Predicting psychological distress among former Soviet immigrants

This study investigated whether age, gender, marital status, education, employment, length of time in the U.S. and immigration demands (novelty, occupation, language, discrimination, loss, and not feeling at home) were predictors of psychological distress in a sample of 1,647 former Soviet immigrants. Multiple regression analysis indicated that the combined model of demographic and demand of immigration variables was significant. Results indicated that women, older immigrants, those with less than a college education, and those with greater immigration demands related to novelty, language, discrimination, loss, and not feeling at home were most distressed.

Health Related Behaviors and Cancer Screening of Lesbians: Results of the Boston Lesbian Health Project II

This paper reports data on health related behaviors and cancer screening from the Boston Lesbian Health Project II (BLHP II), a replication of a national survey of lesbians on a variety of health-related variables completed in 1987. The findings suggest that lesbians have increased their use of primary care, including routine physical examinations, pap smear screening for cervical cancer, and mammography for breast cancer, but that rates continue to be lower than would be expected for women in general. Younger lesbians in this sample smoked at high rates. Smoking rates continue to be of concern in other age groups, although they are lower than national data from women in general. BLHP II data confirm other findings that lesbians are more likely to drink alcohol and to drink more heavily than other women. Implications for health care of lesbians and future research with this population are discussed.

Multiple-method, cross-cultural assessment of psychological distress

The purpose of this study was to test the validity of cross-cultural use of a standardized instrument to measure psychological distress by triangulation of data obtained through a multiple-method approach. The sample consisted of 25 adult Polish immigrants who had at least a basic command of the English language. The three methodological approaches included a paper-and-pencil self-report instrument (Brief Symptom Inventory [BSI], verbal self-reports elicited during an in-depth interview, and micro-level and macro-level observations. The translated BSI was relatively valid except for the psychoticism, paranoid and interpersonal sensitivity subscales. Invalidity could be explained through information gathered by other methods. The importance of instrument translation for cross-cultural use and the need to incorporate multiple-method assessment into both clinical practice with ethnic populations and cross-cultural research are discussed.

Use of the Brief Symptom Inventory to assess psychological distress in three immigrant groups

This paper examined the internal consistency reliability of two newly developed alternate language versions of the Brief Symptom Inventory (BSI) (This is not the Bradford Somatic Inventory, which is also known as the BSI) when used with Polish and Filipino immigrants and the original versions of the BSI and its parent instrument, the Symptom Checklist 90 (SCL-90) when used with Irish immigrants; and, the theoretical and criterion related validity of the Psychoticism subscale of the BSI for Polish, Filipino, and Irish immigrants. Internal consistency estimates and triangulation of individual BSI global and subscale scores with verbal self-reports and clinical assessments demonstrated that the BSI is a relatively reliable and valid cross-cultural measure of psychological distress. However, problems with the Psychoticism subscale occurred across all three immigrant groups, which suggested that this subscale should be interpreted with caution when used with immigrants.

From silencing the self to action: experiences of women living with HIV/AIDS

Feminist literature has demonstrated that women often maintain behaviors that support silencing of their voices. The critical issue is whether the silencing experience is (a) a destructive process of burying feelings and needs, (b) a protective strategy to preserve personal and professional relationships which they value, (c) a coping mechanism to divorce themselves from an androcentric/ethnocentric health care culture, or all of these. The transition from silence to action may be a process of reacting to a threat to self (i.e., HIV/AIDS diagnosis) where gender normative behaviors become irrelevant and self-advocacy becomes paramount for survival. Alternatively, the transition may be a conscious process of gaining insight into past behaviors that have been learned and culturally supported and making purposeful changes. Data for this study were extracted for secondary analysis from data from a larger study on experiences and needs of persons living with HIV/AIDS. Data were obtained from transcripts from three focus groups (N = 14 women) and six individual interviews. Women ranged in age from 21 to 55; 9 were European American, 7 were African American, and 4 were Latina American. Data were content analyzed and organized using four categories proposed by Jack (1991): (a) externalized self-perception, (b) care as self-sacrifice, (c) silencing the self, and (d) the divided self. Data supported that women with HIV/AIDS reported all four categories of silencing behaviors, particularly early in the HIV trajectory. For some women, an HIV/AIDS diagnosis ignited them to speak for themselves and to shape their own lives based on feelings and needs. For others, peer or professional support or both was the catalyst for the transition from silence to action. Findings suggest interventions that would assist women in judging themselves by internal versus external standards, putting their own needs before the perceived needs of others, expressing themselves toward action rather than avoidance, and feeling comfortable expressing anger.

Cancer Prevention and Screening Behaviors in Lesbians

The incidence of cancer diagnosis has increased in the United States highlighting the need for astute cancer prevention and screening behaviors. Previous literature has suggested that lesbians may not follow the American Cancer Society's (ACS) guidelines regarding prevention and screening for cancer due to disparity in access to care and increased use of alcohol and tobacco. The purpose of this study was to examine the cancer prevention and screening behaviors of lesbians using the ACS guidelines as the standards for comparison, and to determine factors that influence mammography screening. A 102-item self-report survey was distributed to lesbians nationwide using various methods including snowballing sampling techniques. The sample included 1139 self-identified lesbians from 44 states. In general, healthy lifestyle behaviors were followed. The majority of the women did not smoke, ate plenty of fruits and vegetables, ate protein sources low in fat and consumed alcohol at a moderate rate. However, safe sex practices were often not used by participants. Most women did have mammograms and Papanicolaou smears (PAP) as recommended; however, adherence to self-breast examination guidelines was not followed. Women who were older, had higher yearly incomes, did not smoke, performed regular self breast exams and had regular physical exams were most likely to have a mammogram. Over half of the women met American Cancer Society guidelines for prevention and screening for breast and cervical cancer. However, strategies are needed to increase compliance with these guidelines in order to improve cancer health outcomes.

Psychological distress in family members living with human immunodeficiency virus/acquired immune deficiency syndrome

This article describes the psychological distress experienced by family members living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Survey data were collected from 133 individuals, (47 parents, 53 siblings, 33 adult family members who have HIV/AIDS) representing 80 families. In-depth interview and observational data were collected from a subset of the sample. The physical and psychological health of individual family members was assessed by the 53-item Brief Symptom Inventory. Parents, siblings, and people living with AIDS (PWAs) reported higher levels of overall distress and scored higher on symptom dimensions and clinically discrete symptoms than normative comparison groups. Implications of these findings for research, clinical practice, and health and social service policy are identified and discussed.

A mobile HIV education and testing program: bringing services to hard-to-reach populations

Few programs exist that offer a range of human immunodeficiency virus (HIV) services to multiple populations (i.e., substance abusers, individuals on probation, sex workers and their clients, court-mandated perpetrators of domestic violence) in multiple settings (i.e., courts, methadone maintenance clinics, residential and outpatient substance abuse treatment programs). The purpose of this article is to describe a model mobile HIV program, highlighting its flexibility in providing services to clients who infrequently present to traditional clinic-based testing sites. This mobile HIV program was developed to provide on-site HIV testing and counseling, education, and linkages to primary care services. The implementation of the program begins with training of agency staff, who then provide preliminary orientation with clients regarding HIV testing. Approximately 3 weeks later, the mobile program staff (HIV nurse specialist and HIV counselors) provide standardized group pretest counseling and education. Clients who decide to be tested meet with mobile program staff for individualized risk assessment and specimen collection. Two weeks later, clients meet with mobile program staff to obtain results and receive posttest counseling; risk reduction strategies are reemphasized at that time. Unique to this program is the provision of referrals for a wide range of primary care services for both seropositive and seronegative clients. Since 1994, the mobile program has been implemented at six sites, and over 1100 clients have been served. Two major outcomes from the program have been observed: 1. With adequate preparation and psychological support, 40% of hard-to-reach populations will elect to be HIV tested. 2. Through social networks of program participants, HIV-positive individuals not previously engaged in care have been referred to a comprehensive HIV primary care program.

Health care providers' experiences with problem gamblers

The purpose of this study was to document health care providers' awareness of problem gambling and frequency of recognition and treatment. An exploratory survey was designed to collect data on awareness and knowledge of problem gambling. A structured questionnaire was completed anonymously by 180 health care providers (nurses, physicians, social workers, and other allied health professionals). Almost all respondents (96%) reported knowledge of problem gambling, and 30% reported asking clients about gambling problems when they presented with stress related symptoms. A third of the respondents reported identifying and treating clients for a gambling problem. The most frequently reported intervention was referral to counseling and other gambling resources. Respondents were generally interested in learning more about gambling problems, particularly those providers who have had a client discuss gambling related concerns. There were no significant differences in findings between provider groups.

GAMBLING BEHAVIORS in Black Older Adults: PERCEIVED EFFECTS ON HEALTH

Gambling is a popular activity among older adults of multiple ethnic and cultural backgrounds, but gambling research has not focused on elderly individuals or on minority groups. Although most gambling is a social activity, it also could have health implications for older adults. Sixty-seven Black individuals, ages 50 to 88, completed the Massachusetts Gambling Screen and 20 Black older adults were interviewed about gambling behaviors and beliefs about gambling and health. Although participants in this study were low income, they were as active in gambling as the general population. One pathological gambler and two problem gamblers were identified. The correlation between reported overall health and beliefs about the effects of gambling on health was not significant. Researchers, educators, and nurses working with older adults can help define the health implications of gambling on this population.

HAART to heart: HIV-related cardiomyopathy and other cardiovascular complications

More than one million Americans have been diagnosed with human immunodeficiency virus (HIV). Advances in prevention and treatment of HIV have led to an increased life expectancy for patients with HIV infection. Due to their increased life span, HIV+ patients are now presenting to hospitals with an increased number of diverse late-stage complications, such as cardiomyopathy and other cardiovascular conditions. These complications are as a direct or indirect result of HIV disease, HIV treatment modalities, comorbid conditions, dietary and lifestyle factors, and unknown etiologies. Cardiac complications, particularly HIV-related dilated cardiomyopathy, are potentially life-threatening diagnoses, with symptoms that may be minimized with appropriate cardiac-specific assessments and treatments, patient teaching, and collaboration among nurses caring for the HIV-positive client with cardiac disease.

Students' decisions to select HIV services for clinical experiences

The ever-growing numbers of persons living with HIV/AIDS emphasizes the need for highly trained healthcare professionals to care for this population. Understanding why nursing and medical students would choose HIV services for clinical rotations, and the impact of those clinical experiences on their future professional practice, is key to recruiting healthcare providers to care for this population.

Risk classification, clinical outcomes, and the use of nursing resources for cardiac surgery patients

Several studies have used risk classification models to examine the effect of preoperative risk factors on operative morbidity and mortality. However, previous research has not linked risk classification models to factors such as frequency of postoperative complications, length of intensive care unit stay, mortality, and the use of nursing resources. This article reports on significant differences in clinical outcomes and hours of nursing care by risk classifications.

Dementia-Related Behaviors in Alzheimer's Disease and AIDS

In both Alzheimer's disease (AD) and AIDS, family members vary in their perceptions of the individual's ability to control his or her cognitive or behavioral functioning. Family members who believe that the behaviors are unintentional generally experience less distress than do family members who believe that the individual has control over his or her thoughts or behaviors. The manifestations of intellectual and cognitive dysfunction of AD and AIDS are strikingly similar. Impairments of memory, concentration, and abstract thinking; confusion and disorientation; and slowed mental capacities are among the shared symptomatology, and may eventually become the catalysts for family caregiving. It is imperative that clinicians and researchers collaborate in further investigation in order to ease the burden on family caregivers and facilitate adaptations of caregiving methods.

Risk behaviors of Dominican adolescents in their homeland and in the United States

INTRODUCTION

Adolescence is a time of developmental change. The major task of adolescence is to become an independent individual capable of functioning as a contributing adult within culturally expected norms. It is often accompanied by frustration and difficulties with adjustments. One typical response of adolescents to these changes is engaging in high-risk behaviors. The purpose of this study was to compare self-reported high risk behaviors that may lead to unintentional and intentional injuries among adolescents living in the Dominican Republic and Dominican adolescents living in the United States.

METHOD

This study used a cross-sectional, comparative design with data collection sites in Las Matas de Farfan, Dominican Republic, and Boston, MA, United States. Data were collected using the 99-item 1999 Youth Risk Behavior Survey.

RESULTS

Findings indicated that adolescents in both groups reported similar risk behaviors in all areas; however, there were few differences between the two groups that did exist.

DISCUSSION

To educate youth regarding outcomes of high-risk behaviors, it is necessary for providers to engage in discussion with adolescents regarding specific risk behaviors that are commonly practiced in their homeland or in their cultural groups.

The President Clinton crisis and the Starr report: children's perceptions and parents' awareness

INTRODUCTION

The media have suggested that the President Clinton crisis, as publicized by the Starr Report, has had detrimental effects on school-age children. Parents, too, have been concerned that their children are confused about the presidential controversies involving dishonesty, mistrust, betrayal, infidelity, and misuse of authority. The purpose of this study was to explore the perceptions and reactions of school-age children to information surrounding the President Clinton situation, as well as parents' perceptions of their children's knowledge and reactions.

METHOD

A descriptive, qualitative design was used in this study. Data collection took place during the 2-week period following publication of the 1998 Starr Report. Fifty-one parents and 67 school-age children were interviewed using semi-structured interview guides with 5 open-ended questions addressing the President Clinton situation.

RESULTS

Major themes that emerged from children's interviews were lying, getting caught, infidelity, and role modeling. Parents' awareness of their children's knowledge regarding the President Clinton situation varied; few were aware of the depth of knowledge their children had, nor had they discussed this situation with their children.

DISCUSSION

Findings have relevance for nurse practitioners as they support parents in listening to and talking with their children about tough issues such as morality and sexuality in the context of real life events.

The Perceived Effects of Condoms on Sexual Experience: A Comparison of Older Hispanic and Non-Hispanic Men

Heterosexual transmission of HIV and other sexually transmitted diseases (STDs) is increasing in older adult populations around the world. This study compares Hispanic and non-Hispanic men ages 50 years and older currently using prescribed erectile dysfunction medications in relation to their perception of the effect of condoms on sexual experience. A sample of 86 men (40 Hispanic and 46 non-Hispanic men) ages 50-79 years completed the 10-item Effect on Sexual Experience (ESE) subscale. Although there was no difference between the 2 groups on the subscale mean score, t(84) = 1.449, p = .151, analysis of the subscale items found 1 item that was significantly different (p = .005) between the 2 groups, although this difference could have been related to different perceptions of the word disgusting. Hispanic men were also less concerned than non-Hispanic men about condom-related loss of erection. This study adds to the literature on HIV and STD prevention for older Hispanic/Latinos.

Coming full circle: mentorship in HIV/AIDS care

The role of the mentor has been found to be crucial for learning, yet mentorship in HIV/AIDS nursing care has not been well documented. The purpose of this study was to (a) examine the characteristics of a nurse mentor in HIV care as perceived by nursing and medical students and HIV staff, and (b) explore an HIV nurse mentor's perceptions of her role and responsibilities in the professional development of students and staff. Mentorship, as a process of "coming full circle," was highlighted by the mentor's accounts of early influences in her career as well as students' and staff members' intents to facilitate the professional development of the next generation. The legacy of excellent HIV nursing care can be continued if expert HIV nurse mentors are identified and encouraged to work with students, inexperienced nurses, and health care providers. Health care institutions have a responsibility to foster mentorship in HIV/AIDS care to assure quality health care for clients and the professional development of expert nurses in HIV/AIDS care.

Mother-bingo bonding: screening for gambling addiction in the neonatal intensive care unit

As the prevalence of gambling increases in society, problem or pathologic gambling in new mothers may interfere with the bonding process as well as with infant and child care. Although neonatal nurses routinely screen for maternal addictions to substances such as alcohol, cocaine, and heroin, they are less likely to be alerted to signs of gambling addiction in new parents. This article presents a case study of a mother with a bingo preoccupation, provides neonatal nurses with an overview of problem and pathologic gambling, presents brief interview questions and a standardized screening tool for assessing gambling problems in parents, and suggests areas for intervention.