Predicting return of lung function after a pulmonary exacerbation using the cystic fibrosis respiratory symptom diary-chronic respiratory infection symptom scale

Background

Pulmonary exacerbations (PExs) in people with cystic fibrosis (PwCF) are associated with increased healthcare costs, decreased quality of life and the risk for permanent decline in lung function. Symptom burden, the continuous physiological and emotional symptoms on an individual related to their disease, may be a useful tool for monitoring PwCF during a PEx, and identifying individuals at high risk for permanent decline in lung function. The purpose of this study was to investigate if the degree of symptom burden severity, measured by the Cystic Fibrosis Respiratory Symptom Diary (CFRSD)- Chronic Respiratory Infection Symptom Scale (CRISS), at the onset of a PEx can predict failure to return to baseline lung function by the end of treatment.

Methods

A secondary analysis of a longitudinal, observational study (N = 56) was conducted. Data was collected at four time points: year-prior-to-enrollment annual appointment, termed "baseline", day 1 of PEx diagnosis, termed "Visit 1", day 10-21 of PEx diagnosis, termed "Visit 2" and two-weeks post-hospitalization, termed "Visit 3". A linear regression model was performed to analyze the research question.

Results

A regression model predicted that recovery of lung function decreased by 0.2 points for every increase in CRISS points, indicating that participants with a CRISS score greater than 48.3 were at 14% greater risk of not recovering to baseline lung function by Visit 2, than people with lower scores.

Conclusion

Monitoring CRISS scores in PwCF is an efficient, reliable, non-invasive way to determine a person's status at the beginning of a PEx. The results presented in this paper support the usefulness of studying symptoms in the context of PEx in PwCF.

Internet Use Behavior Among Adolescents and Young Adults with Chronic Illnesses

PURPOSE

Approximately 25% of adolescents and young adults (AYA) have special healthcare needs. Transitioning from a pediatric to an adult model of healthcare is an important event but most AYA with special health care needs and their families do not receive the preparation and support they need to transition to adult care. The purpose of this scoping review was to determine how AYA use the internet for health-related information.

METHODS

Three databases were used CINAHL, Medline and PsycINFO with search terms including adolescent, young adult, chronic illness, internet, social media. Inclusion criteria were articles focused on AYA (16-25), use of internet or social media for health-related information, published in English between 2005 and 2020. Initial search yielded 369 articles, 335 were eliminated as not meeting the inclusion criteria.

FINDINGS

Of the 34 remaining, 14 were eligible for inclusion. AYA used the internet for health concerns, socializing, entertainment, homework, general information, and shopping. AYA expressed concerns about disclosing personal health information and potential misinformation on websites. Few used it to look up their diagnosed condition or talk to illness peers. AYA report they also get information from non-internet sources like providers, parents, and peers.

CONCLUSIONS

AYA have a need for health-related information. When planning online resources critical issues include perceived threats to privacy and security and quality of information. Online resources must address these issues so AYA consumers can have confidence in their website.

Distribution of SARS-CoV-2 RNA signal in a home with COVID-19 positive occupants

Although many COVID-19 patients isolate and recover at home, the dispersal of SARS-CoV-2 onto surfaces and dust within the home environment remains poorly understood. To investigate the distribution and persistence of SARS-CoV-2 in a home with COVID-19 positive occupants, samples were collected from a household with two confirmed COVID-19 cases (one adult and one child). Home surface swab and dust samples were collected two months after symptom onset (and one month after symptom resolution) in the household. The strength of the SARS-CoV-2 molecular signal in fomites varied as a function of sample location, surface material and cleaning practices. Notably, the SARS-CoV-2 RNA signal was detected at several locations throughout the household although cleaning appears to have attenuated the signal on many surfaces. Of the 24 surfaces sampled, 46% were SARS-CoV-2 positive at the time of sampling. The SARS-CoV-2 concentrations in dust recovered from floor and HVAC filter samples ranged from 104 to 105 N2 gene copies/g dust. While detection of viral RNA does not imply infectivity, this study confirms that the SARS-CoV-2 RNA signal can be detected at several locations within a COVID-19 isolation home and can persist after symptoms have resolved. In addition, the concentration of SARS-CoV-2 (normalized per unit mass of dust) recovered in home HVAC filters may prove useful for estimating SARS-CoV-2 airborne levels in homes. In this work, using the quantitative filter forensics methodology, we estimated an average integrated airborne SARS-CoV-2 concentration of 69 ± 43 copies/m3. This approach can be used to help building scientists and engineers develop best practices in homes with COVID-19 positive occupants.

Phthalates and organophosphates in settled dust and HVAC filter dust of U.S. low-income homes: Association with season, building characteristics, and childhood asthma

Phthalates and organophosphates are ubiquitous indoor semi-volatile organic contaminants (SVOCs) that have been widely used as plasticizers and flame retardants in consumer products. Although many studies have assessed their levels in house dust, only a few used dust samples captured by filters of building heating, ventilation, and air conditioning (HVAC) systems. HVAC filters collect particles from large volumes of air over a long period of time (potentially known) and thus provide a spatially and temporally integrated concentration. This study measured concentrations of phthalates and organophosphates in HVAC filter dust and settled floor dust collected from low-income homes in Texas, United States, in both the summer and winter seasons. The most frequently detected compounds were benzyl butyl phthalate (BBzP), di-(2-ethylhexyl) phthalate (DEHP), di-n-octyl phthalate (DnOP), tris (1-chloro-2-propyl) phosphate (TCIPP), triphenyl phosphate (TPHP), and tris (1,3-dichloroisopropyl) phosphate (TDCIPP). The median level of TCIPP in settled dust was 3- to 180-times higher than levels reported in other studies of residential homes. Significantly higher concentrations were observed in HVAC filter dust as compared to settled dust for most of the frequently detected compounds in both seasons, except for several phthalates in the winter. SVOC concentrations in settled dust in winter were generally higher than in summer, while different seasonality patterns were found for HVAC filter dust. Settled dust samples from homes with vinyl flooring contained significantly higher levels of BBzP and DEHP as compared to homes with other types of floor material. The concentration of DEHP and TDCIPP in settled dust also significantly associated with the presence of carpet in homes. Cleaning activities to remove dust from furniture actually increased the levels of certain compounds in HVAC filter dust, while frequent vacuuming of carpet helped to decrease the concentrations of some compounds in settled dust. Additionally, the size and age of a given house also correlated with the levels of some pollutants in dust. A statistically significant association between DEHP concentration in HVAC filter dust in summer and the severity of asthma in children was observed. These results suggest that HVAC filter dust represents a useful sampling medium to monitor indoor SVOC concentrations with high sensitivity; in contrast, when using settled dust, in addition to consideration of seasonal influences, it is critical to know the sampling location because the type and level of SVOCs may be related to local materials used there.

Feasibility study of a combined lifestyle behaviors and asthma self-management intervention for school-aged children

PURPOSE

The purpose of this study is to test the feasibility of delivering an intervention that combines healthy lifestyle behaviors related to weight management with asthma self-management, the Living Healthy with Asthma intervention, to children who have asthma.

METHODS AND DESIGN

Using a mixed design, the feasibility study of the 12-week Living Healthy with Asthma intervention was conducted with a single group of children diagnosed with asthma. Pretest and posttest data were collected on asthma-related (self-management, metered dose inhaler [MDI] skill, asthma severity, quality of life [QOL]), and healthy lifestyle variables (body mass index [BMI], dietary quality). A matched comparison sample was drawn from a separate study that tested the same asthma self-management component (single intervention) used in the feasibility study to determine if the Living Healthy with Asthma intervention worked as well as the single intervention for improving children's asthma self-management.

RESULTS

Thirteen school-aged children were enrolled in the feasibility study. There were significant reductions in BMI z-scores (P = 0.007), and improvements in vegetable servings (P = 0.03), MDI skill (P = 0.005), children's QOL (P < 0.001), and parents' QOL (P = 0.03). When comparing the feasibility group with the matched comparison group (n = 13), there were no significant differences in asthma self-management, MDI skill, or asthma severity after the interventions.

PRACTICE IMPLICATIONS

Findings supported the feasibility of implementing the combined intervention, and it was not inferior to the single intervention-which supports nurses' efforts to help families manage multiple health problems.

Filter forensics: microbiota recovery from residential HVAC filters

BACKGROUND

Establishing reliable methods for assessing the microbiome within the built environment is critical for understanding the impact of biological exposures on human health. High-throughput DNA sequencing of dust samples provides valuable insights into the microbiome present in human-occupied spaces. However, the effect that different sampling methods have on the microbial community recovered from dust samples is not well understood across sample types. Heating, ventilation, and air conditioning (HVAC) filters hold promise as long-term, spatially integrated, high volume samplers to characterize the airborne microbiome in homes and other climate-controlled spaces. In this study, the effect that dust recovery method (i.e., cut and elution, swabbing, or vacuuming) has on the microbial community structure, membership, and repeatability inferred by Illumina sequencing was evaluated.

RESULTS

The results indicate that vacuum samples captured higher quantities of total, bacterial, and fungal DNA than swab or cut samples. Repeated swab and vacuum samples collected from the same filter were less variable than cut samples with respect to both quantitative DNA recovery and bacterial community structure. Vacuum samples captured substantially greater bacterial diversity than the other methods, whereas fungal diversity was similar across all three methods. Vacuum and swab samples of HVAC filter dust were repeatable and generally superior to cut samples. Nevertheless, the contribution of environmental and human sources to the bacterial and fungal communities recovered via each sampling method was generally consistent across the methods investigated.

CONCLUSIONS

Dust recovery methodologies have been shown to affect the recovery, repeatability, structure, and membership of microbial communities recovered from dust samples in the built environment. The results of this study are directly applicable to indoor microbiota studies utilizing the filter forensics approach. More broadly, this study provides a better understanding of the microbial community variability attributable to sampling methodology and helps inform interpretation of data collected from other types of dust samples collected from indoor environments.

Enhancing Asthma Self-Management in Rural School-Aged Children: A Randomized Controlled Trial

PURPOSE

To test the effects of 2 modes of delivering an asthma educational intervention on health outcomes and asthma self-management in school-aged children who live in rural areas.

METHODS

Longitudinal design with data collected 4 times over 12 months. The target sample was composed of children in grades 2-5 who had a provider diagnosis of asthma. Elementary schools were stratified into high or low socioeconomic status based on student enrollment in the free or reduced-cost lunch program. Schools were then randomly assigned to 1 of 3 treatment arms: in-school asthma class, asthma day camp, or the attention-control group.

FINDINGS

Sample retention was good (87.7%) and equally distributed by study arm. Improvements in emergency department visits and office visits were related to attending either the asthma class or asthma day camp. Asthma severity significantly decreased in both asthma treatment groups. Other factors such as hospitalizations, parent asthma management, and child asthma management improved for all groups.

CONCLUSIONS

Both asthma class and asthma day camp yielded significant reductions in asthma severity. There were reductions in the emergency department and office visits for the 2 asthma arms, and hospitalizations declined significantly for all groups. Asthma self-management also improved in all groups, while it was somewhat higher in the asthma arms. This may be due to the attention being drawn to asthma management by study participation and the action of completing questionnaires about asthma management, asthma symptoms, and health outcomes.

Home-based diabetes symptom self-management education for Mexican Americans with type 2 diabetes

This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated measures randomized controlled trial was conducted with 72 Mexican Americans aged 25-75 years with type 2 diabetes. Experimental condition participants received eight weekly, in-home, one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness, glucose self-testing and appropriate treatments, followed by eight biweekly support telephone sessions. Wait-listed control condition participants served as comparisons at three time points. Hierarchical linear modeling was used to evaluate the effects of the intervention between- and within groups on psychosocial, behavioral and clinical outcomes. Participants were predominantly female, middle-aged, moderately acculturated and in poor glycemic control. Experimental group participants (n = 39) significantly improved glycemic control, blood pressure, symptoms, knowledge, self-efficacy, empowerment and quality of life. Post intervention focus groups reported satisfaction with the symptom focus. Addressing symptoms led to clinical and psychosocial improvements. Symptoms seem to be an important motivator and a useful prompt to engage patients in diabetes self-management behaviors to relieve symptoms and prevent complications.

An exploration of parent-child dyadic asthma management influences on quality of life

Most studies of childhood asthma management use data from a single family reporter and fail to capture the parent-child dyadic influences. In this descriptive exploratory study with 183 parent-child dyads, data were collected from both parents and children. Using structural equation modeling, the relationships of parents' and children's asthma knowledge, self-efficacy to manage asthma, and asthma management on the child's quality of life were examined. Direct significant relationships from knowledge to self-efficacy to asthma management were found for each member of the dyad. The associations between parents' and children's self-efficacy and asthma management were not statistically significant. Only the children's self-efficacy to manage asthma was significantly associated with children's asthma-related quality of life.

A primary care intervention to improve weight in obese children: A feasibility study

PURPOSE

Examine the effects of a primary care weight management program, which used a parent-child-provider collaborative negotiation intervention, among rural-dwelling families with obese children.

DATA SOURCES

Health histories, physical examinations, fasting blood samples, interviews, and questionnaires.

CONCLUSIONS

Feasibility of implementing a family weight management intervention in a rural primary care setting was demonstrated. Few differences between the treatment and comparison groups were found; however, more favorable trends and outcomes occurred in those who received the intervention.

IMPLICATIONS FOR PRACTICE

Positive provider-patient communication in helping families with obese children make difficult lifestyle changes should be encouraged in primary care clinics as small changes in behavior can result in reducing risk and improving health outcomes.

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.

Taking care of my baby: mexican-american mothers in the neonatal intensive care unit

OBJECTIVES

The admission of an infant to the neonatal intensive care unit (NICU) can produce significant stress for mothers and may contribute to a difficult transition following discharge. Past research has primarily focused on Caucasian women. Mexican-Americans are the fastest growing ethnic population in the U.S. with the highest fertility rate; therefore, the purpose of this grounded theory study was to gain a better understanding of the NICU experience for Mexican-American mothers.

METHODS

Fifteen women were recruited and data were collected through semi-structured interviews.

RESULTS

A theoretical model, taking care of my baby, was developed. The mothers' experiences began with the unexpected event of having an infant admitted to the NICU and played out in a context that fluctuated between being supportive (making meaningful connections) or inhibitive (struggling to mother). The women developed strategies to help them take care of their babies during the NICU stay: balancing responsibilities, leaving part of me with my baby, and watching over. The process concluded in one of two ways: bringing my baby home or losing my baby.

CONCLUSION

These findings offer insight for neonatal nurses who provide care for Mexican-American NICU mothers and may help inform their practice. Further research is needed with this growing population to ensure supportive nursing care and influence positive outcomes.

Evaluating the effect of an asthma self-management intervention for rural families

OBJECTIVE

To present outcomes of an asthma self-management educational intervention delivered to children (grades 2-5) at school and to parents in a home visit.

METHODS

The intervention effectiveness was tested in a 12-month longitudinal study with randomization by elementary schools into treatment and attention-control groups with 183 children who had a diagnosis of asthma. Data were collected at four time points. Change over time was examined with linear mixed models.

RESULTS

Quality of life (QOL), hospitalizations, and emergency department visits improved significantly for all the children. African American and Mexican American children had worse asthma-related QOL than did White children. Asthma management behaviors, asthma self-efficacy, and coping likewise improved with girls improving significantly more than the boys. Significant improvements in inhaler skill and asthma severity were seen in the treatment group children when compared to the control group. Treatment group parents showed significant improvements in home asthma management and self-efficacy.

CONCLUSIONS

The improvement in inhaler skill is an important finding for practitioners as this is a behavior that can be addressed in the clinical setting. The reduction in the treatment group's asthma severity scores may reflect the improvement in medication delivery as their inhaler skill improved. The differential improvement between boys and girls points to the need for testing other formats in asthma education that can address different learning styles. The individualized parent asthma education enabled the intervener to incorporate neighborhood and home environmental information thereby allowing for tailoring of parental instruction.

Is rural school-aged children's quality of life affected by their responses to asthma?

The unpredictable nature of asthma makes it stressful for children and can affect their quality of life (QOL). An exploratory analysis of 183 rural school-aged children's data was conducted to determine relationships among demographic factors, children's responses to asthma (coping and asthma self-management), and their QOL. Coping frequency, asthma severity, and race/ethnicity significantly predicted children's asthma-related QOL. Children reported more frequent coping as asthma-related QOL worsened (higher scores). Children with more asthma severity had worse asthma-related QOL. Post hoc analyses showed that racial/ethnic minorities reported worse asthma-related QOL scores than did non-Hispanic Whites.

Risk-taking behaviors engaged in by early adolescents while on school property

PURPOSE

This longitudinal study was guided by a Youth Resilience Framework. The study purpose was to examine the influence of protective resources, contextual factors, and risk factors in middle childhood (grades 4-6) on health-risk behaviors (e.g., smoking cigarettes, using marijuana, drinking alcohol, carrying a weapon) engaged in on school property by early adolescents (grade 7) who live in rural central Texas.

METHODS

Students in grades 4 to 6, a majority of whom were Mexican American (54.3%) and male (56.4%), completed surveys annually until the 7th grade. Generalized estimating equations were run to determine predictors of 7th graders' health-risk behaviors on school property.

RESULTS

Engaging in healthy behaviors, knowing others cared about them, and having a sense of competence in middle childhood (grades 4-6) were found to be protective factors, while having a large family size and the expectation that they would not complete school were found to be risk factors for engaging in health risk behaviors in 7th grade.

PRACTICE IMPLICATIONS

These findings show the influence of family and schools as environments that can offer protection from health-risk behaviors in early adolescence.

Normative cultural values and the experiences of Mexican-American mothers in the neonatal intensive care unit

PURPOSE

To explore the experiences of Mexican-American mothers who have had infants in the neonatal intensive care unit (NICU).

PARTICIPANTS

A convenience sample of 15 English-speaking, Mexican-American women was interviewed.

DESIGN

The study used an exploratory qualitative approach.

METHODS

Data collection was conducted through audiotaped, transcribed, semistructured, individual interviews and field notes. The 5 normative cultural values for Latino families-(1) simpatia, (2) personalismo, (3) respeto, (4) familismo, and (5) fatalismo-were used as a sensitizing framework to guide data interpretation.

RESULTS

The women's discussions of their NICU experiences clearly reflect the 5 normative Latino cultural values. Positive and negative exemplars of these values are provided as evidence.

CONCLUSIONS

These findings can be used to inform nursing care provided for Mexican-American mothers and their infants by assisting nurses to customize care to meet the cultural needs of this population.

Collaborating with low-income families and their overweight children to improve weight-related behaviors: an intervention process evaluation

PURPOSE

This paper aims to examine the collaborative negotiation process, an interventional approach being tested at a primary-care school-based clinic to help low-income families improve lifestyle and weight-related health indicators in their overweight children.

DESIGN AND METHODS

Process evaluation of the intervention employed in an ongoing longitudinal pilot study. Descriptive analysis is from structured field notes and audiotapes of parent-child-provider interactions during intervention visits (n=111).

RESULTS

Activity levels and eating patterns were families' main concerns in managing their children's weight. Challenges and facilitators of implementing health plans were explored.

PRACTICE IMPLICATIONS

The collaborative negotiation intervention provides a family-centered approach to engage families in management of children's weight.

Improvement of rural children's asthma self-management by lay health educators

BACKGROUND

The purpose of the present analysis is to examine changes in rural children's asthma self-management after they received lay health educator (LHE)-delivered classes.

METHODS

Elementary schools were randomly assigned to the treatment or attention-control condition and their participating students received either asthma education or general health promotion education, respectively. The triethnic sample was composed of 183 children (46% Hispanic, 29.5% non-Hispanic white, 22% African American, and 2.6% other categories) who had a mean age of 8.78 years (SD = 1.24). The time frame from baseline to postintervention was 12 weeks.

RESULTS

Repeated measures analysis of variance found main effects in changes in scores for children's asthma knowledge, asthma self-management, self-efficacy for managing asthma symptoms, and metered dose inhaler (MDI) technique and significant group interaction effects for the treatment intervention on the measures of children's asthma knowledge, asthma self-management, and MDI technique.

CONCLUSIONS

The delivery of an asthma health education intervention by trained LHEs to school-aged children was an effective means for improving children's knowledge and skills in asthma self-management.

Family-centered collaborative negotiation: a model for facilitating behavior change in primary care

PURPOSE

To describe a parent-child-based model that melds a family-centered interaction approach, Touchpoints, with brief negotiation strategies (an adaptation of motivational interviewing) to address health risks in children. An application of the model for addressing childhood overweight in the primary care setting is presented.

DATA SOURCES

Selected research, theoretical, and clinical articles; national recommendations and guidelines; and a clinical case.

CONCLUSIONS

Lifestyle health behaviors are learned and reinforced within the family; thus, changes to promote child health require family involvement. Interventions that engage parents and support parent-child relationships, while enhancing motivation and the abilities to change behavior, are recommended.

IMPLICATIONS FOR PRACTICE

Primary care is an appropriate setting for addressing lifestyle health behaviors. A collaborative partnership, rather than a prescriptive manner, is advocated for primary care providers when working to facilitate health-promoting behavior.

Home visiting for intervention delivery to improve rural family asthma management

The focus of this article is on the use of home visits in an asthma self-management intervention study with rural families who have a school-aged child with asthma. The study design involved randomization of the sample by elementary schools, then baseline (pretest) and postintervention data collection.(1) The purpose of this article is to describe challenges with, and pose solutions for, implementing home visits for asthma self-management in rural areas. Home visiting is a strategy for program delivery that takes advantage of the home context for tailoring services to address the family's individual needs. The advantages of intervening in the home include being able to (a) use actual home conditions for individualizing the asthma education to meet families' needs; (b) match home visitors with family in terms of ethnicity and language; (c) retain a high percentage of families over the year-long duration of the study; and (d) not add to family burden of managing asthma.

Measuring asthma severity: instrument refinement

The focus of this study is to evaluate a brief parent-report instrument, the Severity of Chronic Asthma (SCA) scale, that conforms to the national guidelines for assessing asthma. Convergent validity was found between the SCA and other measures related to asthma severity including an illness severity scale (How Bad is the Asthma?), asthma management scales for parents and children, and the pediatric quality-of-life scale. The SCA is a multidimensional scale with appropriate evidence of reliability and validity that may be a heuristic and effective measure in both clinical practice and research endeavors.

Comparison of Three Modes of Measuring Stress, Coping, and Humor in School-Age Children

Computer-assisted administration of surveys is gaining popularity among many researchers, but the equivalence of this method to more traditional approaches such as using paper and pencil has not been determined for many commonly used questionnaires, particularly among school-age children. This study examined systematic differences in the responses of 4th, 5th, and 6th graders to measures of stress, coping, and humor among three modes of assessment: paper-and-pencil questionnaires, computer-assisted self-interviewing (CASI), or a combination of paper-and-pencil and CASI. Participants were 1,245 ethnically diverse children enrolled in public schools in the central region of the United States. Psychometric and score distribution characteristics were examined using item analyses and analyses of mean and covariance structure as a function of mode of assessment. Differences in response patterns, primarily at the scale score level, were documented on some of the key measures. In general, CASI medians and means were higher and correlations among CASI measures tended to be lower than those obtained with paper-and-pencil and mixed mode assessment, and CASI variances were lower. This study suggests the importance of the continued examination of the impact of mode of questionnaire administration when assessing these and other domains of well-being in school-age children.

The impact of genetic information on policy and clinical practice

This article discusses genetics-related policy issues that have an impact on health care systems, health care providers, and their patients: privacy, mass screening, family screening, and knowledge dissemination. Access, cost, and ethical implications are important discussant points for each of these genetic-related policy issues. Embedded in the issue of privacy are concerns of insurability, confidentiality, and discrimination. The public health policy implications related to mass screening programs include efficacy of the screening tests, availability of primary and secondary interventions, access, costs, and program evaluation. Policy issues for family screening are similar to mass screening, with added concerns about privacy and availability of adequate resources, including health care providers and counselors trained in genetics. Knowledge dissemination is critical to maintaining currency of clinical information and applications of genetic technologies and treatments. As genetic information expands, the need for knowledge dissemination will increase. The importance of advanced practice nurses' involvement in these policy issues is discussed.

Barriers that influence eating behaviors in adolescents

Adolescence is a time of rapid growth and development with biologic, psychological, and emotional changes occurring simultaneously. We conducted a critical review of the literature to analyze key topics in the study of adolescents' eating behaviors and to identify barriers to healthy eating experienced by adolescents. The literature documents that nutritional deficits and poor eating established during adolescence have long-term health, growth, and developmental consequences. Gaps in the literature are identified and recommendations for future studies are proposed.

Computer-assisted survey interviewing of school-age children

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

A Genetics Course for Advanced Clinical Nursing Practice

PURPOSE

To describe a genetics course for advanced clinical nursing practice.

BACKGROUND

The Human Genome Project is yielding new discoveries in genetics. The sheer volume of new information threatens to overwhelm healthcare providers as they must find ways to interpret and use these discoveries.

DESCRIPTION OF PROJECT

The course was developed in recognition of the fact that graduate nursing students in advanced practice programs need to understand and apply genetic information in the care of their patients. The course builds on core competencies identified by the National Coalition for Health Professional Education in Genetics and the International Society of Nurses in Genetics.

OUTCOMES

Students demonstrate that they can access, evaluate, and synthesize current information on a genetic condition and develop a comprehensive plan of care for patients with the selected condition.

INTERPRETATION/CONCLUSION

Students learn basic and applied genetic concepts and skills. They are able to utilize resources appropriately to identify patient care needs and develop strategies for meeting those needs.

IMPLICATIONS FOR NURSING PRACTICE

The need to remain current in understanding emerging technologies and genetic information will continue to grow as scientific discoveries are made that affect greater numbers of the public. Nurses in advanced practice are in a position to support patients and their families as they deal with the significance of these discoveries for their current and future health.

Youth Resilience Framework for reducing health-risk behaviors in adolescents

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

Cross-cultural validation of the stages of the tobacco acquisition questionnaire and the decisional balance scale

The first phase in a study of smoking behaviors of 11- to 14-year-old Taiwanese children was designed to ensure the reliability and validity of newly translated instruments. The stages of the tobacco acquisition questionnaire (STAQ) and the decisional balance scale (DBS) were translated into Chinese, then back-translated into English. The DBS was adapted based on input from a focus group with young adolescents, reviewed by a panel of experts and laypersons, and pilot-tested. The next step consisted of administering the instruments to 401 children (ages 11-14 years) for psychometric testing. Factor analysis yielded three components for the STAQ accounting for 57.8% of the total variance, with alphas of the subscales ranging from.85 to.92. The DBS had two components accounting for 59.3% of the total variance, with alphas of.87 and.90 for the subscales. Accuracy of the translated instruments was supported by the psychometric test results.

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

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

Home asthma management for rural families

ISSUES AND PURPOSE

To assess home asthma management among rural families with a school-age child who has asthma.

DESIGN AND METHODS

Exploratory analysis of baseline data of a tri-ethnic sample of rural families with school-age children who have asthma.

RESULTS

Parents and children enact a moderate amount of asthma management behaviors. Preventive behaviors were correlated with the Asthma Behavior Inventory and treatment behaviors were correlated with the child's asthma severity. Factors that could affect asthma management include no insurance, no visits to providers in 12 months, or no asthma medications.

PRACTICE IMPLICATIONS

Nurses must use every contact with families to assess their asthma management and availability of resources, and to determine the fit between asthma severity and the asthma management plan.

Validation of the smoking self-efficacy survey for Taiwanese children

PURPOSE

To determine the psychometric properties of the Chinese version of the smoking self-efficacy (SSE) survey.

DESIGN AND METHODS

The SSE survey was translated into Chinese then was back-translated into English, reviewed for content validity, pilot tested, and administered to 401 children between December 1998 and August 1999. A random cluster sampling method was used in this study.

FINDINGS

Reliability was indicated by Cronbach's alpha coefficient, .98. The validity of the SSE scale was determined by face validity, item-total correlation coefficient, content validity index, and concurrent validity. Principal component analysis was done to determine the construct validity of the SSE scale. The revised SSE scale had three components accounting for 74.3% of the total variance with alpha of .96. The correlation coefficient between the SSE and revised SSE scale was .99.

CONCLUSIONS

Findings show that the revised SSE scale is not only parsimonious but also it is as reliable and valid as is the original SSE scale. This translated instrument is appropriate for use in studies of smoking behavior in Taiwanese children aged 11 to 14 years. Further research will be needed to validate the SSE scale with different populations and settings in Taiwan.

The impact of asthma risk factors on home management of childhood asthma

There have been few studies of childhood asthma among families who live in nonmetropolitan settings. This work is part of the baseline assessment conducted before implementing a health education program to study the impact of asthma risk factors (gender, ethnicity, socioeconomic status, asthma severity) on home asthma management. Data analysis yielded no significant differences in home asthma management performed by parents or children with asthma based on the child's gender, ethnicity, asthma severity, or family socioeconomic status. Factors that define the child's experienced asthma pattern, such as activity limitations, number of allergens, and school absenteeism, were associated with the parent's work of asthma management. Trends in the data for the different ethnic and gender subgroups that have implications for clinical practice were identified. Future directions for research to address questions that emerged in this analysis are discussed.

Asthma management efficacy of school nurses in Taiwan

As the key health care providers in school settings, the school nurses' asthma management efficacy is crucial to children's health and their continued participation in school learning activities. This article describes the psychometric testing of the asthma management efficacy scale (AMES) for use with school nurses. A cross-sectional survey design was used to assess the asthma management efficacy of 60 school nurses in Taipei, Taiwan. Factor analysis resulted in four factor domains including asthma medication administration, asthma pattern identification, school management behaviour, and monitoring peak expiratory flow rate which explained 76.4% of the variance in school nurses' asthma management efficacy. The school nurses' experience in performing school asthma management activities was positively correlated to their asthma management efficacy (r=0.33, p<0.05). School nurses who had experience with the inhaled asthma medicines had significantly higher efficacy scores on the medication administration subscale (t=-2.89, p<0.01) than did the school nurses who lacked this experience. School nurses who had experience in using peak expiratory flow meters had significantly higher efficacy scores on the total AMES (t=-1.90, p<0.05) and on the monitoring peak expiratory flow rate subscale (t=-5.37, p<0.001) than the school nurses who lacked this experience. Given the need to have nurses who are well prepared to provide asthma care in school settings, implications for nursing education, practice, and further research are discussed.

Correlates of recent suicide attempts in a triethnic group of adolescents

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Cigarettes: a growing problem for Taiwanese adolescents

An alarming number of Taiwanese teenagers continue to smoke despite the adverse health consequences of cigarette smoking. This research review describes the prevalence and onset of smoking behavior among Taiwanese adolescents and analyzes the risk factors contributing to smoking initiation. The findings of this review suggest that health educators need to target high-risk groups before they initiate smoking. High-risk groups are those who have poor school achievement, have an external locus of control, have a prosmoking attitude, know others who smoke, and are from low socioeconomic status families. These risk factors support the need for nurses to implement an effective smoking prevention program for adolescents.

Using focus group methods with middle school children

Focus group methods are an effective way to clarify middle school children's perceptions of health and illness. Children between 11 and 14 years of age, who are undergoing the developmental transition from child to adolescent, tend to be reticent when talking with adult strangers. However, they are more relaxed and willing to share perceptions when discussions are held with a group of peers. Conducting focus groups involves developing an interview guide, arranging the meeting place, supporting group building, and encouraging participation by the group members while discouraging domination by influential members. Data analysis begins during the focus group session as issues emerge in the context of group discussions.

Improving readability of patient education materials

Functional illiteracy contributes to negative long-term health consequences for patients who must understand and adhere to complex health care instructions and, therefore, is of primary importance to community health nurses. This problem is compounded when English is the patient's second language. A process for improving patient education materials (PEMs) through adaptation or creation of new materials to meet the health needs of diverse groups is presented. The process was applied to a popular health education program used with school-age children and their parents to teach them home management of asthma. Target parents were known to read at a 5th-grade level, and English was a second language for many of them. Therefore, extensive revision of the existing PEMs was required. The steps to successful revision included assessing readability and comprehensibility, editing the materials, and evaluating the new PEMs to determine the effectiveness of the revision measures.

Asthma self-care: just another piece of school work

In the transition from childhood to adolescence, middle school children, aged 11 to 14 years, are becoming increasingly independent. For children who have asthma or other chronic illness, self-care for the condition becomes increasingly important. Cognitive social learning theory framed the questions asked and interpretations made of focus group data collected from 25 middle school children with asthma about their self-care behaviors. Data suggests that managing and preventing asthma episodes takes place in contexts defined by "powerful others" who can either facilitate or hinder self-care. Successful management of asthma reinforces middle school children's autonomy and growing independence. Although participants wanted and needed support during asthma attacks, they did not want to lose their autonomy. This study highlights the kinds of challenges children with asthma face.

Creating alternative immunization clinics to maintain and improve community immunization rates

Immunization campaigns are among the most effective means for improving community health, yet underimmunized groups leave communities at risk for vaccine-preventable diseases. In 1993, the Childhood Immunization Initiative (CII) was implemented to address this risk. The goal of the CII, to achieve immunization coverage 90% or greater among 2-year-old children, was reached nationwide by 1996. However, individual states ranged from 81% to 99% for specific vaccines (Centers for Disease Control and Prevention, 1997b). The work of the CII is ongoing and was expanded in 1996 to address the immunization needs of adolescents. The purpose of this article is to present a model for providing immunization services in alternative sites, in which the community health nurse takes the service to the people. Building linkages with local communities, preparing the clinic site and supplies, arranging for staffing of an alternative clinic, and evaluation after service provision are key elements to a successful outreach clinic.