The influence of pre-college behaviors and parenting practices on alcohol misuse, sexual risk-taking, and adverse outcomes among first-year college women

OBJECTIVE

Although numerous reports document college students' risk-taking behaviors, few examine these behaviors in a developmental context. The purpose of this study was to examine female freshmen college students' pre-college experiences and parenting influences on first semester experiences with alcohol misuse, sexual risk-taking, and adverse outcomes, including violence.

METHODS

We surveyed 229 female freshman residential college students at the end of their first semester in college.

RESULTS

Participants who drank frequently in high school were more likely to binge drink in college and regret doing something while drinking. Mother-daughter closeness and parental discussions of sexual risks, personal safety and danger avoidance were associated with a reduced likelihood of regretting doing something while drinking, experiencing sexual violence, and having sex without a condom. Parental provision of alcohol was associated with alcohol misuse.

CONCLUSION

These findings provide a life course perspective on the development of risk behaviors and adverse outcomes during emerging adulthood.

Student Health Services at Historically Black Colleges and Universities and Predominantly Black Institutions in the United States

Introduction

Student health services are associated with improved health outcomes and academic success, particularly among under-resourced college populations. This study compared student health services at Historically Black Colleges and Universities (HBCUs) and Predominantly Black Institutions (PBIs) and identified factors associated with the availability of comprehensive health services (CHS).

Methods

We conducted a secondary analysis of 2022 data from the Integrated Postsecondary Education Data System (IPEDS), the Minority Serving Institutions (MSIs) Directory, and the websites of HBCUs and PBIs (n=167). Bivariate and multivariate logistic regression analyses were undertaken to identify institutional variables associated with providing CHS. Institutional variables included college type (public vs. private), MSI category (HBCU vs. PBI), undergraduate enrollment, location, and proportion of Pell grant recipients.

Results

Approximately 13% of HBCUs and 26% of PBIs offered no student health services; 65% of HBCUs and 39% of PBIs offered on-campus CHS with prescribing providers. Four-year HBCUs were five times more likely than 4-year PBIs to have CHS (p=0.014). Institutions with more Pell Grant recipients were less likely to offer CHS.

Conclusions

Access to health care is an important social determinant of health, academic persistence, and achievement for college students. HBCUs were significantly more likely than PBIs to offer CHS. HBCUs are more likely than PBIs to have resources from federal funding, donors, and endowments that may support the development of student health centers and services. Increased funding for PBI health centers could improve access and promote health equity among the most vulnerable student populations.

A Multi-Center Structural Equation Modeling Approach to Investigate Interpersonal Violence Screening for Public Health Promotion

Background: Interpersonal violence is a significant public health issue. Routine health screening is a cost-effective strategy that may reduce harmful physical and mental consequences. However, existing research finds consistently low rates of violence screening offered by healthcare providers, e.g., nurses, nurse practitioners, physicians. There is a critical need for research that helps understand how providers' screening behaviors are impacted by individual-level and organizational-level factors to promote the uptake of routine screening for interpersonal violence. Two recent studies, i.e., The Health Care Providers study and Nurse Practitioners Violence Screening study, involved quantitative data collected to measure providers' screening behavior and multi-level factors impacting violence screening. Methods: The current analysis includes a combination of multi-center data collected from The Health Care Providers and Nurse Practitioners Violence Screening studies, respectively. The total sample is 389 providers across the United States. The proposed research develops a system-level multi-center structural equation model framework to rigorously integrate data from the two studies and examine providers' screening behavior for interpersonal violence based upon Theory of Planned Behavior from a quantitative perspective. Results & Conclusions: We successfully examine the efficacy of the Theory of Planned Behavior proposed by Ajzen to predict healthcare providers' screening behavior for interpersonal violence. Organizational factors, e.g., availability of policy for interpersonal violence screening, organizational priority given to violence screening relative to other priorities, and if providers within the health center are interested in improving care quality, were significantly associated with providers' screening behavior. The knowledge and insights generated from our study may facilitate the design and optimization of health professional training and practice environment, and lead to improved women's health and quality of care.

Individual and Institutional Predictors of IPV/SV Screening in College Health Centers

Intimate partner violence (IPV) and sexual violence (SV) are significant public health issues for women, particularly for college women. IPV and SV have been associated with numerous adverse health consequences and involvement in unhealthy behaviors. Given the health risks and high rates of IPV/SV among college women, it is important to understand and promote screening in this population. The purpose of this study was to examine college women's experiences with IPV/SV screening at college health centers and identify individual and institutional characteristics associated with screening. Random samples of female undergraduate college students from five colleges in the northeast United States were recruited to participate in an anonymous online survey in January 2015. Inclusion criteria included at least one visit to the college health center during the preceding fall semester. Participants were questioned regarding demographics and whether they were screened or asked about IPV/SV at the college health center. A total of 873 women met the inclusion criteria and completed surveys. Only 10.2% of the college women in the study reported that they were screened for IPV/SV at their most recent visit to the college health center. Participants from public colleges/universities were 3 times more likely than others to report screening, whereas participants from urban college/university campuses were more than twice as likely as others to report screening. College women who went to the college health center for a gynecological or sexual health reason were nearly 4 times as likely as other women to report being screened for IPV/SV. Low rates of IPV/SV screening at college health centers represent missed opportunities. Further research across more numerous and diverse college sites is needed to understand the factors that promote or inhibit IPV/SV screening in college health centers to develop interventions to facilitate routine screening practices.

Organizational influences on the intimate partner violence and sexual violence screening practices of college health care providers

Experts and professional organizations in the U.S. have issued recommendations that health care providers (HCPs) should screen women for intimate partner violence (IPV) and sexual violence (SV). Despite the high rates of IPV and SV experienced by female college students, investigators have found that providers are not screening for IPV and SV in college health centers. In this study, a cross-sectional survey design was utilized to: (a) examine college HCPs' reports of IPV/SV screening behaviors and (b) identify the individual-level and organization-level structure and process characteristics that promote or inhibit IPV/SV screening. A total of 773 college HCPs (physicians, nurse practitioners, and registered nurses) were invited to participate in the study using two separate sampling frames. The final sample included 210 college HCPs. Providers reported low rates of IPV/SV screening (median = 20%). Screening rates varied by provider type with nurse practitioners reporting the highest screening rates. Urban location was associated with a three and one-half times greater likelihood of IPV/SV screening. Use of an electronic health record that included a prompt to screen was associated with a three-fold increase in the likelihood that HCPs would screen for IPV/SV. Further study is needed to better understand how organizational factors influence providers' screening behaviors in college health centers and how these influences are mediated. Future studies should include larger and more diverse samples of colleges and examine geographical variations in screening practices.

Lifetime and Recent Experiences of Violence Among College Women

INTRODUCTION

Intimate partner violence (IPV) and sexual violence (SV) are serious issues for female college students. Approximately one third of women have experienced physical violence or SV in their lifetime. Female college students experience high rates of both IPV and SV. The purpose of this secondary analysis was to describe the experiences of violence and associated factors reported by college women.

METHODS

This secondary analysis included data from a cross-sectional study focused on IPV/SV screening in college health centers. Random samples of female undergraduate students, aged 18-25 years, from five participating universities in the northeastern United States were contacted via email and invited to participate in the study. Eight hundred seventy-three young women met the inclusion criteria and completed survey measures.

RESULTS

More than half (52%, n = 457) of female undergraduate students reported having experienced at least one episode of violence in their lifetime. Almost 12% reported experiencing IPV or SV during the preceding semester. For women reporting recent experiences of violence, forced unwanted sexual activities accounted for nearly half of all reported episodes of violence (n = 46). Heavier alcohol drinking on the weekends was correlated with reports of forced sex.

DISCUSSION

The results highlight the prevalence of past and recent IPV/SV and increased risk among college women. Further research is needed to identify risk factors of both victimization and perpetration and the milieu of risk on college campuses. Forensic nurses should be key stakeholders in the development and implementation of interventions for violence education, screening, and referral.

Intimate partner and sexual violence screening practices of college health care providers

BACKGROUND

Female college students experience higher rates of intimate partner violence (IPV) and sexual violence (SV) compared to men of all ages, older women and young women who are not attending college. Experts and medical organizations have issued recommendations that health care providers should routinely screen women for IPV and SV. However, most female college students report they are not being screened for IPV and SV at college health centers.

AIM

This exploratory study sought to examine the IPV and SV screening practices of college health care providers and identify individual and organizational influences using a cross-sectional, quantitative survey design.

METHODS

Sixty-four health care providers (physicians, nurse practitioners and registered nurses) from five colleges and universities in the northeastern U.S. were invited to participate in an anonymous, web-based survey about their IPV/SV-related screening practices and beliefs, and organizational characteristics of their college health centers.

RESULTS

Twenty-six health care providers completed surveys (56% response rate). The median reported IPV/SV screening rate was 15%. More IPV/SV screening was reported by nurse practitioners, providers at state colleges, and by those in health centers that prioritized IPV/SV screening and had greater organizational capacity for change.

CONCLUSIONS

College health centers represent unique, yet often missed, opportunities to screen for IPV/SV in a high-risk population. Provider- and organization-level influences should be incorporated into future interventions to improve IPV/SV screening in college health centers. Future studies with larger numbers of colleges and providers are needed to better understand organizational influences and identify mediators and moderators of effects.

The association between discrimination and the health of Sikh Asian Indians

OBJECTIVE

We investigated the relationships between self-reported discrimination (SRD) and mental and physical health (self-reported physical health conditions and direct, physiologic measures [BMI, waist-to-hip ratio, and blood pressure]) among Sikh Asian Indians (AI), a group that may be particularly discriminated against because of physical manifestations of their faith, including a tendency to wear turbans or ethnic clothing.

METHODS

Sikh AIs (N = 196) were recruited from Sikh gurdwaras in Queens, New York. Data were collected on SRD, social support, and self-reported health, along with multiple direct physiological measures for cardiovascular health.

RESULTS

Participants who wore turbans/scarves reported higher levels of discrimination than those who did not wear turbans/scarves. As hypothesized, multiple regression analysis supported that discrimination is significantly associated with poorer self-reported mental (B = -.53, p < .001) and physical health (B = -.16, p = .04) while controlling for socioeconomic, acculturation, and social support factors. The study did not support an association between SRD and physiologic measures (elevated BMI, waist-to-hip ratio, and blood pressure).

CONCLUSION

Consistent with previous discrimination and health reports, this study demonstrated an inverse relationship between discrimination and health among Sikh AIs, an understudied yet high-risk minority population. Community-based efforts are also needed to reduce the occurrence or buffer the effects of discrimination experienced by Sikh AIs. (PsycINFO Database Record

Experiences and Lessons Learned in Using Community-Based Participatory Research to Recruit Asian American Immigrant Research Participants

PURPOSE

By 2050, the number of international migrants is expected to double from 214 million people. Of these, Asian immigrants are projected to comprise the largest foreign-born population in the United States by the year 2065. Asian American immigrants experience numerous health disparities, but remain under-represented in health research. The purpose of this article is to examine the experiences and lessons learned in applying community-based participatory research (CBPR) principles to access and recruit a sample of Asian American research participants.

APPROACH

This article reviews unique barriers to research participation among Asian Americans, describes the principles of CBPR, and provides examples of how these principles were employed to bridge recruitment challenges within a qualitative study.

FINDINGS AND CONCLUSIONS

CBPR facilitated greater research participation among a group of immigrant Asian Americans. Researchers must be additionally mindful of the importance of building trusting relationships with their community partners, understanding the significance of shared experiences, considering fears around immigration status, and considering ongoing challenges in identifying and reaching hidden populations.

CLINICAL RELEVANCE

Clinicians and researchers can employ CBPR principles to guide their work with Asian immigrant communities and other under-represented groups to facilitate access to the population, improve participant recruitment, and foster engagement and collaboration.

Relationship Satisfaction and Communication Among Urban Minority HIV-Positive and HIV-Negative Mothers: The Influence on Daughter's Alcohol Use

Family relationships influence children's beliefs and behaviors. This work examined qualities associated with communication about alcohol among 176 mothers and the influence of this communication on daughters' alcohol use. Path analyses by maternal HIV status indicated significant differences. Relationship satisfaction was associated with self-efficacy for both HIV-positive (β = 0.545, p < .001) and HIV-negative (β = 0.557, p < .001) mothers. Maternal self-efficacy was associated with communication for both HIV-positive (β = 0.364, p < .01) and HIV-negative (β = 0.310, p < .05) mothers; maternal attitudes toward alcohol use were associated with communication among HIV-negative mothers (β = 0.20, p < .05). Relationship satisfaction was indirectly related to daughter's alcohol use in HIV-positive dyads (β = 0.153, p < .05). In families with interfamilial and environmental stressors, investing in the mother-daughter relationship, in part by discussing issues related to alcohol use, is protective in nature.

Screening for Intimate Partner and Sexual Violence in College Women: Missed Opportunities

BACKGROUND

Intimate partner violence (IPV) and sexual violence (SV) are significant health issues for college women. Leading organizations and experts recommend screening for IPV/SV in health care settings, including college health centers. Given the prevalence and health risks associated with IPV/SV among college women, it is important to examine screening in this population.

METHODS

A cross-sectional, web-based survey was administered to college women at two universities in the northeastern United States. The survey consisted of demographic questions, assessment of experiences with IPV/SV (lifetime and past 6 months), use of health care services with either a college health center or an off-campus provider, and assessment of health care setting screening practices.

RESULTS

The sample included 615 college women (M = 21.5 years). Lifetime experiences of IPV/SV were reported by 222 women (36.1%). Approximately 8.1% of participants (n = 51) experienced IPV/SV in the past 6 months. Almost 63% (n = 238) reported not being asked about IPV/SV at their most recent off-campus health care visit. Nearly 90% (n = 237) reported not being asked about IPV/SV at their most recent visit to the college health center.

CONCLUSIONS

Participants reported high rates of IPV/SV and low rates of violence screening at college health centers and off-campus settings. Routine provider screening for IPV/SV in health care settings can identify women at risk and can lead to interventions that reduce subsequent violence and improve health outcomes and referrals. Theory-based, culture-specific, multilevel interventions are needed to promote IPV/SV screening among college health providers.

Alcohol outlet density and related use in an urban Black population in Philadelphia public housing communities

Adolescent alcohol use behaviors are influenced by familial patterns and neighborhood factors. This work explored the influence of individual, family, and environment on alcohol use. Baseline data from a randomized controlled trial with Black mothers son dyads (n=382) were paired with census tract and alcohol control board data. Among mothers, younger age, along with neighborhood factors of alcohol outlet density, race, and education were significantly associated with use. Among sons, older age and alcohol outlet density in the neighborhood predicted use. Findings highlight neighborhood influence, beyond family qualities, as a significant determinant of disadvantaged Black mothers' alcohol use. Implications for public health policy are discussed.

Maternal HIV serostatus, mother-daughter sexual risk communication and adolescent HIV risk beliefs and intentions

Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters' abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter's HIV risk and provide them with relationship building and parent process skills to help reduce these risks.

Maternal HIV serostatus, mother-daughter sexual risk communication and adolescent HIV risk beliefs and intentions

Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters' abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter's HIV risk and provide them with relationship building and parent process skills to help reduce these risks.

Characteristics related to sexual experience and condom use among Jamaican female adolescents

Young women in Jamaica face significant risk for HIV and other STIs. A clearer understanding of the factors associated with sexual experience and unprotected intercourse is needed. Data were collected from 330 adolescent females aged 13 to 17 recruited through community based organizations in Kingston, Jamaica, from 2009-2011. Nearly one-third of sexually experienced participants reported not using a condom the last time they had sex. Characteristics associated with sexual experience included older age, marijuana use, and less comfort talking to mother about sexual topics. Characteristics associated with condom use included perceived importance of religion, positive attitudes toward condoms, and not-having multiple sexual partners. Sexually experienced Jamaican female adolescents were engaging in behaviors that made them vulnerable to HIV and other STIs. Interventions with young adolescent girls and their mothers are recommended to postpone sexual debut and promote safer sexual behaviors in those who do engage in sex.

Feasibility of implementing rapid oral fluid HIV testing in an urban University Dental Clinic: a qualitative study

Background

More than 1 million individuals in the U.S. are infected with HIV; approximately 20% of whom do not know they are infected. Early diagnosis of HIV infection results in earlier access to treatment and reductions in HIV transmission. In 2006, the CDC recommended that health care providers offer routine HIV screening to all adolescent and adult patients, regardless of community seroprevalence or patient lifestyle. Dental providers are uniquely positioned to implement these recommendations using rapid oral fluid HIV screening technology. However, thus far, uptake into dental practice has been very limited.

Methods

The study utilized a qualitative descriptive approach with convenience samples of dental faculty and students. Six in-depth one-on-one interviews were conducted with dental faculty and three focus groups were conducted with fifteen dental students.

Results

Results were fairly consistent and indicated relatively high levels of acceptability. Barriers and facilitators of oral fluid HIV screening were identified in four primary areas: scope of practice/practice enhancement, skills/knowledge/training, patient service/patient reactions and logistical issues.

Conclusions

Oral fluid HIV screening was described as having benefits for patients, dental practitioners and the public good. Many of the barriers to implementation that were identified in the study could be addressed through training and interdisciplinary collaborations.

An integrative review of relationships between discrimination and Asian American health

PURPOSE

Many ethnic minorities in the United States experience disproportionate rates of adverse health outcomes or health disparities. Factors such as socioeconomic status do not fully explain how these disparities are generated and maintained. Research has demonstrated that chronic experiences of discrimination are harmful to the health of African Americans and Latinos. However, there is a dearth of research examining Asian Americans' experiences with discrimination and health disparities. The purpose of this integrative review was to summarize the current literature examining discrimination and the mental and physical health of Asian Americans.

DESIGN AND METHODS

Combinations of search terms related to discrimination, health, and Asian Americans were used to search five electronic databases. Inclusion criteria were primary research studies, published in English between 1980 and 2011, Asian American adults, and discrimination examined in relationship to a physical or mental health outcome. The search initially yielded 489 results; 14 quantitative studies met inclusion criteria.

FINDINGS AND CONCLUSIONS

Quantitative studies in this review revealed several significant associations between discrimination and health outcomes in Asian Americans. Discrimination was significantly associated with depressive symptoms in seven studies. Three studies found associations between discrimination and physical health, including cardiovascular disease, respiratory conditions, obesity, and diabetes. Although the literature was limited by self-reported data, cross-sectional designs, and inconsistent definitions and measurement of discrimination, the findings suggest that discrimination is a significant contributor to poorer health and health disparities for Asian Americans. The findings clearly demonstrate the need for further nursing research in this area to inform evidence-based practice and social policy.

CLINICAL RELEVANCE

Patient care providers can recognize discrimination as a significant stressor or purveyor of illness and explore ways to facilitate coping and resilience with their Asian American patients. Community-based participatory research approaches can be implemented by clinicians, academicians, and Asian American community partners to address the issue of discrimination and Asian American health outcomes.

Jamaican mothers' influences of adolescent girls' sexual beliefs and behaviors

PURPOSE

The purpose of this study was to identify the ways in which urban Jamaican mothers influence their adolescent daughters' sexual beliefs and behaviors in order to incorporate them into the design of a family-based human immunodeficiency virus (HIV) risk reduction intervention program.

DESIGN

Focus groups were conducted with 46 14- to 18-year-old adolescent girls and 30 mothers or female guardians of adolescent girls recruited from community-based organizations in and around Kingston and St. Andrew, Jamaica. Separate focus groups were held with mothers and daughters; each included 6 to 10 participants. Focus group sessions were scripted, led by teams that included trained Jamaican and American facilitators and note-takers, and audio-taped to ensure data accuracy. Data were analyzed using qualitative content analysis.

FINDINGS

Four major maternal influences were identified: mother-daughter relationship quality, mother-daughter sexual communication, monitoring or supervision, and maternal sexual role modeling. Mothers' and daughters' reports were consistent; both groups identified positive and negative influences within each category.

CONCLUSIONS

Some maternal influences were positive and health promoting; others were negative and promoted unsafe sexual activity and risk for HIV and other sexually transmitted infections. These influences were incorporated into the design of a culture-specific family-based HIV risk reduction intervention tailored to the needs of urban Jamaican adolescent girls and their mothers.

CLINICAL RELEVANCE

In order to be effective, family-based HIV risk reduction interventions should be theory based and tailored to the target audience. The four maternal influences identified in this formative study were incorporated into the subsequent intervention design.

A Qualitative Study of Patients' Attitudes toward HIV Testing in the Dental Setting

An estimated 1.1 million people in the USA are living with HIV/AIDS. Nearly 200,000 of these individuals do not know that they are infected. In 2006, the CDC recommended that all healthcare providers routinely offer HIV screening to adolescent and adult patients. Nurse-dentist collaborations present unique opportunities to provide rapid oral HIV screening to patients in dental clinic settings and reach the many adults who lack primary medical providers. However, little is known about the feasibility and acceptability of this type of innovative practice. Thus, elicitation research was undertaken with dental providers, students, and patients. This paper reports the results of qualitative interviews with 19 adults attending a university-based dental clinic in New York City. Overall, patients held very positive attitudes and beliefs toward HIV screening in dental sites and identified important factors that should be incorporated into the design of nurse-dentist collaborative HIV screening programs.

Cigarette Smoking and Alcohol Use among Adolescents and Young Adults with Asthma

Asthma is one of the most common, serious chronic diseases in pediatric and young adult populations. Health-risk behaviors, including cigarette smoking and alcohol use, may exacerbate chronic diseases and complicate their management. The aim of this study was to longitudinally analyze rates of cigarette smoking and alcohol use in adolescents and young adults who have asthma and those who do not have asthma. A secondary analysis of data from the National Longitudinal Study of Adolescent Health was undertaken. Individuals with asthma were found to exhibit increasing rates of cigarette smoking and alcohol use as they aged. When an adolescent with a chronic health issue begins health-risk-taking behaviors, behavior change interventions must be planned. Pediatric nurses, practitioners, and clinicians are uniquely positioned to assess for health-risk behaviors in youth with asthma and to intervene with plans of care that are tailored for the needs of this vulnerable population.

Jamaican adolescent girls with older male sexual partners

PURPOSE

The purpose of this study was to describe the relationships between adolescent girls and older male sexual partners in urban Kingston, Jamaica, and identify the human immunodeficiency virus (HIV)-related sexual risks that occur within these relationships.

DESIGN

The study employed a descriptive qualitative design.

METHODS

Data were collected through focus groups and individual interviews conducted with 43 late adolescent girls (18-21 years old). An age-discordant relationship was defined as a sexual relationship between a Jamaican adolescent female and a man who was 2 or more years older. Data were analyzed using qualitative content analysis.

FINDINGS

Age-discordant relationships were common and often began when girls were early adolescents. Both adolescent girls and older men tended to have multiple partners, and transactions of gifts, money, or resources from an older partner were expected and common. Older partners were highly influential in HIV-related risk behaviors.

CONCLUSIONS

Age-discordant relationships need to be explicitly addressed in HIV prevention programs for adolescent girls in Jamaica. Further, the implications of gift-giving, informal sexual transactions, and intradyadic power must be incorporated into strategies for reducing HIV-related sexual risk with older partners. Future studies should examine the perspectives of Jamaican men.

CLINICAL RELEVANCE

This study found that many Jamaican adolescent girls engage in sexual relationships with older men and that the unique characteristics of these relationships may increase girls' risks for HIV and other sexually transmitted diseases. HIV risk reduction interventions for adolescent girls should address sexual risks associated with older male partners.

Sexually transmitted infection among adolescents receiving special education services

BACKGROUND

To estimate the relative risk of sexually transmitted infections (STIs) among children identified as having learning disabilities through the special education system.

METHODS

This cross-sectional study used special education data and Medicaid data from Philadelphia, Pennsylvania, for calendar year 2002. The sample comprised 51,234 Medicaid-eligible children, aged 12-17 years, 8015 of whom were receiving special education services. Claims associated with diagnoses of STIs were abstracted, and logistic regression was used to estimate the odds of STI among children in different special education categories.

RESULTS

There were 3% of males and 5% of females who were treated for an STI through the Medicaid system in 2002. Among females, those in the mental retardation (MR) category were at greatest risk (6.9%) and those in the emotionally disturbed or "no special education" category at lowest risk (4.9% each). Among males, STIs were most prevalent among those classified as mentally gifted (6.7%) and lowest among those in the MR category (3.0%). In adjusted analyses, males with specific learning disabilities and females with MR or who were academically gifted were at excess risk for STIs.

CONCLUSIONS

The finding that children with learning disabilities are at similar or greater risk for contracting STIs as other youth suggests the need to further understand their risk behaviors and the potential need to develop prevention programs specific to their learning needs.

Reconceptualizing adolescent sexual risk in a parent-based expansion of the Theory of Planned Behavior

PURPOSE

To expand the theory of planned behavior (TPB) to explicate the influence of parents on adolescent behaviors and describe its application to adolescent sexual risk behaviors.

ORGANIZING CONSTRUCT

Parents have repeatedly been shown to be among the most significant influences on adolescents' sexual risk-related attitudes, intentions, and behaviors. However, many of the leading theoretical frameworks for understanding HIV-related sexual risk behavior are individual-level models that do not include important influences outside the individual, such as parents and families.

FINDINGS AND CONCLUSIONS

The proposed expansion of the TPB indicates the conceptual underpinnings for the design of family-based prevention programs to reduce HIV-related risk behaviors among adolescents. Additional research is needed to examine the predictive validity of the expanded model, and instrument development is needed for many of the expanded model constructs, most notably the parent constructs.

Parent communication and sexual risk among African Americans

African American adolescents and young adults disproportionately experience adverse sexual health outcomes, including HIV, other sexually transmitted infections, and unintended pregnancy. Despite the diversity of the African American population, many studies of sexual risk are limited to inner-city and clinic samples. The purpose was to examine the influence of parent-teen sexual risk communication on the sexual risk attitudes, beliefs, and behaviors of 488 African American college students from a historically Black university and document the psychometric properties of the Parent-Teen Sexual Risk Communication Scale (PTSRC-III) when used with this population. The PTSRC-III demonstrated excellent internal reliability and construct validity across all four parent-teen communication dyad categories (e.g., mother-son, mother-daughter, father-son, father-daughter). PTSRC was associated with students' reports of more conservative sexual attitudes and beliefs and greater perceived ease of sexual communication with partners. PTSRC with mothers was also associated with fewer sexual risk behaviors and pregnancies among the female students.

Culture-Specific Factors Contributing to HIV Risk Among Jamaican Adolescents

The purpose of this article is to describe the results from an elicitation research study addressing the multisystem-level factors that contribute to HIV risk among Jamaican adolescents. Focus group and survey data were determined from parents, adolescents, and teachers in Kingston, Jamaica, from 2004 and 2005. Guided by an ecological extension of the Theory of Planned Behavior, focus groups and survey questionnaires identified cultural factors at the individual, family, and societal levels that significantly influence Jamaican adolescents' behavioral, normative, and control beliefs related to sexual behaviors that contribute to risk for HIV and other sexually transmitted infections. Although some factors were similar to those reported among adolescents living in the United States, others were culture-specific influences and beliefs that were unique to Jamaica. Results from the current study could contribute to the development of theory-based, culture-specific HIV risk-reduction interventions for use with Jamaican adolescents.

The Parent-Teen Sexual Risk Communication Scale (PTSRC-III): instrument development and psychometrics

BACKGROUND

Adolescents are a group at high risk for sexually transmitted infections (STIs), including the human immunodeficiency virus (HIV). Several parenting processes, including parental monitoring, support, role modeling, and sexual communication, have been shown to be significant influences of adolescents' sexual attitudes, beliefs, and behaviors. Parent-child sexual risk communication, in particular, has been associated significantly with adolescents' attitudes, beliefs, and behaviors related to risk of and prevention of STIs and HIV.

OBJECTIVE

The aim of this study was to report on the development of the Parent-Teen Sexual Risk Communication Scale (PTSRC-III), an eight-item self-report instrument for measuring the amount of communication about sexual risk and sexual risk reduction occurring between parents and their adolescent children, as reported by the adolescent.

METHODS

Psychometrics of the PTSRC-III and the stability of the psychometric properties across two samples of late adolescents, college freshmen (N=95) and female licensed drivers aged 19 to 21 years (N=234), are reported.

RESULTS

Internal reliability of the scale was excellent (alpha of >.93 and >.88 for sexual risk communication with mothers and fathers, respectively); test-retest reliability was acceptable (r=.88 and .79 over 2 months for PTSRC with mothers and fathers, respectively). Concurrent validity, predictive validity, and stability of psychometrics were also demonstrated. Factor analysis demonstrated a two-factor structure.

DISCUSSION

The PTSRC-III provides a valid and reliable measure for assessing female adolescents' perceptions of parent-teen sexual risk communication, particularly with their mothers. Psychometrics were shown to be stable across the two samples. Implications for use and future development are discussed.

Promoting research partnerships to reduce health disparities among vulnerable populations: sharing expertise between majority institutions and historically black universities

This chapter focuses on promoting cultural competence in research and the care of vulnerable populations by establishing inter-university nursing partnership centers for health disparities research between historically Black universities and minority-serving institutions and research-intensive majority institutions. The Hampton-Penn Center to Reduce Health Disparities (HPC), an inter-university collaborative center funded through the National Institutes of Health (NIH) National Institute of Nursing Research (NINR) P20 funding mechanism, is discussed as the exemplar. The mission of the Hampton-Penn Center is to promote culturally competent research on health promotion and disease prevention and the examination of how culture, race and ethnicity and their interactions with the health care system and the larger society influence health outcomes and the occurrence of health disparities. The history, goals, and conceptual model underlying this collaborative effort between the University of Pennsylvania and Hampton University Schools of Nursing are described as are the accomplishments and lessons learned to date. Based upon the Hampton-Penn experience, recommendations for similar collaborations to reduce health disparities among vulnerable populations are made in three major areas: (a) increasing the study of the multi-system level factors that contribute to health disparities among vulnerable populations, (b) promoting the development of culturally competent research on health disparities, and (c) promoting the recruitment and training of health researchers who are themselves members of vulnerable populations.

Multisystem Factors Contributing to Disparities in Preventive Health Care Among Lesbian Women

Lesbians experience significant health disparities in preventive care utilization and health outcomes compared to heterosexual women. In this study, a multisystems ecologic approach is taken to identify barriers to access, treatment, and preventive care among lesbian women. Recommendations include increasing knowledge of lesbian health care needs, developing cultural sensitivity and competence in communication and care for lesbian women, and creating practice environments that convey respect, acceptance, and welcome to all women, regardless of sexual orientation.

Analysis of count data using poisson regression

Nurses and other health researchers are often concerned with infrequently occurring, repeatable, health-related events such as number of hospitalizations, pregnancies, or visits to a health care provider. Reports on the occurrence of such discrete events take the form of non-negative integer or count data. Because the counts of infrequently occurring events tend to be non-normally distributed and highly positively skewed, the use of ordinary least squares (OLS) regression with non-transformed data has several shortcomings. Techniques such as Poisson regression and negative binomial regression may provide more appropriate alternatives for analyzing these data. The purpose of this article is to compare and contrast the use of these three methods for the analysis of infrequently occurring count data. The strengths, limitations, and special considerations of each approach are discussed. Data from the National Longitudinal Survey of Adolescent Health (AddHealth) are used for illustrative purposes.

The role of mother-daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: a prospective study

PURPOSE

To prospectively examine the relationship between mother-daughter communication about sex and selected sexual risk behaviors among inner-city adolescent females.

METHODS

Participants were 219 sexually experienced females, 12 to 19 years of age, recruited from an inner-city adolescent medicine clinic in Philadelphia, PA, and randomly assigned to the control group of an HIV-risk reduction intervention study. Analyses were limited to data from control group participants to avoid confounding intervention effects. Poisson regression was employed to model three self-reported sexual risk behaviors: number of male sexual partners, number of episodes of sexual intercourse, and number of episodes of unprotected intercourse. Mediation effects were evaluated using variables from the Theory of Planned Behavior. Data were analyzed using Poisson regression.

RESULTS

Higher levels of mother-daughter sexual risk communication were associated with fewer episodes of sexual intercourse and unprotected intercourse at 3-month follow-up. There was evidence that the relationship of communication to unprotected intercourse was mediated by condom use self-efficacy. Mother-daughter sexual risk communication was not significantly associated with adolescents' reports of numbers of male sexual partner.

CONCLUSIONS

This prospective study supports the notion that mothers who communicate with their daughters about sex can affect their daughters' sexual behaviors in positive ways. These findings lend support for the design and implementation of family-based approaches to improve parent-adolescent sexual risk communication as one means of reducing HIV-related sexual risk behaviors among inner-city adolescent females.

Sexual protective strategies of late adolescent females: more than just condoms

OBJECTIVE

To identify the sexual protective strategies of late adolescent heterosexual women.

DESIGN

Open-ended questioning regarding sexual protective strategies was included in a larger cross-sectional survey on sexual risk. Participants' responses were recorded verbatim and analyzed using content analysis.

PARTICIPANTS

234 African American, Hispanic/ Latina, and non-Hispanic white 19- to 21-year-old females were recruited from the driver's license records of a mid-Atlantic state.

MAIN OUTCOME MEASURES

Participants responded to the open-ended question, "How or what do you do to reduce your risk for sexually transmitted diseases and HIV?"

RESULTS

Seven primary sexual protective strategies were identified from participants' responses: using condoms, abstaining or postponing sexual intercourse, getting tested for human immunodeficiency virus (HIV) and sexually transmitted diseases (STDs), selecting safe partners, negotiating condom use, talking about sexual risk histories, and limiting the number of sexual partners.

CONCLUSIONS

Some of the sexual protective strategies identified by study participants were less than effective and left young women vulnerable to infection with HIV and STDs. In addition, the use of these alternative strategies may leave young women feeling less at risk and thus less likely to use other more effective strategies such as condoms. The implications for nursing practice and the assessment of the sexual protective strategies of young heterosexual women are discussed.

Individual, family, and relationship predictors of young women's sexual risk perceptions

OBJECTIVE

To identify the individual, dyad, and family variables that influence young women's perceptions of risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV).

DESIGN

Cross-sectional telephone survey using forced-choice questioning. Data were analyzed using first-order correlations and logistic regression.

SETTING

Participants were recruited from a mid-Atlantic study of young adults and from volunteers at a mid-Atlantic university and surrounding community.

PARTICIPANTS

A convenience sample of 93 sexually active, unmarried, heterosexual women, ages 17-26 years. The majority of the study sample was white.

MAIN OUTCOME MEASURE

Respondents were asked to estimate their own level of risk for STDs, including HIV, using the responses no, low, moderate, and high risk. Responses were later recoded into no risk versus some risk.

RESULTS

Communication with parents about sexual risk decreased the odds that women would see themselves as being at no risk. Consistent condom use, relationship satisfaction, and perceiving the partner as no risk increased the odds that women would believe they were at no risk.

CONCLUSIONS

Nurses can incorporate these and other study findings into the design of sexual risk reduction programs. Programs that enhance parent-teen communication about sexual risks and assist young women to examine their perceptions of their partners may be more effective than programs that provide information only.

Something to talk about: sexual risk communication between young women and their partners

OBJECTIVES

To describe sexual risk communication between young women and their male sexual partners and examine its impact on women's perceptions of sexual risk.

DESIGN

The study and results reported were part of a larger descriptive, retrospective study in which data were collected from young women and their male partners via telephone interviews.

PARTICIPANTS

Participants included 93 unmarried, sexually active heterosexual women, ages 17 to 26 years, and 82 of their male sexual partners. The sample was predominantly white; all other ethnic groups were underrepresented.

RESULTS

Nearly all of the women described their partners as "no risk" or "low risk," despite the fact that nearly half never discussed their partner's sexual risk histories. Women gave three primary reasons why sexual risk was not discussed: (a) did not know the partner well enough/too embarrassed to ask; (b) "knew" the partner was low risk/no need to discuss it; and (c) did not think of it.

CONCLUSIONS

Nurses should adopt and promote the premise that all sexually active women are at some risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). Furthermore, sexually active women should be advised to distinguish between what they think they know about their partners and what they actually know. As client advocates, nurses should empower women to recognize that they have the right to insist on full sexual history disclosure and STD/HIV testing, to question whether they want to have sexual relations, and to refuse to engage in sexual activity if they wish.

Nursing care of the childbearing Muslim family

It is estimated that 2 to 3 million Muslims live in the United States. This article describes the Islamic beliefs and practices nurses must be aware of to understand the spiritual needs of childbearing Muslim families. Strategies are suggested for developing a plan of care to meet the needs of childbearing Muslim families during the prenatal, intrapartal, and postpartal periods.