The effects and challenges of alcohol use disorder peer support service in South Korea: A focus group study

Although alcohol use disorder (AUD) is associated with a high disease burden due to medical consequences, people with AUD often do not receive appropriate treatment or community health service support. Peer-support services, intended to bridge the gap between patients with AUD and mental health providers have produced successful results. However, the number of studies on peer supporters in South Korea, especially those with AUD, is limited. Therefore, research on the effectiveness or challenges faced by AUD peer supporters in Korea is required to meet the challenges posed by increases in the numbers and capabilities of peer supporters in the mental health field. This qualitative study (N = 13), included focus group interviews of AUD peer supporters (n = 7), and supervisors of peer supporters (n = 6). Focus group data were analysed using thematic analysis methods. These analyses identified themes including 'Life before AUD peer supporters: The moment of change', 'Effects of peer support services: Working as peer supporters changed our lives', 'Challenges of peer supporter services: Things experienced as a team' and 'Future directions: How we can improve peer support services'? Findings indicate that healthcare professionals, educated to maintain clear boundaries, are discouraged from disclosing personal information or developing personal relationships with patients. On the other hand, peer supporters discuss personal histories and prioritize personal connections. By acting as comrades, peer supporters have positive effects. By sharing their experiences, peer supporters formed appropriate relationships with AUD patients and families resulting in more active engagement in treatment programmes and increased numbers of patients receiving outpatient treatment.

Characteristics of late preterm infant readmissions: A systematic review

BACKGROUND

Prematurity represents a critical health disparity. It is important to note that late preterm (LPT) infants comprise the majority of preterm births, yet they are the least studied within the premature population. Evidence-based practice guidelines are now a decade old, indicating the potential need for review and revision.

OBJECTIVES

This systematic review proposed the assessment of sociodemographic characteristics of LPT infants, clinical practice standards, and associated hospital readmission rates, mortality, and morbidity to determine the need for revision of evidence-based practice guidelines for these infants.

DATA SOURCES

The Preferred Reporting System Items for Systematic Reviews and Meta Analysis methodology provided the framework for the completion of this review. Literature searches of PubMed/Medline (Ovid), Web of Science, Cumulative Index of Nursing, and Allied Health Literature Plus databases and citation searches included articles published after 2012 using the search terms "late preterm infants," "readmissions," and "readmission rates."

CONCLUSIONS

The literature search identified 11 studies meeting search criteria. These studies included quasi experimental, retrospective, and prospective cohort studies. These studies highlighted the characteristics of LPT infants that potentially contribute to increased readmission rates, morbidity and mortality rates, health care costs, and long-term health inequities. Overall findings indicate the need for review and revision of evidence-based practice guidelines for these infants.

IMPLICATIONS FOR PRACTICE

This systematic review manifests the vulnerability of LPT infants and the accompanying need for up-to-date clinical practice guidelines to effectively reduce their morbidity and mortality rates, hospital readmissions rates, and burden of health care costs.

Personal, Interpersonal, and Sociocultural Factors of Condom Use in Rural Indigenous Nahuas Adolescents in Mexico

The goal of this research was to determine the personal, interpersonal, and sociocultural predictors of condom use among rural Indigenous adolescents. Predictor variables were selected from Bandura's Social Cognitive Theory and Leininger's Transcultural Theory. The sample consisted of 419 Nahuas adolescents randomly selected from the total number of neighborhood blocks in a rural community in Puebla, Mexico. The instruments had acceptable psychometric characteristics (Cronbach alpha and validity scores). Multiple linear regression models were used. Results: 56.8% of participants were female, and 50.40% were students. Mean age was M = 17.5 (SD = 0.97), and the majority (63%) identified as Catholic. Age at menarche/first ejaculation (β = -1.2, p = 0.038), attitude toward condom use (β = 0.13, p < 0.001), ethnic identity (β = 0.21, p < 0.001), and ability to negotiate condom use (β = 0.13, p = 0.003) predicted (R² = 22.3) condom use. This study provided a basis for integration of the cultural values of Indigenous adolescents within interventions for sexual health promotion.

Technology-facilitated Sexual Violence in South Korea: A Content Analysis of a Website for Victims

Technology-facilitated sexual violence (TFSV) is an emerging form of gender-based violence. An understanding regarding the circumstance of TFSV and related health outcomes is limited. This qualitative study analyzed postings from an anonymous Korean website on which women suffering from TFSV freely posted messages asking for help and voicing concerns. Victims made efforts to solve problems that remained unresolved, thereby creating difficulties in their daily lives, and compelling them to quit jobs or break social relationships. They reported mental health concerns including suicide ideation, anxiety, frustration, sleep disorders, and depression. Results infer the imperative nature of research, intervention, and political action.

An Assessment of HIV Risk, Perceptions of Risk, and Potential Adherence to Preexposure Prophylaxis Among HIV-Negative People With Injection Drug Use Who Access Mobile Outreach Services

OBJECTIVE

The purpose of this study was to assess HIV risk, perceptions of risk, and potential adherence to preexposure prophylaxis (PrEP) for the prevention of HIV infection among people who inject drugs (PWID), who self-report HIV negative status and access mobile outreach intravenous drug use (IVDU) services.

METHODS/SAMPLE

Participants (N = 93) were non-Hispanic White (59.1%) and Hispanic (36.6%), between the ages of 18 and 63 years, primarily male (58.1%), who reported a length of IVDU between 1 and >20 years and accessed mobile outreach IVDU services in a metropolitan area of the Southwestern United States; all self-reported HIV-negative status. Self-report questionnaires completed via iPad included HIV risk behavior, perceived risk of HIV, and beliefs about medicines.

RESULTS

PWID perceived themselves at a low risk for HIV with minimal concerns about contracting HIV. High levels of comorbidities (schizophrenia, anxiety, depression, hepatitis, diabetes, and hypertension), substance use, and limited HIV protective behavior and social support existed; women reported significantly more risk behaviors and comorbidities. Positive attitudes toward and interest in use of medication for HIV prevention were present, however, with concurrent concerns regarding long-term medication use and the potential to forget medications.

CONCLUSIONS

PrEP adherence for PWID presents challenges for clinicians. Addressing perceptions of PrEP, perceived and actual risk for contracting HIV, potential barriers to PrEP adherence, social support, and treatment of comorbidities in primary care and IVDU outreach services potentially enhances PrEP maintenance among PWID, notably women.

Rural Women in Colombia, Facing the Postconflict: A Qualitative Synthesis

Women have been the major victims of the Colombian armed conflict for more than 50 years. Nowadays, when the country faces an aftermath focused on reconciliation, understanding women's experiences during the conflict is key to providing them tools for social justice and effective fulfilling of their needs. This qualitative synthesis of literature includes publications in Spanish and English of electronic databases over the past 20 years regarding rural women and the Colombian armed conflict. Studies were included for review if they were published between 2000 and 2019, were qualitative peer-reviewed articles, and addressed directly or indirectly the pregnancy process as well as the women's sexual and reproductive health in rural Colombia. Seven of 169 articles initially identified were included for an inductive analysis of categories and themes. After the analysis process, three main themes emerged from the literature: (a) crumbling families, (b) being a woman: the challenges between being a peacemaker and a victim, and (c) protecting and caring of life. These three themes comprise 10 categories and 20 subcategories that provide support to the inductive qualitative synthesis. This review provides a comprehensive synthesis of the Colombian armed conflict focused on the victimization of women. It concludes with reflections about the Colombian women's role in transitioning toward peace.

Nonpharmacological Interventions for Management of Behavioral and Psychological Symptoms of Dementia in Long-Term Care Facilities by Direct Caregivers: A Systematic Review

Behavioral and psychological symptoms of dementia (BPSD) are a worldwide problem. Estimates indicate approximately 96% of persons with dementia (PWD) exhibit BPSD that are directly associated with long-term care (LTC) placement and approximately one half of these persons experience symptoms classified as severe. BPSD are associated with lost days of work, high turnover, and poor job satisfaction for direct caregivers. Nonpharmacological interventions (NPIs) are effective for management of BPSD when used properly. NPIs are more likely to be used by direct caregivers who are knowledgeable about and have confidence in BPSD effectiveness. Various training techniques promote development of this self-efficacy. The current systematic review synthesizes evidence concerning the use of NPIs for management of BPSD by direct caregivers in LTC settings. Gaps in the literature include evaluation of positive impact of NPIs on PWD and behavior precedent factors. This review emphasizes the need for development and provision of quality NPI education for direct caregivers in LTC settings. [Journal of Gerontological Nursing, 48(7), 18-23.].

Predictors of Acute Care Transfers From Skilled Nursing Facilities: Recommendations for Preventing Unnecessary Hospitalization

Preventing acute care transfers from skilled nursing facilities (SNFs) is a challenge secondary to residents' associated debilitated status and comorbidities. Acute care transfers often result in serious complications and unnecessary health care expenditure. Literature implies that approximately two thirds of these acute care transfers could be prevented using proactive interventions. The purpose of the current study was to identify the predictors of acute care transfers for SNF residents in developing relevant prevention strategies. A retrospective chart review using multivariate logistic regression analysis showed increased odds of SNF hospitalization was significantly associated with impaired cognition, chronic obstructive pulmonary disease, and chronic kidney disease, whereas decreased odds of hospitalization was identified among non-Hispanic White residents. Study recommendations include prompt assessment of comorbid symptomatology among SNF residents for the timely management and prevention of unnecessary acute care transfers. [Research in Gerontological Nursing, xx(x), xx-xx.].

Intimate Partner Femicide in South Korea: An Integrative Review of the Literature

BACKGROUND

Intimate partner femicide (IPF) is a severe form of violence perpetrated against women in intimate relationships. The purpose of this integrative literature review was to identify studies of IPF in South Korea.

METHODS

A web-based literature search was performed in six databases: PubMed, CINAHL, PsycINFO, MEDLINE, SocINDEX, and RISS (Korean academic online database). Because of the limited number of findings, Google Scholar was used to find additional studies.

RESULTS

Nine articles were selected. There were no studies of IPF in South Korea utilizing a healthcare perspective. The studies were primarily designed to understand the characteristics of the cases and the perpetrators. Through the application of the ecological model to these studies, risk factors at the individual, relationship, community, and societal levels were identified. Although these studies identified that risk factors at the societal level-Korean culture, policy, and law-have a considerable influence on femicide, a clear solution is not proposed.

CONCLUSION

It is imperative to understand IPF in South Korea from a female societal perspective to facilitate violence prevention and recovery for those experiencing intimate partner violence.

Qualitative Descriptive Study of Illegal Behaviors among Those with Gambling Disorder in South Korea: Their Efforts for Recovery and Role of Mental Health Care Providers

The prevalence of Gambling Disorder among Koreans suggests that it is relatively higher than other countries. This study explored gambling-related crimes and related mental health care needs of those with Gambling Disorder on a case-by-case basis. Participants (n = 6) included men attending Gamblers Anonymous in South Korea with gambling debts and histories of illegal acts. Thematic analysis of qualitative interviews identified themes: (1) Meaning of Gambling Disorder in life, (2) Initiation of illegal acts stemming from Gambling Disorder, and (3) Life after addiction, efforts for recovery, and mental health care needs. Gambling Disorder destroyed lives and created criminal victims thereby threatening familial and community health.

Traditional partería providing women's health care in Latin America: A qualitative synthesis

AIM

To identify practices, beliefs, and potential gaps in knowledge about partería tradicional in Latin America.

BACKGROUND/INTRODUCTION

Partería tradicional (lay midwifery) refers to ancestral knowledge used by laypersons, mainly parteras tradicionales (lay midwives), to provide health care to women and children. This care, initiated prior to formalization of health care continues today. Descriptions of the intergenerational oral transmission of partería tradicional knowledge and practice in Latin America exist without related synthesis.

METHODS

Qualitative synthesis of the literature, including publications in Spanish, English, and Portuguese indexed in public databases over the previous 22 years concerning partería tradicional. Identification of categories, themes, and bias reporting via PRISMA processes, using the Thomas and Harden's approach and the Noblit and Hare's methodological recommendations.

RESULTS

Partería tradicional themes included "ancestral knowledge," "destiny and a spiritual calling," "woma's heritage," and "a means for providing health care."

DISCUSSION

Parteras tradicionales are key providers of health care for rural and urban marginalized communities. Limited knowledge and understanding of this practice impacts interactions between parteras tradicionales, midwives, and nurses. An interchange of knowledge is fundamental for care congruent with culture and the humanization of women's reproductive health.

CONCLUSIONS AND POLICY IMPLICATIONS

Communities with unresolved health care needs benefit via collaboration between formal health practices and partería tradicional. A compelling need for inquiry to preserve the art of partería tradicional exists internationally. Parteras tradicionales must be considered when formulating health care policy, thereby enhancing their historic role among the most vulnerable populations in Latin America: protecting, caring, and addressing health care needs.

Advance Care Planning Among Chinese Americans Through a Web-Based Culturally Tailored Education Program

At any time, a medical crisis could result in an individual too sick to make one's own health care decisions. Advance care planning (ACP) is an important step to ensure that each person receives the medical care desired. Despite its significant importance and proven benefits, the completion rate for advance directive is approximately one-third among the general population in the United States and lower among Chinese Americans. This study explored Chinese Americans' knowledge and attitudes about ACP following completion of a web-based culturally tailored health education program. Ninety-six individuals completed the study between October 1 and December 31, 2020. Prestudy-poststudy outcomes measured included the Advance Directive Knowledge Survey and Advance Directive Attitude Scale administered before and after completion of the education program. Each measure has 9 questions and 16 questions, respectively. Participants' Advance Directive Knowledge Survey scores (pre: mean, 6.04 [SD, 2.28]; post: mean, 8.75 [SD, 0.53]; P < .01) and Advance Directive Attitude Scale scores (pre: mean, 47.31 [SD, 5.69]; post: mean, 53.59 [SD, 4.37]; P < .01) increased significantly following program completion. Findings indicated feasibility for integration of web-based technology and culturally tailored approaches to promote ACP knowledge and attitudes among Chinese Americans.

Curbside Consultation for the Nurse Practitioner: Qualitative Inquiry for Education, Policy, and Practice

BACKGROUND AND PURPOSE

Curbside consultation (CC), defined as pursuing information or recommendation regarding patient care, without request for formal consultation is a favored information source for nurse practitioners (NPs) when making clinical decisions in practice settings. Research and education concerning CC among NPs is lacking. The purpose of this study was to obtain an understanding of NP perceptions of interpersonal aspects of the CC process to inform NP clinical practice and education.

METHODS

Qualitative descriptive design and inductive content analysis was used. Twenty primary care and specialty care NP were recruited using purposive sampling for conduct of individual interviews.

RESULTS

Content analysis identified themes describing interpersonal components of the CC process. NP practiced in collaboration with physicians in variable roles within primary care and specialty care settings. These collaborations varied dependent upon supervisory relationships with physicians. Additional themes concerned NP professional experience and characteristics of experts desired for CC. These characteristics included NP perceptions of colleague experience and expertise, trust, and interpersonal relationship dynamics.

IMPLICATIONS FOR PRACTICE

CC processes for NPs are multidimensional, including interpersonal themes as components of this communication exchange. Given CC is a highly utilized resource for NPs, further inquiry is critical for understanding of its implications for NP practice, policy, and education internationally.

Accompanying the Path of Maternity: The Life History of a Colombian Doula

Doulas have fundamentally improved the health-care experience of pregnant women internationally. Women who recognize the importance of not being alone during pregnancy have embraced this role for centuries. However, less is known about doulas practicing in countries experiencing health inequities like Colombia. Miller's methodology and Atkinson's interview domain was used to answer the question “What life experiences led a Colombian woman to become a doula?” A central theme emerged, “A calling from within: Growing up to accompany the transition from woman to mother.” The path to becoming a doula evolved from life experiences involving health inequities, and a sense of femininity, maternity, and the women's role in rural Colombia.

COVID outbreak after the 1st dose of COVID vaccine among the nursing home residents: What happened?

The purpose of this study was to assess the effectiveness of Pfizer-BioNTech COVID19 vaccine among nursing home residents by exploring the outcomes of a major COVID-19 outbreak following COVID-19 vaccination in a nursing home located at a metropolitan area of South-Central Texas. 91 residents resided in this nursing home during the outbreak, and 86 residents received the 1st dose of COVID-19 vaccine on January 4th, 2021. A retrospective chart review explored outcomes of this outbreak by accessing the electronic medical records from January 4th, 2021 thru February 28th, 2021. Residents partially vaccinated with COVID-19 vaccine were found less likely to be symptomatic during this outbreak. The risk of SARS-CoV-2 infection was significantly lower among residents who received both doses of the COVID-19 vaccine. Completion of both doses of COVID vaccination for all nursing home residents is essential and can prevent future COVID-19 outbreaks in nursing homes.

Attitude and Acceptability of the Self-Sampling in HPV Carrier Women

METHODS

The descriptive, cross-sectional design included a convenience sample of Mexican women with a previous diagnosis of cervical dysplasia.

RESULTS

Women (n = 61) were young adults (M = 27 years, SD = 6.92) reporting single marital status (55%) and sexually active (93%). Mean age at onset of sexual activity was 17 years; a majority of women (78.8%) had more than one sexual partner in their lifetime with 56.6% reporting between two and five partners. All (100%) of the women indicated that they would "choose self-sampling for HPV detection" and would recommend it to other women. Concerning "attitudes toward HPV," the women responded that it is necessary to comply with HPV treatment and understand that preventative measures can avoid HPV transmission.

CONCLUSION

Women reported high acceptability for self-sampling and positive attitudes toward HPV diagnostic procedures. Women indicated substantial interest in learning more about HPV, its transmission, preventive measures, routine testing, and recommended self-sampling for HPV detection.

Acute blood loss anemia after COVID-19 nasopharyngeal sampling

ABSTRACT

Long-term care residents with novel coronavirus disease 2019 (COVID-19) experience high mortality rates and require frequent screening. Most resident testing occurs via nasopharyngeal swab that potentially causes epistaxis with rates of 5% to 8% in healthy populations. It is estimated that 48% of long-term care residents receive oral anticoagulation that increases risk of bleeding. A long-term care resident receiving oral anticoagulation experienced an episode of acute blood loss anemia after nasopharyngeal sampling. Current medications were not reviewed before testing, and oral anticoagulation was not held resulting in acute blood loss anemia. A medication review is indicated for skilled nursing and assisted living residents to identify oral anticoagulation before nasopharyngeal testing. Less invasive testing may be recommended or should bleeding occur, discontinuation of oral anticoagulation for a short term may be appropriate.

Changes in Advance Care Planning for Nursing Home Residents During the COVID-19 Pandemic

OBJECTIVE

Describe the care preference changes among nursing home residents receiving proactive Advance Care Planning (ACP) conversations from health care practitioners during the COVID-19 pandemic.

DESIGN

Retrospective chart review.

SETTING AND PARTICIPANTS

Nursing home residents (n = 963) or their surrogate decision makers had at least 1 ACP conversation with a primary health care practitioner between April 1, 2020, and May 30, 2020, and made decisions of any changes in code status and hospitalization preferences.

METHODS

Health care practitioners conducted ACP conversations proactively with residents or their surrogate decision makers at 15 nursing homes in a metropolitan area of the southwestern United States between April 1, 2020, and May 30, 2020. ACP conversations reviewed code status and goals of care including Do Not Hospitalize (DNH) care preference. Resident age, gender, code status, and DNH choice before and after the ACP conversations were documented. Descriptive data analyses identified significant changes in resident care preferences before and after ACP conversations.

RESULTS

Before the most recent ACP discussion, 361 residents were full code status and the rest were Out of Hospital Do Not Resuscitate (DNR). Of the individuals with Out of Hospital DNR, 188 residents also chose DNH. After the ACP conversation, 88 residents opted to change from full code status to Out of Hospital DNR, thereby increasing the percentage of residents with Out of Hospital DNR from 63% to 72%. Almost half of the residents decided to keep or change to the DNH care option after the ACP conversation.

CONCLUSION AND IMPLICATIONS

Proactive ACP conversations during COVID-19 increased DNH from less than a quarter to almost half among the nursing home residents. Out of Hospital DNR increased by 9%. It is important for all health care practitioners to proactively review ACP with nursing home residents and their surrogate decision makers during a pandemic, thereby ensuring care consistent with personal goals of care and avoiding unnecessary hospitalizations.

Social Support and Perinatal Depression: The Perspectives of Mexican-American Adolescent Mothers

Perinatal depression is estimated to affect one in seven pregnant women. As such, social support has been shown to impact the mental health of women during the perinatal period. The purpose of this qualitative descriptive study was to examine the types of social support received by pregnant and parenting Mexican-American adolescent mothers and their perceptions of how it can influence perinatal mental health. Deductive content analysis was used to analyze the data using emotional, instrumental, and informational support as primary categories. Positive and negative aspects of the adolescent's social network were also included to understand how individuals impact their mental health. A convenience sample of 20 perinatal Mexican-American adolescents were interviewed. Emotional support, such as encouragement and affirmation, as well as instrumental support, via financial assistance and help with infant care, were primarily sought from significant others, which consisted of family members and their partner. Having strained relationships with their significant others primarily contributed to emotional distress. Health care providers were often sought out for informational support concerning perinatal depression. However, some adolescents were unable to establish rapport with their health care provider, making it difficult to inquire about pertinent mental health information. Study findings suggest that identifying support needs and expectations is an important component of facilitating positive mental health outcomes for Mexican-American adolescent mothers. Future efforts to promote mental health and prevent perinatal depression among Mexican-American adolescent mothers should consider integrating a strong focus on social support.

Exploring the use of curbside consultations for interprofessional collaboration and clinical decision-making

Nurse practitioners utilize curbside consultation, an interprofessional collaboration communication process in which one clinician seeks advice from another, in clinical decision-making practices. Nevertheless, this process is not well-understood. A qualitative design with individual open-ended interviews was used to explore the phenomenon of curbside consultation among nurse practitioners for clinical decision-making. Twenty primary care and specialty nurse practitioners participated. Participants were recruited via purposive sampling from in-patient and out-patient settings in order to reach saturation of themes. Using inductive content analyses, the findings revealed that nurse practitioners made multiple decisions in the course of information-seeking and its application during the curbside consultation process. Motivated by the patient's best interest, nurse practitioners provided advice in the curbside consultation exchange and sought answers to questions encountered in clinical decision-making. Multiple resources were often utilized with curbside consultation frequently evolving into formal consultation. Dynamics of curbside consultation included (a)synchronous approaches including text, e-mail, telephone, or face-to-face processes. Once information was received, nurse practitioners decided whether they (dis)agreed with advice and if validation was necessary. Nurse practitioners utilized curbside consultation for clinical decision-making and means for interprofessional collaboration, thereby increasing clinical competency and promoting quality patient outcomes. Implications of curbside consultation for education and practice require further exploration to enhance outcomes of curbside consultation processes.

Psychosocial Factors Associated with Paternal Perinatal Depression in the United States: A Systematic Review

Paternal perinatal depression can occur in approximately one out of ten fathers. However, research within this population is limited. A previous systematic review suggested that United States had higher rates of paternal perinatal depression compared to other countries. Therefore, this systematic review identified psychosocial factors for depression during the perinatal period in fathers who live in the United States. A literature search was conducted from multiple databases using keywords and MeSH terms to retrieve articles up to the year 2019. Twenty five articles were included in this review. A social-ecological framework was applied to identify psychosocial factors associated with paternal depression. Individual factors include prior history of depression, having maladaptive cognitive coping styles, fathers who self-identified as African-American or Hispanic, parenting stress, substance use, and history of criminal conviction. Interpersonal factors include lack of social support, quality of relationship with the mother of the baby, coparenting conflict, quality of current and childhood relationships with their own parents, and maternal depression. Community factors include frequent daily experiences with racism, and limited access to transportation and housing. These findings underscore the importance of assessing depression and developing father-inclusive interventions that address the psychological needs of fathers.

Factors Associated With the Role of Parents for the Prevention of Human Papillomavirus in Mexican Adolescents

BACKGROUND

The parental role is key for the prevention of human papillomavirus (HPV) in adolescents; however, there are factors that can facilitate or inhibit its performance. For this reason, the purpose of this study was to determine the factors that influence the role of parents for prevention of HPV in their adolescent children.

METHOD

A descriptive correlational study design included a convenience sample of 582 Mexican parents, whose son or daughter, 13 to 15 years of age, was in either the second or third year of high school. Data analyses included multiple linear regression.

RESULTS

Factors related to the role of parents included knowledge about HPV (r_s = 0.180, p < .01), perceived risk to contract HPV (r_s = 0.148, p < .01), self-efficacy for sexual communication with adolescents (r_s = 0.507, p < .01), and attitude toward prevention of HPV (r_s = 0.272, p < .01). Self-efficacy for sexual communication with adolescents and attitude toward prevention of HPV positively influenced the parental role, explaining 28.8% of the variance, F(4, 577) = 59.80, p < .001.

CONCLUSIONS

Parents with positive attitudes regarding prevention of HPV and who perceive self-efficacy in communicating sexuality issues with their adolescent children, develop a preventative role.

Outcomes of Depression Screening for Adolescents Accessing Pediatric Primary Care-Based Services

PURPOSE

Assess outcomes of depression screening among adolescents accessing pediatric primary care-based services. These findings will contribute to development of clinical protocols for depression screening and intervention in primary care settings.

DESIGN AND METHODS

Retrospective chart review conducted via electronic medical records at a pediatric primary care-based clinic to extract PHQ-9 data for adolescents screened from 1/17/2018 to 4/18/2018. De-identified data included age, gender, ethnicity, provider, PHQ-9, and referral/follow-up/medication status.

RESULTS

Data included 1213 adolescents of whom N = 600 were depressed without additional comorbidities; 96 adolescents had PHQ-9 scores >5. Descriptive analyses by age, gender, ethnicity, referral type, follow-up, and provider services identified targeted primary care-based interventions for depression and referral. Depression screening occurred primarily at well child visits. 82.5% of those with PHQ-9 scores >5 were not currently receiving treatment. Overall, referrals by physicians (45.8%) and nurse practitioners (42.9%) were equivalent with more referrals for adolescents with moderate-severe depression. Nurse practitioners provided more counseling than physicians among adolescents with mild to moderate depression.

CONCLUSIONS

Adolescent mental health necessitates an enhanced continuum of care. Primary care-based interventions provided by pediatric nurse practitioners are imperative to address adolescent mental health needs. Findings provide practical means to incorporate protocols for depression enhancing primary care-based mental health access.

PRACTICE IMPLICATIONS

Need for incorporation of practical modalities for depression assessment and follow up as recommended by American Academy of Pediatrics. Future study for comparison of methods (phone/text reminder, follow up appointment, online resource reminder, telehealth), indicated to enhance follow-up care for adolescents experiencing depression.

Perceived Mental Healthcare Barriers and Health-seeking Behavior of African-American Caregivers of Adolescents with Mental Health Disorders

African-American adolescents with mental health disorders are more likely to experience higher rates of depressive moods but are less likely to utilize mental health resources. Mental healthcare providers inform caregivers of adolescents with mental health issues about appropriate resources to facilitate appropriate treatment decisions. Although we understand rates of utilization of services, little understanding exists concerning socio-ecological barriers African-American caregivers experience when seeking mental health care for their adolescents. This study explores African-American caregiver perceptions of barriers to mental health care for adolescents with mental health disorders. We sought to understand how these perceptions influence African-American caregiver mental health-seeking behavior. This qualitative study utilized semi-structured interviews using a grounded theory approach to identify common themes describing experiences of African-American caregivers accessing mental health care for their adolescents. Previous caregiver experiences with mental illness, perceptions of social support, early intervention by educators and extrinsic behavior requiring medication compliance affected caregiver decision-making. Stigma associated with mental illness was a potential barrier to access to mental health care. Financial barriers that prevent access to care and an overall belief that mental health may not be as important as other issues was not identified as affecting health-seeking behaviors for mental health care. Caregivers who struggled with mental health issues themselves recognized these in adolescents and sought mental healthcare services. Caregiver previous experiences with mental healthcare services influenced their decision-making. Healthcare provider ability to engage adolescents, caregivers, and support systems increases the possibilities for positive experiences and continuation of treatment.

Summative Content Analysis for Understanding of Romantic Relationships Among Rural Mexican American Adolescent Women

An understanding of romantic relationships among adolescent Mexican-American females is lacking yet needed to provide culturally appropriate sexual health interventions. Although explored among other populations, romantic relationships among adolescents in rural settings is under-studied. This study explores romantic relationships for rural Mexican American female adolescents as a component of sexual health promotion. Rural Mexican-American adolescent females (n = 82) aged 14-18 years were recruited via convenience sampling at a rural health clinic. They completed open-ended individual interviews describing romantic relationships. Responses to open-ended questions were analyzed using summative content analysis. The majority reported sexual activity (62.2%) of which 23.5% had been pregnant. Summative content analyses identified personal characteristics and relationship characteristics as main categories with eight additional subcategories from responses. Sex was reported as what men wanted from women while physical attractiveness was perceived as important for both genders in development of romantic relationships. They prioritized other relational and personal characteristic such as integrity, and partner treatment of self and others. More obesity was present among those reportedly in romantic relationships. Description of parental roles as a component of romantic relationships was not present. Addressing adolescent romantic relationship with an emphasis on what male and female adolescents want or perceive as expected from relationships, long-term outcomes of relationships and on parental roles may enhance sexual health among rural Mexican-American adolescent populations. This study addresses a gap in literature by exploring romantic relationships for rural Mexican American female adolescents. This understanding of romantic relationships augments existing sexual health programing for these adolescents.

Assessment of Gestational Diabetes Mellitus Outcomes for Hispanic Women Living in the Rio Grande Valley

INTRODUCTION

Gestational diabetes mellitus (GDM) among women living along the U.S.-Mexico border are approximately twice that of the general population of pregnant U.S. women. This study compared outcomes for Hispanic pregnant women diagnosed and treated for GDM (i.e., two abnormal 3-hour oral glucose tolerance tests [OGTT]) with those who were screened but had only one abnormal 3-hour OGTT and therefore received no treatment.

METHODS

Retrospective chart review of pregnant Hispanic women of Mexican origin (N = 95), with GDM (N = 41) or one abnormal 3-hour OGTT value (N = 54) who delivered between January 1, 2015, and December 31, 2017.

RESULTS

No significant differences were found between the two groups with regard to sociodemographic variables, hyperbilirubinemia, or other adverse neonatal outcomes. Comparisons identified differences between women with and without adverse neonatal outcomes concerned type of delivery; there were more C-sections among women with GDM.

CONCLUSION

Pregnant women with one abnormal 3-hour OGTT value are at risk of giving birth to neonates with biomarkers similar to those diagnosed and treated for GDM. The treatment of hyperglycemia in Hispanic women of Mexican origin with one abnormal 3-hour OGTT value may improve the health outcomes and quality of life of the mother and the neonate. More research is warranted to clarify the risk of adverse outcomes of diverse pregnant women who do not meet guidelines for diagnosis of GDM.

Cervical Cancer Protective Behavioral Patterns Among Mexican Women Living With HPV

Purpose:

Human papillomavirus (HPV) causes morbidity and mortality worldwide. Evidence-based models addressing health for women who have HPV may prevent development of cervical cancer (CC). We applied Meleis’ transition model to identify barriers and facilitators influencing CC protective behavior for women with HPV.

Method:

Descriptive, correlational design including nonprobabilistic sampling of women with HPV ( N = 201) in Mexico.

Results:

Variables linked to CC protective behavior (cervical cytology, stable partner, condom use, communication) included awareness of HPV/CC as well as attitude toward diagnosis and cytological control of HPV (λ = 890, F[196.00] = 6.057, p = .001). Acceptance of HPV diagnosis related to HPV carrier attitude, stigma, age, education, and length of HPV diagnosis ( R2 = .155 , F[5, 195] = 8.34, p < .05). Knowledge of HPV, attitude toward HPV diagnosis/cytological control, and age had direct effects on self-efficacy for CC protective behavior ( R2 = .239, F[7, 193] = 9.95, p < .05). Coping with HPV diagnosis, self-efficacy for CC protective behavior, and age were also associated with CC protective behavior ( R2 = 14.6, F[3.7] = 12.39, p = .001).

Conclusions:

Identification of factors inhibiting or facilitating transition among women who have HPV decrease progression to CC by increasing CC protective behaviors.

Mobile Health, Information Preferences, and Surrogate Decision-Making Preferences of Family Caregivers of People With Dementia in Rural Hispanic Communities: Cross-Sectional Questionnaire Study

BACKGROUND

Mobile health (mHealth) technology holds promise for promoting health education and reducing health disparities and inequalities in underserved populations. However, little research has been done to develop mHealth interventions for family caregivers of people with dementia, particularly those in rural Hispanic communities, who often serve as surrogate decision makers for their relatives with dementia.

OBJECTIVE

As part of a larger project to develop and test a novel, affordable, and easy-to-use mHealth intervention to deliver individually tailored materials in rural Hispanic communities, in this pilot study, we aimed to examine (1) characteristics of people with dementia and their family caregivers in rural Hispanic communities, (2) caregivers' preferences for types and amounts of health information and participation in surrogate decision making, and (3) caregivers' mobile device usage and their desire for receiving information via mobile devices.

METHODS

This was a cross-sectional survey. A convenience sample of 50 caregivers of people with dementia was recruited from rural health care facilities in Southwest Texas during 3 weeks of April 2017 to May 2017 via word-of-mouth and flyers posted at the facilities.

RESULTS

More women than men were in the patient group (χ21=17.2, P<.001) and in the caregiver group (χ21=22.2, P<.001). More patients were on Medicare and Medicaid; more caregivers had private insurance (P<.001 in all cases). Overall, 42% of patients did not have a power of attorney for their health care; 40% did not have a living will or advance directive. Caregivers were interested in receiving all types of information and participating in all types of decisions, although on subscales for diagnosis, treatment, laboratory tests, self-care, and complementary and alternative medicine, their levels of interest for decision-making participation were significantly lower than those for receiving information. On the psychosocial subscale, caregivers' desire was greater for surrogate decision-making participation than for information. Caregivers did not differ in their interests in information and participation in decision making on the health care provider subscale. All but 1 caregiver (98%) owned a mobile phone and 84% had a smartphone. Two-thirds wanted to receive at least a little dementia-related information via a smartphone or tablet. The amount of dementia-related information caregivers wanted to receive via a mobile device was significantly greater for women than for men (U=84.50, P=.029). Caregivers who owned a tablet were more likely to want to receive dementia-related information via a mobile device than those who did not own a tablet (U=152.0, P=.006).

CONCLUSIONS

Caregivers in rural Hispanic communities were interested in receiving a wide range of information as well as participating in making decisions for their relatives with dementia. There is much need for effective mHealth interventions that can provide information tailored to the needs and preferences of these caregivers.

"We Don't Want to be Judged": Perceptions about Professional Help and Attitudes Towards Help-Seeking among Pregnant and Postpartum Mexican-American Adolescents

PURPOSE

The purpose of this qualitative study is to understand how depression is recognized, as well as perceptions of professional help and attitudes concerning perinatal depression among pregnant and postpartum (perinatal) Mexican-American adolescents.

DESIGN AND METHODS

This qualitative descriptive study used deductive and inductive content analysis to analyze data. Categories and subcategories describing the mental health literacy of perinatal Mexican-American adolescents concerning perinatal depression are presented. A convenience sample of 20 perinatal Mexican-American adolescents between the ages of 15 and 19 years were interviewed. Participants were recruited from parenting classes across urban high-schools in Southwestern United States.

RESULTS

Adolescents expressed difficulties in recognizing perinatal depression. Depressive symptoms were identified through self-appraisals or the appraisal of others. Establishing rapport with empathetic health care providers facilitated trust among adolescents. Fear of judgement was the most common response and prevented help-seeking. Lack of trust, normalization of depression, and reluctance with disclosing symptoms were also indicated by participants.

CONCLUSIONS

Stigma concerning perinatal depression was identified as a barrier for help-seeking among participants who were already experiencing criticism due to their pregnancy status. The quality of interactions with health providers may hinder or facilitate adolescents from professional help-seeking.

PRACTICE IMPLICATIONS

Active engagement and collaboration with Mexican-American adolescents are indicated in identification and treatment of perinatal depression. Integration of mental health services in primary care settings is suggested to facilitate help-seeking for perinatal depression. Mental Health First Aid may be utilized to improve knowledge and decrease stigma concerning perinatal depression among Mexican-American adolescents.

Adaptation of the Contraceptive Behavior Scale for Mexican Heterosexual Populations

INTRODUCTION

The Contraceptive Behavior Scale requires adaptation for use by health professionals among Mexican heterosexual populations of reproductive age.

METHODS

Cross-sectional, descriptive, correlational design assessed adaptation of the Contraceptive Behavior Scale.

RESULTS

Six hundred Mexican men and women of reproductive age (18-35 years) were recruited from a second-level health care unit in a metropolitan area in Mexico. Exploratory factor analysis identified two factors with an explanatory variance of 69.238%. Confirmatory factor analysis identified acceptable index values. Cronbach alpha of .729 obtained for the scale was acceptable. Significant correlation ( p = .007) was observed between Contraceptive Conduct and participant gender. Component 1 constituted Items 1, 2, and 4, while Component 2 consisted of Items 3 and 5. No items were eliminated as adequate factorial saturation was present.

CONCLUSIONS

The Contraceptive Conduct Scale is a reliable assessment tool for Mexican men and women of reproductive age. This scale is potentially useful for health professionals to assess contraceptive behavior in heterosexual couples of reproductive age. Clinicians may use the tool to obtain information for development of strategies responding to sexual and reproductive health needs of both men and women.

End-of-life decision making by family caregivers of persons with advanced dementia: A literature review of decision aids

Objectives:

To investigate existing knowledge in the literature about end-of-life decision making by family caregivers of persons with dementia, focusing on decision aids for caregivers of persons with advanced dementia, and to identify gaps in the literature that can guide future research.

Methods:

A literature review through systematic searches in PubMed, CINAHL Plus with Full Text, and PsycINFO was conducted in February 2018; publications with full text in English and published in the past 10 years were selected in multiple steps.

Results:

The final sample included five decision aids with predominantly Caucasian participants; three of them had control groups, and three used audiovisual technology in presenting the intervention materials. No other technology was used in any intervention. Existing interventions lacked tailoring of information to caregivers’ preferences for different types and amounts of information necessary to make decisions consistent with patients’ values.

Conclusion:

Research is needed in exploring the use of technology in decision aids that could provide tailored information to facilitate caregivers’ decision making. More diverse samples are needed.

Factors Protecting Male and Female Adolescents in Mexico From Human Papillomavirus Infection

Introduction:

Adolescents may be infected with human papillomavirus (HPV) during their first sexual relationship. Persistent infections in adulthood may result in associated cancers among both women and men. This study explored condom use action plans, its influence on sexual activity in adolescents, and associated HPV protective behavior.

Methods:

A descriptive correlational design was used. A convenience sample including adolescents ( N =313; male n = 171, female n = 142), aged 15 to 17 years, attending one of three public high schools in Mexico was recruited. Self-report structured questionnaires were used to assess sociodemographics, sexual behavior, and HPV protective behavior.

Findings:

Self-reported HPV knowledge among Mexican adolescents was low. Adolescents ( n = 81, 25.9%) self-reported sexual experience. Comparisons of adolescents by self-reported sexual experience identified significant differences, including higher condom use self-efficacy, sexual rights knowledge, a condom use action plan, and greater interpersonal influence on HPV protective behavior among those who had sexual experience. Significant factors predicting HPV protective behavior included self-reported number of sexual partners, condom use in past 3 months, and having a condom use action plan.

Conclusion:

An intervention targeting adolescents should encourage adolescents to develop their own cognitive processes, thereby facilitating the adoption or development of action plans for HPV protective behavior.

Outcomes of Depression Screening Among Adolescents Accessing School-based Pediatric Primary Care Clinic Services

PURPOSE

Implementation of routine Patient Health Questionnaires (PHQ-9) screening among adolescents aged 12-18year, accessing school-based pediatric primary care clinic services for identification of adolescents at potential risk for Major Depressive disorder (MDD).

DESIGN AND METHODS

Retrospective chart review (N=256 cases) documented PHQ-9 depression screening outcomes among adolescents accessing school-based pediatric primary care clinic services for episodic illness and wellness visits. Data analyses included descriptive statistical methods.

RESULTS

Chart review included 137 (53.5%) females and 119 (46.5%) males. PHQ-9 depression screening was identified for 56.3% (n=144) of charts with scores ≥10 for 12.5% (n=18) among those screened. Mental health referrals were made for 83.3% (n=15) with PHQ-9 scores ≥10. Dysthymia related concerns were reported among 20.1% (n=29) of which 55.2% (n=16) received mental health referrals. Female adolescents reported more sleep problems (χ²=9.174, p=0.002) and tiredness (χ²=6.165, p=0.013) than males. The 15-18year age group (χ²=5.443, p=0.020) was more likely to experience sleep problem and low self-esteem than 12-14year age group (χ²=5.143, p=0.023).

CONCLUSION

Implementation of PHQ-9 depression screening protocol identified MDD among adolescent accessing pediatric school-based primary care clinic services facilitating referrals to mental health providers, potentially improving morbidity and mortality among adolescents.

PRACTICE IMPLICATIONS

MDD is common among adolescents and associated with functional impairments and increased morbidity and mortality. Due to its high prevalence, it is imperative to improve screening and treatment access in this population via school-based clinics.

Assessment of Mental Health Literacy among Perinatal Hispanic Adolescents

According to the United States (U.S.) Census Bureau, Hispanics are the fastest growing ethnic minority in the U.S. As such, Hispanic females have the highest birth rate (35 per 1000) among adolescents between the ages of 15 and 19 years. Despite high fertility rates, there is limited mental health information among Hispanic adolescents during the perinatal period. Perinatal depression is a major concern as it poses health risks for both the mother and infant. Adverse outcomes such as preterm birth, low infant birth weight, and poor maternal-infant attachment may result from perinatal depression. However, less than half of Hispanic adolescent mothers who experience perinatal depression receive treatment. Previous research identified low mental health literacy (MHL) as one of the primary reasons for the limited use of mental health services among ethnic minorities. This study assessed the MHL of pregnant and postpartum Hispanic adolescents (n = 30) using a modified MHL scale. Implications for nursing practice are discussed to help improve mental health outcomes among pregnant and postpartum Hispanic adolescents.

Designing and revising a cognitive behavioral group intervention for psychological distress among female university students

Background: Psychological distress in the form of depression and/or anxiety has been found to be common among university students, especially in females. Roughly one in five of Icelandic female university students exhibit elevated psychological distress, yet less than 30% of them do receive professional mental health care. To ameliorate the psychological distress a cognitive behavioral group therapy was designed to target the distress. The purpose of this paper is to describe the main steps in designing the respective intervention and the revisions made by the expert panel based on the validation of the preliminary intervention and the experience of the advanced practice psychiatric nurses therapists.Methods: The intervention design took place in four phases. Initially psychological distress was defined, secondly a literature review was conducted to see if there were effective interventions available to solve the problem. Thirdly the drafting of the intervention took place based on theory and evidence and finally the intervention was validated with quantitative and qualitative methods. The intervention was provided by two advanced practice psychiatric nurses in 4 sessions in groups of 5 to 8 females. An expert panel of 6 psychiatric nurses was formed to guide the intervention design, the delivery of the intervention and intervention validation.Results: The quantitative and qualitative validation of the preliminary intervention showed that psychological distress decreased and was acceptable to participants.Conclusions: The validation of the preliminary intervention provided the expert group with rationale for modifying the content and structure of the intervention in nine categories.

Psychosocial Risk Factors for Perinatal Depression among Female Adolescents: A Systematic Review

Perinatal depression is a health concern among pregnant and postpartum adolescents as it may negatively impact fetal development and result in complications such as preterm delivery, low infant birth weight, and poor maternal-infant attachment. The purpose of this systematic review is to examine psychosocial risk factors for depression among adolescents during pregnancy and postpartum. A literature search was conducted from five databases from 1995 to 2016. A total of 17 studies matched the inclusion criteria. Lack of social support, perceived stress, prior history of depression, and a history of sexual or physical violence were most frequently identified as potential risk factors for perinatal depression. Additional risk factors include the adolescent's perception of her pregnancy, family criticism, self-efficacy, self-esteem, substance use, parental stress, community violence, anxiety, and African-American ethnicity. Research and clinical implications are indicated for adolescents at risk for perinatal depression.

Adaptation of the contraceptive self-efficacy scale for heterosexual Mexican men and women of reproductive age

AIM

Development of a Spanish Version Contraceptive Self-efficacy Scale for use among heterosexual Mexican populations of reproductive age inclusive of 18-35years.

BACKGROUND

Methods of family planning have decreased in Mexico which may lead to an increase in unintended pregnancies. Contraceptive self-efficacy is considered a predictor and precursor for use of family planning methods.

METHODS

Cross-sectional, descriptive study design was used to assess contraceptive self-efficacy among a heterosexual Mexican population (N=160) of reproductive age (18-35years). Adaptation of a Spanish Version Contraceptive Self-efficacy scale was conducted prior to instrument administration.

RESULTS

Exploratory and confirmatory factorial analyses identified seven factors with a variance of 72.812%. The adapted scale had a Cronbach alpha of 0.771. A significant correlation between the Spanish Version Contraceptive Self-efficacy Scale and the use of family planning methods was identified.

CONCLUSIONS

The Spanish Version Contraceptive Self-efficacy scale has an acceptable Cronbach alpha. Exploratory factor analysis identified 7 components. A positive correlation between self-reported contraceptive self-efficacy and family planning method use was identified. This scale may be used among heterosexual Mexican men and women of reproductive age. The factor analysis (7 factors versus 4 factors for the original scale) identified a discrepancy for interpretation of the Spanish versus English language versions. Interpretation of findings obtained via the Spanish versión among heterosexual Mexican men and women of reproductive age require interpretation based upon these differences identified in these analyses.

Mexican Adolescents' Self-Reports of Parental Monitoring and Sexual Communication for Prevention of Sexual Risk Behavior

PURPOSE

Assess perceptions of parental monitoring and sexual communication for sexual health promotion among adolescents who are Mexican.

DESIGN AND METHODS

Adolescents (N=153, n=85 females, n=68 males) between 14years (n=80) and 15 years (n=73) were recruited at a public high school in Monterrey in the state of Nuevo Leon, Mexico. All participants were living with a parent(s). Descriptive statistical analyses were conducted to assess sociodemographic characteristics of the group. Chi-square analyses were conducted to identify potential group differences among the adolescents by age, gender and sexual activity regarding responses to each item of the Spanish Version Parental Monitoring and Sexual Communication Scale (a=0.88).

RESULTS

Eleven percent of adolescents self-reported sexual activity. Significant group differences by age, gender and sexual activity were identified concerning parental monitoring and sexual communication including: less parental monitoring with older age (14 versus 15 year olds); more parental monitoring for females than males; less monitoring for sexually active adolescents; greater sexual communication for males than females, and among adolescents who were sexually active.

CONCLUSIONS

An assessment of adolescents' perceptions of parental monitoring and sexual communication is useful for development of strategies concerning sexual health promotion in Mexico.

PRACTICE IMPLICATIONS

The Spanish Version Parental Monitoring and Sexual Communication Scale can be used for assessment and modification of interventions for adolescent populations in Mexico. Information obtained from this assessment can be used to assist parents to enhance positive outcomes for parental monitoring and sexual communication with their children.

Examining Fall Recurrence Risk of Homebound Hispanic Older Adults Receiving Home Care Services

INTRODUCTION

Unintentional falls and injuries is a major problem among older adults and the fourth cause of death in the United States. A previous fall event doubles the risk of recurrence and lessens the person's quality of life. Hispanic older adults have higher rates of disability and lower independent functioning due to poor medical health and risk for fall recurrence. Most fall studies focus on fall risk with few studies on fall recurrence in older adults receiving home health care services unrelated to fall incident.

METHOD

A descriptive pilot study of 30 homebound Hispanic older adults receiving home care services who reported a fall within 3 months was conducted by a multidisciplinary team to evaluate risk of fall recurrence.

RESULTS

A heightened risk for fall recurrence was identified with high number of chronic illnesses, high intake of medications, vision problems, and prevalence of urinary incontinence.

CONCLUSION

Findings highlight significant number of intrinsic factors for fall risk recurrence and injuries in a Hispanic older adults population that is homebound and receiving home care services. A multidisciplinary evaluation and culturally appropriate interventions to lessen the risk of fall recurrence are recommended.

Identifying Health Promotion Needs Among Dominican-American Adolescents

PURPOSE

Immigration from the Dominican Republic to the United States has grown rapidly. Yet, although adolescent pregnancy and obesity are common concerns among Hispanics, little is known specifically about Dominican adolescent health. This study was undertaken to assess Dominican-American adolescents' health concerns and their perceptions about their health promotion needs.

DESIGN AND METHODS

Dominican-American adolescents (N=25) were recruited in a pediatric clinic in New York City which primarily serves a Dominican population. Eligibility criteria included age 13-21years, self-identifying as Dominican ethnicity, and able to speak and read English. They completed a questionnaire, with demographic questions and questions about their risk behaviors including sexual and substance use. After completing the questionnaire, they participated in a semi-structured interview addressing their health education experiences and suggestions for such programs. Quantitative data were analyzed using frequencies to provide a demographic and behavioral profile. Qualitative data were analyzed using thematic analysis.

RESULTS

Twenty-five adolescents, ages 13-21years, (female N=19, male N=6) participated in the study. Most were in school (92%) and were sexually experienced (68%). Programmatic preferences included in-person programs rather than online. They spontaneously addressed the importance of cultural issues, and the need to address several issues in addition to sexuality, including obesity and substance use.

CONCLUSIONS

Programming for this population should address a broad conceptualization of health, and incorporate Dominican cultural issues.

PRACTICE IMPLICATIONS

Nurses working with adolescents of Dominican origin, should provide health education that incorporates the specific needs of this population, including culturally congruent face-to-face interventions.

Psychological Distress and Associated Factors Among Mexican American Adolescent Females

INTRODUCTION

Mental health literacy is a critical component of adolescent health enabling recognition, management, and prevention of psychological distress. Adolescents engaging in risk behaviors and experiencing interpersonal violence, substance use, and pregnancy are at high risk for psychological distress.

METHOD

Secondary analysis of data collected via a control randomized trial among Mexican American females (aged 14-18 years; N = 461) experiencing high-risk sexual behavior, interpersonal violence, and sexually transmitted infection was conducted with comparisons of psychological distress by pregnancy status.

RESULTS

At study entry, 46.4% (n = 214) self-reported ever experiencing pregnancy (ever-pregnant) while 53.6% (n = 246) self-reported never experiencing pregnancy (never-pregnant). Adolescents reporting ever-pregnancy status were older and school dropouts. However, adolescents reporting never-pregnancy experienced higher sexual risk behaviors, substance use, interpersonal violence, and psychological distress than those reporting ever-pregnancy. A higher proportion of ever- versus never-pregnant adolescents were born in Mexico and preferred Spanish language indicating less acculturation.

CONCLUSIONS

Findings support the need for mental health literacy concerning psychological distress with consideration of implications of acculturation among adolescents experiencing high-risk sexual behavior, interpersonal violence, and substance use. More never- than ever-pregnant adolescents were attending school, presenting opportunities for implementation of health promotion strategies within community health settings for mental health literacy.

Woman Abuse, Assimilation, and Self-Concept in a Rural Mexican American Community

This study proposed to describe the effect of assimilation on self-concept and abuse in a rural, minority population of Mexican American women. Ethnic language translations were developed to enable investigation with a rural, Spanish-speaking, Mexican American population. Reassessment of reliability and validity of both English and Spanish translations of instrumentation for a rural population was performed. Data were collected through convenience sampling from both rural battered women's shelters and rural community service centers. Significant differences were found between groups of abused (n = 85) versus non-abused (n = 84) women on dimensions of self-concept. Assimilation variables found to be significantly correlated with self-concept for abused and non-abused Mexican American women included language, attitudes toward traditionalfamily structure, and values. Significant differences werefound between abused and non-abused Mexican American women in attitudes toward traditional family structure and sex-role identification.

Abused Women and Risk for Pelvic Inflammatory Disease1

Mexican and African American women with sexually transmitted diseases (STDs) underwent targeted physical exams and questioning regarding sexual or physical abuse, current genitourinarysymptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms affecting diagnoses of STDs and risk for PID. Bivariate comparisons found abused women reported more PID risk behaviors including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found abused women were more likely to report pathologic genitourinary symptomatology than nonabused women. Clinicians made more presumptive diagnosesof PID for abused than for nonabused women upon physical examination. These findings indicate abused women are at high risk for PID. Its considerable impact on genitourinary symptomatology and risk for PID make assessment for abuse essential in clinical management of women with STDs and diagnosis of PID.

The Meaning of Weight: A Big Way of Life for Rural Mexican-American Adolescent Men and Caregivers

OBJECTIVE

To describe the meaning of body weight among rural Mexican-American adolescents (RMAA) and an influential person (IP) of their social network.

DESIGN AND SAMPLE

This is qualitative descriptive study. Convenience sampling was used to recruit RMAA seeking care at a rural primary care-based clinic. Content analysis was used to identify categories and subcategories. Fifteen male adolescents and 14 IPs were interviewed (n = 29).

MEASURES

Individual interviews were conducted using a semi-structured questionnaire.

RESULTS

Participants described body weight through family norms, body size, and history of heart disease or diabetes. Cultural scripts were used to describe weight gain, judgment of size, and resource limitations.

CONCLUSIONS

Health care providers must evaluate cultural scripts associated with body size to develop interventions that are derived from the meaning ascribed to weight status rather than simply based on evidence-based standards. ClinicalTrials.gov Identifier: NCT01387646.