Factors that influence Asian American college students use of mental health services: A systematic mixed studies review

WHAT IS KNOWN ON THE SUBJECT?: Only 8.6% Asian Americans (AAs) report seeking mental health services compared to nearly 18% of the general population. There is a stigma against seeking mental health services among AAs. Mental illness is thought to be caused by a lack of harmony of emotions or evil spirits leading to delay in treatment among AAs. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Asian students are hesitant to use mental health services because they are balancing their desire to be part of the two cultures. Concepts used to define culture were found to have overlapping aspects of how researchers operationally define them, and few studies examined a combination of these concepts as a means of examining interactions between the concepts. AA emerging adults feel pressure through personal stigma from elders to 'save face' by keeping their problems to themselves or within the family to maintain a positive reputation for the family. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overlap of conceptual definitions to understand cultural beliefs and values affecting measurement have complicated the interpretation of the research. Future research should include a multidimensional operationalization of culture that includes acculturation, ethnic identity, personal stigma and their effect on mental health help-seeking attitudes. Differences between South Asian and East Asian philosophical and cultural perspectives could influence access to mental health services; therefore, future studies should consider sampling that would allow for comparison of the groups. Understanding the factors that influence mental health help-seeking behaviours can determine intervention strategies to improve AA emerging adult mental health.

ABSTRACT

INTRODUCTION: Only 8.6% of Asian Americans (AA) sought mental health services compared to 18% of United States population. AA college students report higher levels of mental health concerns compared to White students.

AIM

The purpose of this systematic review was to identify the factors that influence AA students' mental health help-seeking behaviours.

METHOD

Employing a data-based convergent synthesis design. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the sample. Inclusion criteria were peer-reviewed studies published in English, focused on AA college students' mental health seeking attitudes in United States.

RESULTS

The final sample was forty-four studies. Four themes emerged: acculturation, ethnic identity, racism and stigma. There were discrepant findings regarding how acculturation affects mental health help-seeking attitudes. Several studies included more than one theme in their analyses. The different concepts included across studies make it difficult to compare the findings.

DISCUSSION

There is some overlap between acculturation and ethnic identity that could affect the analysis in studies where both concepts are included. Personal stigma negatively influences mental health help-seeking attitudes.

IMPLICATIONS FOR PRACTICE

Defining culture to include acculturation, ethnic identity, personal stigma can help in understanding their effect on mental health help-seeking attitudes.

The Role Nurses Can Play in Addressing and Preventing the Prevalence of Missing or Murdered Indigenous Women and Girls (MMIWG)

INTRODUCTION

In 2016, 5,712 American Indian/Alaskan Native (AI/AN) women and girls were reported missing in the United States. In Canada, 4% of the population is Indigenous, yet Indigenous females represent 50% of all sex trafficking victims. This systematic mixed-studies review examined the effects of Missing and Murdered Indigenous Women and Girls (MMIWG) to define a role for nurses.

METHODS

We used five databases with keywords, inclusion criteria, and the Mixed Methods Appraisal Tool.

RESULTS

Findings of 22 papers discuss: (a) demographic data; (b) factors that increase vulnerability of AI/AN women; and (c) how nurses can decrease the prevalence of MMIW.

DISCUSSION

Nurses are the first provider patients see when accessing care. Increasing knowledge about the impact of violence against AI/AN women and girls is the first step in identifying measures needed to address this public health concern.

Facilitating diversity of thought in learning environments for nursing students

Human capital development is one of the goals of higher education and a decrease in open dialogue threatens these ideals and aspirations. A recent survey of undergraduate students showed that many students censor their point of view. There are many potential reasons for this, but it could be secondary to the current sociopolitical climate. Having educators who encourage and model open dialogue while supporting diversity of thought would provide alternative perspectives and innovation. Encouraging diversity of thought will enhance understanding of other's perspectives and unleash creative problem solving to address concerns in nursing practice and facilitate innovative research. The purpose of this article is to present strategies that can be employed to promote diversity of thought among nursing students in a learning environment. Exemplars are presented illustrating some of the strategies discussed.

The development and pandemic-related adaptation of a resilience program for native middle-school youth: A case study

BACKGROUND

As of 2017, American Indian/Alaska Natives (AI/AN) had the highest prevalence of illicit drug use of any ethnic group in the United States, with 17.6% of the population aged 12 and older reporting using illicit drugs in the last month. Studies have shown the positive correlation between a history of trauma and substance use disorder. In fact, the majority of youth in treatment for substance misuse reported a history of trauma. Intergenerational trauma, systematic discrimination, and displacement are downstream effects of colonization, and experiences of racism often define the life experiences of AI/ANs who use substances. This paper describes the process of designing a developmentally and culturally appropriate primary prevention supplement for an evidence-based program to prevent substance use and increase cultural identity among AI/AN youth.

The impact of patient-centred care on the relationship between access to care and subjective health outcomes amongst people experiencing homelessness: A mediation analysis

People experiencing homelessness (PEH) have stated that impersonal care and feelings of discrimination are barriers to accessing healthcare which is associated with poor health outcomes amongst PEH. This study examined whether patient-centred care (PCC) mediates the relationship between access to care and subjective health outcomes. Using the 2014-15 Healthcare Center Patient Survey, we identified 1873 homeless and vulnerably housed adults. Items related to the delay or inability to receive primary or mental healthcare, PCC provided by healthcare providers, general health status, and the Kessler-6 psychological distress scale were selected. Ordinary least squares analyses were used to perform mediation analysis. We found that both access to primary care and access to mental healthcare were positively associated with physical health status (β = 0.492, p < 0.001; β = 0.311, p < 0.001) and negatively associated with psychological distress (β = -2.53, p < 0.001; β = -1.85, p < 0.001). PCC partially mediated all associations, but the mediation was stronger in the relationships between access to primary care and health outcomes (ab = 0.25, 95% CI [0.002, 0.052]; ab = -0.21, 95% CI [-0.37, -0.07]) compared to mental healthcare (ab = 0.02, 95% CI [0.01, 0.04]; ab = -0.14, 95% CI [-0.25, -0.06]). The results of this study indicated access to primary and mental healthcare is important in the patient-centred health outcomes of PEH. Additionally, the partial mediation of PCC in these relationships indicated that participants' perception of collaborative, trustworthy, respectful care from healthcare providers impacted the relationship between access to healthcare and health outcomes.

Homelessness and Vulnerably-Housed Defined: A Synthesis of the Literature

There is no single accepted definition used in policy or research for the concepts of homelessness and vulnerably housed. Neuman's systems model (NSM) was the framework for this mixed-studies review, with the client system defined as these social issues and categorized as environmental stressors. Eighteen unique definitions of the concepts were identified in 30 studies. Extrapersonal stressors included housing history, interpersonal stressors included dependence on others for housing, and intrapersonal stressors included self-identification. Each level of stressor should be considered when defining these populations for inclusion in future research. Proposed definitions were formulated from the analysis of the results.

Psychological Distress and Work-Related Quality of Life Among Oncology Nurses During the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

Oncology nurses are at disproportionate risk for psychological distress because they often encounter ethical challenges and deaths while providing care. Exposures to emergent suffering during the COVID-19 pandemic compound their chronic distress, which likely increased their vulnerability to psychological distress and may increase their risk for reduced work-related quality of life (WRQOL).

OBJECTIVES

This study examined the association between psychological distress and WRQOL among oncology nurses during the COVID-19 pandemic.

METHODS

A cross-sectional analysis of psychological distress and WRQOL among oncology nurses (N = 63) was conducted.

FINDINGS

The mean Depression, Anxiety and Stress Scale score was 33.4, showing low depression levels, mild anxiety, and mild stress. The mean PTSD score was 29.3, and the mean WRQOL Scale score was 78.8. Depression, anxiety, and stress were strongly correlated to PTSD, and WRQOL was negatively correlated to PTSD, depression, anxiety, and stress.

Factors That Influence Quality of Life in People Experiencing Homelessness: A Systematic Mixed Studies Review

BACKGROUND

An emerging category of morbidity in research among people experiencing homelessness (PEH) is quality of life (QoL). The Commission on Social Determinants of Health (CSDH) framework was used to explain the relationship between the resulting factors and their impact on QoL among PEH.

AIMS

The purpose of this systematic mixed studies review was to explore the factors that are associated with QoL among homeless individuals.

METHOD

A systematic mixed studies review was conducted using CINAHL, Medline, PubMed, and SocIndex databases. Quantitative, qualitative, and mixed methods studies were included and synthesized employing results-based convergent synthesis design.

RESULTS

The initial search resulted in 757 studies with 55 studies meeting the inclusion criteria. Thematic analysis revealed themes influencing QoL among PEH categorized by the CSDH determinants of structural, social cohesion and social capital, and intermediary determinants. Among these themes, higher social status, strong relationships, better reported physical and mental health, and a positive life outlook were associated with increased QoL. Social isolation, substance use, poorer life outlook, increased years spent homeless, and perceived quality of housing were associated with decreased QoL. Age, sex, and housing programs revealed inconsistent results on QoL.

CONCLUSIONS

While the factors presented in this review indicate some consistent relationships with QoL in PEH, this review has shown QoL among this population is complex and multifactorial. Future research should focus on relationships between the CSDH determinants, particularly the psychosocial factors and the QoL priorities defined by PEH, and how they may influence QoL among PEH.

Factors That Influence Substance Use Among American Indian/Alaskan Native Youth: A Systematic Mixed Studies Review

BACKGROUND

The American Indian/Alaskan Native (AI/AN) mortality rate from illicit drug use was 22.7%, double that of the general population between 2007 and 2009. Fifteen percent of AI/AN youth reported receiving treatment for substance use compared with 10% of non-AI/AN peers.

OBJECTIVE

The purpose was to explore the factors that influence substance use among AI/AN youth.

METHOD

We performed a systematic review using a results-based convergent synthesis design. Eight electronic databases were searched for articles published between 2014 and 2019 using the search terms "Native American youth," "Native American adolescent," "Native Youth," "substance use," "substance misuse," and "substance abuse." The Mixed Methods Appraisal Tool was used to appraise the studies.

RESULTS

Forty-seven studies met the inclusion criteria (44 quantitative, one qualitative, and two mixed-methods studies). The results were organized using the ecological systems model and included evaluation of both protective and risk factors related to AI/AN youth substance use. Three system levels were found to influence substance use: individual, micro- and macrosystems. The individual systems-level coping mechanisms played a key role in whether AI/AN youth initiated substance use. Family, school, and peer factors influence the microsystem level. At the macrosystem level, community environmental factors were influential.

CONCLUSION

The major factor linking all the systems was the influence of a connected relationship with a prosocial adult who instilled future aspirations and a positive cultural identity. Findings of this systematic mixed studies review will assist in intervention development for AI/AN youth to prevent substance misuse.

Psychometric Evaluation of the School Nurses' Awareness and Perceptions Survey (SNAPS) for Youth At-Risk of Trafficking

BACKGROUND AND PURPOSE

Estimates suggest approximately 244,000-360,000 school-aged children in the United States are at risk of being trafficked. The purpose of this study was to test the psychometric properties of the School Nurses' Awareness and Perceptions Survey (SNAPS).

METHODS

A multi-phase approach for reliability and validity using correlation, exploratory, and confirmatory factor analysis (CFA) with samples of school nurses from Massachusetts (Phase I) and nationally (Phase II).

RESULTS

SNAPS is a 32-item 5-point Likert scale with a potential score range of 32-160. Cronbach's alpha was .94 with sub-scales ranging from 0.84-0.94. CFA revealed a three-factor scale with a cumulative variance of 70.79% (Chisquare 3.13, df 461, p < .001; RMSEA .10; GFI .80; CFI .78; TLI .76).

CONCLUSIONS

Strong psychometric properties were found for the new measure allowing assessment of school nurses' knowledge of youth trafficking.

A policy analysis of nurse practitioner scope of practice in Massachusetts

ABSTRACT

Nurse practitioner (NP) practice has evolved since inception of the role in 1965. Educational requirements have been standardized requiring a master's degree, yet variation in NPs scope of practice exists across the United States. As the population ages and more Americans have health insurance coverage, the demand for health care continues to increase. Shortages of clinical providers and changes in hospital models of care continue to burden the health care system. Nurse practitioners have been found to provide safe, high-quality patient care and are a potential solution to ease the burden on our health care system. Nurse practitioner scope of practice restrictions limit the ability for NPs to practice independently. The purpose of this article was to analyze the advanced practice registered nurse's (APRNs) scope of practice policy in Massachusetts (MA) where APRNs just recently obtained full practice authority. Legislation to remove NP scope of practice restrictions in MA had been presented several times but was met with resistance from physician advocacy groups stating that NPs lack the education requirements to practice independently. A recent report from the MA Health Policy Commission demonstrates the impact that NPs have on lowering health care costs and servicing individuals in underserved areas of the state. During the pandemic, restrictions on NP scope of practice in MA were temporarily removed. It was realized that if NPs can practice independently during a pandemic, then they certainly are competent to practice independently at other times. A reassessment of NP scope of practice to allow for full authority should be completed nationally.

Obtaining Exposure and Depth of Field: School Nurses "Seeing" Youth Vulnerability to Trafficking

Trafficking of youth is a growing phenomenon. How commercially exploited youth present in schools is multifaceted and poorly understood. Like other providers, school nurses are on the frontlines, yet can misunderstand youth who are commercially exploited. Using Grounded Theory, we employed theoretical sampling with school nurses and survivors of trafficking to generate a theory that explains (a) the factors that increase the risk of youth being trafficked and (b) how school nurses might identify youth at risk of being trafficked. The emerging theory developed from the data was Obtaining Exposure and Depth of Field: School Nurses "Seeing" Youth Vulnerability to Trafficking. Voices of school nurses and survivors illuminated the invisibility of youth in schools who are victims of trafficking and the magnified lens of exploiters who see their vulnerability. The lens of school nurses can be refocused to "see" youth who are victims of trafficking presenting at school.

Asian American Women's Recall of Conversations With Their Mothers About Sexual Health: A Secondary Analysis of Qualitative Data

ABSTRACT

Between 2010 and 2016, Asian Americans (AA) had a 35% increase in HIV diagnosis. Although mother-daughter sexual communication was found to be protective in minority populations, the opposite is true among AAs. The purpose of this study was to explore AA women's experiences of sexual communication with their mothers. Secondary qualitative analysis using analytic expansion with a phenomenological approach was used. Thematic analysis was used to search for common patterns and themes that emerged using qualitative description methodology. Twenty East and Southeast AA cisgender women, ages 18-33 years, were interviewed. The primary finding was an intergenerational gap with two themes: (a) mothers' attitudes about sexual communication and (b) content of sexual communication. Indirect sexual communication included cautionary messages consistent with previous studies. AA mothers' strong cultural beliefs created a barrier to communication. Future research should focus on the young women who want open sexual communication and could influence the next generation.

A Mixed-Studies Review of the School-to-Prison Pipeline and a Call to Action for School Nurses

Zero-tolerance school disciplinary policies have contributed to the proliferation of exclusionary practices, which increase the risk that minoritized students will be harmed by the school-to-prison pipeline (STPP). The purpose of this review was to explore factors that influence the STPP and highlight the role school nurses can play in protecting students from this public health crisis. We used a systematic mixed-studies review method, and 14 studies were included. Exclusionary discipline disproportionately affects minoritized students, but decreased student–teacher ratios, wellness-focused environments, and lower levels of school punishment can improve student achievement and health. The National Association of School Nurses position statement provides a framework to guide school nurses in the dismantlement of the STPP. School nurses should advocate for their position on the interdisciplinary team, funding for alternative disciplinary programs, abolition of school policing, restorative justice approaches, support for at-risk students, and anti-racism education programs for all school staff.

How Do Acculturation, Maternal Connectedness, and Mother-Daughter Sexual Communication Affect Asian American Daughters' Sexual Initiation?

Purpose: There was a growth of approximately ten million Asian American individuals in the United States between 2000 and 2015. Asian Americans have conservative values surrounding sexual health and sexual communication is a cultural taboo. Researchers have shown discrepancies on whether the level of acculturation influences Asian mother-daughter sexual communication. In other minority populations there is evidence that a connected mother-daughter relationship increases sexual communication and delays sexual initiation. The purpose of this study was to examine whether mother-daughter connectedness and level of acculturation predict sexual communication in turn affecting the age of female Asian emerging adult's sexual initiation. Methods: This was a longitudinal, secondary analysis of AddHealth examining whether mother-daughter connectedness and level of acculturation predict sexual communication. There were 243 Asian American mother-daughter dyads in Wave I with linked data in Wave III who were included in the study. Acculturation, connectedness, and sexual communication were all measured using interval level data. Results: Connectedness did not significantly contribute to the relationship between any of the concepts. Although it was predicted that sexual communication would delay initiation, the opposite was found. Also, communication mediated the relationship between acculturation and initiation. Conclusions: Further studies are needed to explore how connectedness is defined by Asian American mother-daughter dyads. In addition, more detailed operational definitions of acculturation and communication are needed, specifically the timing of sexual communication.

Using Cognitive Interviewing Methodology to Define Acculturation Among Asian American Women

Introduction: Berry acculturation model (BAM) includes five measurement components. Current instruments do not examine all five components. This study's aim was to complete cognitive interviews with Asian American college-aged women using two frequently used measures and investigate whether all five BAM's components of acculturation are included. Methodology: This is a qualitative study using in-depth semistructured cognitive interviewing. Data were collected until saturation was reached (n = 20). Content analysis was completed. Results: Two themes emerged: Components of acculturation and survey structure. All components of BAM were evident in the data. The women agreed that physical, biological, cultural, and social relationships are important aspects of acculturation. The psychological component emerged as women discussed intergenerational conflicts related to acculturation. Discussion: Future research includes psychometric testing of a new acculturation instrument that incorporates all five components of BAM. A valid, comprehensive measure is needed to understand how AA women adapt to mainstream culture.

<p>Factors Associated with Treatment Uptake Among Women with Acetic Acid/Lugol’s Iodine Positive Lesions of the Cervix in Cameroon</p>

Purpose

Treatment of cervical precancer is the primary aim in secondary prevention of cervical cancer. The purpose of this study was to examine factors associated with treatment uptake among women with acetic acid/Lugol’s iodine positive lesions identified by digital cervicography (DC) in a cervical cancer prevention program in Cameroon.

Patients and Methods

We conducted a cross-sectional survey of medical records from 2013 to 2018 of 755 women in Cameroon who screened positive with acetic acid/Lugol’s iodine in 2013.

Results

Of the 755 women, 422 (55.9%) had treatment/biopsy on the same day or followed up later, but only 344 (45.6%) received treatment/biopsy and 333 (44.1%) were lost to follow-up. Overall, 180 (52.3%) of the 344 women were treated/biopsied the same day they were screened, and 164 (47.7%) were treated/biopsied after the initial visit. Women aged 30–49 and HIV-positive women were significantly more likely to have received treatment or returned for treatment than women less than 30 and HIV-negative women. Of the 266 women who followed up at a later date, the lesions of 78 (29.3%) women regressed spontaneously without treatment. Women with low-grade lesions, HIV-negative women and women who had follow-up more than a year after the initial exam were significantly more likely to have spontaneous regression with regression rates of 30.6%, 32.1% and 62.2%, respectively (p<0.001). Age was not a significant determinant of spontaneous regression (p=0.149).

Conclusion

Efforts to increase treatment uptake are needed in this population, including adherence to same day “See and treat” policies.

An Integrative Review of Factors Associated With Symptom Burden at the End of Life in Children With Cancer

Children with cancer experience multiple symptoms at end of life (EOL) that impair their health-related quality of life. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, this integrative literature review comprehensively summarized symptom experiences of children with cancer at EOL. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Academic Premier were searched between January 2007 to September 2019 for articles published in English using the MeSH terms: symptom burden or distress AND children with cancer or pediatric cancer or cancer children or oncology and pediatrics AND EOL care or palliative care or death or dying or terminally ill. The inclusion criteria were the following: (a) study designs [randomized controlled trials, nonexperimental, secondary analysis (if aims were distinct from primary studies) and qualitative]; (b) participants <18 years old (died of cancer, had no realistic chance of cure, or had advanced cancer); and (c) focused on symptom experiences/burden at EOL. Exclusion criteria were nonresearch articles, systematic reviews, case studies, reports, and studies that focused on cancer survivors and/or those receiving curative therapies. Twenty-seven articles met inclusion criteria. The most prevalent symptoms-pain, fatigue, dyspnea, and loss of appetitewere associated with impairments in health-related quality of life. Children with brain tumors experienced higher symptom burden compared to those with hematologic/solid malignancies. Children who received cancer-directed therapies experienced disproportionate symptoms and were more likely to die in the intensive care unit compared with those who did not receive cancer-directed therapies. Most common location of death was home. This integrative review indicated that children with cancer were polysymptomatic at EOL. Strategies facilitating effective symptom management at EOL are needed.

A Literature Review of Racial Disparities in Overall Survival of Black Children With Acute Lymphoblastic Leukemia Compared With White Children With Acute Lymphoblastic Leukemia

Despite major advances in acute lymphoblastic leukemia [ALL] treatment, poorer overall survival (OS) persists for Black children with ALL compared with White children with ALL. The purpose of this literature review was to examine the racial disparities on OS in Black versus White children with ALL. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed, and Academic Search Complete databases were searched using the Medical Subject Heading (MeSH) terms: survival or mortality or outcome AND black or African-American or AA or minority AND racial disparities or race or racial/ethnic disparities AND cancer in children or pediatric cancer or children with leukemia or children with ALL for articles published in English between January 2009 and July 2019. Exclusion criteria were non-research articles, systematic reviews, conference abstracts, editorials, commentaries, correspondence, and case reports. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, data were extracted, appraised, and synthesized. Sixteen articles met the inclusion criteria. Sample sizes across studies ranged from 184 to 31,866 participants. The factors most associated with disparities in OS included: age at diagnosis (e.g., <1 year and/or >10 years old), differences in clinical prognosticators (e.g., white blood cell count at diagnosis, T-cell vs. precursor B-cell immunophenotype, central nervous system disease status, cytogenetic profile) and lower socioeconomic status. Future prospective studies are needed to elucidate the role of these factors in OS of Black children with ALL.

A Storytelling Intervention in a Mobile, Web-Based Platform: A Pilot Randomized Controlled Trial to Evaluate the Preliminary Effectiveness to Promote Human Papillomavirus Vaccination in Korean American College Women

Korean American women have substantially greater incidence rates of cervical cancer and the lowest rates of cervical cancer screening in the United States. However, there has been minimal research to promote human papillomavirus (HPV) vaccination among this population. A pilot randomized controlled trial was conducted to evaluate preliminary effectiveness of a storytelling video intervention using mobile, Web-based technology. One hundred and four Korean American college women were randomized to the experimental group (storytelling video) or the comparison group (information-based written material). The effects of the intervention were assessed immediately postintervention and at the 2-month follow-up. Both groups improved in knowledge of and attitude toward the HPV vaccine at the postintervention. At the 2-month follow-up, the experimental group was twice as likely to receive the HPV vaccine compared to the comparison group. This preliminary evidence supports the use of a storytelling video intervention and shows substantial promise for further development and testing in larger scale studies.

Parental Uncertainty: Parents' Perceptions of Health-Related Quality of Life in Newly Diagnosed Children With Cancer

BACKGROUND

Parents of children with cancer are predisposed to psychological distress symptoms, such as anxiety, depression, and uncertainty. This vulnerability may exacerbate underlying mood disturbances, including trait anxiety and depression, and influence parents' perception of health-related quality of life (HRQOL) in their children.

OBJECTIVES

This study examined the relationship between parental uncertainty and parent proxy reports of HRQOL in newly diagnosed children with cancer.

METHODS

A longitudinal descriptive approach was used to examine the relationship between parental uncertainty and parent proxy reports of HRQOL in 55 parent-child dyads. Parental trait anxiety, depression, and perceived social support were evaluated as potential predictor variables.

FINDINGS

Parents of newly diagnosed children with cancer reported lower parent proxy HRQOL scores. Parental uncertainty was prevalent and affected parents' perceptions of HRQOL three months following diagnosis; however, higher social support scores buffered these negative effects.

Systematic Review of Human Trafficking Educational Interventions for Health Care Providers

Human trafficking is a global population health threat. Trafficking minors threatens the safety and well-being of youth. Limited studies measure health care providers’ awareness and attitudes toward trafficking. This systematic review synthesized retrospective and current knowledge and identified gaps in educational interventions aimed at increasing providers’ awareness and attitudes toward trafficking. A systematic search of four databases identified peer-reviewed published papers between January 1, 2000 and September 1, 2018. The Cochrane Collaboration’s Preferred Reporting Items for Systematic Reviews was followed. Study quality was assessed using the Downs and Black checklist. The Psychometric Grading Framework was used to assess the validity of instruments. Findings across studies ( N = 7) reveal providers (mostly social workers and physicians) have low awareness of trafficking and can have negative attitudes toward victims. Multiphase educational approaches and use of content experts, including survivors, in developing interventions enhanced sustainability of outcomes. Targeting multidisciplinary health care teams, including nurses, enhanced interventions.

HPV Vaccination and Korean American College Women: Cultural Factors, Knowledge, and Attitudes in Cervical Cancer Prevention

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection that leads to nearly all cervical cancers in the United States (U.S.), which could be prevented with the HPV vaccine. Korean American women experience a high burden of cervical cancer, but little is known about their awareness, knowledge, attitudes, sociocultural factors and social network/support related to intention to obtain the HPV vaccine. This study reports baseline characteristics of 104 Korean American college women aged 18-26 and who have not been previously vaccinated against HPV, as part of a pilot randomized controlled trial testing feasibility, acceptability, and preliminary effectiveness of an HPV storytelling intervention. Data were analyzed including descriptive statistics, bivariate analysis, and multivariate logistic regression. Multivariate logistic regression was performed to understand the relationship between independent predictors of intention to receive HPV vaccination. Overall, 34.6% of participants intended to obtain the vaccine. Positive predictors of intention to receive HPV vaccine were: years in the U.S., academic major, awareness of HPV and HPV vaccine, knowledge, and HPV recommendation by healthcare provider and parents. The multivariate logistic model showed that intention to receive the HPV vaccine was significantly associated with HPV vaccine recommendation by parents (OR 4.58, 95% CI 1.37-15.36) and knowledge (OR 1.11, 95% CI 1.11-1.22). These findings suggest a need for development of interventions that are not only culturally tailored but also acculturation-sensitive to promote HPV vaccination among Korean American college women. This may play a significant role in cervical cancer prevention among Korean American college women.

Invisible Minority: HIV Prevention Health Policy for the Asian American Population

There has been a 72% increase in the Asian American population from approximately 12 million in 2000 to 21 million in 2015. By 2050, there will be 33.4 million Asian Americans living in the United States, making this population the most rapidly growing ethnic group in the country. There is a myth that Asian Americans are a model conservative minority group in terms of sexual behavior and safe sexual practices and are not at risk of sexually transmitted infections including HIV. However, they are the only ethnic group in the United States that had a continuous increase in HIV infection rates from 4.9 per 100,000 in 2011 to 5.5 per 100,000 in 2016. Due to state and national methods of data collection for race and ethnicity with regard to sexually transmitted infection and HIV, the Asian American population's data are often limited. The purpose of this article is to identify the potential historical and political reasons why the Asian American population's HIV or sexual risk has not been fully documented and to propose potential health policy solutions.

Engaging college students in a substance misuse & sexual health intervention using social marketing principles

BACKGROUND/PURPOSE

The successful recruitment and retention of participants is integral to the translation of research findings. Recruitment begins once you have defined your focus population and identified where and how to reach them (i.e., targeting). Formative evaluation can provide valuable information on recruitment, given the dynamics of different communities and the potential for certain strategies to work better than others with high-risk groups. The preliminary work of engaging the population of interest is essential to successfully attracting and retaining the involvement of populations of interest. The purpose of this paper is to present methods used to engage college students in a multi-level intervention aimed at preventing substance abuse, HIV and STIs.

THEORETICAL FRAMEWORK

Andreasen's six principles of social marketing were used to develop intervention activities and engage students in these activities.

METHODS

A multi-method approach was employed using both survey and focus groups for preliminary feedback, post-event surveys and annual evaluations.

RESULTS

Pamphlets are not enough to attract potential participants because advertisements need to be engaging and employ social networking sites. Students also enjoy playing both on-line and in person games and are quite competitive. Testing for HIV tripled in the first year.

CONCLUSIONS & IMPLICATIONS

Students became more aware with each subsequent event participation increased over time. Although word of mouth is still very effective in getting students to events, the use of social networking sites greatly improved student participation.

Factors That Influence Parental Uncertainty and Health-Related Quality of Life in Children With Cancer: A Framework

The purpose of this paper is to present a conceptual-theoretical-empirical model addressing factors that influence the relation between parental uncertainty and health-related quality of life in children with cancer. The basic concepts identified and defined in the model include parental uncertainty, health-related quality of life, parental trait anxiety, parental depression, and perceived parental social support. The proposed relationships between the concepts are explained with explicit linkages to their empirical indicators. There is limited research in childhood cancer regarding the relation between parental uncertainty and health-related quality of life; therefore, the proposed model will help to better understand this relationship.

Abstract C56: An online-based storytelling video intervention on promoting Korean American female college students' HPV vaccine uptake

Introduction: Korean American (KA) women are at high risk for human papillomavirus (HPV) infection and cervical cancer, yet they have low awareness and knowledge about HPV vaccine, and subsequently have low HPV vaccine uptake rates. Therefore, it is imperative to develop culturally appropriate education interventions to reduce the health disparities.

Objective: This study aimed to evaluate the effects of an online storytelling intervention to promote HPV vaccine uptake by conducting a pilot randomized controlled trial (RCT).

Method: We recruited 104 participants from multiple sites in six different states in Northeast.

Participants were eligible if they were current KA female college students between the ages of 18-26 and who have not been vaccinated for HPV. This study was implemented in an innovative online laboratory from data collection to experimentation. Participants were randomly assigned to the experimental group (a storytelling video) or control group (written information). The effects of the intervention were assessed at post-intervention and 2-month follow-up.

Results: Both experimental group and control group improved in knowledge and attitudes from baseline to post-intervention. However, the experimental group had higher overall knowledge score, satisfaction with the education program, and intention to get the HPV vaccine within 1 year and was twice as likely to receive or schedule an appointment for the HPV vaccine compared with the control group (15.6% vs. 7.1%).

Conclusion: This pilot study provides evidence in support of the effectiveness of the storytelling video intervention in using an innovative online laboratory setting aimed at HPV and HPV-related cancer prevention.

Citation Format: Minjin Kim, Haeok Lee, Teri Aronowitz, Lisa Kennedy Sheldon, Peter Kiang, Jeroan Allison, Ling Shi. An online-based storytelling video intervention on promoting Korean American female college students' HPV vaccine uptake [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C56.

The Peace and Power Conceptual Model: An Assessment Guide for School Nurses Regarding Commercial Sexual Exploitation of Children

Human trafficking is a global problem; more than half of all victims are children. In the United States (US), at-risk youth continue to attend school. School nurses are on the frontlines, presenting a window of opportunity to identify and prevent exploitation. Available papers targeting school nurses report that school nurses may lack awareness of commercial sexual exploitation and may have attitudes and misperceptions about behaviors of school children at risk. This is a theoretical paper applying the Peace and Power Conceptual Model to understand the role of school nurses in commercial sexual exploitation of children.

Evaluating Cultural Competence of Pediatric Oncology Nurses at a Teaching Hospital: A Pilot Study

This cross-sectional descriptive study evaluated registered nurses’ self-ratings of cultural competence on the hematology/oncology unit at a large Northeastern urban children’s hospital. The Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals was used to measure 5 constructs of cultural competence. The study findings show that there were significant correlations between the knowledge and skill subscales (ρ = .57, P < .001) and the knowledge and desire subscales (ρ = .42, P < .05). The highest mean among the 5 subscales was cultural desire (mean = 15.5), indicating that nurses were motivated to engage in the process of becoming culturally competent. The lowest mean among the 5 subscales was cultural knowledge (mean = 11.2), followed by cultural skill (mean = 11.8), indicating that nurses did not perceive themselves to be well informed in these areas. The findings from this pilot study suggest that nurses on this pediatric oncology unit are most likely to possess cultural desire and cultural awareness, but there is certainly opportunity to engage and educate the staff. Targeted interventions to improve cultural competence on this inpatient unit are being explored and a larger scale study is being planned to assess the cultural competence of nurses across the hospital.

Using Objective Structured Clinical Examination (OSCE) as Education in Advanced Practice Registered Nursing Education

Approximately 3 million nurses make up the U.S. health care workforce. The Robert Wood Johnson Foundation and the Institute of Medicine (2011) supported the call to strengthen the nursing profession by establishing global standards of educational criteria and outcomes. Throughout the world, health education is affected by fundamental inadequacies related to static, fragmented, and content-oriented curricula. There are inadequacies in our curricula, and nursing faculties are facing challenges with clinical placements (both the number and quality of these placements); therefore, alternative methods of providing practice to students need to be considered. A transformative agenda comprising changes in the way students are taught fully harnessing the potential of information and communications technology (i.e., simulation) is necessary. Simulated patient encounters and Objective Structured Clinical Examinations are 2 means to achieve needed practice in a safe environment. The purpose of this article is to show, by using simulation, how students can practice and be evaluated within their clinical practice role in a safe, controlled environment. In addition, this practice can (a) enable students to increase the complexity of their understanding and their autonomy and (b) educate students about social accountability, health and gender equity, social justice, and human rights.

Thoughts About Social Issues: A Neuman Systems Model Perspective

The Neuman systems model includes social issues as a client system of interest. The other client systems of this conceptual model of nursing are individuals, families, other groups, and communities, about which exists a considerable amount of literature. However, social issues as a client system have not yet been defined or described, nor has any application of this client system been published. This essay is a discussion of the meaning of social issues as a client system from the perspective of the Neuman systems model, and offers examples from the literature, from the results of a survey of Neuman systems model trustees, including Betty Neuman, and from dialogue with participants at the 15th Biennial Neuman systems model symposium. This article was adapted from a paper presented at the 15(th) Biennial International Neuman Systems Model Symposium, Philadelphia, PA. June 19, 2015.

Knowledge and Attitudes toward HIV, Hepatitis B Virus, and Hepatitis C Virus Infection among Health-care Workers in Malawi

Objective:

The highest prevalence of HIV infection occurs in Sub-Saharan Africa and hepatitis B virus (HBV), and hepatitis C virus (HCV) prevalence are the second highest in Sub-Saharan Africa including Malawi. Health-care workers (HCWs) play an important role in the prevention of, response to, and management of these infectious diseases. There is, however, no published research about the level of knowledge and attitudes toward HIV, HBV, and HCV infection among Malawian HCWs. The purpose of this study was to explore and determine the knowledge of and attitudes toward HIV, HBV, and HCV among a targeted population of Malawian HCWs.

Methods:

A cross-sectional community-based participatory research with 194 HCWs was completed employing health survey method. The project was a collaborative effort between nursing faculties in the USA and Malawian. A one-way analysis of variance (ANOVA) with the Bonferroni adjustment for multiple comparisons was used to assess the differences in knowledge and attitude among three subgroups of HCWs.

Results:

Of 194 of Malawian HCWs surveyed, 41% were support staff, 37% were nursing students, and 22% were health-care professionals. Both health-care professionals and support staff had high knowledge scores related to HIV/AIDS, and their attitudes were mainly positive. However, a series of one-way ANOVAs revealed significant differences in knowledge and attitude toward HIV/AIDs, HBV, and HCV among HCWs (P < 0.01). The majority had less knowledge about HBV and HCV and more negative attitudes toward hepatitis.

Conclusions:

This study highlights the ongoing need for reducing negative attitudes toward HIV, HBV, and HCV; and providing health education among HCWs, especially focusing on HBV and HCV prevention. The findings of the research project can be used to develop interventions addressing low HBV- and HCV-related knowledge and attitudes.

Thoughts about the Name of Our Discipline

This essay addresses the name of our discipline. Discussion of the use of the term, nursology, focuses on the origin of the term, its use as a name for our discipline and its use as a research method and a practice methodology. Advantages and disadvantages of nursology as the name for our discipline are gleaned from PhD program students’ responses to a question posed by Reed (1997).

Sexual communication intervention for African American mothers & daughters

BACKGROUND

African American girls ages 13-19 comprised nearly 3 out of 4 new cases of HIV in 2009. The goal of this study was to deliver a theoretically-driven intervention to test the feasibility for recruitment and retention of mother-daughter dyads.

METHODS

Twenty mother-daughter dyads were recruited from a community health center between February-April 2014. Comparisons were made between pre- and post-intervention scores using percent change.

RESULTS

Twelve dyads (60%) completed the intervention. There were no demographic differences between completers and noncompleters. Notable post-intervention percent increases in scores were observed in the domains: Sexual knowledge (15%), confidence to talk (23.2%); and openness of sexual communication (26.4%).

CONCLUSION

Our small-sized study showed promise in the intervention. Increasing sexual communication between African American mothers and daughters is likely to be sustainable over time and across relationships, and thus have a greater impact on HIV-prevention behaviors later in life.

Thoughts about conceptual models of nursing and health policies

In this essay, we present a conceptual framework for analysis and evaluation of sexuality education health policies based on the conceptual model of nursing and health policy and the Neuman systems model. The framework is intended to facilitate understanding of sexuality education policies promulgated by the governments of any country in the world.

Recognizing global disparities in health and in health transitions in the 21st century: what can nurses do?

PURPOSE

To examine changes in patterns of health and disease in global context between rich countries (USA, Korea, South Africa) and poor countries (Cambodia, Malawi) by using the framework of epidemiology theory developed by Orman (1971, 2005), and to raise awareness of global health disparities thereby prompting actions to reduce such disparities.

FINDINGS

1) Life expectancy has increased across all selected countries except South Africa; 2) Korea and the USA have substantially lower mortality rates than other countries; 3) Infant and maternal mortality are still high in the poor countries; 4) The major cause of mortality in the poor countries is still communicable disease with evidence of the onset of non-communicable disease; and 5) The health transition theory provides a description and explanation of the differences in progress in economic development between countries but fails to explain differences in health status within and between countries.

CONCLUSIONS

Life expectancy and mortality are enormously different among the five selected countries. This excessive health disparity is primarily due to the higher risk of communicable diseases in low-income countries. Social determinants of health are mainly responsible for the health disparities observed within and between countries.

CLINICAL RELEVANCE

Future health care development and global research priorities will not be the same for all countries because the pattern of health transitions in the developing countries is not the same as the developed countries. Actions to reduce global health disparities need to recognize the conditions and social context in which persons live. An effective strategic approach to global health equality should develop a shared system of values, priorities, and delivery infrastructures with the populations who are targeted, aligning delivery within the local social contexts.

An Expansion and Modification of the Information, Motivation, and Behavioral Skills Model: Implications from a Study with African American Girls and Their Mothers

African American females make up a disproportionate number of adolescent HIV cases. Focus groups were conducted to investigate sexual communication between 11- to 14-year-old girls and their mothers. Twenty-eight African American mother-daughter dyads from inner-city community centers participated. Implementing an intervention for families with children requires the use of a framework that is amenable to the development of intervention strategies as well as taking a family approach. The focus of the study was to adapt a leading theory used in interventions for HIV risk reduction at the individual level to be employed with a dyadic relationship between mother and daughter. Following qualitative analysis, data were reexamined according to an expanded and modified version of the Information, Motivation, and Behavioral Skills (IMB) Model. Each of the constructs was represented in the data, and insights for intervention strategies were obtained. However, the IMB model restricted an understanding of the dynamic relationship and the mother-daughter interactions with the community.

Attitudes that affect the ability of African American preadolescent girls and their mothers to talk openly about sex

Approximately 50% of new HIV infections in the US occur in teenagers, with African American females making up a disproportionate number. The purpose of this study was to identify factors that could encourage delaying sexual debut. Twenty-eight African American mothers and their early adolescent daughters were recruited from four inner-city community centers. Seven separate focus groups were conducted for mothers and daughters using principles of Participatory Action Research. Four codes emerged from the data: social norms regarding sex, males, self-esteem, and family structure. These codes support the importance of an intervention to facilitate sexual communication between a mother and her daughter.

Ecological influences of sexuality on early adolescent African American females

African Americans make up the greater proportion of AIDS cases in adolescent girls but little is understood about the development of sexual risk behaviors during the early adolescent years. This article will explore ecological factors influencing adolescent sexual risk behaviors. In the focus groups, which were conducted using 28 African American mothers and their early adolescent daughters, 2 major themes emerged: exposure and support systems. Mothers described the impact community had on their daughters and how monitoring and support systems worked together to control exposure. The girls detailed the different ways they were impacted by the community. Attitudes the girls adopted from their exposures resulted in risk-taking behaviors or a determination to positively impact the community. Community was shown to be the context of the acquisition of sexual knowledge and attitudes. These findings support the development of interventions to address the impact of community on the participation of sexual risk behaviors.

Teaching Adolescents About Adolescence

As abstract reasoning increases in complexity, adolescents may face dissonance between new thoughts and prior beliefs. Students in the health professions may be forced to resolve these dissonances in order to execute their professional responsibilities. In developing an undergraduate interdisciplinary course on adolescent health, the authors anticipated challenges in teaching adolescents about adolescence. Over the course of the semester, the anticipated challenges became reality. The author discusses pertinent developmental theories and their application in facilitating late adolescent identity formation and professional role development.

The role of "envisioning the future" in the development of resilience among at-risk youth

The objective was to explore the process by which adolescents develop resilience and change their risk behaviors despite multiple stressors in their environment. The design was exploratory using grounded theory to understand the process from the teens' perspectives. Semistructured interviews were conducted with 32 individuals-28 adolescents (age range 16-21 years) and 4 adults (age range 32 and 72)-on two occasions. The participants used the basic social process "envisioning the future" to become resilient and stop engaging in risk behaviors. Envisioning the future included two processes "feeling competent" and "elevating expectations" that were facilitated within the context of a relationship with a reliable, caring, and competent adult. Participants in this study became resilient despite environmental stressors by setting higher expectations for themselves and feeling self-confident. The findings of this study provide information regarding the specific behaviors that promote positive outcomes in at-risk youth and suggest ways in which public health nurses can facilitate these behaviors in both the youth and their mentors.