An integrative analysis of 24 studies showed that, despite varying roles and functions, evidence indicates that community health workers are effective in increasing access to health services, increasing knowledge, and promoting behavior change among ethnic minority women. Other advantages of using community health workers are to provide social support and culturally competent, cost-effective care. Recommendations for future directions of research with community health workers and ethnic minority women include improved conceptualization of the community health worker role, theoretical frameworks for research designs, enhanced methods for evaluating effectiveness, and increased community involvement.

Background Pictorial health warning labels on cigarette packaging have been proposed for the U.S., but their potential influences among populations that suffer tobacco-related health disparities are unknown. Purpose To evaluate pictorial health warning labels, including moderation of their influences by health literacy and race. Methods From July 2011 to January 2012, field experiments were conducted with 981 adult smokers who were randomized to control (i.e., text-only labels, n=207) and experimental conditions (i.e., pictorial labels, n=774). The experimental condition systematically varied health warning label stimuli by health topic and image type. Linear mixed effects (LME) models estimated the influence of health warning label characteristics and participant characteristics on label ratings. Data were analyzed from January 2012 to April 2012. Results Compared to text-only warning labels, pictorial warning labels were rated as more personally relevant (5.7 vs 6.8, p<0.001) and effective (5.4 vs 6.8, p<0.001), and as more credible, but only among participants with low health literacy (7.6 vs 8.2, p<0.001). Within the experimental condition, pictorial health warning labels with graphic imagery had significantly higher ratings of credibility, personal relevance, and effectiveness than imagery of human suffering and symbolic imagery. Significant interactions indicated that labels with graphic imagery produced minimal differences in ratings across racial groups and levels of health literacy, whereas other imagery produced greater group differences. Conclusions Pictorial health warning labels with graphic images have the most-pronounced short-term impacts on adult smokers, including smokers from groups that have in the past been hard to reach.

Accurate temperature measurement is critical to the assessment and management of temperature fluctuation in the acutely ill adult. Unfortunately, an accurate, noninvasive method to measure core temperature has yet to be established, and current instruments produce a wide range of temperatures for any given patient. This article provides an integrative review of studies comparing selected invasive and noninvasive temperature measurement methods in acutely ill, hospitalized adult patients. Medline and CINAHL databases were searched to locate published studies on temperature measurement in the adult hospitalized patient. A partial list of primary search terms included core temperature measurement, oral temperature measurement, temporal artery thermometry, and tympanic thermometers. Studies that were data based and included comparison of a tympanic, temporal artery, and/or oral noninvasive temperature measurement to a pulmonary artery or esophageal invasive core measurement in an adult population were included in the analysis. The search method produced 223 publications and abstracts for initial review; 23 (10%) met the inclusion criteria. The only study evaluating the use of temporal artery thermometry in the adult population found the instrument to be unreliable. Results also indicate that high-quality evidence supporting the accuracy of tympanic thermometry, the preferred instrument for noninvasive core temperature measurement in many acute care settings, is lacking, and in fact, the most recent high-quality studies evaluating the accuracy of this instrument fail to show support for its use. Evidence does, however, support the use of oral thermometry as an accurate means of temperature assessment in the adult, acutely ill population.

The purpose of this study was to test the effectiveness of a multicomponent smoking cessation intervention in African American women residing in public housing. The intervention consisted of: (a) nurse led behavioral/empowerment counseling; (b) nicotine replacement therapy; and, (c) community health workers to enhance smoking self-efficacy, social support, and spiritual well-being. The results showed a 6-month continuous smoking abstinence of 27.5% and 5.7% in the intervention and comparison groups. Changes in social support and smoking self-efficacy over time predicted smoking abstinence, and self-efficacy mediated 6-month smoking abstinence outcomes. Spiritual well-being did not predict or mediate smoking abstinence outcomes. These findings support the use of a nurse/community health worker model to deliver culturally tailored behavioral interventions with marginalized communities. ß