Mediation of Psychological Capital in Youth Experiencing Homelessness

BACKGROUND

Youth who experience homelessness engage in behaviors that place them at high risk for disease and injury. Despite their health risk behaviors, these youth display psychological capital, positive attributes of hope, efficacy, resilience, and optimism that motivate them to engage in health-promoting behaviors such as safer sex. However, this array of positive psychological attributes has not been studied in this vulnerable population.

OBJECTIVES

The specific aim of this analysis was to determine whether factors of psychological capital mediated the relationship between background risk factors (e.g., race/ethnicity, educational attainment, reason for being homeless, sexual abuse history, and HIV status) and outcomes of condom intention, safer sex behaviors, and life satisfaction among youth who participated in a longitudinal intervention study.

METHODS

Using a Solomon four-group design, 602 youth were recruited from drop-in centers in two large cities (Columbus, Ohio, and Austin, Texas) to participate in a brief intervention that included outcomes of enhanced communication skills, goal setting, safer sex behaviors, drug refusal skills, and life satisfaction. Using an autoregressive, cross-lagged, longitudinal mediation model, we tested the direct and indirect effects of background factors, psychological capital, and intervention outcomes. Models were tested for the intervention group alone and the total sample.

RESULTS

There were no significant direct or indirect effects of background factors on intervention outcomes among the intervention group, and the model fit was poor. There were also no significant mediating paths via factors of psychological capital and poor model fit for the combined group.

DISCUSSION

Findings provide important information about intrinsic strengths of youth experiencing homelessness and psychological capital as a significant construct for understanding health behaviors among disadvantaged and underserved youth. The lack of significant mediation effects may have been due, in part, to the lack of a robust measure of psychological capital. Further study with various background factors and outcomes would contribute further to our understanding of how best to support this population.

Sexual Activity as Self-Injury: A Scoping Review

Suicide and other self-injurious behaviors (SIB) are significant causes of morbidity and mortality as well as healthcare costs. Sexual risk behaviors are associated with many SIB, and sexual activities may act as SIB as well. In this scoping review, we consider ways in which sexual activity has been conceptualized as SIB - types of sexual activities as a form of self-injury - and cases in which sexual activities as SIB have been classified as direct or indirect self-injury. We include English-language publications that discuss any aspect of sexual activity as SIB. Database, citation list, and gray literature searches yielded 33 publications. Sexual activities as a form of self-injury included exposure to HIV/AIDS and other sexually transmitted infections, sadomasochistic behaviors undertaken for punishment rather than pleasure, selling sex, injury to the genitals, and sexual encounters with undesired partners or consisting of undesired acts. Twenty-three publications did not categorize sexual activities to self-injure as either direct or indirect self-injury, three publications categorized them as indirect self-injury, and seven publications as direct self-injury. Sexual activity is used to self-injure in a variety of ways and its conceptualization as indirect or direct self-injury remains unclear.

Youth-centered Recommendations to Address Social Stigma and Discrimination Against Unhoused Youth: An Integrative Literature Review

Youth between ages 13 and 25 who experience homelessness face numerous barriers to excellent health, including social stigma and discrimination. Applying socio-ecological model and intersectionality theory, an integrative literature review was conducted. Peer-reviewed studies (N = 29) representing 808,296 participants extracted from four databases (CINAHL, MEDLINE, PsychINFO, SocINDEX) were analyzed. The studies included sources of discrimination and stigma from interpersonal interactions with support services staff upwards to policy and systemic levels with housing and justice systems. Health outcomes include poorer physical and behavioral health status from increased likeliness of denied access to support services, prolonged time spent being homeless, and higher incidences of experiencing violence. School nursing has power to push for recommended changes and support unhoused youth towards excellent health. Proposed changes include adapting Housing First framework, engaging with unhoused youth in program planning, policy writing, and public education that address the causes of poverty.

Parents' Experiences and Perceptions of Healthcare Transition in Adolescents with Asthma: A Qualitative Study

Adolescence marks a significant transition from pediatric to adult healthcare, and parents play critical roles in supporting their adolescents with chronic conditions through this process. However, little is known about parents' experiences, perceptions, and needs during this healthcare transition. This qualitative study explores the experiences and perceptions of parents regarding the care transition of their 16-17-year-old adolescents with asthma. Nineteen mothers participated in either a focus group or individual interviews, and a content analysis was conducted on the data. Parents expressed negative emotions and various concerns about their teens' transition readiness and asthma management. A need for early transition training for both adolescents and parents was discussed. Overall, the complexity and challenges associated with the healthcare transition of adolescents with asthma take a toll on parents, particularly when their teens are not adequately prepared to manage asthma independently. Parents need appropriate anticipatory guidance regarding the transition and skills to navigate changing roles and negotiate asthma care responsibilities with their teens. Timely interventions and support strategies for both adolescents and parents are needed to ensure the successful healthcare transition of adolescents with asthma.

Effects of COVID-19 on School Nurse Mental Health Intervention Practices

Mental health issues have been exacerbated by COVID-19; therefore we examined how the school nurses' role in addressing mental health changed during the pandemic. We administered a nationwide survey in 2021, guided by the Framework for the 21st Century School Nurse, and analyzed self-reported changes in mental health interventions by school nurses. Most mental health practice changes after the start of the pandemic occurred in the care coordination (52.8%) and community/public health (45.8%) principles. An overall decrease in students visiting the school nurse's office (39.4%) was seen, yet the frequency of students visiting with mental health concerns had increased (49.7%). Open-ended responses indicated that school nurse roles changed due to COVID-19 protocols, including decreased access to students and changes in mental health resources. These insights into the role of school nurses in addressing student mental health during public health disasters have important implications for future disaster preparedness efforts.

A Systematic Scoping Review of Psychological Capital Related to Mental Health in Youth

Psychological capital (PsyCap) is a term coined in organizational psychology and refers to a person's development of states that motivate behavior. Also known in the literature as PsyCap, this construct typically refers to positive states of hope, self-efficacy, resilience, and optimism that are amenable to intervention and that are related to subjective well-being and life satisfaction. The aims of this systematic scoping review were to explore how PsyCap is described in youth mental health literature and how PsyCap and mental health are related. Results from four databases were reported following PRISMA guidelines. A total of 772 studies were identified and 16 studies were fully reviewed, including an overall sample of 6,772 youth from six countries. PsyCap has a positive relationship with mental health in youth. Future studies should involve school nurses to validate the constructs that characterize PsyCap and validate an instrument for measuring PsyCap in youth mental health in English.

School Nurse Staffing in Texas Alternative High Schools: A Mixed Methods Exploration

School nurses represent cost-effective investments in students' health and educational success. Alternative high schools (AHSs) serve an understudied population of youth who are at risk for school dropout and face numerous social inequities, heightening their risk for poor health outcomes. In this two-phase explanatory sequential mixed methods study, we examined school nurse staffing in Texas AHSs. Findings suggest Texas AHSs face understaffing for familiar reasons common across districts (e.g., lack of funding), but also reveal potential deeper inequities. Quantitative findings indicate 71% of Texas AHSs have some form of nursing support, most often an on-call or part-time nurse. Qualitative findings support and enrich this finding with insights into the negative consequences of not having a full-time nurse, indiscriminate approaches to staffing AHSs, and how AHSs can be the only school in the district without a full-time nurse. Altogether, our findings reveal opportunities to better support AHSs with adequate nursing support.

Response: "The Signal and the Noise"-a response to Clayton et al. (2021)

The purpose of this response is to clarify points about the steps we took in a systematic review of the literature and to reaffirm our findings.

Validation of remote atopic dermatitis severity assessment with the Eczema Area and Severity Ondex in children using caregiver-provided photos and videos

BACKGROUND/OBJECTIVES

We sought to quantify the reliability and validity of remote atopic dermatitis (AD) severity assessment using the Eczema Area and Severity Index (EASI) applied to caregiver-provided photos (p-EASI) and videos (v-EASI).

METHODS

Children (0-17 years) with a physician diagnosis of AD were recruited. Caregivers took photos and a video of their child's skin. A clinician scored in-person EASI on the same day, then p-EASI and v-EASI for each participant 10 days or more between ratings. Two additional clinicians scored p-EASI and v-EASI. Lin's concordance correlation coefficient (CCC) was employed to assess criterion validity using in-person EASI as the gold standard. Intraclass correlation coefficients (ICCs) were calculated to assess interrater reliability of p-EASI and v-EASI.

RESULTS

Fifty racially and ethnically diverse children (age [mean ± SD]: 4.3 ± 4.4 years; 42% female) with a range of AD severity (EASI: 6.3 ± 6.4) and Fitzpatrick skin types (1-2: 9%; 3-4: 60%; 5-6: 31%) were enrolled and received in-person EASI assessment. Fifty had p-EASI and 49 had v-EASI by the same in-person rater, and by two additional raters. The CCC and ICC for p-EASI were 0.89, 95% CI [0.83, 0.95] and 0.81, 95% CI [0.71, 0.89], respectively. The CCC and ICC for v-EASI were 0.75, 95% CI [0.63, 0.88] and 0.69, 95% CI [0.51, 0.81], respectively.

CONCLUSIONS

In this diverse population with a range of skin tones, p-EASI showed good criterion validity and good interrater reliability. v-EASI showed moderate to good criterion validity and moderate interrater reliability. Both may be reliable and valid options for remote AD severity assessment.

Caregiver Preferences and Barriers Toward Accessing Pediatric Dermatology Care for Childhood Atopic Dermatitis

INTRODUCTION

Atopic dermatitis (AD) is a common chronic childhood illness. It is often treated by primary care providers (PCPs) though it may require referral to a dermatology specialist.

METHOD

We administered an exploratory survey to 50 caregivers of children aged 0-17 years with AD to assess their preferences and barriers toward accessing dermatology specialty care for their child's AD.

RESULTS

Caregivers felt PCPs and specialists equally listened to their child's AD concerns. However, many felt there was a difference in the care provided and control of the AD and preferred to see a specialist for ongoing management.

DISCUSSION

Caregivers may benefit from their children being referred to dermatology specialists earlier and more often for their AD. Further work must be done to characterize preferences and barriers toward AD care across race and ethnicity.

Sensitivity Toward Gender and Sexually Diverse Populations: Development of a Scale

BACKGROUND

Individuals who are lesbian, gay, bisexual, transgender, queer, intersex, asexual, or nonbinary (LGBTQIA+) experience inequitable access to and utilization of health care services. Nurses' lack of awareness and sensitivity may contribute to this phenomenon.

PURPOSE

This article describes the development and validation of the Gender and Sexual Diversity Sensitivity Scale (GSDSS). A sample of 210 undergraduate nursing students from a large research-intensive university completed the scale online. An exploratory factor analysis was conducted.

RESULTS

Factor analysis illustrated a three-factor construct of the scale (i.e., General Education Experience, Cognitive Awareness, and Comfort With Interactions); Cronbach's alpha coefficients ranged from .66 to .91, and the total scale alpha coefficient was .782.

CONCLUSION

The GSDSS has evidence of construct validity and reliability, and can be used in studies that include nursing and other health professional students. [J Nurs Educ. 2022;61(7):383-389.].

Outcomes of a Mindfulness-Based Healthy Lifestyle Intervention for Adolescents and Young Adults with Polycystic Ovary Syndrome

STUDY OBJECTIVE

The purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a mindfulness-based healthy lifestyle self-management intervention with adolescents and young adults diagnosed with polycystic ovary syndrome (PCOS).

DESIGN

A pilot randomized controlled trial using a pre-post design was used.

SETTING

Central Texas.

PARTICIPANTS

Individuals aged 14-23 with a diagnosis of PCOS.

INTERVENTIONS

The PCOS Kind Mind Program integrates a manualized mindfulness training program (Taming the Adolescent Mind) with health education in 4 key areas of self-management and health promotion: (1) medication adherence, (2) nutrition, (3) physical activity, and (4) sleep.

MAIN OUTCOME MEASURES

Psychological distress, mindfulness, physical activity strategies, nutrition, and exercise self-efficacy.

RESULTS

Linear regression models revealed that those in the PCOS Kind Mind condition reported significantly higher nutrition self-efficacy (β = 6.50, 95% CI, 1.71-11.28, P = 0.013, d = 0.48), physical activity strategies (β = 0.41, 95% CI, 0.04-0.79, P = 0.040, d = 0.67), and physical activity self-efficacy (β = 0.48, 95% CI, 0.07-0.88, P = 0.028, d = 0.46).

CONCLUSION

The PCOS Kind Mind Program improved self-efficacy in the key areas of nutrition and physical activity and increased physical activity strategies in adolescents and young people with PCOS. These findings are encouraging and suggest the need for larger-scale, randomized controlled trials with longer-term follow-up to more robustly evaluate the effects of the PCOS Kind Mind Program on the psychological and physiological health of adolescents and young people with PCOS.

Promoting Healthy Attitudes and Behaviors in Youth Who Experience Homelessness: Results of a Longitudinal Intervention Study

PURPOSE

The aim of this study is to determine the effectiveness of a brief intervention to promote responsible substance use and safe sex behaviors in youths experiencing homelessness (YEH).

METHODS

Design: A Solomon four-group (double randomized controlled trial) longitudinal design with repeated measures (3- and 6-month follow-ups) was used in drop-in centers for YEH in Austin, Texas and Columbus, Ohio from which 602 youths, 18-24 years-old (M = 21 ± 1.8), 50% white; 69.9% heterosexual were recruited. A manualized one-on-one intervention consisted of six modules delivered via laptop computers. Modules focused on communication, goal-setting, substance use refusal, safe sex behaviors, enhanced psychological capital (hope, optimism, resilience, self-efficacy, gratitude), and life satisfaction. Valid and reliable measures of hope, optimism, future time perspective, resilience, social connectedness, gratitude, condom intention, self-efficacy for safe sex, safe sex behaviors, self-efficacy for substance use refusal, and life satisfaction were used to collect data for which three hypotheses were tested, using intent to treat, with multi-level modeling (R).

RESULTS

The analysis showed partial support for all hypotheses: (1) post-test outcomes were greater than pretests; (2) intervention group outcomes were greater than control group measures; and (3) significant effects for pretesting. YEH in Ohio completed significantly more sessions than YEH in Texas (p = .001), but took significantly longer to complete all six sessions (p = .001).

DISCUSSION

This brief intervention had significant effects on YEH to promote healthy attitudes and behaviors that merit further testing in larger samples.

Connectedness, Self-Esteem, and Prosocial Behaviors Protect Adolescent Mental Health Following Social Isolation: A Systematic Review

Societal trends and COVID-19 quarantines have increased the number of adolescents experiencing social isolation, placing them at heightened risk for mental health issues. The aim of this review is to explore protective factors that might mitigate psychological harm in the presence of social isolation. A systematic literature review was conducted using Fink's step-by-step process. Four library databases were searched, and results were reported using PRISMA. Of the 246 studies reviewed, 12 studies were retained following the quality assessment. The sample includes 14,064 participants from USA, Australia, and Europe, ranging from 10-19 years old. Social connectedness (ie., family connectedness, school connectedness, social support), self-esteem, and prosocial behaviors were the most common protective factors to social isolation. Additional factors such as self-efficacy, optimism, and ethnic identity are discussed. Implications for future research are recommended, including the need to explore spiritual, biological, and sociocultural factors influencing social connectedness and mental health in adolescents.

"I'm losing everything all over again": Responses from youth experiencing homelessness during the COVID-19 pandemic

PURPOSE

Already at high-risk for adverse consequences associated with daily living, youth experiencing homelessness face additional barriers to health and well-being during the COVID-19 pandemic. The purpose of this study was to identify the self-reported experiences and healthcare needs of youth experiencing homelessness as services in the community began to shut down at the beginning of the pandemic.

METHOD

From May through November 2020, qualitative data were obtained by telephone or Facebook messenger from 20 youth (M = 22.4, SD = 2.64 years) who had been enrolled in a longitudinal intervention study.

RESULTS

Content analysis of qualitative data yielded 5 categories and 1 overall theme. Categories were resource availability, financial instability, mental health, relationship conflict, and maladaptive coping. The overall theme was multiple losses. Youths lost jobs, means of financial support for self and family, access to social and healthcare services, meaningful and important relationships, and skills and controls over high-risk behaviors such as substance abuse.

CONCLUSIONS

Having similar experiences such as social isolation as those of high school students during the pandemic, the youths in this sample experienced multiple and simultaneous losses, needing time to grieve, and leaving them once more at high-risk for adverse outcomes.

Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature

BACKGROUND

Increasingly, early adolescents who are transgender or gender diverse (TGD) are seeking gender-affirming healthcare services. Pediatric healthcare providers supported by professional guidelines are treating many of these children with gonadotropin-releasing hormone agonists (GnRHa), which reversibly block pubertal development, giving the child and their family more time in which to explore the possibility of medical transition.

METHODS

We conducted a critical review of the literature to answer a series of questions about criteria for using puberty-blocking medications, the specific drugs used, the risks and adverse consequences and/or the positive outcomes associated with their use. We searched four databases: LGBT Life, PsycINFO, PubMed, and Web of Science. From an initial sample of 211 articles, we systematically reviewed 9 research studies that met inclusion/exclusion criteria.

RESULTS

Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged 'excellent', five studies met the majority of quality criteria resulting in 'good' ratings, whereas three studies were judged fair and had serious risks of bias.

CONCLUSION

Given the potentially life-saving benefits of these medications for TGD youth, it is critical that rigorous longitudinal and mixed methods research be conducted that includes stakeholders and members of the gender diverse community with representative samples.

A Theoretically Grounded Exploration of Individual and Family Self-Management of Polycystic Ovary Syndrome in Adolescents

Polycystic ovary syndrome (PCOS) is highly prevalent and increasingly diagnosed during adolescence. This study explored the context and processes of self-management among adolescents, and parents of adolescents, who have PCOS. Adolescents with PCOS (n = 7) and their parents (n = 8) participated in a series of focus groups. Deductive thematic analysis was guided by the Individual and Family Self-Management Theory (IFSMT), and the patterns that were identified aligned with the contexts and processes described therein. A secondary inductive approach was employed as a novel contextual pattern emerged: psychological health and well-being. Study findings suggest that adolescents and their families have a desire to engage in optimal self-management, and particularly effective strategies may consider a holistic, family intervention approach that addresses psychological health and well-being in addition to behavior change. Study findings are the first to reflect the unique needs of adolescents with PCOS and their families.

Psychometric properties of a modified cultural awareness scale for use in higher education within the health and social care fields

BACKGROUND

Cultural awareness and cultural competence have become important skills in higher education as populations continue to grow in diversity around the world. However, currently, there are few instruments designed to assess student awareness of the aspects of culture, and the existing instruments need further development and testing for use with different target populations. Therefore, the aim of this study was to test the psychometric properties of a modified version of the Cultural Awareness Scale (CAS) for use in higher education within the health and social care fields.

METHODS

A modified version of the CAS was developed, which was tested psychometrically using cross-sectional data. In total, 191 undergraduate students from different health and social care undergraduate programs in Sweden and Hong Kong responded to a call to test the modified instrument.

RESULTS

The results showed that the modified CAS is a four-factor measure of cultural awareness and possesses satisfactory internal consistency. Results also support the use of the modified CAS as a generic tool to measure cultural awareness among students in higher education within the health and social care fields.

CONCLUSION

The modified CAS showed satisfactory psychometric properties and can be recommended as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. However, further psychometric testing on the effectiveness of the modified CAS as a tool to evaluate the efficacy of cultural awareness interventions is required.

School-Level Efforts to Address Sexual Health and Risky Sexual Behavior Among Students in Texas Alternative High Schools

We compared sexual/reproductive health services and sexuality education topics provided in Texas alternative high schools (AHSs) with the prevalence of sexual risk behaviors among students in AHS. Using cross-sectional data from convenience samples of 14 principals, 14 lead health educators, and 515 students, we calculated descriptive statistics for 20 services and 15 sexuality education topics provided by AHSs and seven sexual risk behaviors among students in AHS. AHSs provided few sexual/reproductive health services and limited educational content, despite high levels of sexual risk taking among students. For example, no AHSs taught students about proper condom use, yet 84% of students have had sex. Findings provide preliminary evidence of unmet needs for school-based sexual/reproductive health services and comprehensive sexuality education in AHS settings. Future investigation with larger, representative samples is needed to assess the provision of sexual/reproductive health services and sexuality education in AHSs and monitor sexual risk behaviors in the AHS population.

Sociocultural Influences on Disparities in United States Children with Atopic Dermatitis: A Narrative Review of the Literature

Approximately 13% of United States (US) children have atopic dermatitis (AD), also known as eczema. AD is a chronic skin condition associated with significant burdens on quality of life and both individual and overall health-care system costs. The pathogenesis of AD is considered to be multifactorial, with biologic factors such as family history and genetics often reported as influencing risk. Some lesser discussed determinants of AD prevalence and severity are sociocultural, such as race/ethnicity, neighborhood, housing type, income level, and family structure. While several factors appear to contribute to disparities in childhood AD, black or African American race/ethnicity most significantly predicts AD prevalence, severity, disease control, access to care, and family impact. There is a shortage of research related to disparities in AD, an important topic considering the large percentage of families that are affected by the disease. This article is a narrative literature review of sociocultural influences on AD disparities in US children. The purpose of this review is to increase awareness of these important risk factors and to suggest related, future areas of research that may positively impact overall outcomes in children with AD. Much work remains to be done in order to ensure equitable care and outcomes among all children with AD.

Outpatient- or community-based interventions to prevent SIDS and sleep-related deaths

PURPOSE

To determine the state of science of outpatient- or community-based interventions for sudden infant death syndrome prevention in the United States, an integrative review was completed and studies identified through the application of inclusion and exclusion criteria.

CONCLUSIONS

Of the nine studies identified, three were randomized controlled trials. There was a wide range of measurement tools and variables measured. The timing of interventions also varied. There was a focus on mothers and African Americans. Lastly, study design and approach have not changed significantly over time.

PRACTICE IMPLICATIONS

Findings highlight recommendations for future research: expanding the target population, addressing culture in the development of the intervention or program, including additional providers, such as nurses, in the intervention or program, advancing innovation, and increasing rigor of study design.

Application of project management tools and techniques to support nursing intervention research

Nursing research involves much planning and attention to details, yet novice and seasoned nurse researchers often overlook the day-to-day operations required to conduct research studies. Project management is a set of iterative steps that can facilitate the process of conducting nursing research. In this paper we aim to provide an overview of project management and identify ways in which its specific principles and strategies may be applied to facilitate nursing research. Here we give an overview of our current longitudinal study using a Solomon four-group design and illustrate how we applied strategies and tools from the project management literature. In addition, we offer descriptions and illustrations of several other project management tools that could have been used in specific phases of this research project. We encourage nurse educators and researchers to familiarize themselves with the principles of project management and consider using them in future studies.

Using polytomous latent class analysis to compare patterns of substance use and co-occurring health-risk behaviors between students in alternative and mainstream high schools

INTRODUCTION

Alternative high school (AHS) students, an understudied and underserved population, experience educational, social, and health disparities relative to students in mainstream high schools. Disparities in single types of substance use are particularly high, yet no known studies have compared patterns of substance use or relationships between these patterns and other health-risk behaviors between AHS and mainstream high schools.

METHODS

Using data from the Texas Alternative School Health Survey (n = 515; mean age 17.1 years, 49% male, 59% Hispanic, 23% White, 15% Black) and the Texas Youth Risk Behavior Survey (n = 2,113; mean age 16 years, 47% male, 64% Hispanic, 22% White, 7% Black), we used latent class analyses to compare patterns of substance use in AHSs and mainstream high schools. We used latent class regression to examine relationships between patterns of substance use and involvement in other health-risk behaviors in each school setting.

RESULTS

Students in AHSs and mainstream high schools had similar patterns of substance use, and youth in higher risk categories engaged in higher levels of other health-risk behaviors. A substantially greater proportion of AHS students, however, fell into the moderate and high use categories, in support of continuing disparities for AHS students.

CONCLUSIONS

Additional support is needed in AHSs to address the prevalence of high-risk patterns of substance use and associated health-risk behaviors. For example, ongoing public health surveillance is needed in AHSs, just as is done in mainstream high schools, to monitor trends in substance use and impact of policies and interventions.

Transition to Self-Management among Adolescents with Polycystic Ovary Syndrome: Parent and Adolescent Perspectives

PURPOSE

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among females. The foundation of PCOS self-management is engaging in healthy lifestyle habits, however, there is limited literature regarding adolescents' transition to PCOS self-management. The purpose of this study, therefore, is to explore parental and adolescent views of the transition to PCOS self-management.

DESIGN AND METHODS

A qualitative descriptive approach was used through focus groups (N = 4) with adolescents diagnosed with PCOS and their parents.

RESULTS

A total of seven adolescents and eight parents participated in two focus groups each. The primary theme from the parent groups was Concerns for Transition to Self-Care with the subthemes of facilitation versus direction and recognition of personal habits. The primary theme identified from the adolescent groups was Taking Control with subthemes of managing symptoms, cognitive dissonance, support, and balance.

CONCLUSIONS

Study findings provide insight into the experiences of adolescents with PCOS and their parents as they navigate both a family-level transition in health habits and anticipate the adolescent transition to self-management as an emerging adult.

PRACTICE IMPLICATIONS

Nurses and other health care providers can help facilitate transition to self-management among adolescents with PCOS by encouraging increased independence in health behavior decisions while they are still living at home. Middle and older adolescents who begin to take ownership of their physical activity, nutritional choices, and sleep hygiene will have a firm foundation on which to build as they transition into life beyond high school.

Intervention Fidelity and Facilitator Training

Intervention fidelity is an ongoing concern for rigorous research, from the initial stages of planning and study design to the maintenance of internal validity. An added concern is the balance between fidelity and design accommodation to better suit varied populations and individuals. In this article, we describe our process for monitoring intervention fidelity during an individualized, yet standardized, strengths-based intervention with homeless youths, in which we include periodic training of our professional intervention facilitators. In our ongoing study, which is based on a Solomon four-group design with repeated measures, monitoring and training are essential to ensure intervention fidelity. Despite a rich literature about intervention fidelity, little guidance is available to help researchers and practitioners implement fidelity strategies in the real world with vulnerable populations. This article addresses this gap.

A systematic method for reviewing and analysing health information on consumer-oriented websites

AIM

A discussion of a proposed method for analysing the quality of consumer-oriented websites that provide health-related information.

BACKGROUND

The quality of health information available to consumers online varies widely in quality. In an effort to improve the quality of online information, experts have undertaken systematic reviews on selected health topics; however, no standardized comprehensive methodology currently exists for such review.

DESIGN

An eight-step method is recommended embracing the following steps: (a) select topic; (b) determine the purpose of the analysis; (c) select search terms and engines; (d) develop and apply website inclusion and exclusion criteria; (e) develop processes and tools to manage search results; (f) specify measures of quality; (g) compute readability; (h) evaluate websites. Each of these steps is illustrated in relation to the health topic of gynaecomastia, a physical and mental health challenge for many adolescent males and young men.

IMPLICATIONS FOR NURSING

Although most extant analyses of consumer-oriented websites have focused on disease conditions and their treatment, website analysis methodology would encourage analyses that fall into the nursing care domain.

CONCLUSION

The method outlined in this paper is intended to provide nurses and others who work with specific patient populations with the tools needed for website analytic studies. Such studies provide a foundation for making recommendations about quality websites, and identifying gaps in online information for health consumers.

Sudden Infant Death Syndrome: A Global Public Health Issue and Nursing's Response

Sudden unexplained death in infancy, including sudden infant death syndrome (SIDS), is a global public health challenge. Despite public health campaigns and efforts, SIDS remains the leading cause of postneonatal mortality in many developed countries. In this article, we review SIDS, describe nursing's unique professional position in addressing this problem, and explore how the principles of social justice can inform nursing's response. Motivated by nursing's ethical and moral obligations, the profession is called to take an active role in educating others regarding this phenomenon, to participate in research, and to develop or advocate for policy that aims to reduce the incidence of SIDS on an international scale.

Suicidality in Young Men Who Have Sex with Men: A Systematic Review of the Literature

This systematic literature review addresses risk and protective factors associated with suicidal ideation and attempts in young men who have sex with men (YMSM). The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsychArticles, and PsychInfo yielded 14 articles. Risk factors included (1) not being enrolled in school, (2) earlier sexual debut, (3) substance use/abuse, (4) homelessness, (5) bullying and victimization, (6) fear of community violence, (7) and parental abuse. Protective factors included (1) positive sexual minority LGBT stereotypes, (2) family acceptance, (3) school and peer support, (4) high self-esteem, and (5) adaptive coping mechanisms.

Methods Matter: Tracking Health Disparities in Alternative High Schools

Alternative high school (AHS) students are at-risk for school dropout and engage in high levels of health-risk behaviors that should be monitored over time. They are excluded from most public health surveillance efforts (e.g., Youth Risk Behavior Survey; YRBS), hindering our ability to monitor health disparities and allocate scarce resources to the areas of greatest need. Using active parental consent, we recruited 515 students from 14 AHSs in Texas to take a modified YRBS. We calculated three different participation rates, tracked participation by age of legal consent (≥18 and <18 years), and identified other considerations for obtaining quality data. Being required to use active consent resulted in a much lower cooperation rate among students <18 years (32%) versus those who were ≥18 years and could provide their own consent (57%). Because chronic truancy is prevalent in AHS students, cooperation rates may be more accurate than participation rates based off of enrollment or attendance. Requiring active consent and not having accurate participation rates may result in surveillance data that are of disparate quality. This threatens to mask the needs of AHS students and perpetuate disparities because we are likely missing the highest-risk students within a high-risk sample and cannot generalize findings.

Factors Associated With Physical Activity in Latina Women: A Systematic Review

The purpose of this systemic literature review is to unveil a greater understanding of Physical Activity in Latinas. We used PubMed and PsycInfo databases to search for articles published between 1991 and August 2016, examining physical activity and its correlates exclusively in adult Latinas. Only 21 primary studies met the inclusion criteria. Although physical activity derives from body movements in various domains, the leisure domain led the focus of research interest. The use of self-reports, cross-sectional design, and the ecological framework predominated. Only one study included examining the occupational domain, albeit as disaggregate in studies with a general physical activity approach. Occupational physical activity showed negative associations with education and acculturation. Positive associations were found between leisure-time physical activity, education, acculturation, and perceived health status. Despite the limited evidence to reach overall conclusions, this review uncovered methodological challenges and opportunities to advance knowledge about physical activity in Latinas.

An Intervention to Enhance Psychological Capital and Health Outcomes in Homeless Female Youths

Female homeless youths are vulnerable to risky sex and substance use behaviors, yet they have strengths known as psychological capital. A quasi-experimental pre-post research design with repeated measures was used to examine the feasibility and preliminary efficacy of a brief intervention to enhance psychological capital, reduce health-risk behaviors, and achieve short-term behavioral goals. Study participants were 80 ethnically diverse homeless women between the ages of 18 and 23 years. Intervention participants had significant improvements in psychological capital, hope, resilience, and self-efficacy to refuse alcohol, social connectedness, and substance use ( p < .05). There was a significant group by time interaction for safe sex self-efficacy; intervention participants had greater self-confidence in negotiating safer sex practices than comparison participants. At the follow-up post-test, 82% of intervention participants who remained in the study had met or exceeded their short-term goals. This brief, street-based intervention was feasible and showed preliminary efficacy.

“Developing Holistic Nursing Interventions to Improve Adolescent Health”

Adolescents learn health behaviors in a sociocultural context of community, family, and peers. Although many adolescents engage in behaviors that protect and promote health, others engage in behaviors that threaten or compromise their health. The purpose of this review article is to provide an overview of health-risk behaviors and the morbidities and mortalities of adolescence that are related to these behaviors. Interventions that address these health behaviors and outcomes are presented along with suggestions for a holistic nursing response to this important public health concern.

Suicide Ideation and Life Events in a Sample of Rural Adolescents

Adolescents experience both developmental and situational periods of transition along with myriad stressful life events when they enter and exit high school. These life events may be associated with thinking of, planning, and attempting suicide. Yet despite the development of prevention programs to treat at-risk individuals, suicide rates among adolescents have remained relatively high. Recent research suggests that suicidal ideation is associated with stressful life events and the use of maladaptive coping mechanisms, but studies have been limited to cross-sectional designs and clinical samples. We conducted a longitudinal study of 1345 rural adolescents (50.7% Hispanic) attending public schools in central Texas. The purpose of this analysis was to determine changes in suicide ideation rates over time and to test hypotheses about the life events and coping mechanisms associated with suicide ideation. Gender and race/ethnic differences in suicide were also explored. Rates of reported suicide ideation declined significantly from the first to the last year of high school (p=.015). Statistically significant relationships were found between suicide ideation, several types of life events, and maladaptive coping strategies. Gender and racial/ethnic differences were also found. Taken together, these findings suggest new approaches to developing and testing interventions that can assist specific populations of adolescents to learn how to cope with their life events in productive and health-promoting ways.

Substantiating the need for primary care-based sexual health promotion interventions for ethnic minority adolescent women experiencing health disparities

PURPOSE

Assess the context of psychological distress, violence, and substance use among African- and Mexican-American adolescent women with a history of STI, violence, or high sexual risk behavior. These adolescents experience multiple health disparities, limited access to care, and are at particularly high risk of adverse sexual health outcomes. The results will inform sexual health promotion interventions provided by advanced practice nurses in primary care-based settings for women experiencing these disparities.

METHODS

Analysis of self-report data obtained at study entry from African- and Mexican-American adolescent women (n = 559) enrolled in a randomized trial of a behavioral intervention for sexual risk reduction.

CONCLUSIONS

High levels of psychological distress, sexual risk behavior, sexually transmitted infection (STI), personal and friend/peer substance use, alcohol use, and violence were reported by women at study entry. Analyses found that STI, physical violence, and substance-using friends were twice as likely associated with personal substance use. Alcohol users were five times more likely to use other substances. Mexican Americans were three times more likely than African Americans to use substances.

IMPLICATIONS FOR PRACTICE

Recommendation is made for integration of multicomponent sexual health promotion interventions as advanced practice nurse provider services addressing these health disparities within primary care-based settings.

A Systematic Review of Consent Procedures, Participation Rates, and Main Findings of Health-Related Research in Alternative High Schools From 2010 to 2015

There is a well-established link between educational attainment and health. Alternative high schools (AHSs) serve students who are at risk for school dropout. Health-related research conducted in AHSs has been sparse. Achieving high participation rates is critical to producing generalizable results and can be challenging in research with adolescents for reasons such as using active consent. These challenges become greater when working with vulnerable populations of adolescents. In this systematic review, we examined health-related studies conducted in AHSs between 2010 and 2015. Results indicated that (1) health-related research in AHSs has increased over the past 5 years, (2) AHS students continue to experience significant disparities, (3) active consent is commonly used with AHS students, (4) 42% of studies reported participation rates or provided enough information to calculate participation rates, and (5) school nurses are missing from health-related research conducted in AHSs. Implications for future research and school nursing are discussed.

The Healthy Workplace Project: Results of a Hygiene-Based Approach to Employee Wellness

Purpose.

An employee wellness program was evaluated to assess changes in germ transmission, absenteeism, and cost of infection-related illness among office-based employees.

Design.

One-group pretest-posttest design, with intervention delivered for 90 days and measurement conducted over 1 year.

Setting.

Employees of a large office space in Georgia.

Subjects.

One thousand six hundred forty-five employees.

Intervention.

The Healthy Workplace Project is a 90-day wellness program aimed to increase health and productivity of employees through educational and engagement activities focusing on improving awareness, recognizing infection-related illnesses, and reducing the spread of germs in the workplace.

Measures.

Three types of data were collected: (1) bacterial audits through use of adenosine triphosphate monitoring of various work spaces; (2) self-report absenteeism data using the World Health Organization's Health and Work Performance Questionnaire; and (3) participant employees' medical claims/costs of infection-related minor illnesses.

Analysis.

Frequencies and bacterial audit data; Wilcoxon signed ranks tests to determine changes in rates on absenteeism and health care costs.

Results.

Bacterial audits demonstrated a reduction in contamination levels of 33% across all measured spaces. Absenteeism rates were reduced by 13%. Medical service utilization costs were not significantly reduced for individual employees over the project year.

Conclusion.

Educational strategies and individual monitoring of germ transmission appears effective in improving employees' health and decreasing absenteeism.

Factors affecting sexual function: A comparison between women with gynecological or rectal cancer and healthy controls

This study had two purposes: (i) to explore differences in sexual function between women with gynecological or rectal cancer after related pelvic-area treatments and women without cancer; and (ii) to investigate the relationships among body image, anxiety and depression, sexual relationship power, sexual self-schema, and female sexual function. The participants (n = 139) were recruited through Internet cancer support groups and women's health organizations in the USA. Six structured questionnaires were mailed, and the data were analyzed using descriptive and inferential statistics. The results showed that women with gynecological or rectal cancer had significantly worse sexual function than women without cancer. Having gynecological/rectal cancer and a negative sexual self-schema were significantly related to poor sexual function. Furthermore, sexual self-schema moderated the relationship between sexual relationship power and female sexual function. Healthcare providers could give more attention to sexual issues in women who have undergone treatment for gynecological or rectal cancer, especially for those with a negative sexual self-schema and high sexual relationship power, which might improve these women's quality of life.

A systematic review of interventions to reduce stress in adolescence

Adolescence can be a stressful developmental phase, placing youth at risk for negative health outcomes. Evidence-based interventions are crucial to helping adolescents manage stress; yet, most of the literature on adolescent stress is observational and descriptive. We systematically reviewed the literature on stress management interventions for adolescents and found there is evidence to support the effectiveness of interventions that aim to develop cognitive skills among adolescents; however, most studies had small samples and relied on different operational definitions of outcomes. Few included biological indicators of stress. Further study is needed to develop interventions to enhance adolescents' capacity to manage stress.

The impact of psychosocial factors on subjective well-being among homeless young adults

Homeless young adults are one of this country's most vulnerable populations, and information surrounding issues of subjective well-being among this particularly diverse population is scarce. The purpose of this study was to examine the impact social support, future expectations, and homeless cultural factors have on subjective well-being among homeless young adults. A purposive sample of 185 homeless young people, ages 18 to 23, and known to use alcohol or drugs, participated in the study. Multiple regression analyses showed that participants who had a higher level of subjective well-being reported significantly higher levels of social support, more optimistic expectations of the future, and a better perception of the flow of time. More fatalistic views of the future significantly predicted lower levels of subjective well-being. Findings suggest that service providers should focus on understanding the strengths of individuals and, specifically, gain a deeper understanding of homeless young adults' support networks and views of the future.

Gender and Ethnic Differences in Health-Promoting Behaviors of Rural Adolescents

Although much is known about health-risk behaviors of adolescents, less is known about their health-promoting behaviors. The purpose of this analysis was to compare health-promoting behaviors in adolescents in Grades 9–12 by gender and ethnicity and explore how these behaviors changed over time. Data were collected from 878 rural adolescents (47.5% Hispanic; mean age at baseline 14.7 years). Males from all ethnic groups scored significantly higher than all females on physical activity; non-Hispanic Black males and females scored significantly higher than other ethnic groups on safety behaviors. Hispanic and non-Hispanic White females scored higher than males in these ethnic groups on stress management. Nutrition, physical activity, and safety behaviors decreased significantly for most participants from Grade 9 to 12 whereas stress management remained relatively stable. Findings are similar to those from nationally representative samples that analyzed cross-sectional data and have implications for school nursing interventions to improve health-promoting behaviors in rural adolescents.

Changes in Ethnic Identity and Competence in Middle Adolescents

Purpose: Evidence suggests that the construct of ethnic identity (EI) in adolescents changes over time and is related to factors including social connectedness, social competence, coping, and self-worth. Transitional changes of EI in middle adolescence have not been studied. Method: This analysis, part of a longitudinal study of health behaviors, explored how EI changes from the first year of high school to the last, and it examined relationships among EI, social connectedness, indicators of social competence, coping, and self-worth in 602 youth (49% Hispanic, 59% female). Results: EI was significantly related to social connectedness, social competence, coping, and self-worth as adolescents entered and prepared to exit high school. EI increased significantly over time for both genders and for Hispanics more so than for non-Hispanics. Discussion: Findings support and extend the conceptual framework and previous research. Socialization with one’s ethnic group is associated with developing competence and self-worth. EI development continues throughout high school. Conclusion: Findings extend our understanding of the salience of EI in adolescents in transition throughout high school. Implications: Strengthening EI may contribute to adolescents’ feelings of self-worth, skills in coping, and competence within an ethnically diverse society. Nurses might plan interventions to strengthen EI throughout adolescence.

Predictors of adolescents' health-promoting behaviors guided by primary socialization theory

PURPOSE

The purpose of this study was to determine the influence of parents and peers on adolescents' health-promoting behaviors, framed by primary socialization theory.

DESIGN AND METHOD

Longitudinal data collected annually from 1,081 rural youth (mean age = 17 ± 0.7; 43.5% males; 44% Hispanic) and once from their parents were analyzed using generalized linear models.

RESULTS

Parental monitoring and adolescent's religious commitment significantly predicted all health-promoting behaviors (nutrition, physical activity, safety, health practices awareness, and stress management). Other statistically significant predictors were parent's responsiveness and health-promoting behaviors. Peer influence predicted safety and stress management.

PRACTICE IMPLICATIONS

Nurses may facilitate adolescents' development of health-promoting behaviors through family-focused interventions.