Protective resources and perceptions of stress in a multi-ethnic sample of school-age children

PURPOSE

To investigate the relationship among protective resources of social connectedness, coping skills, and the perception of stress in 613 Hispanic and White school-aged children.

METHODS

A secondary analysis of data, part of a longitudinal cohort-sequential study designed to investigate health-risk behaviors in school-age children. Data were collected by computer-assisted self-interviewing from a non-probability sample of 8-12-year-olds in three independent school districts.

FINDINGS

Hierarchical multiple regression analysis indicated that social connectedness and the frequency of coping strategies used accounted for 18.8% of the variation in stress. "Feeling sick" was the primary stressor of the participants, while the two most frequently endorsed coping strategies were "watch TV or listen to music" and "draw, write, or read something."

CONCLUSION

The findings are significant because nurses working with children are in a strategic position to assess risk factors and protective resources related to stress and intervene in a timely manner to assist children and families develop resiliency.

Cognitive reorganization and stigmatization among persons with HIV

BACKGROUND

A diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a life-changing event, where persons must deal with a life-threatening, debilitating disease and its associated stigma and isolation. Studies over the past decade have shown that writing and talking about stressful and traumatic experiences, such as a life-threatening illness, causes emotions surrounding the trauma to change and to become cognitively reorganized. The result is a reduction in inhibition and change in basic cognitive and linguistic processes, which have contributed to meaningful behavioural, psychological, and physical health benefits across a variety of populations.

AIMS

To describe the construction of the Integrated Model of Health Promotion for persons with HIV/AIDS, and present initial empirical support of the model from a feasibility pilot study of women with HIV/AIDS.

APPROACH

The Integrated Model of Health Promotion is described and relevant literature in the field is reviewed. The model is implemented in a feasibility pilot study utilizing the emotional writing disclosure intervention.

RESULTS

Participants in the experimental condition demonstrated a promising pattern of cognitive reorganization, a reduced perception of stigma, and an improvement in mental health scores compared with the control condition.

CONCLUSION

Implications of these findings are discussed within the framework of the Integrated Model of Health Promotion. The model explores health and behavioural benefits associated with emotional writing in individuals with HIV/AIDS. The limited sample size of this pilot study precludes testing for significance. Further studies are required prior to the development of practice guidelines.

Computer-assisted survey interviewing of school-age children

Longitudinal surveys of children in school settings can yield large volumes of data for use in exploring research questions that may influence development of intervention programs. However, traditional methods of data collection such as paper-and-pencil questionnaires or person-to-person interviewing present major threats to validity throughout the process of data collection, data management, and data analysis. The use of computer-assisted survey interviewing is an alternative that has both advantages and disadvantages. Lessons learned in the first wave of a longitudinal study of approximately 1161 children in fourth, fifth, and sixth grades illustrate both the strengths and limitations of this method.

Youth Resilience Framework for reducing health-risk behaviors in adolescents

Adolescents engage in risky behaviors that compromise their health. Leading causes of morbidity and mortality are associated with a few preventable health-risk behaviors initiated in childhood and early adolescence. Interventions that enhance protective factors in childhood are needed to offset these vulnerabilities and thus promote the health of adolescents. The Youth Resilience Framework is presented that addresses individual and sociocultural risk factors and protective resources that can influence health outcomes throughout adolescence. This framework incorporates a developmental approach to address precursors and health-risk behaviors that may be amenable to early health-promoting interventions.

A theory of taking care of oneself grounded in experiences of homeless youth

BACKGROUND

Homeless adolescents are vulnerable to poor health outcomes owing to the dangerous and stressful environments in which they live. Despite their vulnerability, many of them are motivated to engage in self-care behaviors.

OBJECTIVE

The specific aim of this study was to explore self-care attitudes and behaviors of homeless adolescents.

METHOD

Individual interviews were conducted with 15 homeless adolescents. Interviews were audiotaped, transcribed verbatim, and analyzed using the constant comparative method of grounded theory.

RESULTS

Findings revealed a basic social process of taking care of oneself in a high-risk environment. This basic social process was supported by three categories: Becoming Aware of Oneself, Staying Alive With Limited Resources, and Handling One's Own Health, each including two processes.

DISCUSSION

Findings support Orem's conceptualizations of self-care and self-care agency and suggest the need for programs to support further healthy growth and development among homeless adolescents.

Safer sexual decision making in adolescent women: perspectives from the conflict theory of decision-making

Adolescent women are at risk for unintended pregnancies and sexually transmitted diseases, including human immune deficiency virus (HIV)/acquired immunodeficiency deficiency syndrome (AIDS), if they do not engage in safer sexual practices. Adolescent women are biologically, behaviorally, and socially more at risk for sexually transmitted diseases (STDs) and HIV than adolescent men. Although abstinence is the safest sexual health practice for adolescent women, once sexual activity begins, safer sexual practices involve condom and contraceptive use, and communicating with sexual partners to negotiate condom use. A number of implicit and explicit decisions are involved in these activities. A number of researchers have examined safer sexual decisions of adolescent women, some of whom have used theory models such as the Transtheoretical Model of Change. Although these findings have contributed to the knowledge base about safer sexual decision making, many questions remain unanswered about how adolescent women make safer sexual decisions. The Conflict Model of Decision Making is presented and discussed as a framework for enhanced understanding of safer sexual decision making by adolescent women.

Measuring Cultural Awareness in Nursing Students

Recognizing the need for a valid and reliable way to measure outcomes of a program to promote multicultural awareness among nursing faculty and students, the authors developed a cultural awareness scale. In the first phase of the study, a scale consisting of 37 items was generated from a literature review on cultural awareness, sensitivity, and competence in nursing. A Cronbach's alpha reliability coefficient of .91 was obtained from a sample of 72 student nurses. In the second phase, the items were presented to a panel of experts in nursing and culture to determine content validity. A content validity index of .88 was calculated, and the total number of items on the scale was reduced to 36. The scale then was administered to 118 nursing students. Data from the two samples then were combined, and factor analysis was conducted to support construct validity. Cronbach's alpha for the combined samples was .82.

Personal strengths of homeless adolescents living in a high-risk environment

Health-risk behaviors and associated adverse health outcomes in homeless adolescents are well documented. Strengths of these youth that contribute to their health and well-being are seldom acknowledged. The purpose of this secondary analysis of qualitative data was to identify strengths that protect homeless youth. Two types of strengths emerged: resources and self-improvement. Resources served as the foundation for survival whereas self-improvement served as a process that enabled youth to consider a more healthy future. By recognizing the many strengths of homeless youth, nurses may develop community-based programs to help this population reenter society.

Characteristics and health care needs of homeless adolescents

There is a significant and growing number of adolescents who separate early from their families and become homeless. These youths are heterogeneous in terms of gender, race, ethnicity, and socioeconomic status, but the majority come from families that have been disruptive or dysfunctional in some way. Homeless adolescents are vulnerable to a variety of physical and psychologic problems related not only to their family histories but to the stressful environments in which they try to survive. Although numerous federal, state, and local programs have been developed to meet their needs for shelter, health care, and education, much remains to be done to ensure their healthy development and to prepare them for responsible life in the larger society.

Sexual health practices of homeless youth

PURPOSE

To describe the sexual health practices of homeless adolescents, examine relationships among variables in a conceptual model of sexual health practices, and determine direct and indirect effects of population characteristics, cognitive-perceptual factors, and behavioral factors on sexual health practices among homeless adolescents.

DESIGN AND METHODS

Descriptive exploratory design. A survey was administered to a convenience sample of 414 homeless young men (244) and young women (170) aged 16-20 years, the majority of whom were Anglo American.

FINDINGS

Thirty-five percent reported homosexual or bisexual orientation, and sexual orientation was reported as a reason for leaving home. Over half reported a history of sexual abuse and nearly one in four had been treated for gonorrhea. Safe-sex behaviors were related to age, time away from home, assertive communication, social support, future time perspective, connectedness, perceived health status, intentions to use condoms, and condom self-efficacy. A parsimonious model with good fit indicated that the only direct paths to safe-sex behaviors were future time perspective, intentions to use condoms, and self-efficacy to use condoms, and the direct paths to sexual self-care behaviors were from assertive communication, social support, and self-efficacy to use condoms.

CONCLUSIONS

As in other studies of homeless youth, respondents reported a high incidence of sexual abuse and homosexual and bisexual orientation. Their safe-sex behaviors were surprisingly similar to those of university students, were modestly related to cognitive-perceptual variables in the sexual health model, and might be amenable to brief culturally relevant interventions.

Intuitive skills in crisis management

This article is a synthesis of nursing and management research findings on intuition and explains why intuition is particularly useful in crisis management. Drawing on applications from organizational psychology, it includes ways to enhance the nurse's ability to exercise and develop intuitive skills. The authors assert that the highly complex, rapidly changing, and often unpredictable circumstances that require crisis management in nursing are best met through applying the complementary cognitive skills of analytic reasoning and intuition.

Planning a sexual health promotion intervention with homeless adolescents

BACKGROUND

Homeless adolescents are at very high risk for sexually transmitted diseases (STDs), but few street-based interventions have been developed, tested, and made available to reduce risk and promote sexual health within this growing population.

OBJECTIVES

This study, part of a larger study of the sexual health practices of homeless adolescents, explores participants' perceived need for more knowledge about sexual health and their ideas about developing a brief intervention to promote positive sexual health practices that would reflect their perspective.

METHODS

Four focus groups with five to six participants each were conducted with 22 youth aged 16-20 years, randomly selected from the study sample of 425 homeless youth. Most participants (82%) were White, one was American Indian, two were Hispanic, and one did not indicate ethnicity. Local groups were audiotape recorded, transcribed, and analyzed for manifest and latent content.

RESULTS

Participants were knowledgeable about symptoms, transmission, prevention, and treatment of STDs, but perceived the need for more knowledge about types of hepatitis, cancer, and long-term sequelae of untreated STDs. Participants identified barriers to seeking diagnosis and treatment for symptoms of STDs including cost, not knowing where to go, and lack of services specifically for females. They suggested developing a sexual health intervention based on respect that would provide concrete examples of how to promote their sexual health.

CONCLUSIONS

Homeless adolescents were generally knowledgeable about symptoms and prevention of STDs and thought that street outreach interventions should be (a) brief, (b) gender-specific, (c) focused on the unique vulnerabilities and strengths of homeless youth, and (d) accessible.

Relationships of sexual abuse, connectedness, and loneliness to perceived well-being in homeless youth

ISSUES AND PURPOSE

To describe respondents' perceptions of connectedness, loneliness, and well-being; and to explore relationships among these variables.

DESIGN AND METHOD

Survey data from 96 participants, focus group interviews with 32 participants, and 10 individual interviews were analyzed.

RESULTS

Sixty percent of the sample reported sexual abuse, which was significantly related to loneliness and inversely related to connectedness and perceived well-being. Subjects felt lonely and disconnected. They perceived their well-being in terms of current health status.

PRACTICE IMPLICATIONS

High rates of sexual abuse, lack of connectedness, and loneliness may help to explain poor perceived well-being in homeless youth.

Correlates of recent suicide attempts in a triethnic group of adolescents

PURPOSE

To describe recent self-reported suicide attempts in a triethnic group of adolescents, to analyze differences in the correlates of attempts by ethnicity and gender, and to explore theoretical correlates of recent suicide attempts using a resilience framework.

METHODS

Quantitative data were collected from 10,059 students in 7th, 9th, and 11th grades in Connecticut in 1996. Secondary analysis was done to compare respondents of African American, Hispanic Latino, and Caucasian ethnicities. Data were analyzed using bivariate and multivariate procedures. Logistic regression was used to identify the best set of explanatory variables for recent suicide attempts.

RESULTS

The percentage of suicide attempts was significantly higher among Hispanic Latina girls (19.3%) than in any other ethnic-gender group. Significant relationships were found between recent suicide attempts and (a) family history of suicide attempt, (b) friend's history of suicide attempt, (c) history of sexual abuse, (d) history of physical abuse, and (e) environmental stress. The significant set of explanatory variables for recent suicide attempts for the three ethnic groups combined were stress, internalizing and externalizing behaviors, physical and sexual abuse, family and friend attempted suicide, social connectedness, and religious influence.

CONCLUSIONS

Findings support use of a resilience model for suicide attempts among three ethnic groups. The finding of a significantly higher percentage of recent suicide attempts by Hispanic girls compared to girls in other ethnic-gender groups warrants further investigation along with development and testing of culturally sensitive preventive interventions.

Sexual abuse, alcohol and other drug use, and suicidal behaviors in homeless adolescents

Previous research has shown that homeless youth have high rates of suicidal ideation, sexual abuse, and abuse of alcohol and other drugs. However, little is known about how these rates differ by gender and ethnicity. Our objective was to describe patterns of sexual abuse, alcohol and other drug use, and indicators of suicidal behaviors in homeless adolescents and to determine gender and ethnic differences in these factors. We used secondary data analysis of data from surveys completed by 96 homeless youth whose average age was 17.9 years. Over 60% of the sample reported a history of sexual abuse; the majority were under the age of 12 years when they first tried alcohol, marijuana, and cocaine; 56.3% had injected drugs, and 46.9% had tried inhalants. During the past 12 months, 35.1% had seriously considered suicide and 12.3% had actually attempted suicide at least once. Significantly more Hispanics than Whites had considered suicide (chi 2 = 4.31, p = .038). A disproportionate number of Hispanics (95% of the sample) reported a history of sexual abuse. Participants with a history of sexual abuse were significantly more likely than those who did not have a history of sexual abuse to have used alcohol and/or marijuana (chi 2 = 9.93, p < .01) and to have considered suicide in the past 12 months (F = 14.93, p < .001). We found that sexual abuse history is greater in this sample than in the general population and is particularly prevalent among Hispanic/Latino subjects. As in other studies, sexual abuse was more common among females than among males. High prevalence of sexual abuse, alcohol and other drug use, and suicidal behaviors in this sample of homeless youth underscores the need to develop and test community-based interventions to improve their health status.

Correlates of resilience in homeless adolescents

PURPOSES

To (a) describe reasons adolescents give for their homelessness, (b) explore relationships among resilience and selected risk and protective factors, (c) identify differences in risk and protective factors by gender and sexual orientation, and (d) determine best predictors of resilience.

DESIGN

A descriptive and exploratory correlational design was used to collect and analyze data from a convenience sample of 59 homeless adolescents who sought health and social services from a community street-outreach project in central Texas in 1998.

METHODS

A paper and pencil survey consisting of valid measures (Resilience Scale, UCLA-Revised Loneliness Scale, Beck Hopelessness Scale, Social Connectedness Scale, and Death-Related Attitude Schedule) was administered in a street-outreach setting.

FINDINGS

Nearly half the sample (47%) reported a history of sexual abuse and 36% self-identified as gay, lesbian, or bisexual in orientation. Over half (51%) were thrown out of their homes by their parents, 37% left home because their parents disapproved of their alcohol or drug use, and nearly one-third left home because parents sexually abused them. Lack of resilience was significantly related to hopelessness, loneliness, life-threatening behaviors, and connectedness, but not to gender or sexual orientation. Hopelessness and connectedness explained 50% of the variance in resilience.

CONCLUSIONS

Participants who perceived themselves as resilient, although disconnected from other people, were less lonely, less hopeless, and engaged in fewer life-threatening behaviors than were those who perceived themselves as not being resilient. They survived by adapting to street life and by becoming overly self-reliant. Findings may be useful in planning interventions to promote health and well-being in this vulnerable population.

Sexual health practices of homeless youth: a model for intervention

This article presents a conceptual model of sexual health practices and outcomes among homeless adolescents. The model provides a framework for understanding what is known about homeless youth and how community-based interventions might be developed and tested to curb the rising number of sexually transmitted diseases among this vulnerable population. Research measures are presented and discussed to promote further development and testing of the model for interventions.

Secondary data analysis: new perspective for adolescent research

Adolescents are at high risk for preventable health problems, but realities of research funding and obtaining data from large samples make it difficult for many researchers to answer important questions. Secondary analysis of existing data sets is described as a reasonable alternative in spite of its limitations. Methods and available resources are identified along with suggestions for research priorities with adolescents.

Without parental consent: conducting research with homeless adolescents

ISSUES AND PURPOSE

To identify the ethical and legal implications of conducting research with homeless adolescents and to discuss guidelines for conducting research without parental consent.

CONCLUSIONS

Ethical principles of capacity, risk, postponement, and truthful disclosure within the context of the rights of minors to consent to healthcare treatment form the basis of the argument for allowing adolescents to consent to participate in research without parental consent when there is minimal risk or when such consent could place them at increased risk for harm.

PRACTICE IMPLICATIONS

Adolescents who are the target population for clinical research or who are intended recipients of nursing care should be involved in setting priorities, purposes, and protocols. Parents and other adults from their communities should be included in developing strategies to protect their confidentiality and privacy while helping them achieve autonomy in making informed health-related decisions.

Friends and pets as companions: strategies for coping with loneliness among homeless youth

PROBLEMS

Loneliness and negative health outcomes associated with being homeless and living on the streets.

METHODS

Qualitative data from 32 homeless youth, ages 16 to 23 years, who participated in focus groups, and a subsample of 10 youth, ages 15 to 23 years, who participated in individual interviews, were analyzed using manifest and content analysis, techniques.

FINDINGS

Homeless adolescents who live on the streets or in "squats" described feelings of loneliness that they say "go with the territory." Three themes emerged from the data: how lonely subjects felt, circumstances that provoked feelings of loneliness, and ways of coping with loneliness. Thirteen identified their pets as companions that provided unconditional love, reduced feelings of loneliness, and improved their health status.

CONCLUSIONS

Vulnerable adolescents who are homeless often recognize the therapeutic value of pets. Interventions that enhance this coping strategy need to be developed and tested.

Acknowledging intuition in clinical decision making

The purpose of this study was to develop and validate a scale to measure nurses' acknowledgment of using intuition in clinical decision making. Development and validation of the scale was carried out in three phases. In Phase 1, scale items were generated from the published literature in nursing and management and a Content Validity Index (CVI) of .96 was computed on responses from a panel of five experts. In Phase 2, the scale was pilot-tested on a random sample of 106 psychiatric mental health nurses. In Phase 3, the revised scale was presented to a convenience sample of 112 nurses attending continuing education programs. Seven items were found to explain 40.6% of the variance in scores and were retained as the final unidimensional scale. Construct validity was supported by a difference in means of two groups that also differed on another measure of intuition.

Risky sexual behavior among adolescent women

ISSUES AND PURPOSE

To review the epidemiology and etiology of risky sexual behavior in adolescent women, and to discuss implications for primary prevention.

CONCLUSION

Adolescent women who participate in risky sexual behavior are at risk for sexually transmitted infections, including HIV. Black, Hispanic, and out-of-home adolescent women, however, are at greatest risk. Factors contributing to risky sexual behavior include early initiation of sexual intercourse, inconsistent use of condoms and other barrier contraception, and unprotected sexual intercourse. Identified protective factors for early initiation of sexual activity include the development of healthy sexuality, family and school connectedness, and the presence of caring adults.

PRACTICE IMPLICATIONS

Effective clinical interventions target high-risk adolescent women; incorporate environmental and cognitive-behavioral components; use social learning theories; address differences in regards to culture, developmental stage, and sexual experience; and support family and school involvement.

Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents

PURPOSE

To describe and differentiate the usual sources of health care, patterns of utilization of services, and reasons for foregone health care among Hispanic adolescents by place of birth (U.S. mainland versus Puerto Rico or other country) and gender.

METHODS

All subjects who identified themselves as Hispanic (n = 717) in a larger survey of 10,059 students in 7th (n = 3,596), 9th (n = 3,691), and llth (n = 2,772) grades in the state of Connecticut in 1996 were included in this secondary analysis. Data were analyzed using Pearson product-moment coefficients, Chi-squares, and logistic regression.

RESULTS

The majority of usual sources of medical care services were community clinics or private doctors' offices. Subjects born in Puerto Rico or countries other than the United States were more likely to use a doctor's office. About 5% reported no usual source of care. Over 25% reported not going to a doctor or other health care provider when they thought they should (foregone care). There were significant gender differences in reasons given for foregone care. Feeling connected to others was a significant predictor of having had a physical examination and negatively associated with foregone care for girls. For boys, connectedness and use of alcohol were negative predictors of foregone care.

CONCLUSIONS

The majority of Hispanic youth in this sample report having a usual source of medical care and the source differs by place of birth. Adolescents who do not report high levels of connectedness are more likely to have foregone care. The most frequent explanation given for not having sought care was that subjects thought the problem would go away. Socialization about how to access and use health care services, as well as what to expect, is needed by Hispanic adolescents who may be at risk.