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IU research at the American Public Health Association meeting

Nov. 10, 2009

Dozens of Indiana University researchers are participating in the American Public Health Association in Philadelphia, held Nov. 7-11. Below are several of the studies being presented. They discuss the following topics:

Health education for people with intellectual disabilities
When and why men and women use lubricants during sex
When smoking bans encourage people to stop smoking
The use of stability balls as office chairs
An effective approach to increase mammography screenings for African American women
A boost for workplace wellness efforts

Health education designed for people with intellectual disabilities. An Indiana University study involving adults with intellectual disabilities found that the adults increased their personal health knowledge after taking a semi-weekly class for four weeks. Adults with ID, an internationally accepted term for mental retardation, have slightly higher rates of obesity, physical inactivity and preventable chronic diseases compared to the general population. Lead researcher Amy Bodde, a doctoral candidate in the Department of Applied Health Science in IU's School of Health, Physical Education and Recreation, said the findings further verify that adults with ID are capable of increasing their knowledge of health education, if given the opportunity, and are able to make informed decisions about health. "Many people with intellectual disabilities haven't had general health education," she said. "They are living more and more independent lives but they are not being educated to make good decisions about their health."

Study background:

  • The study involved 42 men and women ages 19 to 62. They took a 30-minute class twice a week at an agency that provides residential, occupational and leisure services to people with ID. The curriculum employs written, pictorial, role play and interactive video teaching strategies, which have been useful in vocational and life skills education for adults with ID.
  • On average, the study participants' general knowledge of health topics increased by 5 percent. Their knowledge of physical activity guidelines increased by 31 percent.

Bodde said people with ID are not expected to be as healthy and active as others. Until about 30 years ago, ID was thought of as a disease, she said, so people with ID were considered inherently unhealthy. Slowly a new conceptualization of disability has arisen, one where people with intellectual and physical disabilities can live healthy lives. "Disability no longer precludes good health," Bodde said. "People with disabilities can have full and healthy lives and this should be an expectation."

Co-authors include Dong-Chul Seo, Department of Applied Health Science; Georgia Frey, Department of Kinesiology; Marieke Van Puymbroeck, Department of Recreation, Park and Tourism Studies; and David Lohrmann, Department of Applied Health Science. Bodde will present her study on Sunday, Nov. 8, at 4:30 p.m. in Hall A-B. She can be reached at Top

Why men and women use lubricants during sex. An Indiana University study involving 2,453 women ages 18 to 68 found that lubricant use during sexual activity alone or with a partner contributed to higher ratings of pleasurable and satisfying sex. Personal lubricants have long been recommended to women to improve the comfort of sexual intercourse and to reduce the risk of vaginal tearing, yet strikingly little available data is available on women's use of lubricants or associated vaginal symptoms. The study, conducted by Debby Herbenick, associate director of the Center for Sexual Health Promotion at IU's School of Health, Physical Education and Recreation, involved women who used one of six different water- or silicone-based lubricants. The study also found that side effects were rarely associated with lubricant use; vaginal tearing occurred during less than 1 percent of vaginal intercourse events and genital pain was reported in less than 5 percent of intercourse acts when lubricant was used. Herbenick will present her findings at on Monday, Nov. 9, at 3:10 p.m. during the "What's Sex Got To Do With It?" session. Co-authors are Devon J. Hensel , IU School of Medicine; Kristen Jozkowski, Center for Sexual Health Promotion; Michael Reece, CSHP; and J. Dennis Fortenberry, IU School of Medicine.

Researchers from the Center of Sexual Health Promotion conducted more than 15 studies being presented at the APHA conference. Public health professionals routinely recommend the addition of lubricant to condoms during sexual activity, yet virtually no research has assessed the sexual situations during which the recommendations are followed. The following two CSHP studies help fill in the gaps.

  • A CSHP study involving 2,453 women examined their use of water-based or silicone-based lubricants during sexual activity. The use of lubricants during sexual activity has been recommended as a strategy to reduce the likelihood of vaginal tearing, which can increase risk for HIV and other STI. The study participants strongly endorsed the notion that lubricant use improved the sexual experience; in more than 70 percent of events, women indicated that using lubricants made sex feel very pleasurable and more comfortable (65.5 percent). The women in the study primarily were heterosexual (85.6 percent) and married (56.4 percent), with an average age of 32.5. Other findings: When applying lubricant, 58.4 percent of events involved application to the woman's genitals by their sexual partner, 54.7 percent involved women applying lubricant to their own or their partner's fingers, and 53.4 percent involved women applying lubricant directly on their partner's genitals. Most frequently reported reasons for lubricant use included the desire to reduce the risk of tearing (22 percent) and to make sex more comfortable (21.8 percent). Co-authors include lead author Jozkowski, Herbenick, Hensel, Reece and Fortenberry. The research was supported by The Patty Brisben Foundation. Jozkowski will present the findings on Monday, Nov. 9, at 2:30 p.m. during the "Women and HIV: Emerging Issues" session.
  • A CSHP study involving 1,834 men examined the use of lubricants during vaginal intercourse. The study involved 8,876 coital events, 46.8 percent of which involved the use of a latex condom and 24.7 percent of which involved the use of a lubricant. Additional results: most frequently, lubricant was added to the external tip of the condom after penile application (22.5 percent), directly in or around the partner's vagina (16.2 percent), and to both the condom and vagina (16.2 percent). The addition of lubricant to condoms was more likely during intercourse with a spouse than with a non-committed partner, during intercourse events of longer duration, when a female partner applied the condom to the partner's penis, and when a female partner used Nuva Ring, IUD or spermicidal jelly/foam as a method of contraception. The research was supported by The Patty Brisben Foundation. Co-authors include, Reece, Hensel, Herbenick, Fortenberry, and Brian Dodge, CSHP. Reece will present the findings on Monday, Nov. 9, at 10:30 a.m. during the "Innovative Research on Sexual Health" session.

Herbenick can be reached at Reece can be reached at Top

Smokers who support smoking bans, more likely to consider quitting. A new study examining how municipal smoking regulations for public places influence smokers' efforts to quit found a strong association between smokers' support of the regulations and their beliefs that other people think they should quit. This is important because when smokers perceive that other people think they should quit, they are more likely to try to quit. Smokers' attitudes about quitting and how much control they think they have over quitting were also tested as outcomes, but the associations with support for smoking regulations were not as strong. Smoke-free air policies are becoming more common in the U.S. and throughout the world, and there is a growing body of research supporting the idea that these policies motivate smokers to smoke less or quit -- but scientists know little about how the policies change smoking behavior. Jon Macy, a researcher in Indiana University's Department of Psychological and Brain Sciences, in the College of Arts and Science, said the findings from his study suggest that when smokers agree with regulating smoking in public places, they are also likely to believe that they should take measures to quit smoking. "Because such beliefs are predictors of future behavior, building support among smokers for smoking regulations may be an effective strategy for increasing quitting behavior," he said.

Study background:

  • The study involved 299 adult smokers from six Texas cities who were contacted by random digit dialing and interviewed by telephone. Statistical analyses were conducted predicting two measures of the smokers' own attitudes about quitting, two measures of what the smokers believe others think about quitting, and three measures of how much control the smokers think they have over quitting. The analyses also took into consideration variables such as demographic factors, amount smoked and strength of the smoking regulations in the respondent's city.
  • According to the results, smokers' extent of agreement with regulating smoking in public places made a statistically significant unique contribution over and above demographics, amount smoked, and strength of smoking regulations in the respondent's city for one of the two measures of the smokers' own attitudes about quitting and both measures of what the smokers believe others think about quitting.
  • Smokers' extent of agreement with regulating smoking in public places was not associated with any of the three measures of how much control the smokers think they have over quitting.

Macy said it also is possible that smokers with attitudes that are positive toward quitting are more likely to agree with regulating smoking, so he said longitudinal research is needed to provide evidence as to the directionality of the effect.

The research was supported by National Cancer Institute. Susan E. Middlestadt, associate professor in the Department of Applied Health Science, in the School of Health, Physical Education and Recreation, is co-author of the study. The study will be presented at 12:30 pm on Tuesday, Nov. 10, as part of the session, "predicting cessation success and documenting rewards of quitting." Macy can be reached at Top

stability ball image

Photo by Aaron Bernstein

Print-Quality Photo

Stability balls at work -- about more than just abs. Using a stability ball as an office chair strengthens core muscles, similar to the use of a backless chair or stool; the freedom of movement from a stability ball also may decrease confined or constrained body postures that frequently occur at workstations. Additionally, a study by Indiana University ergonomics experts found that reaching with the nondominant hand results in different firing patterns in leg musculature compared to reaching with the dominant hand. "It's a learning effect. When you use your dominant hand, your firing patterns are more established, even in the lower body, to stabilize the movement. Interestingly, when reaching with the nondominant hand, muscle recruitment appears to be different," said Kelly Jo Baute, a researcher in the Indiana Ergonomics lab in Indiana University's School of Health, Physical Education and Recreation. Baute and her colleagues at Indiana Ergonomics investigated the effects that performing a common reaching task had on muscle activity in the legs while sitting on a stability ball. They found that the greatest muscle activity was located in the anterior tibialis (shin muscle) which acted in coordination with the hamstrings muscles to provide a stable foundation during the reaching movements.

Study background:

  • The study involved nine men ages 23-29 who performed a reaching task while sitting on a stability ball at a work station. The task involved picking up a cup of water and moving it either away from to closer to the body. EMG activity was measured in the quadriceps, hamstrings, anterior tibialis and gastrocnemious muscles in the legs. EMG activity was measured for muscle contraction onset, duration and intensity. The study found that the duration of the hamstring contraction and the onset of the anterior tibialis had the highest effect size when the study participants reached with the non-dominant hand.

Besides giving the lower body an opportunity to learn some new skills, the use of a stability ball at a work station can let workers move in a more free or natural manner, potentially reducing the risk of musculoskeletal disorders that can lead to low back pain often caused by sitting in the same position for long periods of time. Baute cautions against spending too much time on the ball, however, suggesting employees gradually increasing the amount of time they use it. "Using a ball is going to cause people to use a little more muscle recruitment to stabilize themselves when they're moving," she said. "It also gets them out of confined postures."

The study was supported by the School of HPER graduate research grant in-aid scholarship. Co-authors are Bill Wyatt, Eric Holten, Allison Berger, and John Shea, all with the Indiana Ergonomics lab in the Department of Kinesiology; and Fernando Ona, Department of Applied Health Science. Baute will make her presentation on Sunday, Nov. 8, at 4:30 p.m. in Hall A-B of the Philadelphia Conference Center. Baute can be reached at Top

Lay health advisers help increase mammography screenings. A new program that combines the use of lay health advisers, such as licensed practical nurses, and an interactive computer program was effective at helping low-income middle-aged African American women in Indianapolis obtain mammograms. Six months after participating in the program, 51 percent of the women who received lay health adviser counseling and an interactive computer program and who had not had a recent mammogram got a mammogram, compared to 18 percent of women who received a screening reminder and breast cancer pamphlet. Lay health advisers are people trusted by the community, who know what strengths and issues the community faces. "We had a lot of community participation," said Kathleen Russell, associate professor in the School of Nursing at Indiana University-Purdue University Indianapolis. "The lay health advisers were valuable because they understood the issues that the women were dealing with. I personally believe in the importance of helping communities find ways to solve community health problems. We can teach women in the community to become lay health advisers so they can help other women in their community."


  • The study involved 145 low-income African American women ages 41-75. The lay advisers, who generally live within the community, were trained by the researchers in the importance of mammograms and mammography screenings. Mammograms are important because they help in detecting breast cancer in early stages.
  • The lay health advisers administered a touch-screen computer program to the women in the community. This interactive program consisted of narrators and storytellers discussing the importance of mammograms and giving personal accounts of their experience, as well as beliefs and barriers that women face and must overcome. Russell says the women liked the computer program and they felt as if it were "made just for them."
  • The lay advisers assessed the 35 identified barriers the women faced; examples include not knowing where to go to get a mammogram, not being able to afford one and not having transportation to get to a hospital. They also provided counseling for the women and found community resources to use in order to help the women overcome certain barriers.

"The accomplishments of the program belong to the lay health advisers and the women within the community," Russell said.

Russell will present her study on Tuesday, Nov. 10, at 12:45 p.m. Co-authors are Electra Paskett, Ohio State University; Victoria Champion, IU School of Nursing; Patrick Monahan and Qianqian Zhao, IU School of Medicine. Russell can be reached at Top

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Becoming more active. An Indiana University study found that a 30-minute class called Active Living Every Day was able to help employees of a railroad dispatch center begin the transition from sedentary to more active lifestyles. The findings are important, said lead researcher Whitney Hornsby, a graduate student in IU's School of Health, Physical Education and Recreation, because traditional workplace wellness programs usually take two approaches -- providing health assessments and/or a fitness facility for employees. "These two approaches have been limited in their effectiveness due to the inability to teach individuals the skills necessary to incorporate and maintain a physically active lifestyle," said Hornsby, a researcher in the School of HPER's Department of Kinesiology. "Our study demonstrated that a lifestyle physical activity intervention significantly impacted 'stages of changes' when used with sedentary employees." She said the study also "elucidated the need for future interventions, which may include Active Living Every Day in conjunction with regular exercise or as a precursor to an exercise intervention."

About the study:

  • The study involved sedentary employees at a railroad dispatch center. Twenty-four served as the control group; 29 employees participated in a 20-week course to address physical activity issues such as identifying and overcoming barriers, setting attainable goals and creating social support networks. All the employees wore devices that tracked their physical activity. While there was no difference detected in the amount of time spent on physical activity, the intervention group showed significant movement through the "stages of change" people go through when moving from a sedentary to active lifestyle. Hornsby said 43 percent of the participants in the intervention group shifted from inactive to active.

Hornsby will present the study on Monday, Nov. 9, at 2:30 p.m. during the "Perspectives in Worksite Health Promotion," session at the Marriott, Franklin 9. Co-authors are Jeanne D. Johnston and Carol Kennedy-Armbruster, Department of Kinesiology; Fernando Ona and Susan E. Middlestadt, Department of Applied Health Science; and Kenneth Glover, CSX Transportation.

The study was supported by the School of HPER's Department of Kinesiology AAU-Bell Wynn Updyke Grant and CSX Transportation. Hornsby can be reached at Top