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Papers by Carol Cornell

Cancer Epidemiology, Biomarkers & Prevention, 2020

Introduction: Excess body weight is a critical modifiable risk factor for numerous cancers and on... more Introduction: Excess body weight is a critical modifiable risk factor for numerous cancers and one of the top public health problems in the country. Unfortunately, underserved groups bear a disproportionate burden, with African Americans having the highest rates of obesity. Behavioral weight loss interventions have been recommended by several governmental agencies to treat obesity and improve cancer risk, control, and survivorship. However, health care provider shortages in underserved areas have resulted in access gaps. Community Health Workers (CHWs), trusted community members, have filled these gaps and been successful in changing health behaviors (e.g. dietary intake, screening), associated with weight loss or cancer, but have not been thoroughly engaged to deliver evidence-based behavioral weight loss interventions. To increase reach among the underserved, community-based weight loss and maintenance interventions are critical. Methods: Building on a 10+ year partnership between...

Journal of health care for the poor and underserved, 2017

Rural African American cocaine users experience high rates of STIs/HIV. This NIDA-funded trial te... more Rural African American cocaine users experience high rates of STIs/HIV. This NIDA-funded trial tested an adapted evidence-based risk reduction program versus an active control condition. Participants were 251 African American cocaine users in rural Arkansas recruited from 2009-2011. Outcomes included condom use skills and self-efficacy, sexual negotiation skills, peer norms, and self-reported risk behavior. The intervention group experienced greater increases in condom use skills and overall effectiveness in sexual negotiation skills. Both groups reported reductions in trading sex, improvements in condom use self-efficacy, and increased use of specific negotiation skills. Implications and limitations are discussed.

Handbook of Health Promotion and Disease Prevention, 1999

... Delay in M. Janice Gilliland, James M. Raczynski• Behavioral Medicine Unit, Division of Preve... more ... Delay in M. Janice Gilliland, James M. Raczynski• Behavioral Medicine Unit, Division of Preventive Medicine, De-partment of Medicine, School of ... as 11 phases (Gillum, Feinleib, Margolis, Fabsitz, & Brasch, 1976; Maynard et al, 1991; Moss, Wynar, & Goldstein, 1969; Safer et al ...

Psychosomatic Medicine, 2004

The Enhancing Recovery in Coronary Heart Disease study was a multicenter clinical trial in which ... more The Enhancing Recovery in Coronary Heart Disease study was a multicenter clinical trial in which patients with depression and/or low perceived social support after an acute myocardial infarction were randomly assigned to an intervention consisting of cognitive behavior therapy and, in some cases, sertraline, or to usual care. There was no difference in survival between the groups. A possible reason why the intervention failed to affect survival is that too many patients with mild, transient depression were enrolled. Another is that some patients died too soon to complete the intervention. This analysis evaluates whether there was a difference in late (ie, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =6 months after the myocardial infarction) mortality among initially depressed patients who had a Beck Depression Inventory score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =10 and a past history of major depression, and who completed the 6-month post-treatment assessment. It also examines the relationship between change in depression and late mortality. Out of the 1,165 (47%) of the Enhancing Recovery in Coronary Heart Disease study participants who met our criteria, 57 died in the first 6 months, and 858 (409 usual care, 449 intervention) completed the 6-month assessment. Cox regression was used to analyze survival. The intervention did not affect late mortality. However, intervention patients whose depression did not improve were at higher risk for late mortality than were patients who responded to treatment. Patients whose depression is refractory to cognitive behavior therapy and sertraline, two standard treatments for depression, are at high risk for late mortality after myocardial infarction.

Contemporary Clinical Trials, 2015

Background-The positive effects of weight loss on obesity-related risk factors diminish unless we... more Background-The positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained. Yet little work has focused on the translation of evidence-based weight loss interventions with the aim of sustaining weight loss in underserved populations. Using a community-based participatory approach (CBPR) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans, who bear a disproportionate burden of the obesity epidemic. Objectives-Led by a collaborative community-academic partnership, The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural, African American adults of faith. Design-The WORD is a randomized controlled trial with 450 participants nested within 30 churches. All churches will receive a 16-session core weight loss intervention. Half of the churches will be randomized to receive an additional 12-session maintenance component. Methods-The WORD is a cultural adaptation of the Diabetes Prevention Program, whereby small groups will be led by trained church members. Participants will be assessed at baseline, 6, 12, and 18 months. A detailed cost-effectiveness and process evaluation will be included. Summary-The WORD aims to sustain weight loss in rural African Americans. The utilization of a CBPR approach and the engagement of the faith-based social infrastructure of African American communities will maximize the intervention's sustainability. Unique aspects of this trial

COLLABORATORS: BARBARA E. AINSWORTH, Ph.D., MPH,1 LYNDA A. ANDERSON, Ph.D.,2 DIANE M. BECKER, Sc.... more COLLABORATORS: BARBARA E. AINSWORTH, Ph.D., MPH,1 LYNDA A. ANDERSON, Ph.D.,2 DIANE M. BECKER, Sc.D., MPH,4 SUSAN J. BLALOCK, Ph.D.,3 DAVID R. BROWN, Ph.D.,2 ROSS C. BROWNSON, Ph.D.,5 NELL BROWNSTEIN, Ph.D.,2 CAROL E. ...

Psychosomatic Medicine, 2006

Depression is a robust predictor of cardiovascular risk. In this study, we examined the associati... more Depression is a robust predictor of cardiovascular risk. In this study, we examined the association between depression measured in terms of symptom severity and treatment history, cardiac symptom presentation, and clinical outcomes among a sample of women with suspected myocardial ischemia. Seven hundred fifty women with chest pain, mean age 53.4, completed a diagnostic protocol including depression measures, coronary angiogram, ischemia testing, and coronary disease risk factor assessment. Five hundred five participants also completed the Beck Depression Inventory. We further tracked participants over a mean 2.3-year period to evaluate subsequent cardiac events, hospitalization, and mortality. Depression treatment history and current symptom severity were differentially associated with cardiac symptoms and outcomes. Both measures were reliably associated with coronary artery disease (CAD) risk factors and more severe cardiac symptoms. Depression symptom severity was linked to an increased mortality risk over follow-up (RR = 1.05; 95% CI, 1.01-1.09), whereas depression treatment history predicted an increased risk of hospitalization (RR = 1.3; 95% CI, 1.02-1.6), less severe CAD from angiogram, and a reduced likelihood of a positive ischemia test. Among a sample of women with suspected myocardial ischemia, depression was associated with cardiac symptoms and health outcomes over follow-up. The findings extend the range of depression effects by demonstrating relationships within a sample of women experiencing symptoms of myocardial ischemia but showing a relative absence of flow limiting coronary stenoses. Depression measurements can assist the clinician in evaluating cardiac symptom presentation and cardiovascular risk status in women.

Psychotherapy and Psychosomatics, 2007

Objective: To determine whether the ‘dose’ of treatment exposure, delivery of specific components... more Objective: To determine whether the ‘dose’ of treatment exposure, delivery of specific components of cognitive behavior therapy (CBT), patient adherence and/or use of antidepressants predict favorable depression and social support outcomes after 6 months of cognitive behavioral treatment. Methods: Secondary analyses of the intervention arm of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial involving persons with acute myocardial infarction (MI): n = 641 for the depression outcomes and n = 523 for the social support outcomes. The outcome measures were, for depression: the Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAM-D); for social support: the ENRICHD Social Support Instrument (ESSI) and Perceived Social Support Scale (PSSS). Results: Better depression outcomes (measured by the BDI) were receiving a high number of depression-specific intervention components, p < 0.01, and completing a high proportion of homework assignment...

Preventive Medicine, 2003

Background. The purpose of this study was to examine the impact of the Pathways intervention on p... more Background. The purpose of this study was to examine the impact of the Pathways intervention on pychosocial variables related to physical activity and diet in American Indian children. Methods. Schools serving American Indian children were randomized to a multicomponent intervention or control condition. At baseline (fall of third grade) and in the spring semester of third, fourth, and fifth grades 755 boys and 692 girls completed a classroom-administered questionnaire. The questionnaire assessed self-efficacy, knowledge, and behavioral intentions related to diet and physical activity, as well as weight loss behaviors and body image. Results. Knowledge of nutrition and physical activity messages increased in both boys and girls in the intervention group compared to controls; however, knowledge of which foods contained more fat did not increase consistently. Compared to controls, self-efficacy to be physically active increased among girls in intervention schools, but not among boys, whereas self-efficacy to make more healthy food choices did not increase more than in controls in either gender. In the intervention group, compared to controls, healthy food intentions and participation in physically active behaviors increased in both boys and girls. Perception of healthy body size and weight loss attempts did not differ in the intervention and control groups. Conclusion. The Pathways intervention program had a positive impact on several aspects of obesity-related knowledge, attitudes, and behaviors.

Perceptual and Motor Skills, 1988

The purpose of this study was to determine whether different extents of mouth opening affect norm... more The purpose of this study was to determine whether different extents of mouth opening affect normal subjects' ( N = 24; 12 women, 12 men) ability to discriminate differences in their interincisor bite force. Three mouth openings were selected including 50, 70, and 90 percent of maximum opening for each subject. Bite force was measured using a specially designed strain gauge scale which permitted subjects to monitor visually when their biting force equalled a preset resistance. Resistance forces of 500 and 1000 gm. were selected as standards. The procedure involved the use of a modified method of constant stimuli in which each subject was presented with a series of paired resistance settings, one at a time—the first resistance setting being the standard and the second resistance was the comparator. This paired-comparisons procedure was continued until the subjects' difference limen (DL) value (the threshold of discrimination between two forces) could be established. An analys...

Journal of Women's Health, 2009

Background: Although extensive research has been conducted on both smoking and low exercise capac... more Background: Although extensive research has been conducted on both smoking and low exercise capacity alone, few studies have examined the joint impact or interaction of these two risk factors. We examined the joint and interactive effects of smoking and self-reported exercise capacity on subsequent clinical events (heart failure, myocardial infarction [MI], stroke, and cardiovascular-related mortality) among women with suspected myocardial ischemia. Methods: At baseline (1996-1999), 789 women completed angiographic testing of coronary artery disease (CAD) severity and provided self-report information about their smoking history and exercise capacity as well as demographic and other risk factor data. Incidence of clinical events among the women was tracked for a median of 5.9 years; this analysis was conducted in 2008. Results: In an adjusted survival analysis, women with a positive smoking history and self-reported low exercise capacity had the greatest risk of experiencing a clinical event (HR ¼ 7.7, 95% CI 2.3, 25.5), followed by women with a positive smoking history and self-reported high exercise capacity (HR ¼ 6.9, 95% CI 2.0, 24.6) and those with a negative smoking history and self-reported low exercise capacity (HR ¼ 4.9, 95% CI 1.5, 15.8), relative to women with a negative smoking history and self-reported high exercise capacity. Additional analyses revealed a significant interaction between smoking history and exercise capacity, such that (1) women with a positive smoking history did not experience an additional significantly greater risk due to low exercise capacity, unlike those with a negative smoking history, and (2) all women experienced a significantly greater risk due to a positive smoking history regardless of their exercise capacity. Conclusions: Among women with suspected myocardial ischemia, the combined protective health effects of selfreported high exercise capacity and a negative smoking history remained significant after controlling for preexisting CAD severity and other established risk factors. These findings highlight the importance of studying behavioral risk factors in combination.

Journal of Women's Health, 2004

We analyzed the impact of hormone replacement therapy (HRT) on psychological factors in white and... more We analyzed the impact of hormone replacement therapy (HRT) on psychological factors in white and black women. We hypothesized that both groups of women would have fewer symptoms of depression and lower hostility scores associated with HRT use. The cohort included 463 postmenopausal women from the National Heart, Lung and Blood Institute (NHLBI)-sponsored Women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Ischemia Syndrome Evaluation (WISE) study. WISE is a four-center study of women with chest pain who underwent quantitative coronary angiography for suspected ischemia. The psychosocial indices included the Beck Depression Inventory (BDI) and the Cook Medley Hostility questionnaire measuring cynicism, hostility, and aggression. There were no differences by race in use, duration, and type of HRT or presence of menopausal symptoms. There were differences by race in baseline psychological measurements, with black women exhibiting higher BDI scores and higher total Cook Medley scores (p = 0.03) than white women. Use of HRT was consistently associated with better psychological health in white women, with fewer symptoms of depression and lower aggression and cynicism scores (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.04). Black women with menopausal symptoms who used HRT had significantly lower hostility (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) and cynicism scores (p…

Journal of Women's Health, 2008

Aim-The aim of this study was to examine the association between the use of lipid-lowering medica... more Aim-The aim of this study was to examine the association between the use of lipid-lowering medication and aggressive responding, hostility, cynicism, and depression scores in women undergoing coronary angiography. Methods-The cohort included 498 women from the National Heart, Lung and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. WISE is a four-center study of women with chest pain who underwent quantitative coronary angiography for suspected myocardial ischemia. The psychosocial indices included the Cook Medley Hostility questionnaire, measuring aggression, hostility, and cynicism, and the Beck Depression Inventory (BDI). Results-Compared to those not on lipid-lowering medication, women receiving lipid-lowering pharmacotherapy were older (62 vs. 55 years, p < 0.001) and had more hypertension, dyslipidemia, diabetes, and coronary artery disease (CAD, defined as ≥50% stenoses in at least one epicardial artery) (all p < 0.003). Women on lipid-lowering medication had higher aggressive responding scores than those not on medication, 3.0 ± 1.8 vs. 2.7 ± 1.7, respectively (age-adjusted p < 0.003). This association persisted after adjustment for coronary risk factors, education, and extent of angiographic disease (CAD) (p < 0.005), and after exclusion of women using psychotropic medications (p < 0.001). Hostility, cynicism, and depression scores did not differ by medication use. Conclusions-In women, lipid-lowering medication may predispose to aggression without affecting hostility or mood, but this hypothesis requires evaluation in placebo-controlled clinical trials.

Journal of Oral Rehabilitation, 1988

This study examined and compared bilabial compression force difference limen (DL) values (the min... more This study examined and compared bilabial compression force difference limen (DL) values (the minimally perceivable difference between two compression forces) for a group of twenty normal-speaking female subjects (mean age, 25 years) under conditions with and without the teeth clenched. In addition, measures of maximum bilabial compression force under conditions with and without the teeth clenched were obtained. Mean DL values obtained against a standard of 100 gm were 36 gm for the clenched condition and 38 gm with no clenching. Discrimination performance under these two conditions was not significantly different (P>0-05). Mean maximum bilabial compression force was 411 gm with the teeth clenched and 568 gm without clenching. This difference in performance was significant (/'<0-01). This study provides initial normal data against which individuals with labial sensorimotor dysfunction can be compared.

The Journal of Nervous and Mental Disease, 1993

Forensic experts have focused more on the psychological profile of a serial killer rather than on... more Forensic experts have focused more on the psychological profile of a serial killer rather than on the pronounced effects on the community at large. Coping with a stressful event is thought to influence emotional states. However, little empirical understanding of this process exists. The present study examined changes in psychological factors 9 days after the occurrence of serial killings in a college community. Multivariate analyses of variance conducted on the variables of stress, anxiety, physical symptoms, and depression revealed a significant difference between the group tested after the murders and a cross-sectional cohort group. Univariate analyses revealed that the study class was significantly more depressed compared with the cohort group. The study class was also significantly more depressed compared with their own responses 1 year before the killings. For both classes, depression was significantly correlated with certain coping styles, including escape-avoidance and accept responsibility. Results have implications for certain coping behaviors (i.e., avoidant behaviors), such as that leaving the community may have been maladaptive and perhaps diverted attention from the more necessary active problem-solving behaviors (e.g., increasing security) in addition to increasing depression.

Journal of Cardiopulmonary Rehabilitation, 2003

High levels of depressive symptoms have been shown to affect the morbidity, mortality, and functi... more High levels of depressive symptoms have been shown to affect the morbidity, mortality, and functioning of patients with myocardial infarction (MI). Findings have shown that social support is associated with depression in both patient and community samples. This study examined various aspects of social support as they relate to depressive symptoms in patients with MI, both in the hospital and 2 weeks later. As part of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) pilot study, measures of perceived social support, social networks, social support received, and social conflict were administered to 196 patients with MI. These patients also were administered the Beck Depression Inventory and the Hamilton Rating Scale for Depression. Depression was reassessed 2 weeks later. Relations between social support indicators and the depression measures were examined. The prevalence of depression symptoms was high, especially among poorer and younger patients. There was modest improvement across time. Patients with high social support scores, particularly those reflecting perceived support, had lower scores on depression measures at baseline. High levels of perceived support and low social conflict at baseline were associated with less follow-up depression, as measured by the Beck cognitive scale, but not the Beck somatic scale nor the Hamilton scale. There were few associations with measures of social networks and received support. Social support indicators were differentially related to depression among patients with MI while in the hospital and 2 weeks later. The pattern of associations also depended on the measure of depression. A broad assessment strategy of both social support and depression is needed for a full understanding of their interrelations.

JAMA, 2000

LINICAL TRIALS OF THERAPY for acute myocardial infarction (AMI) demonstrate the potential to limi... more LINICAL TRIALS OF THERAPY for acute myocardial infarction (AMI) demonstrate the potential to limit infarct size and decrease mortality by coronary reperfusion and arrhythmia control. The effectiveness of these treatments is dependent on time and access to acute medical care. Coronary reperfusion requires early administration of thrombolytic agents or angioplasty. 1-3 Defibrillation and other methods to control cardiac arrhythmias require trained personnel and equipment in an appropriate clinical setting. 4,5 Although the need for timely receipt of these therapeutic strategies is well recognized, rapid access to emergency medical care re-Author Affiliations are listed at the end of this article.

Health Education & Behavior, 2004

This supplemental issue of Health Education & Behavior is devoted to the theme of prevention ... more This supplemental issue of Health Education & Behavior is devoted to the theme of prevention research in women’s health. Women’s health has improved markedly in the past century. A woman’s life expectancy increased from 48.3 years in 1900 to 79.8 years in 2001. The change in life expectancy for older women has been especially dramatic. In 1900, women rarely lived to age 90; in 1990, nearly one-quarter of 50-year-old women could expect to live to age 90. As documented in the recent Department of Health and Human Services (DHHS) publication, A Century of Women’s Health 1900-2000, life expectancy gains for women are largely attributable to prevention efforts such as washing hands, sanitizing medical equipment, and ensuring access to a safe water supply. That publication also describes how women’s health issues were integrated into health care training, public policy debates, health education programs, and clinical practice during the 20th century. Despite this progress, the scientific community paid little serious attention to genderspecific issues in research before the 1980s. When women were included in studies, gender differences were typically not reported and presumably not assessed. Findings from studies of men were generalized to women with little regard for the possibility that the results might lack validity across genders. In the decades since 1980, however, recognition of major differences between the sexes has increased substantially, as demonstrated by the establishment of an Institute of Medicine committee on understanding the biology of sex and gender differences. Increased attention has also been given to including women in research. This is reflected in such events as the 1986 National Institutes of Health (NIH) mandate that women be included in government-funded research (http://www4.od.nih.gov/orwh/ tracking97.pdf). At the same time, several federal-level offices were established that focused on women’s health, including the DHHS Office on Women’s Health (http:// www.4woman.gov/owh/), the NIH Office of Research on Women’s Health (http:// www4.od.nih.gov/orwh/), and the Centers for Disease Control and Prevention (CDC) Office of Women’s Health (http://www.cdc.gov/od/spotlight/nwhw/). In addition to

Coronary Artery Disease, 2000

Background There are few data on possible age and sex differences in presentation of symptoms for... more Background There are few data on possible age and sex differences in presentation of symptoms for patients with acute coronary disease. Objective To investigate demographic differences in presentation of symptoms at the time of hospital presen-() tation for acute myocardial infarction AMI and unstable angina. Conclusions Results of this study suggest that there are differences between symptoms at presentation of men and women, and those in various age groups, hospitalized with acute coronary disease. Clinicians should be aware of these differences when diagnosing and managing patients suspected to have coronary heart disease. Coron Artery Dis 11:399-407 ᮊ 2000 Lippincott Williams & Wilkins.

Controlled Clinical Trials, 1996

The African American Study of Kidney Disease and Hypertension (AASK) Pilot Study evaluated the fe... more The African American Study of Kidney Disease and Hypertension (AASK) Pilot Study evaluated the feasibility of carrying out a randomized, multicenter, 7-year clinical trial to determine the effects of two goal levels of blood pressure control and three antihypertensive drug regimens on decline in glomerular filtration rate in African Americans with clinically diagnosed hypertensive nephrosclerosis. Participants were randomized to either a usual mean arterial blood pressure (MAP) goal group (102-107 mm Hg) or a low-MAP goal group (592 mm Hg) and to a drug regimen (initial therapy with either atenolol, amlodipine, or enalapril). Quality of life was assessed by the Medical Outcomes Short-Form 36 (MOS SF-36) at baseline and the last follow-up visit for 84 of the 94 participants of the AASK Pilot Study. Symptoms were assessed at baseline and throughout the course of therapy by participant selfreport. Mean SF-36 scores increased significantly on physical functioning (9.2), role limitations (physical) (19.0), social functioning (9.0), and vitality dimensions (5.6) from baseline to the last follow-up visit in the usual MAP goal group. Scores for the eight health dimensions assessed by the MOS SF-36 did not change significantly during the same time period either in the low-MAP goal group or in any of the drug regimens. The mean score for general health perception was significantly lower at the last follow-up visit in the enalapril drug regimen (49.9) compared to drug regimens with atenolol(65.4) or amlodipine (63.9). Physical functioning, role limitations (emotional), social functioning, mental health, vitality, and general health perception scores were negatively correlated with self-reported symptoms during treatment. We conclude that selected dimensions of quality of life improved during the AASK Pilot Study only in participants randomized to the usual MAP goal group. Significant differences between MAP goal groups and drug regimens at the end of follow-up were observed for only a few health dimensions.