoken with another church member about a PA program or were encouraged to join a PA program, respectively. Individu...
Physical activity (PA) participation offers many benefits especially among ethnic groups that exp... more Physical activity (PA) participation offers many benefits especially among ethnic groups that experience health disparities. Partnering with faith-based organizations allows for a more culturally tailored approach to changing health behaviors. 8 Steps to Fitness was a faith-based behavior-change intervention promoting PA among members of African American churches. A quasi-experimental design was used to examine differences between the intervention group (n = 72) and comparison group (n = 74). Health (resting blood pressure, body mass index, waist-hip ratio, fasting blood glucose), psychosocial (PA self-efficacy, social support, enjoyment, self-regulation, depression), and behavioral variables (PA, diet) were assessed at baseline, 3- and 6-months. Repeated measures ANCOVAs tested changes across time between groups. At 3-months, the intervention group showed significantly more favorable changes in body mass index, waist circumference and social support than the control group. At 6-mon...
Health-e-AME was a 3-year intervention designed to promote physical activity at African Methodist... more Health-e-AME was a 3-year intervention designed to promote physical activity at African Methodist Episcopal churches across South Carolina. It is based on a community-participation model designed to disseminate interventions through trained volunteer health directors. We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate this intervention through interviews with 50 health directors. Eighty percent of the churches that had a health director trained during the first year of the intervention and 52% of churches that had a health director trained during the second year adopted at least one component of the intervention. Lack of motivation or commitment from the congregation was the most common barrier to adoption. Intervention activities reached middle-aged women mainly. The intervention was moderately well implemented, and adherence to its principles was adequate. Maintenance analyses showed that individual participants in the interv...
The 7th Episcopal District African Methodist Episcopal Church represents 23% of African Americans... more The 7th Episcopal District African Methodist Episcopal Church represents 23% of African Americans in South Carolina. We describe lessons learned when a large faith community and two research universities collaborate. In 2001, the bishop of the 7th Episcopal District and the president of the Medical University of South Carolina signed a memorandum of understanding on how to collaborate, including the principles of sharing resources, credit, and responsibility. Planning and research committees, with representatives from the church and university, designed and evaluated a website to reduce health disparities and encourage the use of the internet In 2002, with the University of South Carolina as a new partner, we obtained a grant from the Centers for Disease Control and Prevention to promote physical activity. Open communications and trust are keys to a successful partnership. This partnership requires people who are dedicated to the principles in the memorandum of understanding, are op...
Poor dietary habits and sedentary lifestyle contribute to excessive morbidity and mortality. Heal... more Poor dietary habits and sedentary lifestyle contribute to excessive morbidity and mortality. Healthy People 2010 goals are for 85% of physicians to counsel their patients about physical activity and for 75% of physician office visits made by patients with cardiovascular disease, diabetes, or dyslipidemia to include dietary counseling. The purpose of this study was to 1) determine the rate of participant-reported health care provider advice for healthy lifestyle changes among African Americans who do not meet recommendations for physical activity, fruit and vegetable consumption, and healthy weight; 2) examine correlates of provider advice; and 3) assess the association between provider advice and stage of readiness for change for each of these health behaviors. Data for this study were collected as part of a statewide faith-based physical activity program for African Americans. A stratified random sample of 20 African Methodist Episcopal churches in South Carolina was selected to pa...
Retaining women in substance abuse treatment is difficult. Increased length of stay (LOS) has bee... more Retaining women in substance abuse treatment is difficult. Increased length of stay (LOS) has been found to be predictive of positive treatment outcomes, including lower drug use, criminal behavior, and unemployment among adults, and improved growth and development for children. This study used survival analysis statistical methods to examine LOS in a residential treatment program for women and children as the program shifted from a traditional therapeutic community, to gender-specific programming, to interdisciplinary, family-focused treatment. Results suggest that with implementation of family-focused treatment, LOS increases more than with gender-specific programming alone.
The purpose of this study was to examine the influence of sociodemographic factors, attitudes, kn... more The purpose of this study was to examine the influence of sociodemographic factors, attitudes, knowledge, and experiences regarding the use of various contraceptive methods, future plans prenatally, and actual use postpartum among a population of low income pregnant women. Women were interviewed prenatally and during the postpartum period in a large, urban academic health center serving primarily an indigent population. The primary analytic method employed was logistic regression. The key finding in this study is that women are not consistently using the method of contraception postpartum that they planned during the prenatal period. Only 54.7% of the women planning to use oral contraceptive pills were using them postpartum, and only 31.3% of the women planning to use condoms were actually using them postpartum. Expanding contraceptive education and counseling throughout the perinatal period may assist women's decision making.
Reports by others that stress surrounding AID alters the menstrual cycle has prompted some physic... more Reports by others that stress surrounding AID alters the menstrual cycle has prompted some physicians to provide pharmacologic control to predict the day of ovulation. We studied the BBT charts of 47 women who had predictable menstrual cycles in the 2 months preceding AID in order to compare them with day of ovulation and length of luteal phase of the 1st month of AID. Although there was a significant difference in the day of ovulation between AID and non-AID months, the difference was less than 1 day. We did not find the large shift in ovulation day during the 1st month of AID reported by others.
Variation in semen measures was assessed bimonthly in 15 healthy men over a 6-month period. Avera... more Variation in semen measures was assessed bimonthly in 15 healthy men over a 6-month period. Average within-subject coefficients of variation for sperm count, morphologic features, motility, and semen volume demonstrate considerable variation. Each day of abstinence increased the volume by an increment of 0.62 ml, the count by 17.6 X 10(6)/ml, and motility by 1.2%. Sperm count and semen volume correlated positively within subjects. Intraclass and serial correlations of semen measures provided an empirical clinical guide to the number and spacing of specimens. Three specimens spaced no more than 2 weeks apart established a reliable semen profile. Findings can be applied to basic research and clinical practice.
This article reports the development of a paraprofessional home visiting program based upon empir... more This article reports the development of a paraprofessional home visiting program based upon empirically documented client needs, maintenance of the qualities of mutuality and cooperation found in the indigenous paraprofessionals, and methods of ongoing program revision. Three studies are described that suggested four areas of program emphasis: (1) continuity of services from pregnancy through infancy, (2) needs assessment procedures sensitive to a broad range of health and social problems, (3) an ongoing personal relationship with an indigenous paraprofessional, and (4) reduction of barriers to prenatal care inherent in the health care system itself. We provide examples of program application and revision through training of paraprofessionals, case management procedures, and interventions within the perinatal health care system.
While hospitals have widely adopted quality improvement (QI) initiatives, primary care practices ... more While hospitals have widely adopted quality improvement (QI) initiatives, primary care practices continue to face unique challenges to QI implementation. The purpose of this article is to outline a strategy for promoting QI in primary care practices by introducing specially trained nurses. Two case examples are described, one with a QI nurse external to the practice and one with a nurse internal to the practice. Lessons learned and barriers and facilitators to QI in primary care are presented. Barriers and facilitators are identified in the following categories: practice infrastructure, practice leadership, and practice organizational culture. Implications for primary care practitioners and avenues for future work are discussed.
The aim of this study was to evaluate the frequency of Internet use among African-Americans at ri... more The aim of this study was to evaluate the frequency of Internet use among African-Americans at risk of cardiovascular disease and to determine the feasibility of developing Webbased, culturally relevant health information programs to reduce cardiovascular disease in the African American faith community. A cross-sectional survey was used to investigate the association of Internet use with the risk of cardiovascular disease (CVD) among members of African Methodist Episcopal churches in South Carolina. A telephone survey including questions on demographic factors, medical history, diet, and exercise was administered to a sample of 208 adult church members. A preventable CVD risk factor was defined as having any of the following: hypertension, obesity, diabetes, high cholesterol, cigarette use, and not participating in moderate physical activity. A logistic regression determined the relationship of having a preventable CVD risk factor with Internet use while controlling for potential confounding variables. Among respondents, 47% used the Internet with most (65%) using it for 1 month or less. Most (87%) have at least one preventable CVD risk factor. Both higher education and younger age were significantly associated with Internet use. Results of the logistic regression indicate that individuals with a cardiovascular risk factor were not significantly less likely to use the Internet when controlling for age and education. Use of the Internet has potential to reach large populations, however, more work needs to be done to increase access to the Internet by older African-Americans at greatest risk of CVD before this approach can be effective.
We are currently not able to contact all our patients consistently by phone. VOC and VOP were rev... more We are currently not able to contact all our patients consistently by phone. VOC and VOP were reviewed. Phone contact inconsistencies impact patient care, continuity and take extra office resources and time. The process was reviewed with a SIPOC. This process starts with check in for an appointment when contact information is updated each visit and concludes with updated information.
We are currently not able to contact all our patients consistently by phone. VOC and VOP were rev... more We are currently not able to contact all our patients consistently by phone. VOC and VOP were reviewed. Phone contact inconsistencies impact patient care, continuity and take extra office resources and time. The process was reviewed with a SIPOC. This process starts with check in for an appointment when contact information is updated each visit and concludes with updated information.
Although the co-occurrence of multiple risk factors increases the risk of cardiovascular disease ... more Although the co-occurrence of multiple risk factors increases the risk of cardiovascular disease (CVD) morbidity/mortality, few studies have examined the prevalence of risk factor clustering among African Americans in community-based faith settings. This study examined the prevalence and clustering of CVD risk factors in a sample of church members from South Carolina. Cross-sectional analysis of baseline data from a faith-based intervention, Faith, Activity, and Nutrition (FAN). African Methodist Episcopal churches in four geographically-defined districts in South Carolina. 1119 church members. Self-reported presence or absence of healthcare provider diagnosed diabetes, high cholesterol, and hypertension. Objectively measured blood pressure, height, and weight (body mass index) were also taken. The prevalence of single, multiple, and clustering of risk factors was computed. 62% of participants were obese, 64% had hypertension, 23% had diabetes, and 39% had high cholesterol; 15% had ...
The potential benefit of physical activity (PA) programs delivered through churches is largely un... more The potential benefit of physical activity (PA) programs delivered through churches is largely unexamined. This study examined availability of PA programs, interpersonal support for PA, and PA participation in African-American churches. Individuals from a random sample of 20 churches in South Carolina participated in a telephone survey (N = 571). Forty two percent of respondents reported PA programs at their churches. Walking programs (20%), aerobics (22%) or a combination of both (20%) were most common. Respondents who reported having these programs were more likely to meet PA recommendations than those who did not (p = 0.05). Larger churches were more likely to offer PA programs (p = 0.02) than small or medium sized churches. Only 24% of respondents had spoken with the health director at their church about participating in a PA program, and only 25% and 33% had ever spoken with another church member about a PA program or were encouraged to join a PA program, respectively. Individu...
Physical activity (PA) participation offers many benefits especially among ethnic groups that exp... more Physical activity (PA) participation offers many benefits especially among ethnic groups that experience health disparities. Partnering with faith-based organizations allows for a more culturally tailored approach to changing health behaviors. 8 Steps to Fitness was a faith-based behavior-change intervention promoting PA among members of African American churches. A quasi-experimental design was used to examine differences between the intervention group (n = 72) and comparison group (n = 74). Health (resting blood pressure, body mass index, waist-hip ratio, fasting blood glucose), psychosocial (PA self-efficacy, social support, enjoyment, self-regulation, depression), and behavioral variables (PA, diet) were assessed at baseline, 3- and 6-months. Repeated measures ANCOVAs tested changes across time between groups. At 3-months, the intervention group showed significantly more favorable changes in body mass index, waist circumference and social support than the control group. At 6-mon...
Health-e-AME was a 3-year intervention designed to promote physical activity at African Methodist... more Health-e-AME was a 3-year intervention designed to promote physical activity at African Methodist Episcopal churches across South Carolina. It is based on a community-participation model designed to disseminate interventions through trained volunteer health directors. We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate this intervention through interviews with 50 health directors. Eighty percent of the churches that had a health director trained during the first year of the intervention and 52% of churches that had a health director trained during the second year adopted at least one component of the intervention. Lack of motivation or commitment from the congregation was the most common barrier to adoption. Intervention activities reached middle-aged women mainly. The intervention was moderately well implemented, and adherence to its principles was adequate. Maintenance analyses showed that individual participants in the interv...
The 7th Episcopal District African Methodist Episcopal Church represents 23% of African Americans... more The 7th Episcopal District African Methodist Episcopal Church represents 23% of African Americans in South Carolina. We describe lessons learned when a large faith community and two research universities collaborate. In 2001, the bishop of the 7th Episcopal District and the president of the Medical University of South Carolina signed a memorandum of understanding on how to collaborate, including the principles of sharing resources, credit, and responsibility. Planning and research committees, with representatives from the church and university, designed and evaluated a website to reduce health disparities and encourage the use of the internet In 2002, with the University of South Carolina as a new partner, we obtained a grant from the Centers for Disease Control and Prevention to promote physical activity. Open communications and trust are keys to a successful partnership. This partnership requires people who are dedicated to the principles in the memorandum of understanding, are op...
Poor dietary habits and sedentary lifestyle contribute to excessive morbidity and mortality. Heal... more Poor dietary habits and sedentary lifestyle contribute to excessive morbidity and mortality. Healthy People 2010 goals are for 85% of physicians to counsel their patients about physical activity and for 75% of physician office visits made by patients with cardiovascular disease, diabetes, or dyslipidemia to include dietary counseling. The purpose of this study was to 1) determine the rate of participant-reported health care provider advice for healthy lifestyle changes among African Americans who do not meet recommendations for physical activity, fruit and vegetable consumption, and healthy weight; 2) examine correlates of provider advice; and 3) assess the association between provider advice and stage of readiness for change for each of these health behaviors. Data for this study were collected as part of a statewide faith-based physical activity program for African Americans. A stratified random sample of 20 African Methodist Episcopal churches in South Carolina was selected to pa...
Retaining women in substance abuse treatment is difficult. Increased length of stay (LOS) has bee... more Retaining women in substance abuse treatment is difficult. Increased length of stay (LOS) has been found to be predictive of positive treatment outcomes, including lower drug use, criminal behavior, and unemployment among adults, and improved growth and development for children. This study used survival analysis statistical methods to examine LOS in a residential treatment program for women and children as the program shifted from a traditional therapeutic community, to gender-specific programming, to interdisciplinary, family-focused treatment. Results suggest that with implementation of family-focused treatment, LOS increases more than with gender-specific programming alone.
The purpose of this study was to examine the influence of sociodemographic factors, attitudes, kn... more The purpose of this study was to examine the influence of sociodemographic factors, attitudes, knowledge, and experiences regarding the use of various contraceptive methods, future plans prenatally, and actual use postpartum among a population of low income pregnant women. Women were interviewed prenatally and during the postpartum period in a large, urban academic health center serving primarily an indigent population. The primary analytic method employed was logistic regression. The key finding in this study is that women are not consistently using the method of contraception postpartum that they planned during the prenatal period. Only 54.7% of the women planning to use oral contraceptive pills were using them postpartum, and only 31.3% of the women planning to use condoms were actually using them postpartum. Expanding contraceptive education and counseling throughout the perinatal period may assist women's decision making.
Reports by others that stress surrounding AID alters the menstrual cycle has prompted some physic... more Reports by others that stress surrounding AID alters the menstrual cycle has prompted some physicians to provide pharmacologic control to predict the day of ovulation. We studied the BBT charts of 47 women who had predictable menstrual cycles in the 2 months preceding AID in order to compare them with day of ovulation and length of luteal phase of the 1st month of AID. Although there was a significant difference in the day of ovulation between AID and non-AID months, the difference was less than 1 day. We did not find the large shift in ovulation day during the 1st month of AID reported by others.
Variation in semen measures was assessed bimonthly in 15 healthy men over a 6-month period. Avera... more Variation in semen measures was assessed bimonthly in 15 healthy men over a 6-month period. Average within-subject coefficients of variation for sperm count, morphologic features, motility, and semen volume demonstrate considerable variation. Each day of abstinence increased the volume by an increment of 0.62 ml, the count by 17.6 X 10(6)/ml, and motility by 1.2%. Sperm count and semen volume correlated positively within subjects. Intraclass and serial correlations of semen measures provided an empirical clinical guide to the number and spacing of specimens. Three specimens spaced no more than 2 weeks apart established a reliable semen profile. Findings can be applied to basic research and clinical practice.
This article reports the development of a paraprofessional home visiting program based upon empir... more This article reports the development of a paraprofessional home visiting program based upon empirically documented client needs, maintenance of the qualities of mutuality and cooperation found in the indigenous paraprofessionals, and methods of ongoing program revision. Three studies are described that suggested four areas of program emphasis: (1) continuity of services from pregnancy through infancy, (2) needs assessment procedures sensitive to a broad range of health and social problems, (3) an ongoing personal relationship with an indigenous paraprofessional, and (4) reduction of barriers to prenatal care inherent in the health care system itself. We provide examples of program application and revision through training of paraprofessionals, case management procedures, and interventions within the perinatal health care system.
While hospitals have widely adopted quality improvement (QI) initiatives, primary care practices ... more While hospitals have widely adopted quality improvement (QI) initiatives, primary care practices continue to face unique challenges to QI implementation. The purpose of this article is to outline a strategy for promoting QI in primary care practices by introducing specially trained nurses. Two case examples are described, one with a QI nurse external to the practice and one with a nurse internal to the practice. Lessons learned and barriers and facilitators to QI in primary care are presented. Barriers and facilitators are identified in the following categories: practice infrastructure, practice leadership, and practice organizational culture. Implications for primary care practitioners and avenues for future work are discussed.
The aim of this study was to evaluate the frequency of Internet use among African-Americans at ri... more The aim of this study was to evaluate the frequency of Internet use among African-Americans at risk of cardiovascular disease and to determine the feasibility of developing Webbased, culturally relevant health information programs to reduce cardiovascular disease in the African American faith community. A cross-sectional survey was used to investigate the association of Internet use with the risk of cardiovascular disease (CVD) among members of African Methodist Episcopal churches in South Carolina. A telephone survey including questions on demographic factors, medical history, diet, and exercise was administered to a sample of 208 adult church members. A preventable CVD risk factor was defined as having any of the following: hypertension, obesity, diabetes, high cholesterol, cigarette use, and not participating in moderate physical activity. A logistic regression determined the relationship of having a preventable CVD risk factor with Internet use while controlling for potential confounding variables. Among respondents, 47% used the Internet with most (65%) using it for 1 month or less. Most (87%) have at least one preventable CVD risk factor. Both higher education and younger age were significantly associated with Internet use. Results of the logistic regression indicate that individuals with a cardiovascular risk factor were not significantly less likely to use the Internet when controlling for age and education. Use of the Internet has potential to reach large populations, however, more work needs to be done to increase access to the Internet by older African-Americans at greatest risk of CVD before this approach can be effective.
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Papers by Marilyn Laken